Browse Health
Emergency Physician, Family Practitioner, Primary Care Doctor
31 years of experience

Education ?

Medical School Score Rankings
University of Virginia (1979)
  • Currently 4 of 4 apples
Top 25%

Awards & Distinctions ?

Associations
American Board of Emergency Medicine
American Board of Family Medicine

Affiliations ?

Dr. Niska is affiliated with 1 hospitals.

Hospital Affilations

  • Phoenix Indian Medical Center
    4212 N 16th St, Phoenix, AZ 85016
  • Publications & Research

    Dr. Niska has contributed to 11 publications.
    Title Ambulatory Medical Care in Rural Haiti.
    Date May 2010
    Journal Journal of Health Care for the Poor and Underserved
    Excerpt

    In 2005, a team of U.S. physicians, nurse practitioners, nurses, pharmacists, emergency medical technicians and lay support personnel provided health services in an isolated town in rural Haiti.

    Title Research Using Emergency Department-related Data Sets: Current Status and Future Directions.
    Date March 2010
    Journal Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
    Excerpt

    The 2009 Academic Emergency Medicine consensus conference focused on "Public Health in the ED: Surveillance, Screening and Intervention." One conference breakout session discussed the significant research value of health-related data sets. This article represents the proceedings from that session, primarily focusing on emergency department (ED)-related data sets and includes examples of the use of a data set based on ED visits for research purposes. It discusses types of ED-related data sets available, highlights barriers to research use of ED-related data sets, and notes limitations of these data sets. The paper highlights future directions and challenges to using these important sources of data for research, including identification of five main needs related to enhancing the use of ED-related data sets. These are 1) electronic linkage of initial and follow-up ED visits and linkage of information about ED visits to other outcomes, including costs of care, while maintaining de-identification of the data; 2) timely data access with minimal barriers; 3) complete data collection for clinically relevant and/or historical data elements, such as the external cause-of-injury code; 4) easy access to data that can be parsed into smaller jurisdictions (such as states) for policy and/or research purposes, while maintaining confidentiality; and 5) linkages between health survey data and health claims data. ED-related data sets contain much data collected directly from health care facilities, individual patient records, and multiple other sources that have significant potential impact for studying and improving the health of individuals and the population.

    Title National Hospital Ambulatory Medical Care Survey: 2006 Emergency Department Summary.
    Date December 2008
    Journal National Health Statistics Reports
    Excerpt

    This report presents the most current (2006) nationally representative data on visits to hospital emergency departments (ED) in the United States. Statistics are presented on selected hospital, patient, and visit characteristics.

    Title Hospital Collaboration with Public Safety Organizations on Bioterrorism Response.
    Date October 2008
    Journal Prehospital Emergency Care : Official Journal of the National Association of Ems Physicians and the National Association of State Ems Directors
    Excerpt

    OBJECTIVE: To identify hospital characteristics that predict collaboration with public safety organizations on bioterrorism response plans and mass casualty drills. METHODS: The 2003 and 2004 Bioterrorism and Mass Casualty Supplements to the National Hospital Ambulatory Medical Care Survey examined collaboration with emergency medical services (EMS), hazardous materials teams (HAZMAT), fire departments, and law enforcement. The sample included 112 geographic primary sampling units and 1,110 hospitals. Data were weighted by inverse selection probability, to yield nationally representative estimates. Characteristics included residency and medical school affiliation, bed capacity, ownership, urbanicity and Joint Commission accreditation. The response rate was 84.6%. Chi-square analysis was performed with alpha set at p < 0.05. Logistic regression modeling yielded odds ratios with 95% confidence intervals. RESULTS: During a bioterrorism incident, 68.9% of hospitals would contact EMS, 68.7% percent law enforcement, 61.6% fire departments, 58.1% HAZMAT, and 42.8% all four. About 74.2% had staged mass casualty drills with EMS, 70.4% with fire departments, 67.4% with law enforcement, 43.3% with HAZMAT, and 37.0% with all four. Predictors of drilling with some or all of these public safety organizations included larger bed capacity, nonprofit and proprietary ownership, and JCAHO accreditation. Medical school affiliation was a negative predictor of drilling with EMS. CONCLUSIONS: The majority of hospitals involve public safety organizations in their emergency plans or drills. Bed capacity was most predictive of drilling with these organizations. Medical school affiliation was the only characteristic negatively associated with drilling.

    Title Emergency Response Planning in Hospitals, United States: 2003-2004.
    Date October 2007
    Journal Advance Data
    Excerpt

    OBJECTIVE: This study presents baseline data to determine which hospital characteristics are associated with preparedness for terrorism and natural disaster in the areas of emergency response planning and availability of equipment and specialized care units. METHODS: Information from the Bioterrorism and Mass Casualty Preparedness Supplements to the 2003 and 2004 National Hospital Ambulatory Medical Care Surveys was used to provide national estimates of variations in hospital emergency response plans and resources by residency and medical school affiliation, hospital size, ownership, metropolitan statistical area status, and Joint Commission accreditation. Of 874 sampled hospitals with emergency or outpatient departments, 739 responded for an 84.6 percent response rate. Estimates are presented with 95 percent confidence intervals. RESULTS: About 92 percent of hospitals had revised their emergency response plans since September 11, 2001, but only about 63 percent had addressed natural disasters and biological, chemical, radiological, and explosive terrorism in those plans. Only about 9 percent of hospitals had provided for all 10 of the response plan components studied. Hospitals had a mean of about 14 personal protective suits, 21 critical care beds, 12 mechanical ventilators, 7 negative pressure isolation rooms, and 2 decontamination showers each. Hospital bed capacity was the factor most consistently associated with emergency response planning and availability of resources.

    Title National Ambulatory Medical Care Survey: Terrorism Preparedness Among Office-based Physicians, United States, 2003-2004.
    Date September 2007
    Journal Advance Data
    Excerpt

    OBJECTIVES: This investigation describes terrorism preparedness among U.S. office-based physicians and their staffs in identification and diagnosis of terrorism-related conditions, training methods and sources, and assistance with diagnosis and reporting. METHODS: The National Ambulatory Medical Care Survey (NAMCS) is an annual national probability survey of approximately 3,000 U.S. nonfederal, office-based physicians. Terrorism preparedness items were added in 2003 and 2004. RESULTS: About 40 percent of physicians or their staffs received training for anthrax or smallpox, but less than one-third received training for any of the other exposures. About 42.2 percent of physicians, 13.5 percent of nurses, and 9.4 percent of physician assistants and nurse practitioners received training in at least one exposure. Approximately 56.2 percent of physicians indicated that they would contact state or local public health officials for diagnostic assistance more frequently than federal agencies and other sources. About 67.1 percent of physicians indicated that they would report a suspected terrorism-related condition to the state or local health department, 50.9 percent to the Centers for Disease Control and Prevention (CDC), 27.5 percent to the local hospital, and 1.8 percent to a local elected official's office. Approximately 78.8 percent of physicians had contact information for the local health department readily available. About 53.7 percent had reviewed the diseases reportable to health departments since September 2001, 11.3 percent had reviewed them before that month, and 35 percent had never reviewed them.

    Title National Hospital Ambulatory Medical Care Survey: 2005 Emergency Department Summary.
    Date September 2007
    Journal Advance Data
    Excerpt

    OBJECTIVE: This report presents the most current (2005) nationally representative data on visits to hospital emergency departments (ED) in the United States. Statistics are presented on selected hospital, patient, and visit characteristics. Selected trends in ED utilization from 1995 through 2005 are also presented. METHODS: Data are from the 2005 National Hospital Ambulatory Medical Care Survey (NHAMCS), the longest continuously running nationally representative survey of hospital ED and outpatient department (OPD) utilization. The NHAMCS collects data on visits to emergency and outpatient departments of nonfederal, short-stay, and general hospitals in the United States. Sample data are weighted to produce annual national estimates. RESULTS: During 2005, an estimated 115.3 million visits were made to hospital EDs, about 39.6 visits per 100 persons. This represents on average roughly 30,000 visits per ED in 2005, a 31 percent increase over 1995 (23,000). Visit rates have shown an increasing trend since 1995 for persons 22-49 years of age, 50-64 years of age, and 65 years of age and over. In 2005, about 0.5 million (0.4 percent) of visits were made by homeless individuals. Nearly 18 million patients arrived by ambulance (15.5 percent). At 1.9 percent of visits, the patient had been discharged from the hospital within the previous 7 days. Abdominal pain, chest pain, fever, and cough were the leading patient complaints, accounting for nearly one-fifth of all visits. Abdominal pain was the leading illness-related diagnosis at ED visits. There were an estimated 41.9 million injury-related visits or 14.4 visits per 100 persons. Diagnostic and screening services were provided at 71.1 percent of visits, and procedures were performed at 47.3 percent of visits. Medications were either given in the ED or prescribed at discharge at 76.7 percent of visits, resulting in 204.9 million drug mentions. On average, patients spent 56.3 minutes waiting to see a physician, and 3.3 hours for the full duration of their ED visit. About 12 percent of ED visits resulted in hospital admission. The average total length of stay for those admitted was 5.2 days, and the leading principal hospital discharge diagnosis was nonischemic heart disease.

    Title Terrorism Preparedness: Have Office-based Physicians Been Trained?
    Date July 2007
    Journal Family Medicine
    Excerpt

    BACKGROUND AND OBJECTIVES: Terrorism may have a severe impact on physicians' practices. We examined terrorism preparedness training of office-based physicians. METHODS: The National Ambulatory Medical Care Survey uses a nationally representative multi-stage sampling design. In 2003 and 2004, physicians were asked if they had received training in six Category-A viral and bacterial diseases and chemical and radiological exposures. Differences were examined by age, degree, specialty, region, urbanicity, and managed care involvement. Chi-squares, t tests, and logistic regressions were performed in SUDAAN-9.0, with univariate significance at P<.05 and multivariate significance within 95% confidence intervals. RESULTS: Of 3,968 physicians, 56.3% responded. Forty-two percent were trained in at least one exposure. Primary care specialists were more likely than surgeons to be trained for all exposures. Medical specialists were more likely than surgeons to be trained for smallpox, anthrax, and plague. Physicians ages 55-69 years were less likely than those in their 30s to be trained for smallpox, anthrax, and chemical exposures. Managed care physicians were more likely to be trained for all exposures except botulism, tularemia, and hemorrhagic fever. CONCLUSIONS: Terrorism training frequencies were low, although primary care and managed care physicians reported more training than their counterparts.

    Title Training for Terrorism-related Conditions in Hospitals: United States, 2003-04.
    Date March 2007
    Journal Advance Data
    Excerpt

    OBJECTIVE: This study estimates baseline data to determine which hospital characteristics are associated with providing terrorism preparedness training to clinical staff. METHODS: Information from a Bioterrorism and Mass Casualty Supplement to the 2003 and 2004 National Hospital Ambulatory Medical Care Surveys was used to provide national estimates of variations in terrorism preparedness training by eight hospital characteristics. Of 874 hospitals in scope, 739 (84.6 percent) responded. Estimates are presented with 95 percent confidence intervals. RESULTS: Hospitals with Joint Commission accreditation were more likely to provide terrorism preparedness training to all types of clinical staff (staff physicians, residents, nurse practitioners, physician assistants, and laboratory staff). Teaching hospitals, medical school affiliation, bed capacity, and urban location were also associated with training staff physicians, residents, nurse practitioners, and physician assistants. Hospitals with residency programs were associated with training only staff physicians and residents. There was more parity across hospital characteristics in training nurses and laboratory staff than for physicians, residents, nurse practitioners, and physician assistants. Joint Commission accreditation was the most consistent factor associated with providing training for all nine exposures studied (smallpox, anthrax, chemical and radiological exposures, botulism, plague, tularemia, viral encephalitis, and hemorrhagic fever).

    Title Bioterrorism and Mass Casualty Preparedness in Hospitals: United States, 2003.
    Date December 2005
    Journal Advance Data
    Excerpt

    OBJECTIVES: This study examined the content of hospital terrorism preparedness emergency response plans; whether those plans had been updated since September 11, 2001; collaboration of hospitals with outside organizations; clinician training in the management of biological, chemical, explosive, and nuclear exposures; drills on the response plans; and equipment and bed capacity. METHODS: The National Hospital Ambulatory Medical Care Survey (NHAMCS) is an annual survey of a probability sample of approximately 500 non-Federal general and short-stay hospitals in the United States. A Bioterrorism and Mass Casualty Supplement was included in the 2003 survey and provided the data for this analysis. RESULTS: Almost all hospitals have plans for responding to natural disasters (97.3 percent). Most have plans for responding to chemical (85.5 percent), biological (84.8 percent), nuclear or radiological (77.2 percent), and explosive incidents (76.9 percent). About three-quarters of hospitals were integrated into community-wide disaster plans (76.4 percent), and 75.9 percent specifically reported a cooperative planning process with other local health care facilities. Despite these plans, only 46.1 percent reported written memoranda of understanding with these facilities to accept inpatients during a declared disaster. Hospitals varied widely in their plans for re-arranging schedules and space in the event of a disaster. Training for hospital incident command and smallpox, anthrax, chemical, and radiological exposures was ahead of training for other infectious diseases. The percentage of hospitals training their staff in any exposure varied from 92.1 percent for nurses to 49.2 percent for medical residents. Drills for natural disasters occurred more often than those for chemical, biological, explosive, nuclear, and epidemic incidents. More hospitals staged drills for biological attacks than for severe epidemics. Despite explosions being the most common form of terrorism, drills for these were staged by only one-fifth of hospitals. Hospitals collaborated on drills most often with emergency medical services, fire departments, and law enforcement agencies.

    Title Localized Right Cerebral Hemisphere Dysfunction and Recurrent Mania.
    Date August 1980
    Journal The American Journal of Psychiatry

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