Emergency Medicine Commons^™

Analyzing The Effect Of Interview Time And Day On Emergency Medicine Residency Interview Scores, Alanna O'Connell, Sean Greco, Tingting Zhan, Tracy Brader, Megan Crossman, Robin Naples, Anthony Sielicki, Megan Stobart Gallagher, Peter Tomaselli, Dimitrios Papanagnou

Department of Medicine Faculty Papers

Background: When it comes to scheduling interviews, medical students may wonder if they need a strategy to increase their likelihood of matching. Previous studies examined the temporal effects of the residency interview on overall match rate; however, there are additional factors that affect the match process, including board examination scores and letters of recommendation. Only few studies have examined the effect interview time of day has on match success. The current study examines the impact date and time of interview during the interview season have on candidates' respective interview scores.

Methods: Interview data over a three-year period (i.e., three interview …

Promotion Of Covid-19 Va(X)Ccination In The Emergency Department-Procovaxed: Study Protocol For A Cluster Randomized Controlled Trial., Robert M Rodriguez, Kelli O'Laughlin, Stephanie A Eucker, Anna Marie Chang, Kristin L. Rising, Graham Nichol, Alena Pauley, Hemal Kanzaria, Alexzandra Gentsch, Cindy Li, Herbie Duber, Jonathan Butler, Vidya Eswaran, Dave Glidden

Department of Emergency Medicine Faculty Papers

Background: We conducted in-depth interviews to characterize reasons for COVID-19 vaccine hesitancy in emergency department (ED) patients and developed messaging platforms that may address their concerns. In this trial, we seek to determine whether provision of these COVID-19 vaccine messaging platforms in EDs will be associated with greater COVID-19 vaccine acceptance and uptake in unvaccinated ED patients.

Methods: This is a cluster-randomized controlled trial (RCT) evaluating our COVID-19 vaccine messaging platforms in seven hospital EDs (mix of academic, community, and safety-net EDs) in four US cities. Within each study site, we randomized 30 1-week periods to the intervention and 30 …

A Just-In-Time Video Primer On Pneumothorax Pathophysiology And Early Management, Nicholas Macdonald, Jacob Garcia, Gregory C. Kane, Xiao Chi Zhang, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

Audience: Emergency medicine residents (interns, junior residents), medical students, and mid-level providers (physician assistants, nurse practitioners).

Introduction: Pneumothorax refersto the presence of gas within the pleuralspace and is a relatively common clinical entity in the emergency department Traumatic pneumothorax results from blunt or penetrating trauma to the thorax. Iatrogenic pneumothorax is a risk inherent to a number of invasive procedures and represents a significant cause of preventable morbidity. Specifically, central venous catheterization (43.8%), thoracentesis (20.1%), and barotrauma due to mechanical ventilation (9.1%) are the most frequent causes. A feared complication of pneumothorax is the development of tension pneumothorax, which involves …

Troponin Is Unrelated To Outcomes In Heart Failure Patients Discharged From The Emergency Department, Gregory J Fermann, Jon W Schrock, Phillip D Levy, Peter Pang, Javed Butler, Anna Marie Chang, Douglas Char, Deborah Diercks, Jin H Han, Brian Hiestand, Chris Hogan, Cathy A Jenkins, Christy Kampe, Yosef Khan, Vijaya A Kumar, Sangil Lee, Joann Lindenfeld, Dandan Liu, Karen F Miller, W Frank Peacock, Carolyn M Reilly, Chad Robichaux, Russell L Rothman, Wesley H Self, Adam J Singer, Sarah A Sterling, Alan B Storrow, William B Stubblefield, Cheryl Walsh, John Wilburn, Sean P Collins

Department of Emergency Medicine Faculty Papers

Background: Prior data has demonstrated increased mortality in hospitalized patients with acute heart failure (AHF) and troponin elevation. No data has specifically examined the prognostic significance of troponin elevation in patients with AHF discharged after emergency department (ED) management.

Objective: Evaluate the relationship between troponin elevation and outcomes in patients with AHF who are treated and released from the ED.

Methods: This was a secondary analysis of the Get with the Guidelines to Reduce Disparities in AHF Patients Discharged from the ED (GUIDED-HF) trial, a randomized, controlled trial of ED patients with AHF who were discharged. Patients with elevated conventional …

"You Can't Go Wrong Being Safe": Motivations, Patterns, And Context Surrounding Use Of Fentanyl Test Strips For Heroin And Other Drugs., Megan K Reed, Amanda Guth, Venise J Salcedo, Jeffrey K Hom, Kristin L Rising

Department of Emergency Medicine Faculty Papers

BACKGROUND: Unintentional drug overdose fatalities due to fentanyl contamination continue to increase. Fentanyl test strip (FTS) use has emerged as a valuable harm reduction strategy to detect the presence of fentanyl in drugs. However, motivation for FTS uptake and context surrounding use have not been well characterized in the literature. This study aimed to capture people who use drugs' (PWUD) lived experiences to understand motivations underlying FTS uptake, ongoing use, and actions after testing.

METHODS: We conducted qualitative interviews with PWUD at a harm reduction organization in Philadelphia, PA. Interviews asked about experiences with using FTS. Interviews were audio-recorded, professionally …

Study Protocol For The Innovative Support For Patients With Sars-Cov-2 Infections Registry (Inspire): A Longitudinal Study Of The Medium And Long-Term Sequelae Of Sars-Cov-2 Infection, Kelli N O'Laughlin, Matthew Thompson, Bala Hota, Michael Gottlieb, Ian D Plumb, Anna Marie Chang, Lauren E Wisk, Aron J Hall, Ralph C Wang, Erica S Spatz, Kari A Stephens, Ryan M Huebinger, Samuel A Mcdonald, Arjun Venkatesh, Nikki Gentile, B. H. Slovis, Mandy Hill, Sharon Saydah, Ahamed H Idris, Robert Rodriguez, Harlan M Krumholz, Joann G Elmore, Robert A Weinstein, Graham Nichol

Department of Emergency Medicine Faculty Papers

Background: Reports on medium and long-term sequelae of SARS-CoV-2 infections largely lack quantification of incidence and relative risk. We describe the rationale and methods of the Innovative Support for Patients with SARS-CoV-2 Registry (INSPIRE) that combines patient-reported outcomes with data from digital health records to understand predictors and impacts of SARS-CoV-2 infection.

Methods: INSPIRE is a prospective, multicenter, longitudinal study of individuals with symptoms of SARS-CoV-2 infection in eight regions across the US. Adults are eligible for enrollment if they are fluent in English or Spanish, reported symptoms suggestive of acute SARS-CoV-2 infection, and if they are within 42 days …

Curriculum Development By Design Thinking: Analyzing A Program For Social Determinants Of Health Screening By Pre-Clerkship Medical Students., Ari M Fish, J Matthew Fields, Deborah Ziring, Gina Mccoy, Paula Ostroff, Geoffrey Hayden

Department of Emergency Medicine Faculty Papers

Problem: Health systems science (HSS) curricula in medical schools facilitate an understanding of social determinants of health (SDOH) and their impact on health outcomes. After implementation of an experiential, patient-centered program based around SDOH screening, however, our medical college noted poor student receptivity and engagement. In order to improve the program, we chose a design thinking approach based on the perceived value of actively engaging learners in the design of education. The role of design thinking in curricular quality improvement, however, remains unclear.

Intervention: We sought to determine if a current educational model for SDOH screening could be improved by …

C1q/Tnf-Related Protein 3 Prevents Diabetic Retinopathy Via Ampk-Dependent Stabilization Of Blood–Retinal Barrier Tight Junctions, Zheyi Yan, Chunfang Wang, Zhijun Meng, Lu Gan, Rui Guo, Jing Liu, Wayne Bond Lau, Dina Xie, Jianli Zhao, Bernard Lopez, Theodore Christopher, Ulhas P. Naik, Xin-Liang Ma, Yajing Wang

Department of Medicine Faculty Papers

Background The impairment of the inner blood–retinal barrier (iBRB) increases the pathological development of diabetic retinopathy (DR), a severe complication in diabetic patients. Identifying approaches to preserving iBRB integrity and function is a significant challenge in DR. C1q/tumor necrosis factor-related protein-3 (CTRP3) is a newly discovered adipokine and a vital biomarker, predicting DR severity. We sought to determine whether and how CTRP3 affects the pathological development of non-proliferative diabetic retinopathy (NPDR). Methods To clarify the pathophysiologic progress of the blood–retinal barrier in NPDR and explore its potential mechanism, a mouse Type 2 diabetic model of diabetic retinopathy was used. The …

I Don't Have A Diagnosis For You: Preparing Medical Students To Communicate Diagnostic Uncertainty In The Emergency Department, Maria Poluch, Jordan Feingold-Link, Nethra S. Ankam, Jared Kilpatrick, Kenzie Cameron, Shruti Chandra, Amanda Doty, Matthew Klein, Danielle Mccarthy, Kristin L. Rising, David Salzman, Deborah Ziring, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

Introduction: Diagnostic uncertainty abounds in medicine, and communication of that uncertainty is critical to the delivery of high-quality patient care. While there has been training in communicating diagnostic uncertainty directed towards residents, a gap remains in preparing medical students to understand and communicate diagnostic uncertainty. We developed a session to introduce medical students to diagnostic uncertainty and to practice communicating uncertainty using a checklist during role-play patient conversations.

Methods: This virtual session was conducted for third-year medical students at the conclusion of their core clerkships. It consisted of prework, didactic lecture, peer role-play, and debriefing. The prework included reflection prompts …

Principles Of Hypotensive Shock: A Video Introduction To Pathophysiology And Treatment Strategies, Brittany Macdonald, Nicholas Macdonald, Jacob Garcia, Xiao Chi Zhang, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

Audience: Emergency medicine interns, medical students, and mid-level providers (physician assistants, nurse practitioners).

Introduction: Shock is defined as a state of global tissue hypoxia and is typically the result of hypotension and circulatory system failure. A variety of disease states may ultimately culminate in hypotensive shock through one or more generally recognized mechanisms – hypovolemic, cardiogenic, obstructive, and/or distributive shock. These mechanisms differ significantly in terms of their pathophysiology and requisite treatment. While the effects of hypotensive shock are initially reversible, untreated hypotensive shock may rapidly progress to multiorgan failure and death. Hence, the ability to promptly recognize a state …

The Art Of Sim-Making: What To Learn From Film-Making, Fatimah Lateef, Brad Peckler, Eric Saindon, Shruti Chandra, Indrani Sardesai, Mohamed Alwi Abdul Rahman, S Vimal Krishnan, Afrah Abdul Wahid Ali, Rose V Goncalves, Sagar Galwankar

Department of Emergency Medicine Faculty Papers

The components of each stage have similarities as well as differences, which make each unique in its own right. As the film-making and the movie industry may have much we can learn from, some of these will be covered under the different sections of the paper, for example, "Writing Powerful Narratives," depiction of emotional elements, specific industry-driven developments as well as the "cultural considerations" in both. For medical simulation and simulation-based education, the corresponding stages are as follows: DevelopmentPreproductionProductionPostproduction andDistribution. The art of sim-making has many similarities to that of film-making. In fact, there is potentially much to be learnt …

Analyzing The Effect Of Interview Time And Day On Emergency Medicine Residency Interview Scores, Alanna O’Connel, Sean Greco, Peter Tomaselli, Megan Stobart Gallagher, Robin Naples, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

Learning Objectives: To analyze whether interview date or time has an effect on residency interview score for applicants to Emergency Medicine residency programs.

Utility Of S100a12 As An Early Biomarker In Patients With St-Segment Elevation Myocardial Infarction, Xiaolin Zhang, Minghui Cheng, Naijing Gao, Yi Li, Chenghui Yan, Xiaoxiang Tian, Dan Liu, Miaohan Qiu, Xiaozeng Wang, Bo Luan, Jie Deng, Shouli Wang, Hongyan Tian, Geng Wang, Xin-Liang Ma, Gregg W Stone, Yaling Han

Department of Emergency Medicine Faculty Papers

Importance: S100A12 is a calcium binding protein which is involved in inflammation and progression of atherosclerosis.

Objective: We sought to investigate the utility of S100A12 as a biomarker for the early diagnosis and prognostication of patients presenting with ST-segment elevation myocardial infarction (STEMI).

Design, Setting, and Participants: S100A12 was measured in 1023 patients presenting to the emergency department with acute chest pain between June 2012 and November 2015. An independent cohort of 398 patients enrolled at 3 different hospitals served as a validation cohort.

Main Outcomes and Measures: The primary clinical endpoint of interest was major adverse cardiac and cerebral …

Mistrust, Neighborhood Deprivation, And Telehealth Use In African Americans With Diabetes., Barry W. Rovner, Robin J. Casten, Anna Marie Chang, Judd E. Hollander, Kristin Rising

Department of Emergency Medicine Faculty Papers

This study explored the relationship between trust in physicians and telehealth use during the COVID pandemic in 162 African Americans with diabetes. More than 90% of patients had internet-capable devices and internet service but only 61 patients (39%) had a telehealth visit. Compared to the latter, participants with no telehealth visits had less trust in physicians' ability to diagnose COVID, less trust in physicians' ability to treat via telehealth, and resided in more deprived neighborhoods. There were no differences in age, sex, education, nor literacy. For African Americans with diabetes, health disparities may increase unless fundamental issues such as trust …

A Prospective Examination Of Sex Differences In Posttraumatic Autonomic Functioning., Antonia V Seligowski, Elizabeth R Steuber, Rebecca Hinrichs, Mariam H Reda, Charis N Wiltshire, Cassandra P Wanna, Sterling J Winters, Karlye A Phillips, Stacey L House, Francesca L Beaudoin, Xinming An, Jennifer S Stevens, Donglin Zeng, Thomas C Neylan, Gari D Clifford, Sarah D Linnstaedt, Laura T Germine, Kenneth A Bollen, Guia Guffanti, Scott L Rauch, John P Haran, Alan B Storrow, Christopher Lewandowski, Paul I Musey, Phyllis L Hendry, Sophia Sheikh, Christopher W Jones, Brittany E Punches, Michael C Kurz, Vishnu P Murty, Meghan E Mcgrath, Lauren A Hudak, Jose L Pascual, Mark J Seamon, Elizabeth M Datner, Anna Marie Chang, Claire Pearson, David A Peak, Roland C Merchant, Robert M Domeier, Niels K Rathlev, Brian J O'Neil, Leon D Sanchez, Steven E Bruce, Mark W Miller, Robert H Pietrzak, Jutta Joormann, Deanna M Barch, Diego A Pizzagalli, John F Sheridan, Beatriz Luna, Steven E Harte, James M Elliott, Karestan C Koenen, Ronald C Kessler, Samuel A Mclean, Kerry J Ressler, Tanja Jovanovic

Department of Emergency Medicine Faculty Papers

Background: Cross-sectional studies have found that individuals with posttraumatic stress disorder (PTSD) exhibit deficits in autonomic functioning. While PTSD rates are twice as high in women compared to men, sex differences in autonomic functioning are relatively unknown among trauma-exposed populations. The current study used a prospective design to examine sex differences in posttraumatic autonomic functioning.

Methods: 192 participants were recruited from emergency departments following trauma exposure (

Results: 2-week systolic BP was significantly higher in men, while 2-week HR was significantly higher in women, and a sex by PTSD interaction suggested that women who developed PTSD demonstrated the highest HR …

Building Trauma And Ems Systems Capacity In Rwanda: Lessons And Recommendations, Sudha Jayaraman, Faustin Ntirenganya, Menelas Nkeshimana, Ashley Rosenberg, Theophile Dushime, Ignace Kabagema, Jean Marie Uwitonze, Eric Uwitonize, Jeanne D'Arc Nyinawankusi, Robert Riviello, Irene Bagahirwa, Kenneth L Williams, Elizabeth Krebs, Rebecca Maine, Paulin Banguti, Stephen Rulisa, Patrick Kyamanywa, Jean Claude Byiringiro

Department of Emergency Medicine Faculty Papers

Background: Surgical capacity building has gained substantial momentum. However, care at the hospital level depends on improved access to emergency services. There is no established model for facilitating trauma and EMS system capacity in LMIC settings. This manuscript describes our model for multi-disciplinary collaboration to advance trauma and EMS capacity in Rwanda, along with our lessons and recommendations.

Methods: After high-level meetings at the Ministry of Health in Rwanda (MOH), in 2016, a capacity building plan focusing on improved clinical services, quality improvement/research and leadership capacity across prehospital and emergency settings. The main themes for the collaborative model included for …

Coaching Junior Faculty For The Uncertainties Of Academic Professional Practice, Richard Mcknight, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

No abstract provided.

Emergency Medicine And Covid-19: Now And Next Year, Theodore A. Christopher, Adrienne N. Christopher

Department of Emergency Medicine Faculty Papers

The COVID-19 pandemic is responsible for infecting to date more than 93 million people worldwide and causing more than 2 million deaths. That the vast majority of deaths have occurred in the United States (U.S.) can be attributed to nonadherence by Americans to basic public health mitigation strategies that are known to curtail coronavirus spread. Emergency Departments (ED’s) throughout the U.S. experienced a dramatic decrease in patient visits during the first surge of COVID-19, followed by an ED patient visit rebound to approximately 80% of pre-COVID-19 numbers, which have remained relatively stable through the current second COVID-19 surge. The pandemic …

Towards A Medical School Curriculum For Uncertainty In Clinical Practice, Dimitrios Papanagnou, Nethra S. Ankam, David Ebbott, Deborah Ziring

Department of Emergency Medicine Faculty Papers

Uncertainty abounds in the clinical environment. Medical students, however, are not explicitly prepared for situations of uncertainty in clinical practice, which can cause anxiety and impact well-being. To address this gap, we sought to capture how students felt in various clinical scenarios and identify programs they found helpful as they worked through uncertainty in their clerkships to better inform curriculum that prepares them to acknowledge and navigate this uncertainty. This is an observational cross-sectional study of third-year medical students surveyed at the end of core clerkships. The survey consisted of the General Self-Efficacy (GSE) Scale and Intolerance of Uncertainty Scale …

The Relationship Between Vitamin C Or Thiamine Levels And Outcomes For Severe Sepsis Patients Admitted To The Icu., Nandan Prasad, Anne V. Grossestreuer, Nuala J. Meyer, Sarah M. Perman, Mark E. Mikkelsen, Judd Hollander, David F. Gaieski

Department of Emergency Medicine Faculty Papers

Preliminary data have produced conflicting results regarding whether initial vitamin C levels in patients with severe sepsis correlate with mortality outcomes. We hypothesized that low plasma ascorbic acid or thiamine levels in severe sepsis patients admitted from the Emergency Department (ED) to the Intensive Care Unit (ICU) would be associated with increased mortality and an increased incidence of shock. Retrospective analysis of a prospective database of severe sepsis patients admitted to the ICU at an urban, academic medical center. Ascorbic acid and thiamine levels were analyzed in relation to survivors vs. non-survivors and shock vs. non-shock patients. 235 patients were …

Developing Standardized Patient-Based Cases For Communication Training: Lessons Learned From Training Residents To Communicate Diagnostic Uncertainty., Dimitrios Papanagnou, Matthew R Klein, Xiao Chi Zhang, Kenzie A Cameron, Amanda Doty, Danielle M Mccarthy, Kristin L. Rising, David H Salzman

Department of Emergency Medicine Faculty Papers

Health professions education has benefitted from standardized patient (SP) programs to develop and refine communication and interpersonal skills in trainees. Effective case design is essential to ensure an SP encounter successfully meets learning objectives that are focused on communication skills. Creative, well-designed case scenarios offer learners the opportunity to engage in complex patient encounters, while challenging them to address the personal and emotional contexts in which their patients are situated. Therefore, prior to considering the practical execution of the patient encounter, educators will first need a clear and structured strategy for writing, organizing, and developing cases. The authors reflect on …

Pre-Operative Fluid Resuscitation In The Emergency General Surgery Septic Patient: Does It Really Matter?, Benjamin Moran, Erin Major, Joseph A Kufera, Samuel A Tisherman, Jose Diaz

Department of Emergency Medicine Faculty Papers

OBJECTIVE: Emergency general surgery (EGS) patients presenting with sepsis remain a challenge. The Surviving Sepsis Campaign recommends a 30 mL/kg fluid bolus in these patients, but recent studies suggest an association between large volume crystalloid resuscitation and increased mortality. The optimal amount of pre-operative fluid resuscitation prior to source control in patients with intra-abdominal sepsis is unknown. This study aims to determine if increasing volume of resuscitation prior to surgical source control is associated with worsening outcomes.

METHODS: We conducted an 8-year retrospective chart review of EGS patients undergoing surgery for abdominal sepsis within 24 h of admission. Patients in …

Lncrna Nonhsat069381 And Nonhsat140844 Increase In Aging Human Blood, Regulating Cardiomyocyte Apoptosis., Jinyang Zhao, Xiaolong Lin, Haoxuan Sun, Donghui Zhao, Qin Ma, Wayne Bond Lau, Zichao Cheng, Fanqi Li, Jinghua Liu, Qian Fan

Department of Emergency Medicine Faculty Papers

Aging augments postischemic apoptosis via incomplete mechanisms. Our previous animal study suggests that in addition to proapoptotic effects, lncRNAs also exert antiapoptotic effects in cardiomyocytes. However, whether this unexpected phenomenon exists in humans is unknown. In the present study, we investigated the relationship between aging and apoptosis regulation in human blood samples and confirmed their role by utilizing the cardiomyocyte lines (AC16 cells). Human blood samples were collected from 20 pairs of older adult and young volunteers. Age-different apoptotic regulatory lncRNAs and miRNAs were identified by microarray and bioinformatics analysis. The results indicated that lncRNA (NONHSAT069381 and NONHSAT140844) and miRNA …

Data From Emergency Medicine Palliative Care Access (Empalla): A Randomized Controlled Trial Comparing The Effectiveness Of Specialty Outpatient Versus Telephonic Palliative Care Of Older Adults With Advanced Illness Presenting To The Emergency Department., Abigail M. Schmucker, Mara Flannery, Jeanne Cho, Keith S. Goldfeld, Corita Grudzen, Empalla Investigators

Student Papers, Posters & Projects

BACKGROUND: The Emergency Medicine Palliative Care Access (EMPallA) trial is a large, multicenter, parallel, two-arm randomized controlled trial in emergency department (ED) patients comparing two models of palliative care: nurse-led telephonic case management and specialty, outpatient palliative care. This report aims to: 1) report baseline demographic and quality of life (QOL) data for the EMPallA cohort, 2) identify the association between illness type and baseline QOL while controlling for other factors, and 3) explore baseline relationships between illness type, symptom burden, and loneliness.

METHODS: Patients aged 50+ years with advanced cancer (metastatic solid tumor) or end-stage organ failure (New York …

Provider Use Of Risk Stratification Tools For Pe And Cta Ordering Practices, Christy Johnson, Do, Daniel I. Shpigel, Md, Nicole Caltabiano, Do, Benjamin Slovis, Md, Ma, Facep

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

Quantify utilization of clinical decision tools, D-dimer and CTA-PE at TJUH and compare to benchmark and implement the logic seen in the adjacent QR code to an EPIC pop-up

Female With Intermittently Bleeding Abdominal Wall Mass., Evan Osterman, Rebecca Lisowski, Arthur Au

Department of Emergency Medicine Faculty Papers

No abstract provided.

Nicotine Aggravates Vascular Adiponectin Resistance Via Ubiquitin-Mediated Adiponectin Receptor Degradation In Diabetic Apolipoprotein E Knockout Mouse, Jia Gao, Jianghong Fan, Zhijun Meng, Rui Wang, Caihong Liu, Jing Liu, Bin Liang, Jing Wang, Yaoli Xie, Jing Zhao, Rui Guo, Jianli Zhao, Xin-Liang Ma, Xiangying Jiao, Jimin Cao, Yajing Wang

Department of Emergency Medicine Faculty Papers

There is limited and discordant evidence on the role of nicotine in diabetic vascular disease. Exacerbated endothelial cell dysregulation in smokers with diabetes is associated with the disrupted adipose function. Adipokines possess vascular protective, anti-inflammatory, and anti-diabetic properties. However, whether and how nicotine primes and aggravates diabetic vascular disorders remain uncertain. In this study, we evaluated the alteration of adiponectin (APN) level in high-fat diet (HFD) mice with nicotine (NIC) administration. The vascular pathophysiological response was evaluated with vascular ring assay. Confocal and co-immunoprecipitation analysis were applied to identify the signal interaction and transduction. These results indicated that the circulating …

Goals-Of-Care Course For Emergency Physicians During The Covid-19 Pandemic., Mari Siegel, Erica Westlake

Department of Emergency Medicine Faculty Papers

BACKGROUND

COVID-19 increased the need for goals of care (GOC) discussions in the Emergency Department (ED). Many Emergency Physicians (EPs) report no formal training in holding GOC discussions. COVID-19 created unique teaching challenges given social distancing requirements.

METHODS

Eight teaching sessions were held using Zoom in March and April at an urban institution in the United States. Sessions were limited to 4-8 participants. They were comprised of a 30-minute lecture and 15 minutes of role-playing, in which providers read scripts to practice communication skills. The lecture introduced vocabulary and models to shape GOC discussions. Participants were invited to complete an …

Reduction In Hospital System Opioid Prescribing For Acute Pain Through Default Prescription Preference Settings: Pre-Post Study, Benjamin Heritier Slovis, Jeffrey Riggio, Melanie Girondo, Cara Martino, Bracken Babula, Lindsey Roke, John C. Kairys

Department of Medicine Faculty Papers

BACKGROUND: The United States is in an opioid epidemic. Passive decision support in the electronic health record (EHR) through opioid prescription presets may aid in curbing opioid dependence.

OBJECTIVE: The objective of this study is to determine whether modification of opioid prescribing presets in the EHR could change prescribing patterns for an entire hospital system.

METHODS: We performed a quasi-experimental retrospective pre-post analysis of a 24-month period before and after modifications to our EHR's opioid prescription presets to match Centers for Disease Control and Prevention guidelines. We included all opioid prescriptions prescribed at our institution for nonchronic pain. Our modifications …

Analysis Of An Obstetrics Point-Of-Care Ultrasound Training Program For Healthcare Practitioners In Zanzibar, Tanzania., Elizabeth A Hall, Danielle Matilsky, Rachel Zang, Naomasa Hase, Ali Habibu Ali, Patricia C Henwood, Anthony J Dean

Department of Emergency Medicine Faculty Papers

BACKGROUND: A point-of-care ultrasound education program in obstetrics was developed to train antenatal healthcare practitioners in rural Zanzibar. The study group consisted of 13 practitioners with different training backgrounds: physicians, clinical officers, and nurse/midwives. Trainees received an intensive 2-week antenatal ultrasound course consisting of lectures and hands-on practice followed by 6 months of direct supervision of hands-on scanning and bedside education in their clinical practice environments. Trainees were given a pre-course written exam, a final exam at course completion, and practical exams at 19 and 27 weeks. Trainees were expected to complete written documentation and record ultrasound images of at …