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Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine

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https://www.readbyqxmd.com/read/28727258/changing-systems-through-effective-teams-a-role-for-simulation
#1
Elizabeth D Rosenman, Rosemarie Fernandez, Ambrose H Wong, Michael Cassara, Dylan D Cooper, Maybelle Kou, Torrey A Laack, Ivette Motola, Jessica R Parsons, Benjamin R Levine, James A Grand
Teams are the building blocks of the healthcare system, with growing evidence linking the quality of health care to team effectiveness, and team effectiveness to team training. Simulation has been identified as an effective modality for team training and assessment. Despite this, there are gaps in methodology, measurement, and implementation that prevent maximizing the impact of simulation modalities on team performance. As part of the 2017 Academic Emergency Medicine Consensus Conference "Catalyzing System Change through Health Care Simulation: Systems, Competency, and Outcomes," we explored the impact of simulation on various aspects of team effectiveness...
July 20, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28726326/speechless
#2
Nadine T Himelfarb
Bright blue eyes rimmed with deep sun wrinkles, a crown of mousy brown hair that appeared freshly cut by a four-year old with safety scissors, the patient was thin figured, wearing a flannel, yellowed t-shirt peaking from underneath, and a boxy, heavily stained canvas jacket over the shoulders. Old jeans were cinched at the waist by a crackled leather belt. The dirty right foot which lay bare on the stretcher was then thrust at me. The patient pointed angrily at the exposed foot. This article is protected by copyright...
July 20, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28715149/welcome-to-the-real-world-do-the-conditions-of-fda-approval-devalue-high-sensitivity-troponin
#3
Richard Body, Simon Mahler
In January 2017 the Food and Drug Administration (FDA) approved the first high sensitivity cardiac troponin (hs-cTn) assay for use in the United States: the 5(th) generation hs-cTnT assay manufactured by Roche Diagnostics. This landmark decision finally enables Americans to benefit from the same improvements in diagnostic technology that the rest of the world has utilized for some six years. This article is protected by copyright. All rights reserved.
July 17, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28715105/a-simulation-based-approach-to-measuring-team-situational-awareness-in-emergency-medicine-a-multicenter-observational-study
#4
Elizabeth D Rosenman, Aurora J Dixon, Jessica M Webb, Sarah Brolliar, Simon J Golden, Kerin A Jones, Sachita Shah, James A Grand, Steve W J Kozlowski, Georgia T Chao, Rosemarie Fernandez
OBJECTIVES: Team situational awareness (TSA) is critical for effective teamwork and supports dynamic decision-making in unpredictable, time-pressured situations. Simulation provides a platform for developing and assessing TSA; but these efforts are limited by suboptimal measurement approaches. The objective of this study was to develop and evaluate a novel approach to TSA measurement in interprofessional emergency medicine teams. METHODS: We performed a multicenter, prospective, simulation-based observational study to evaluate an approach to TSA measurement...
July 17, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28714287/bacteremia-prediction-model-for-community-acquired-pneumonia-external-validation-in-a-multicenter-retrospective-cohort
#5
Byunghyun Kim, Jungho Choi, Kyuseok Kim, Sujin Jang, Tae Gun Shin, Won Young Kim, Jung-Youn Kim, Yoo Seok Park, Soo Hyun Kim, Hui Jai Lee, Jonghwan Shin, JeSung You, Kyung Su Kim, Sung Phil Chung
OBJECTIVE: Many studies have described constructing a prediction model for bacteremia in community-acquired pneumonia (CAP), but these studies were not validated in external heterogeneous groups. The objective of this study was to test the generalizability of a previous bacteremia prediction model for CAP by external validation. METHODS: This multicenter retrospective cohort analysis was performed in eight tertiary urban hospital emergency departments (ED). We reviewed adult patients who were hospitalized after presentation to the ED with CAP...
July 16, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28695643/diagnostic-value-and-effect-of-bedside-ultrasound-in-acute-appendicitis-in-the-emergency-department
#6
Brian C Weiner
In their introduction, Gungor et al described ultrasound as a technique for evaluation of patients with low prior probability of acute appendicitis. This testing protocol for appendicitis is being proposed to challenge and perhaps replace the current standard of care for imaging, CT scanning. Specificity of CT scanning is reported in the range of 92-98% and CT is generally felt to be more accurate than ultrasonography The finding of 95.8% specificity for their method appears competitive and may be arithmetically correct but is seriously flawed...
July 11, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28688200/conflicts-of-interest-in-emergency-medicine
#7
Joel Martin Geiderman, Kenneth V Iserson, Catherine A Marco, John Jesus, Arvind Venkat
Conflicts of interest are common in the practice of emergency medicine and may be present in the areas of clinical practice, relations with industry, expert witness testimony, medical education, research, and organizations. A conflict of interest occurs when there is dissonance between a primary interest and another interest. The concept of professionalism in medicine places the patient as the primary interest in any interaction with a physician. We contend that patient welfare is the ultimate interest in the entire enterprise of medicine...
July 8, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28675519/outcomes-following-possible-undiagnosed-aneurysmal-subarachnoid-hemorrhage-a-contemporary-analysis
#8
Dustin G Mark, Mamata V Kene, David R Vinson, Dustin W Ballard
OBJECTIVES: Existing literature suggests that patients with aneurysmal subarachnoid hemorrhage (aSAH) and "sentinel" aSAH symptoms prompting health care evaluations prior to aSAH diagnosis are at increased risk of unfavorable neurologic outcomes and death. Accordingly these encounters have been presumed to be unrecognized opportunities to diagnose aSAH, and the worse downstream outcomes representative of the added risks of delayed diagnoses. We sought to reinvestigate this paradigm among a contemporary cohort of patients with aSAH...
July 4, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28672064/response-to-letter-diagnostic-value-of-bedside-ultrasound-in-acute-appendicitis-in-ed-methodological-and-statistical-issues-on-diagnostic-value
#9
Faruk Gungor, Erkan Goksu, Taylan Kilic
The validity of a diagnostic test can be demonstrated by comparing it to a gold standard test. Sensitivity, specificity, positive and negative predictive values (PPV, NPV), positive and negative likelihood ratios, diagnostic odds ratio, and the area under the ROC curve are the parameters that reflect the discriminative ability of a diagnostic study. Diagnostic accuracy is very sensitive to the characteristics of the study population and it is affected by the prevalence or the spectrum of the disease studied...
July 3, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28662312/accuracy-of-computed-tomography-imaging-criteria-in-the-diagnosis-of-adult-open-globe-injuries-by-neuroradiology-and-ophthalmology
#10
Eric L Crowell, Vivek A Koduri, Emilio P Supsupin, Robert E Klinglesmith, Alice Z Chuang, Gene Kim, Laura A Baker, Robert M Feldman, Lauren S Blieden
OBJECTIVE: To evaluate the sensitivity and specificity of computed tomography (CT) diagnosis of open globes; determine which imaging factors are most predictive of open globe injuries; and evaluate the agreement between neuroradiologist and ophthalmologist readers for diagnosis of open and closed globes. METHODS: This study was a retrospective cohort study. Patients who presented to Memorial Hermann-Texas Medical Center with suspicion for open globes were reviewed...
June 29, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28662281/using-press-ganey-provider-feedback-to-improve-patient-satisfaction-a-pilot-randomized-controlled-trial
#11
Craig D Newgard, Rongwei Fu, James Heilman, Mary Tanski, O John Ma, Alan Lines, L Keith French
STUDY OBJECTIVE: To conduct a pilot randomized controlled trial to assess the feasibility, logistics and potential effect of monthly provider funnel plot feedback reports from Press Ganey data and semi-annual face-to-face coaching sessions to improve patient satisfaction scores. METHODS: This was a pilot randomized controlled trial of 25 emergency medicine faculty providers in one urban academic emergency department. We enrolled full-time clinical faculty with at least 12 months of baseline Press Ganey data, who anticipated working in the ED for at least 12 additional months...
June 29, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28650562/the-economic-value-of-hybrid-single-photon-emission-computed-tomography-with-computed-tomography-imaging-in-pulmonary-embolism-diagnosis
#12
Lauren K Toney, Richard D Kim, Swetha R Palli
OBJECTIVE: To quantify the potential economic value of single-photon emission computed tomography (SPECT) with computed tomography (CT; SPECT/CT) versus CT pulmonary angiography (CTPA), ventilation-perfusion (V/Q) planar scintigraphy and V/Q SPECT imaging modalities for diagnosing suspected pulmonary embolism (PE) patients in an emergency setting. METHODS: An Excel-based simulation model was developed to compare SPECT/CT versus the alternate scanning technologies from a payer's perspective...
June 26, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28650086/systemic-thrombolysis-catheter-directed-thrombolysis-and-anticoagulation-for-intermediate-risk-pulmonary-embolism-a-simulation-modeling-analysis
#13
Christopher Kabrhel, Ayman Ali, Jin Choi, Chin Hur
OBJECTIVES: Decision-making around the use of thrombolysis for patients with intermediate-risk (submassive) PE remains challenging. Studies indicate favorable clinical outcomes with systemic thrombolytics (IV tPA), but the risk of major bleeding and hemorrhagic stroke is a deterrent. Catheter-directed thrombolysis (CDT) may be a preferable strategy, as it has been shown to have a lower risk of bleeding than systemic thrombolysis. However, a three-arm randomized control study comparing IV tPA, CDT, and anticoagulation alone, with long-term follow up, would be costly and is unlikely to be performed...
June 26, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28646590/randomized-controlled-double-blind-trial-comparing-haloperidol-combined-with-conventional-therapy-to-conventional-therapy-alone-in-patients-with-symptomatic-gastroparesis
#14
Carlos J Roldan, Kimberly A Chambers, Linda Paniagua, Sonali Patel, Marylou Cardenas-Turanzas, Yashwant Chathampally
OBJECTIVE: Gastroparesis is a debilitating condition that causes nausea, vomiting, and abdominal pain. Management includes analgesics and antiemetics, but symptoms are often refractory. Haloperidol has been utilized in the palliative care setting for similar symptoms. The study objective was to determine whether haloperidol as an adjunct to conventional therapy would improve symptoms in gastroparesis patients presenting to the emergency department. METHODS AND TRIAL DESIGN: This was a randomized, double-blind, placebo-controlled trial of adult emergency department patients with acute exacerbation of previously diagnosed gastroparesis...
June 24, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28646584/prehospital-advanced-cardiac-life-support-for-out-of-hospital-cardiac-arrest-a-cohort-study
#15
Alexis Cournoyer, Eric Notebaert, Massimiliano Iseppon, Sylvie Cossette, Luc Londei-Leduc, Yoan Lamarche, Judy Morris, Éric Piette, Raoul Daoust, Jean-Marc Chauny, Catalina Sokoloff, Yiorgos Alexandros Cavayas, Jean Paquet, André Denault
OBJECTIVES: Out-of-hospital advanced cardiac life support (ACLS) has not consistently shown a positive impact on survival. Extracorporeal cardiopulmonary resuscitation (E-CPR) could render prolonged on-site resuscitation (ACLS or basic cardiac life support [BCLS]) undesirable in selected cases. The objectives of this study were to evaluate, in patients suffering from out-of-hospital cardiac arrest (OHCA) and in a subgroup of potential E-CPR candidates, the association between the addition of prehospital ACLS to BCLS and survival to hospital discharge, prehospital return of spontaneous circulation (ROSC) and delay from call to hospital arrival...
June 24, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28646558/neurology-concepts-young-women-and-ischemic-stroke-evaluation-and-management-in-the-emergency-department
#16
Bernard P Chang, Charles Wira, Joseph Miller, Murtaza Akhter, Bradley E Barth, Joshua Willey, Lauren Nentwich, Tracy Madsen
OBJECTIVE: Ischemic stroke is a leading cause of morbidity and mortality worldwide. While the incidence of ischemic stroke is highest in older populations, incidence of ischemic stroke in adults has been rising particularly rapidly among young (e.g. premenopausal) women. The evaluation and timely diagnosis of ischemic stroke in young women presents a challenging situation in the emergency department, due to a range of sex-specific risk factors and to broad differentials. The goals of this concepts paper are to summarize existing knowledge regarding the evaluation and management of young women with ischemic stroke in the acute setting...
June 24, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28646519/the-association-of-health-literacy-with-preventable-ed-visits-a-cross-sectional-study
#17
Meenakshi P Balakrishnan, Jill Boylston Herndon, Jingnan Zhang, Thomas Payton, Jonathan Shuster, Donna L Carden
BACKGROUND: Policy-makers argue that emergency department (ED) visits for conditions preventable with high-quality outpatient care contribute to waste in the healthcare system. However, access to ambulatory care is uneven, especially for vulnerable populations like minorities, the poor and those with limited health literacy. The impact of limited health literacy on ED visits that are preventable with timely, high-quality ambulatory care is unknown. OBJECTIVE: To determine the association of health literacy and preventable ED visits...
June 24, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28628260/society-for-academic-emergency-medicine-statement-on-plagiarism
#18
Shellie L Asher, Kenneth V Iserson, Lisa H Merck
The integrity of the research enterprise is of the utmost importance for the advancement of safe and effective medical practice for patients and for maintaining the public trust in health care. Academic societies and editors of journals are key participants in guarding scientific integrity. Avoiding and preventing plagiarism helps to preserve the scientific integrity of professional presentations and publications. The Society for Academic Emergency Medicine (SAEM) Ethics Committee discusses current issues in scientific publishing integrity and provides a guideline to avoid plagiarism in SAEM presentations and publications...
June 19, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28621810/adherence-to-standards-for-reporting-diagnostic-accuracy-in-emergency-medicine-research
#19
Lucas Gallo, Nadia Hua, Mathew Mercuri, Angela Silveira, Andrew Worster
BACKGROUND: Diagnostic tests are used frequently in the emergency department (ED) to guide clinical decision-making and, hence, influence clinical outcomes. The Standards for Reporting of Diagnostic Accuracy (STARD) criteria was developed to ensure diagnostic test studies are performed and reported to best inform clinical decision making in the ED. OBJECTIVE: To determine the extent to which diagnostic studies published in emergency medicine journals adhered to STARD 2003 criteria...
June 16, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28608494/comparing-the-no-objective-testing-rule-to-the-heart-pathway
#20
Jaimi Greenslade, Louise Cullen
We read with great interest the article by Stopyra and colleagues(1) comparing the no objective testing (NOT) rule and the HEART pathway using a cohort of 141 patients. The two rules, developed to risk stratify patients presenting to the emergency department (ED) with acute chest pain, were 100% sensitive for identifying major adverse cardiac events (MACE) at 30 days. The HEART pathway identified a more sizeable portion of low-risk patients who could be discharged without additional cardiac testing. This article is protected by copyright...
June 13, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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