Browsing by Author "Rutz, Matt"

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    Abscess Size and Depth on Ultrasound and Association with Treatment Failure without Drainage
    (eScholarship, 2020-03) Russell, Frances M.; Rutz, Matt; Rood, L. Ken; McGee, Justin; Sarmiento, Elisa J.; Emergency Medicine, School of Medicine
    Introduction: Skin and soft tissue infections (SSTI) occur along a continuum from cellulitis to abscess. Point-of-care ultrasound (POCUS) is effective in differentiating between these two diagnoses and guiding acute management decisions. Smaller and more superficial abscesses may not require a drainage procedure for cure. The goal of this study was to evaluate the optimal abscess size and depth cut-off for determining when a drainage procedure is necessary. Methods: We conducted a retrospective study of adult patients with a SSTI who had POCUS performed. Patients were identified through an ultrasound database. We reviewed examinations for the presence, size, and depth of abscess. Medical records were reviewed to determine acute ED management and assess outcomes. The primary outcome evaluated the optimal abscess size and depth when a patient could be safely discharged without a drainage procedure. We defined a treatment failure as a return visit within seven days requiring admission, change in antibiotics, or drainage procedure. Results: A total of 162 patients had an abscess confirmed on POCUS and were discharged from the ED without a drainage procedure. The optimal cut-off to predict treatment failure by receiver operating curve analysis was 1.3 centimeters (cm) in longest dimension with a sensitivity of 85% and specificity of 37% (area under the curve [AUC] 0.60, 95% confidence interval [CI], 0.44-0.76), and 0.4cm in depth with a sensitivity of 85% and specificity of 68% (AUC 0.83, 95% CI, 0.74-93). Conclusion: This retrospective data suggests that abscesses greater than 0.4 cm in depth from the skin surface may require a drainage procedure. Those less than 0.4 cm in depth may not require a drainage procedure and may be safely treated with antibiotics alone. Further prospective data is needed to validate these findings and to assess for an optimal size cut-off when a patient with a skin abscess may be discharged without a drainage procedure.
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    Factors that Contribute to Resident Teaching Effectiveness
    (Cureus, 2019-03-21) Rutz, Matt; Turner, Joseph; Pettit, Katie; Palmer, Megan M.; Perkins, Anthony; Cooper, Dylan D; Emergency Medicine, School of Medicine
    Background One of the key components of residency training is to become an educator. Resident physicians teach students, advanced practice providers, nurses, and even faculty on a daily basis. Objective The goal of this study was to identify the objective characteristics of residents, which correlate with perceived overall teaching effectiveness. Methods We conducted a one-year, retrospective study to identify factors that were associated with higher resident teaching evaluations. Senior emergency medicine (EM) teaching residents are evaluated by medical students following clinical teaching shifts. Eighteen factors pertaining to resident teaching effectiveness were chosen. Two items from the medical students' evaluations were analyzed against each factor: teaching effectiveness was measured on a five-point Likert scale and an overall teaching score (1-75). Results A total of 46 EM residents and 843 medical student evaluations were analyzed. The ACGME milestones for systems-based practice (p = 0.02) and accountability (p = 0.05) showed a statistically significant association with a rating of "five" on the Likert scale for teaching effectiveness. Three other ACGME milestones, systems-based practice (p = 0.01), task switching (p = 0.04), and team management (p = 0.03) also showed a statically significant association of receiving a score of 70 or greater on the overall teaching score. Conclusion Residents with higher performance associated with system management and accountability were perceived as highly effective teachers. USMLE and in-service exams were not predictive of higher teaching evaluations. Our data also suggest that effective teachers are working in both academic and community settings, providing a potential resource to academic departments and institutions.