IU Indianapolis ScholarWorks :: Browsing by Author "Turner, Joseph S."

Browsing by Author "Turner, Joseph S."

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An investigation into emergency medicine resident cricothyrotomy competency: Is three the magic number?
(Wiley, 2023-11-22) Turner, Joseph S.; Stewart, Lauren K.; Hybarger, Andrew C.; Ellender, Timothy J.; Stepsis, Tyler M.; Bartkus, Edward A.; Garverick, Paul, II; Cooper, Dylan D.; Emergency Medicine, School of Medicine
Objectives: Cricothyrotomy is a high-stakes emergency procedure. Because the procedure is rare, simulation is often used to train residents. The Accreditation Council for Graduate Medical Education (ACGME) requires performance of three cricothyrotomies during residency, but the optimal number of training repetitions is unknown. Additional repetitions beyond three could increase proficiency, though it is unknown whether there is a threshold beyond which there is no benefit to additional repetition. The objective of this study was to establish a minimum number of simulated cricothyrotomy attempts beyond which additional attempts did not increase proficiency. Methods: This was a prospective, observational study conducted over 3 years at the simulation center of an academic emergency medicine residency program. Participants were residents participating in a cricothyrotomy training as part of a longitudinal airway curriculum course. The primary outcome was time to successful completion of the procedure as first-year residents. Secondary outcomes included time to completion as second- and third-year residents. Procedure times were plotted as a function of attempt number. Data were analyzed using descriptive statistics, repeated-measures analysis of variance, and correlation analysis. Preprocedure surveys collected further data regarding procedure experience, confidence, and comfort. Results: Sixty-nine first-year residents participated in the study. Steady improvement in time to completion was seen through the first six attempts (from a mean of 75 to 41 sec), after which no further significant improvement was found. Second- and third-year residents initially demonstrated slower performance than first-year residents but rapidly improved to surpass their first-year performance. Resident mean times at five attempts were faster with each year of residency (first-year 48 sec, second-year 30 sec, third-year 24 sec). There was no statistically significant correlation between confidence and time to complete the procedure. Conclusions: Additional repetition beyond the ACGME-endorsed three cricothyrotomy attempts may help increase proficiency. Periodic retraining may be important to maintain skills.
Association of Checklist Use in Endotracheal Intubation With Clinically Important Outcomes: A Systematic Review and Meta-analysis
(American Medical Association, 2020-07-01) Turner, Joseph S.; Bucca, Antonino W.; Propst, Steven L.; Ellender, Timothy J.; Sarmiento, Elisa J.; Menard, Laura M.; Hunter, Benton R.; Emergency Medicine, School of Medicine
Importance: The ε4 allele of the apolipoprotein E (APOE) gene and lower apolipoprotein E (apoE) protein levels in plasma are risk factors for Alzheimer disease, but the underlying biological mechanisms are not fully understood. Half of plasma apoE circulates on high-density lipoproteins (HDLs). Higher apoE levels in plasma HDL were previously found to be associated with lower coronary heart disease risk, but the coexistence of another apolipoprotein, apoC3, modified this lower risk. Objective: To investigate associations between the presence of apoE in different lipoproteins with cognitive function, particularly the risk of dementia. Design, Setting, and Participants: This prospective case-cohort study embedded in the Ginkgo Evaluation of Memory Study (2000-2008) analyzed data from 1351 community-dwelling participants 74 years and older. Of this group, 995 participants were free of dementia at baseline (recruited from September 2000 to June 2002) and 521 participants were diagnosed with incident dementia during follow-up until 2008. Data analysis was performed from January 2018 to December 2019. Exposures: Enzyme-linked immunosorbent assay–measured concentration of apoE in whole plasma, HDL-depleted plasma (non-HDL), HDL, and HDL subspecies that contain or lack apoC3 or apoJ. Main Outcomes and Measures: Adjusted hazard ratios for risk of dementia and Alzheimer disease during follow-up and adjusted differences (β coefficients) in Alzheimer Disease Assessment–Cognitive Subscale (ADAS-cog) and Modified Mini-Mental State Examination scores at baseline. Results: Among 1351 participants, the median (interquartile range) age was 78 (76-81) years; 639 (47.3%) were women. The median (interquartile range) follow-up time was 5.9 (3.7-6.5) years. Higher whole plasma apoE levels and higher apoE levels in HDL were associated with better cognitive function assessed by ADAS-cog (whole plasma, β coefficient, −0.15; 95% CI, −0.24 to −0.06; HDL, β coefficient, −0.20; 95% CI, −0.30 to −0.10) but were unassociated with dementia or Alzheimer disease risk. When separated by apoC3, a higher apoE level in HDL that lacks apoC3 was associated with better cognitive function (ADAS-cog per SD: β coefficient, 0.17; 95% CI, −0.27 to −0.07; Modified Mini-Mental State Examination score per SD: β coefficient, 0.25; 95% CI, 0.07 to 0.42) and lower risk of dementia (hazard ratio per SD, 0.86; 95% CI, 0.76 to 0.99). In contrast, apoE levels in HDL that contains apoC3 were unassociated with any of these outcomes. Conclusions and Relevance: In a prospective cohort of older adults with rigorous follow-up of dementia, the apoE level in HDL that lacked apoC3 was associated with better cognitive function and lower dementia risk. This finding suggests that the cardioprotective associations of this novel lipoprotein extend to dementia.
Bereavement scheduling policy for emergency medicine residents: A descriptive pilot study
(Wiley, 2024-07-10) Kelly, Timothy D.; de Venecia, Bryce T.; Pang, Peter S.; Turner, Joseph S.; Reed, Kyra D.; Pettit, Katie E.; Graduate Medical Education, School of Medicine
Background: The Accreditation Council for Graduate Medical Education has tasked residency programs to prioritize resident wellness, reduce trainee stress, and prevent burnout. Grief and bereavement can significantly impact residents' wellness during difficult clinical training schedules. There are no best practices on how to support residents during this time. Methods: In a split academic county emergency medicine (EM) residency, this pilot study documents a resident-driven change to scheduling practices for bereavement leave. An advisory group of residents, chief residents, and program directors informally polled peer institutions to develop bereavement leave guidelines. Considerations were made to balance resident wellness, education, and patient care in developing a bereavement scheduling policy. Results: The bereavement policy was adopted in January 2023, aiming to "support the resident during a difficult time and reduce concerns around shift coverage" following the death of a family member without impacting sick call. The number of covered days depended on the relationship of the resident to the deceased. Residents covering bereavement days for their peers were financially compensated. During the first 7 months following implementation, five residents utilized the policy. These residents noted this to be the most positive impact on the residency during the past year. Based on resident feedback, the scope was expanded to include grave medical illness of a family member as an implementation criterion. Conclusions: This article outlines the creation, implementation, and benefits of a bereavement scheduling policy within an EM residency. Describing this approach will provide guidance for other residencies to adopt similar wellness-focused strategies.
Cross-over study of novice intubators performing endotracheal intubation in an upright versus supine position
(Springer, 2016) Turner, Joseph S.; Ellender, Timothy J.; Okonkwo, Enola R.; Stepsis, Tyler M.; Stevens, Andrew C.; Eddy, Christopher S.; Sembroski, Erik G.; Perkins, Anthony J.; Cooper, Dylan D.; Department of Emergency Medicine, IU School of Medicine
There are a number of potential physical advantages to performing orotracheal intubation in an upright position. The objective of this study was to measure the success of intubation of a simulated patient in an upright versus supine position by novice intubators after brief training. This was a cross-over design study in which learners (medical students, physician assistant students, and paramedic students) intubated mannequins in both a supine (head of the bed at 0°) and upright (head of bed elevated at 45°) position. The primary outcome of interest was successful intubation of the trachea. Secondary outcomes included log time to intubation, Cormack–Lehane view obtained, Percent of Glottic Opening score, provider assessment of difficulty, and overall provider satisfaction with the position. There were a total of 126 participants: 34 medical students, 84 physician assistant students, and 8 paramedic students. Successful tracheal intubation was achieved in 114 supine attempts (90.5 %) and 123 upright attempts (97.6 %; P = 0.283). Upright positioning was associated with significantly faster log time to intubation, higher likelihood of achieving Grade I Cormack–Lehane view, higher Percent of Glottic Opening score, lower perceived difficulty, and higher provider satisfaction. A subset of 74 participants had no previous intubation training or experience. For these providers, there was a non-significant trend toward improved intubation success with upright positioning vs supine positioning (98.6 % vs. 87.8 %, P = 0.283). For all secondary outcomes in this group, upright positioning significantly outperformed supine positioning.
Dr. Rodgers' Last Lessons: Reflections After the Death of a Mentor
(Wiley, 2018) Mugele, Josh; Pettit, Katie E.; Rusk, Debra S.; Turner, Joseph S.; Humbert, Aloysius J.; Emergency Medicine, School of Medicine
Effect of an Aerosol Box on Intubation in Simulated Emergency Department Airways: A Randomized Crossover Study
(University of California, 2020-11) Turner, Joseph S.; Falvo, Lauren E.; Ahmed, Rami A.; Ellender, Timothy J.; Corson-Knowles, Dan; Bona, Anna M.; Sarmiento, Elisa J.; Cooper, Dylan D.; Emergency Medicine, School of Medicine
Introduction: The use of transparent plastic aerosol boxes as protective barriers during endotracheal intubation has been advocated during the severe acute respiratory syndrome coronavirus 2 pandemic. There is evidence of worldwide distribution of such devices, but some experts have warned of possible negative impacts of their use. The objective of this study was to measure the effect of an aerosol box on intubation performance across a variety of simulated difficult airway scenarios in the emergency department. Methods: This was a randomized, crossover design study. Participants were randomized to intubate one of five airway scenarios with and without an aerosol box in place, with randomization of intubation sequence. The primary outcome was time to intubation. Secondary outcomes included number of intubation attempts, Cormack-Lehane view, percent of glottic opening, and resident physician perception of intubation difficulty. Results: Forty-eight residents performed 96 intubations. Time to intubation was significantly longer with box use than without (mean 17 seconds [range 6-68 seconds] vs mean 10 seconds [range 5-40 seconds], p <0.001). Participants perceived intubation as being significantly more difficult with the aerosol box. There were no significant differences in the number of attempts or quality of view obtained. Conclusion: Use of an aerosol box during difficult endotracheal intubation increases the time to intubation and perceived difficulty across a range of simulated ED patients.
Effect of an Educational Intervention on Medical Student Scripting and Patient Satisfaction: A Randomized Trial
(eScholarship, 2018-05) Pettit, Katie E.; Turner, Joseph S.; Pollard, Katherine A.; Buente, Bryce B.; Humbert, Aloysius J.; Perkins, Anthony J.; Hobgood, Cherri D.; Kline, Jeffrey A.; Emergency Medicine, School of Medicine
Introduction: Effective communication between clinicians and patients has been shown to improve patient outcomes, reduce malpractice liability, and is now being tied to reimbursement. Use of a communication strategy known as "scripting" has been suggested to improve patient satisfaction in multiple hospital settings, but the frequency with which medical students use this strategy and whether this affects patient perception of medical student care is unknown. Our objective was to measure the use of targeted communication skills after an educational intervention as well as to further clarify the relationship between communication element usage and patient satisfaction. Methods: Medical students were block randomized into the control or intervention group. Those in the intervention group received refresher training in scripted communication. Those in the control group received no instruction or other intervention related to communication. Use of six explicit communication behaviors were recorded by trained study observers: 1) acknowledging the patient by name, 2) introducing themselves as medical students, 3) explaining their role in the patient's care, 4) explaining the care plan, 5) providing an estimated duration of time to be spent in the emergency department (ED), and 6) notifying the patient that another provider would also be seeing them. Patients then completed a survey regarding their satisfaction with the medical student encounter. Results: We observed 474 medical student-patient encounters in the ED (231 in the control group and 243 in the intervention group). We were unable to detect a statistically significant difference in communication element use between the intervention and control groups. One of the communication elements, explaining steps in the care plan, was positively associated with patient perception of the medical student's overall communication skills. Otherwise, there was no statistically significant association between element use and patient satisfaction. Conclusion: We were unable to demonstrate any improvement in student use of communication elements or in patient satisfaction after refresher training in scripted communication. Furthermore, there was little variation in patient satisfaction based on the use of scripted communication elements. Effective communication with patients in the ED is complicated and requires further investigation on how to provide this skill set.
Effect of Socioeconomic Status Bias on Medical Student–Patient Interactions Using an Emergency Medicine Simulation
(Wiley, 2017-04) Pettit, Katie E.; Turner, Joseph S.; Kindrat, Jason K.; Blythe, Gregory J.; Hasty, Greg E.; Perkins, Anthony J.; Ashburn-Nardo, Leslie; Milgrom, Lesley B.; Hobgood, Cherri D.; Cooper, Dylan D.; Emergency Medicine, School of Medicine
Objectives Implicit bias in clinical decision making has been shown to contribute to healthcare disparities and results in negative patient outcomes. Our objective was to develop a high‐fidelity simulation model for assessing the effect of socioeconomic status (SES) on medical student (MS) patient care. Methods Teams of MSs were randomly assigned to participate in a high‐fidelity simulation of acute coronary syndrome. Cases were identical with the exception of patient SES, which alternated between a low‐SES homeless man and a high‐SES executive. Students were blinded to study objectives. Cases were recorded and scored by blinded independent raters using 24 dichotomous items in the following domains: 13 communication, six information gathering, and five clinical care. In addition, quantitative data were obtained on the number of times students performed the following patient actions: acknowledged patient by name, asked about pain, generally conversed, and touching the patient. Fisher's exact test was used to test for differences between dichotomous items. For continuous measures, group differences were tested using a mixed‐effects model with a random effect for case to account for multiple observations per case. Results Fifty‐eight teams participated in an equal number of high‐ and low‐SES cases. MSs asked about pain control more often (p = 0.04) in patients of high SES. MSs touched the low‐SES patient more frequently (p = 0.01). There were no statistically significant differences in clinical care or information gathering measures. Conclusions This study demonstrates more attention to pain control in patients with higher SES as well as a trend toward better communication. Despite the differences in interpersonal behavior, quantifiable differences in clinical care were not seen. These results may be limited by sample size, and larger cohorts will be required to identify the factors that contribute to SES bias.
Feasibility of upright patient positioning and intubation success rates at two academic emergency departments
(Elsevier, 2017-07) Turner, Joseph S.; Ellender, Timothy J.; Okonkwo, Enola R.; Stepsis, Tyler M.; Stevens, Andrew C.; Sembroski, Erik G.; Eddy, Christopher S.; Perkins, Anthony J.; Cooper, Dylan D.; Emergency Medicine, School of Medicine
Objectives Endotracheal intubation is most commonly taught and performed in the supine position. Recent literature suggests that elevating the patient's head to a more upright position may decrease peri-intubation complications. However, there is little data on the feasibility of upright intubation in the emergency department. The goal of this study was to measure the success rate of emergency medicine residents performing intubation in supine and non-supine, including upright positions. Methods This was a prospective observational study. Residents performing intubation recorded the angle of the head of the bed. The number of attempts required for successful intubation was recorded by faculty and espiratory therapists. The primary outcome of first past success was calculated with respect to three groups: 0–10° (supine), 11–44° (inclined), and ≥ 45° (upright); first past success was also analyzed in 5 degree angle increments. Results A total of 231 intubations performed by 58 residents were analyzed. First pass success was 65.8% for the supine group, 77.9% for the inclined group, and 85.6% for the upright group (p = 0.024). For every 5 degree increase in angle, there was increased likelihood of first pass success (AOR = 1.11; 95% CI = 1.01–1.22, p = 0.043). Conclusions In our study emergency medicine residents had a high rate of success intubating in the upright position. While this does not demonstrate causation, it correlates with recent literature challenging the traditional supine approach to intubation and indicates that further investigation into optimal positioning during emergency department intubations is warranted.
Medical student use of communication elements and association with patient satisfaction: a prospective observational pilot study
(BioMed Central, 2016-05-23) Turner, Joseph S.; Pettit, Katie E.; Buente, Bryce B.; Humbert, Aloysius J.; Perkins, Anthony J.; Kline, Jeffrey A.; Department of Emergency Medicine, IU School of Medicine
BACKGROUND: Effective communication with patients impacts clinical outcome and patient satisfaction. We measure the rate at which medical students use six targeted communication elements with patients and association of element use with patient satisfaction. METHODS: Participants included fourth year medical students enrolled in an emergency medicine clerkship. A trained observer measured use of six communication elements: acknowledging the patient by name, introducing themselves by name, identifying their role, explaining the care plan, explaining that multiple providers would see the patient, and providing an estimated duration of time in the emergency department. The observer then conducted a survey of patient satisfaction with the medical student encounter. RESULTS: A total of 246 encounters were documented among forty medical student participants. For the six communication elements evaluated, in 61% of encounters medical students acknowledged the patient, in 91% they introduced themselves, in 58 % they identified their role as a student, in 64% they explained the care plan, in 80% they explained that another provider would see the patient, and in only 6% they provided an estimated duration of care. Only 1 encounter (0.4%) contained all six elements. Patients' likelihood to refer a loved one to that ED was increased when students acknowledged the patient and described that other providers would be involved in patient care (P = 0.016 and 0.015 respectively, Chi Square). Likewise, patients' likelihood to return to the ED was increased when students described their role in patient care (P = 0.035, Chi Square). CONCLUSIONS: This pilot study demonstrates that medical students infrequently use all targeted communication elements. When they did use certain elements, patient satisfaction increased. These data imply potential benefit to additional training for students in patient communication.

Browsing by Author "Turner, Joseph S."

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