IU Indianapolis ScholarWorks :: Browsing by Subject "Emergency medicine"

Browsing by Subject "Emergency medicine"

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Advanced closed-loop communication training: the blindfolded resuscitation
(BMJ, 2019-12-20) Hughes, Kate E.; Hughes, Patrick G.; Cahir, Thomas; Plitt, Jennifer; Ng, Vivienne; Bedrick, Edward; Ahmed, Rami A.; Emergency Medicine, School of Medicine
Closed-loop communication (CLC) improves task efficiency and decreases medical errors; however, limited literature on strategies to improve real-time use exist. The primary objective was whether blindfolding a resuscitation leader was effective to improve crisis resource management (CRM) skills, as measured by increased frequency of CLC. Secondary objectives included whether blindfolding affected overall CRM performance or perceived task load. Participants included emergency medicine (EM) or EM/paediatric dual resident physicians. Participants completed presurveys, were block randomised into intervention (blindfolded) or control groups, lead both adult and paediatric resuscitations and completed postsurveys before debriefing. Video recordings of the simulations were reviewed by simulation fellowship-trained EM physicians and rated using the Ottawa CRM Global Rating Scale (GRS). Frequency of CLC was assessed by one rater via video review. Summary statistics were performed. Intraclass correlation coefficient was calculated. Data were analysed using R program for analysis of variance and regression analysis. There were no significant differences between intervention and control groups in any Ottawa CRM GRS category. Postgraduate year (PGY) significantly impacts all Ottawa GRS categories. Frequency of CLC use significantly increased in the blindfolded group (31.7, 95% CI 29.34 to 34.1) vs the non-blindfolded group (24.6, 95% CI 21.5 to 27.7). Participant's self-rated perceived NASA Task Load Index scores demonstrated no difference between intervention and control groups via a Wilcoxon rank sum test. Blindfolding the resuscitation leader significantly increases frequency of CLC. The blindfold code training exercise is an advanced technique that may increase the use of CLC.
Assessing the Risk of Interfacility Transport in Pregnant Patients Due to Progression of Labor: Lessons From a Specialized Maternal-Fetal Transport Program
(Springer Nature, 2024-09-30) Lardaro, Thomas; Balaji, Adhitya; Yang, David; Kuhn, Diane; Glober, Nancy; Brent, Christine M.; Couturier, Katherine; Breyre, Amelia; Vaizer, Julia; Hunter, Benton R.; Emergency Medicine, School of Medicine
Background: Pregnant laboring patients sometimes require interfacility transfer to a higher level of care. There is a paucity of evidence to inform when it is safe to transfer a laboring patient and when delivery may be too imminent to transfer. Methods: This is a retrospective study of pregnant patients undergoing interfacility transfer with a specialized obstetric transport team deployed from a large Midwest regional healthcare system. The primary outcome was delivery prior to or within one hour of arrival at the receiving institution due to progression of labor. Data collected included basic demographics, vital signs, gravidity, parity, gestational age, contraction frequency if contractions were present, and cervical dilation. We sought to define the association between these variables and the primary outcome to inform risk assessment for precipitous delivery among patients being considered for interfacility transfer. Results: Of the 370 pregnant patients for whom the specialized transfer team was requested, 11 (3%) met the primary outcome. Those with more advanced cervical dilation and those who did not receive regular prenatal care were more likely to meet the criteria for the primary outcome. For every centimeter of cervical dilation, the odds of meeting the primary outcome increased 2.3-fold (95% CI: 1.5-3.4). Conclusions: We identified risk factors for early delivery among pregnant patients for whom an interfacility transfer was requested and described patients who were high-risk for obstetric interfacility transport due to the progression of labor. Our results can help inform risk assessments for transferring potentially high-risk laboring patients.
Association Between Empathy and Burnout Among Emergency Medicine Physicians
(Elmer Press, 2019-07) Wolfshohl, Jon A.; Bradley, Keegan; Bell, Charles; Bell, Sarah; Hodges, Caleb; Knowles, Heidi; Chaudhari, Bharti R.; Kirby, Ryan; Kline, Jeffrey A.; Wang, Hao; Emergency Medicine, School of Medicine
Background: The association between physician self-reported empathy and burnout has been studied in the past with diverse findings. We aimed to determine the association between empathy and burnout among United States emergency medicine (EM) physicians using a novel combination of tools for validation. Methods: This was a prospective single-center observational study. Data were collected from EM physicians. From December 1, 2018 to January 31, 2019, we used the Jefferson scale of empathy (JSE) to assess physician empathy and the Copenhagen burnout inventory (CBI) to assess burnout. We divided EM physicians into different groups (residents in each year of training, junior/senior attendings). Empathy, burnout scores and their association were analyzed and compared among these groups. Results: A total of 33 attending physicians and 35 EM residents participated in this study. Median self-reported empathy scores were 113 (interquartile range (IQR): 105 - 117) in post-graduate year (PGY)-1, 112 (90 - 115) in PGY-2, 106 (93 - 118) in PGY-3 EM residents, 112 (105 - 116) in junior and 114 (101 - 125) in senior attending physicians. Overall burnout scores were 43 (33 - 50) in PGY-1, 51 (29 - 56) in PGY-2, 43 (42 - 53) in PGY-3 EM residents, 33 (24 - 47) in junior attending and 25 (22 - 53) in senior attending physicians separately. The Spearman correlation (ρ) was -0.11 and β-weight was -0.23 between empathy and patient-related burnout scores. Conclusion: Self-reported empathy declines over the course of EM residency training and improves after graduation. Overall high burnout occurs among EM residents and improves after graduation. Our analysis showed a weak negative correlation between self-reported empathy and patient-related burnout among EM physicians.
Brief Educational Video plus Telecare to Enhance Recovery for Older Emergency Department Patients with Acute Musculoskeletal Pain: an update to the study protocol for a randomized controlled trial
(Springer, 2022-05-12) Hurka-Richardson, Karen; Platts-Mills, Timothy F.; McLean, Samuel A.; Weinberger, Morris; Stearns, Sally C.; Bush, Montika; Quackenbush, Eugenia; Chari, Srihari; Aylward, Aileen; Kroenke, Kurt; Kerns, Robert D.; Weaver , Mark A.; Keefe, Francis J.; Berkoff, David; Meyer, Michelle L.; Medicine, School of Medicine
Background This update describes changes to the Brief Educational Tool to Enhance Recovery (BETTER) trial in response to the COVID-19 pandemic. Methods/design The original protocol was published in Trials. Due to the COVID-19 pandemic, the BETTER trial converted to remote recruitment in April 2020. All recruitment, consent, enrollment, and randomization now occur by phone within 24 h of the acute care visit. Other changes to the original protocol include an expansion of inclusion criteria and addition of new recruitment sites. To increase recruitment numbers, eligibility criteria were expanded to include individuals with chronic pain, non-daily opioid use within 2 weeks of enrollment, presenting musculoskeletal pain (MSP) symptoms for more than 1 week, hospitalization in past 30 days, and not the first time seeking medical treatment for presenting MSP pain. In addition, recruitment sites were expanded to other emergency departments and an orthopedic urgent care clinic. Conclusions Recruiting from an orthopedic urgent care clinic and transitioning to remote operations not only allowed for continued participant enrollment during the pandemic but also resulted in some favorable outcomes, including operational efficiencies, increased enrollment, and broader generalizability.
Brief Educational Video plus Telecare to Enhance Recovery for Older Emergency Department Patients with Acute Musculoskeletal Pain: an update to the study protocol for a randomized controlled trial
(Springer Nature, 2022-05-12) Hurka‑Richardson, Karen; Platts‑Mills, Timothy F.; McLean, Samuel A.; Weinberger, Morris; Stearns, Sally C.; Bush, Montika; Quackenbush, Eugenia; Chari, Srihari; Aylward, Aileen; Kroenke, Kurt; Kerns, Robert D.; Weaver, Mark A.; Keefe, Francis J.; Berkoff, David; Meyer, Michelle L.; Medicine, School of Medicine
Background: This update describes changes to the Brief Educational Tool to Enhance Recovery (BETTER) trial in response to the COVID-19 pandemic. Methods/design: The original protocol was published in Trials. Due to the COVID-19 pandemic, the BETTER trial converted to remote recruitment in April 2020. All recruitment, consent, enrollment, and randomization now occur by phone within 24 h of the acute care visit. Other changes to the original protocol include an expansion of inclusion criteria and addition of new recruitment sites. To increase recruitment numbers, eligibility criteria were expanded to include individuals with chronic pain, non-daily opioid use within 2 weeks of enrollment, presenting musculoskeletal pain (MSP) symptoms for more than 1 week, hospitalization in past 30 days, and not the first time seeking medical treatment for presenting MSP pain. In addition, recruitment sites were expanded to other emergency departments and an orthopedic urgent care clinic. Conclusions: Recruiting from an orthopedic urgent care clinic and transitioning to remote operations not only allowed for continued participant enrollment during the pandemic but also resulted in some favorable outcomes, including operational efficiencies, increased enrollment, and broader generalizability.
A call for collaboration and consensus on training for endotracheal intubation in the medical intensive care unit
(BMC, 2020-10-22) Brown, Wade; Santhosh, Lekshmi; Brady, Anna K.; Denson, Joshua L.; Niroula, Abesh; Pugh, Meredith E.; Self, Wesley H.; Joffe, Aaron M.; O’Neal Maynord, P.; Carlos, W. Graham; Medicine, School of Medicine
Endotracheal intubation (EI) is a potentially lifesaving but high-risk procedure in critically ill patients. While the ACGME mandates that trainees in pulmonary and critical care medicine (PCCM) achieve competence in this procedure, there is wide variation in EI training across the USA. One study suggests that 40% of the US PCCM trainees feel they would not be proficient in EI upon graduation. This article presents a review of the EI training literature; the recommendations of a national group of PCCM, anesthesiology, emergency medicine, and pediatric experts; and a call for further research, collaboration, and consensus guidelines.
Comparing the effectiveness of existing anxiety treatment options among patients evaluated for chest pain and anxiety in the emergency department setting: Study protocol for the PACER pragmatic randomized comparative effectiveness trial
(Elsevier, 2023-01) Connors, Jill Nault; Kroenke, Kurt; Monahan, Patrick; Chernyak, Yelena; Pettit, Kate; Hayden, Julie; Montgomery, Chet; Brenner, George; Millard, Michael; Holmes, Emily; Musey, Paul; Psychiatry, School of Medicine
ackground Anxiety disorders are a common underlying cause of symptoms among low-risk chest pain patients evaluated in the emergency department setting. However, anxiety is often undiagnosed and undertreated in any setting, and causes considerable functional impairment to work, family, and social life. Objectives The Patient-Centered Treatment of Anxiety after Low-Risk Chest Pain in the Emergency Room (PACER) study is a pragmatic randomized trial to test the comparative effectiveness of existing anxiety treatments of graduated intensities and determine what options work best for patient subgroups based on anxiety severity and other comorbidities. Methods The PACER trial will enroll 375 emergency department patients with low-risk chest pain and anxiety (GAD-7 score ≥ 8) and randomize them to either: 1) referral to primary care with enhanced care coordination, 2) online self-administered cognitive behavioral therapy with guided peer support, or 3) therapist-administered cognitive behavior therapy. Outcomes include anxiety symptoms (primary) as well as physical symptom burden, depression symptoms, functional impairment, ED recidivism, and occurrence of major adverse cardiac events. Statistical analyses will be conducted primarily using linear mixed models to perform a repeated measures analysis of patient-reported outcomes, assessed at 3, 6, 9, and 12-month follow-ups. Discussion PACER is an innovative and pragmatic clinical trial that will compare the effectiveness of several evidence-based telecare-delivered treatments for anxiety. Results have the potential to inform clinical guidelines for evaluation and management of low-risk chest pain patients and promote adoption of findings in ED departments across the country.
Correction to: Opening Doors to Training Medical Toxicology Fellows from All Residency Backgrounds
(Springer, 2022) Kao, Louise; Burns, Michele; Murphy, Christine; Schwarz, Evan; ACMT Fellowship Directors Committee; Medicine, School of Medicine
This corrects the article "Opening Doors to Training Medical Toxicology Fellows from All Residency Backgrounds" in volume 18 on page 1., 10.1007/s13181-021-00870-3
A Critical Disconnect: Residency Selection Factors Lack Correlation With Intern Performance
(Accreditation Council for Graduate Medical Education, 2020) Burkhardt, John C.; Parekh, Kendra P.; Gallahue, Fiona E.; London, Kory S.; Edens, Mary A.; Humbert, A.J.; Pillow, M. Tyson; Santen, Sally A.; Hopson, Laura R.; Emergency Medicine, School of Medicine
Background: Emergency medicine (EM) residency programs want to employ a selection process that will rank best possible applicants for admission into the specialty. Objective: We tested if application data are associated with resident performance using EM milestone assessments. We hypothesized that a weak correlation would exist between some selection factors and milestone outcomes. Methods: Utilizing data from 5 collaborating residency programs, a secondary analysis was performed on residents trained from 2013 to 2018. Factors in the model were gender, underrepresented in medicine status, United States Medical Licensing Examination Step 1 and 2 Clinical Knowledge (CK), Alpha Omega Alpha (AOA), grades (EM, medicine, surgery, pediatrics), advanced degree, Standardized Letter of Evaluation global assessment, rank list position, and controls for year assessed and program. The primary outcomes were milestone level achieved in the core competencies. Multivariate linear regression models were fitted for each of the 23 competencies with comparisons made between each model's results. Results: For the most part, academic performance in medical school (Step 1, 2 CK, grades, AOA) was not associated with residency clinical performance on milestones. Isolated correlations were found between specific milestones (eg, higher surgical grade increased wound care score), but most had no correlation with residency performance. Conclusions: Our study did not find consistent, meaningful correlations between the most common selection factors and milestones at any point in training. This may indicate our current selection process cannot consistently identify the medical students who are most likely to be high performers as residents.
Demographics and Fracture Patterns of Patients Presenting to US Emergency Departments for Intimate Partner Violence
(Wolters Kluwer, 2020-02-18) Loder, Randall T.; Momper, Luke; Orthopaedic Surgery, School of Medicine
Orthopaedic surgeons are in a position to assist in identifying intimate partner violence (IPV) patients. It was the purpose of this study to analyze the demographics and fracture patterns of IPV patients in the United States.

Browsing by Subject "Emergency medicine"

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