Publications by authors named "C M De Marco"

641 Publications

The Emergency Medicine Physician Workforce: Projections for 2030.

Ann Emerg Med 2021 Aug 2. Epub 2021 Aug 2.

George Washington University Fitzhugh Mullan Institute for Health Workforce Equity, Washington, DC.

Study Objective: The goals of this study were to determine the current and projected supply in 2030 of contributors to emergency care, including emergency residency-trained and board-certified physicians, other physicians, nurse practitioners, and physician assistants. In addition, this study was designed to determine the current and projected demand for residency-trained, board-certified emergency physicians.

Methods: To forecast future workforce supply and demand, sources of existing data were used, assumptions based on past and potential future trends were determined, and a sensitivity analysis was conducted to determine how the final forecast would be subject to variance in the baseline inputs and assumptions. Methods included: (1) estimates of the baseline workforce supply of physicians, nurse practitioners, and physician assistants; (2) estimates of future changes in the raw numbers of persons entering and leaving that workforce; (3) estimates of the productivity of the workforce; and (4) estimates of the demand for emergency care services. The methodology assumes supply equals demand in the base year and estimates the change between the base year and 2030; it then compares supply and demand in 2030 under different scenarios.

Results: The task force consensus was that the most likely future scenario is described by: 2% annual graduate medical education growth, 3% annual emergency physician attrition, 20% encounters seen by a nurse practitioner or physician assistant, and 11% increase in emergency department visits relative to 2018. This scenario would result in a surplus of 7,845 emergency physicians in 2030.

Conclusion: The specialty of emergency medicine is facing the likely oversupply of emergency physicians in 2030. The factors leading to this include the increasing supply of and changing demand for emergency physicians. An organized, collective approach to a balanced workforce by the specialty of emergency medicine is imperative.
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http://dx.doi.org/10.1016/j.annemergmed.2021.05.029DOI Listing
August 2021

A Rare Case of Coronary Artery Dilatation and Giant Pseudoaneurysm.

JACC Case Rep 2021 May 5;3(5):786-788. Epub 2021 May 5.

Department of Medicine, Université de Montréal, Montréal, Canada.

Coronary artery fistula are anomalous connections with coronary vessels or cardiac chambers, potentially resulting in coronary dilatation and pseudoaneurysm formation. We present the case of a 68-year-old woman referred to our institution for a voluminous coronary pseudoaneurysm secondary to coronary artery fistula presenting as a nearly completely obstructive left atrial mass. ().
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http://dx.doi.org/10.1016/j.jaccas.2021.03.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8311181PMC
May 2021

Assessing the impact of medically tailored meals and medical nutrition therapy on type 2 diabetes: Protocol for Project MiNT.

Contemp Clin Trials 2021 Sep 24;108:106511. Epub 2021 Jul 24.

Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut Street, Suite 300, Philadelphia, PA 19107, USA; Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut St, Suite 704, Philadelphia, PA 19107, USA.

Background: Research has shown that among people with type 2 diabetes mellitus, reduction in hemoglobin A1c (HbA1c) prevents long term complications. Medically tailored meals (MTM) and telehealth-delivered medical nutrition therapy (tele-MNT) are promising strategies for patient-centered diabetes care.

Objectives: Project MiNT will determine whether provision of MTM with and without the addition of telehealth-delivered medical nutrition therapy improves HbA1c and is cost effective for patients with type 2 diabetes mellitus.

Methods: Patients with poorly controlled type 2 diabetes mellitus (HbA1c >8%) will be recruited from Jefferson Health. Eligible patients will be randomized to one of three arms: 1) usual care, 2) 12 weeks of home-delivered MTM, or 3) MTM + 12 months of tele-MNT. All participants (n = 600) will complete three follow-up assessments at 3, 6, and 12 months. The primary outcome is change in HbA1c at 6 months. Secondary outcomes include change in HbA1c at 3 and 12 months and cost-effectiveness of the intervention at 6 and 12 months. Conclusion Findings from Project MiNT will inform MTM coverage and financing decisions, how to structure services for scalability and system-wide integration, and the role of these services in reducing health disparities.
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http://dx.doi.org/10.1016/j.cct.2021.106511DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8453110PMC
September 2021

A Submillimeter Continuous Variable Stiffness Catheter for Compliance Control.

Adv Sci (Weinh) 2021 Sep 17;8(18):e2101290. Epub 2021 Jul 17.

Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, CH-8092, Switzerland.

Minimally invasive robotic surgery often requires functional tools that can change their compliance to adapt to the environment and surgical needs. This paper proposes a submillimeter continuous variable stiffness catheter equipped with a phase-change alloy that has a high stiffness variation in its different states, allowing for rapid compliance control. Variable stiffness is achieved through a variable phase boundary in the alloy due to a controlled radial temperature gradient. This catheter can be safely navigated in its soft state and rigidified to the required stiffness during operation to apply a desired force at the tip. The maximal contact force that the catheter applies to tissue can be continuously modified by a factor of 400 (≈20 mN-8 N). The catheter is equipped with a magnet and a micro-gripper to perform a fully robotic ophthalmic minimally invasive surgery on an eye phantom by means of an electromagnetic navigation system.
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http://dx.doi.org/10.1002/advs.202101290DOI Listing
September 2021
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