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    Randomized Controlled Feasibility Trial of Intranasal Ketamine Compared to Intranasal Fentanyl for Analgesia in Children with Suspected Extremity Fractures.
    Acad Emerg Med 2017 Sep 19. Epub 2017 Sep 19.
    Carolinas Medical Center, Department of Emergency Medicine, Charlotte, North Carolina.
    Objective: We compared the tolerability and efficacy of intranasal sub-dissociative ketamine to intranasal fentanyl for analgesia of children with acute traumatic pain and investigated the feasibility of a larger non-inferiority trial that could investigate the potential opioid sparing effects of intranasal ketamine.

    Methods: This randomized controlled trial compared intranasal ketamine 1 mg/kg to intranasal fentanyl 1.5 μg/kg in children 4-17 years old with acute pain from suspected, isolated extremity fractures presenting to an urban level II pediatric trauma center from December 2015 to November 2016. Read More

    Lessons Learned from the Development and Parameterization of a Computer Simulation Model to Evaluate Task Modification for Healthcare Providers.
    Acad Emerg Med 2017 Sep 19. Epub 2017 Sep 19.
    Department of Emergency Medicine, College of Medicine, University of Cincinnati, Cincinnati Ohio, USA.
    Computer simulation is a highly advantageous method for understanding and improving healthcare operations with a wide variety of possible applications. Most computer-simulation studies in emergency medicine have sought to improve allocation of resources to meet demand, or to assess the impact of hospital and other system policies on emergency department (ED) throughput. These models have enabled essential discoveries that can be used to improve the general structure and functioning of EDs. Read More

    Human factors and simulation in emergency medicine.
    Acad Emerg Med 2017 Sep 19. Epub 2017 Sep 19.
    Department of Psychology, Old Dominion University, Norfolk, VA.
    This consensus group from the 2017 Academic Emergency Medicine Consensus Conference "Catalyzing System Change through Health Care Simulation: Systems, Competency, and Outcomes" held in Orlando, Florida on May 16, 2017 focused on the use of human factors and simulation in the field of emergency medicine. The human factors discipline is often underutilized within emergency medicine but has significant potential in improving the interface between technologies and individuals in the field. The discussion explored the domain of human factors, its benefits in medicine, how simulation can be a catalyst for human factors work in emergency medicine, and how emergency medicine can collaborate with human factors professionals to affect change. Read More

    Implementation and preliminary clinical outcomes of a pharmacist-managed venous thromboembolism clinic for patients treated with rivaroxaban post emergency department discharge.
    Acad Emerg Med 2017 Sep 16. Epub 2017 Sep 16.
    Clinical Services Clinical Pharmacy Specialist - Burn Intensive Care Unit.
    Objective: To describe the implementation, work flow, and differences in outcomes between a pharmacist-managed clinic for the outpatient treatment of venous thromboembolism (VTE) using rivaroxaban versus care by a primary care provider.

    Interventions: Patients in the studied health system that are diagnosed with low-risk VTE in the emergency department are often discharged without hospital admission. These patients are treated with rivaroxban and follow up either in a pharmacist-managed VTE clinic or with their primary care provider. Read More

    Inter-Observer Agreement in Pediatric Cervical Spine Injury Assessment between Prehospital and Emergency Department Providers.
    Acad Emerg Med 2017 Sep 18. Epub 2017 Sep 18.
    Nationwide Children's Hospital and The Ohio State University College of Medicine.
    Background: Investigators have derived cervical spine injury (CSI) decision support tools from physician observations. There is a need to demonstrate that prehospital emergency medical services (EMS) providers can use these tools to appropriately determine the need for spinal motion restrictions and make field disposition decisions.

    Objective: To determine the inter-observer agreement between EMS and emergency department (ED) providers for CSI risk assessment variables and overall gestalt for CSI in children after blunt trauma. Read More

    Hot off the Press: Embedded Clinical Decision Support in Electronic Health Record Decreases Use of High-cost Imaging in the Emergency Department: EmbED study.
    Acad Emerg Med 2017 Sep 15. Epub 2017 Sep 15.
    Emergency Medicine University of Western, Ontario 27 Bruce Street West n7a 2m5, Goderich Ontario, Canada.
    This longitudinal before/after study of embedded CDRs assessed the effects of clinical decision support on use of common imaging studies. Among high users, rates of CT-brain and CT c-spine were reduced after implementation of embedded clinical decision instruments, while in low users, rates increased. This article summarizes the manuscript and the Skeptics Guide to Emergency Medicine podcast, as well as the ensuing social media/online discussion. Read More

    Improved Survival for Rural Trauma Patients Transported by Helicopter to a Verified Trauma Center: A Propensity Score Analysis.
    Acad Emerg Med 2017 Sep 12. Epub 2017 Sep 12.
    Department of Anesthesiology and the Program in Trauma, R Adams Cowley Shock Trauma Center University of Maryland School of Medicine, T3N08, 22 South Greene St, Baltimore, MD, 21201, USA.
    Objectives: Recent studies using advanced statistical methods to control for confounders have demonstrated an association between helicopter transport (HT) vs. ground ambulance transport (GT) in terms of improved survival for adult trauma patients. The aim of this study was to apply a methodologically vigorous approach to determine if HT is associated with a survival benefit for when trauma patients are transported to a verified trauma center in a rural setting. Read More

    Pre-hospital Supraglottic Airway was Associated with Good Neurological Outcome in Cardiac Arrest Victims Especially Who Received Prolonged Cardiopulmonary Resuscitation.
    Acad Emerg Med 2017 Sep 12. Epub 2017 Sep 12.
    Department of Emergency medicine, Kangwon National University Hospital, 156, Baengnyeong-ro, Chuncheon-si, Gangwon-do, 200-701, Republic of Korea.
    Introduction: We performed this study to investigate the association of pre-hospital supraglottic airway (SGA) on neurological outcome in cardiac arrest victims with adjustment of post-resuscitation variables as well as pre-hospital and resuscitation variables.

    Methods: This study was a retrospective study based on a multicenter prospective cohort registry from December 2013 to April 2016. According to the 28-day cerebral performance categories (CPC) scale, patients were divided into good outcome group (CPC 1-2) and poor outcome group (CPC 3-5). Read More

    Using Virtual Reality Simulation Environments to Assess Competence for Emergency Medicine Learners.
    Acad Emerg Med 2017 Sep 9. Epub 2017 Sep 9.
    OSF Healthcare.
    Immersive learning environments that use virtual simulation technology are increasingly relevant as medical learners train in an environment of restricted clinical training hours and a heightened focus on patient safety. We conducted a consensus process with a breakout group of the 2017 Academic Emergency Medicine Consensus Conference "Catalyzing System Change Through Health Care Simulation: Systems, Competency, and Outcomes." This group examined the current uses of virtual simulation in training and assessment, including limitations and challenges in implementing virtual simulation into medical education curricula. Read More

    A Decision Instrument to Identify Isolated Traumatic Subdural Hematomas at Low Risk of Neurological Deterioration, Surgical Intervention or Radiographic Worsening.
    Acad Emerg Med 2017 Sep 4. Epub 2017 Sep 4.
    Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
    Background And Objectives: Subdural hematoma (SDH) is the most common form of traumatic intracranial hemorrhage. Severity of disease in patients with SDH varies widely. It was hypothesized that a decision rule could identify patients with SDH who are at very low-risk for neurological decline, neurosurgical intervention or radiographic worsening. Read More

    Patients Visiting Multiple Emergency Departments: Patterns, Costs and Risk Factors.
    Acad Emerg Med 2017 Sep 1. Epub 2017 Sep 1.
    Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.
    Objective: We sought to characterize the population of patients seeking care at multiple EDs and to quantify the proportion of all ED visits and costs accounted for by these patients.

    Methods: We performed a retrospective, cohort study of de-identified insurance claims for privately insured patients with ≥ 1 ED visit between 2010 and 2016. We measured the number of EDs visited by each patient and determined the overall proportion of all ED visits and ED costs accounted for by patients who visit multiple EDs. Read More

    Critical Appraisal of Emergency Medicine Educational Research: The Best Publications of 2015.
    Acad Emerg Med 2017 Aug 31. Epub 2017 Aug 31.
    Oregon Health & Science University, Portland, OR.
    Objective: To critically appraise the medical education research literature of 2015, and review the highest quality quantitative and qualitative examples.

    Methods: 434 EM-related articles were discovered upon a search of ERIC, PsychINFO, PubMED and SCOPUS. These were both quantitative and qualitative in nature. Read More

    Rate-control with beta-blockers versus calcium-channel blockers in the emergency setting: predictors of medication class choice and associated hospitalization.
    Acad Emerg Med 2017 Aug 29. Epub 2017 Aug 29.
    Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
    Objectives: Rate-control is an important component of the management of patients with atrial fibrillation (AF). Previous studies of emergency department (ED) rate-control have been limited by relatively small sample sizes. We examined the use of beta-blockers (BB) versus non-dihydropyridine calcium channel blockers (CCB) in ED patients from 24 sites, and the associated hospital admission rates. Read More

    The 2017 Academic Emergency Medicine Consensus Conference: Catalyzing System Change through Healthcare Simulation: Systems, Competency, and Outcomes.
    Acad Emerg Med 2017 Aug 29. Epub 2017 Aug 29.
    Division of Emergency Medicine, University of Washington.
    Over the past decade, emergency medicine took a lead role in healthcare simulation in part due to its demands for successful interprofessional and multidisciplinary collaboration, along with educational needs in a diverse array of cognitive and procedural skills. Simulation-based methodologies have the capacity to support training and research platforms that model micro-, meso- and macro- systems of healthcare. To fully capitalize on the potential of simulation-based research to improve emergency healthcare delivery will require the application of rigorous methods from engineering, social science, and basic science disciplines. Read More

    "What do people do if they don't have insurance?": ED to ED Referrals.
    Acad Emerg Med 2017 Aug 28. Epub 2017 Aug 28.
    Office of Population Health Management, Northwell Health/Hofstra Medical School, Great Neck, NY.
    Objective: Up to 20% of patients seen in public emergency departments (EDs) have already been seen for the same complaint at another ED, but little is known about the origin or impact of these duplicate ED visits. The goals of this investigation were to explore (1) whether patients making a repeat ED visit are self-referred or indirectly referred from the other ED; and (2) gather the perspective of affected patients on the health, social, and financial consequences of these duplicate ED visits.

    Methods: This mixed-methods study conducted over a 10-week period during 2016 in a large public hospital ED in Texas prospectively surveyed patients seen in another ED for the same chief complaint. Read More

    Mannequin-based telesimulation: Increasing access to simulation-based education.
    Acad Emerg Med 2017 Aug 28. Epub 2017 Aug 28.
    MGH Learning Laboratory, Massachusetts General Hospital, Boston, MA.
    The 2017 Academic Emergency Medicine Consensus Conference, "Catalyzing System Change through Health Care Simulation: Systems, Competency, and Outcomes," highlights how simulation can improve the delivery of health care across larger systems; however, how can systems change when valuable educational interventions reach only limited populations? Studies have demonstrated the benefit of simulation education(1,2) but have questioned the use of simulation in a system with limited financial resources.(3) Most academic medical centers have mannequin-based simulation technology;(4) yet, it is unclear from the literature how many community hospitals, especially in rural areas, have a simulation center or mannequins. This article is protected by copyright. Read More

    Patient Navigation for Patients Frequently Visiting the Emergency Department: A Randomized, Controlled Trial.
    Acad Emerg Med 2017 Aug 21. Epub 2017 Aug 21.
    Erlanger Health System, Chattanooga, Tennessee.
    Background: ED super-utilizers (patients with 5 or more visits/year) comprise only 5% of the patients seen yet comprise 25% of total ED visits. Though the reasons for this are multifactorial, the cost to the patient and the community is exceedingly high. The cost is not just monetary; care of these patients is inappropriately fragmented and their presence in the ED may contribute to overcrowding affecting the community's emergency readiness. Read More

    Pediatric Emergency Department Utilization and Reliance by Insurance Coverage in the United States.
    Acad Emerg Med 2017 Aug 18. Epub 2017 Aug 18.
    Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island.
    Objectives: For many children, the Emergency Department (ED) serves as the main destination for health care, whether it be for emergent or non-urgent reasons. Through examination of repeat utilization and ED reliance, in addition to overall ED utilization, we can identify subpopulations dependent on the ED as their primary source of health care.

    Methods: Nationally representative data from the 2010-2014 Medical Expenditure Panel Survey (MEPS) were used to examine the annual ED utilization of children age 0-17 years by insurance coverage. Read More

    Identifying Emergency Department Patients at Low Risk for a Variceal Source of Upper Gastrointestinal Hemorrhage.
    Acad Emerg Med 2017 Aug 22. Epub 2017 Aug 22.
    Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, United States of America.
    Background: Assessing the likelihood of a variceal versus nonvariceal source of upper gastrointestinal bleeding (UGIB) guides therapy, but can be difficult to determine on clinical grounds. The objective of this study was to determine if there are easily ascertainable clinical and laboratory findings that can identify a patient as low risk for a variceal source of hemorrhage.

    Methods: This was a retrospective cohort study of adult ED patients with UGIB between January 2008 and December 2014 who had upper endoscopy performed during hospitalization. Read More

    Prospective Validation of a Clinical Score for Males Presenting with an Acute Scrotum.
    Acad Emerg Med 2017 Aug 20. Epub 2017 Aug 20.
    Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.
    Objective: To validate the Testicular Workup for Ischemia and Suspected Torsion (TWIST) score among pediatric emergency medicine providers for the evaluation of pediatric males presenting with testicular pain and swelling (acute scrotum).

    Methods: We conducted a prospective cohort study of males 3 months to 18 years old presenting with an acute scrotum. History and physical examination findings, including components of the TWIST score (hard testicle, absent cremasteric reflex, nausea/vomiting, and high riding testicle) as well as diagnostic results (ultrasound, urine, sexually transmitted infection (STI) testing) were recorded. Read More

    Simulation for Assessment of Milestones in Emergency Medicine Residents.
    Acad Emerg Med 2017 Aug 20. Epub 2017 Aug 20.
    Emergency Medicine, Kaiser Permanente, Los Angeles Medical Center.
    Introduction: All residency programs in the United States are required to report their residents' progress on the Milestones to the Accreditation Council for Graduate Medical Education (ACGME) biannually. Since the development and institution of this competency-based assessment framework, residency programs have been attempting to ascertain the best ways to assess resident performance on these metrics. Simulation was recommended by the ACGME as one method of assessment for many of the milestone subcompetencies. Read More

    Change in Care Transition Practice for Patients with Non-Specific Chest Pain after ED Evaluation 2006-2012.
    Acad Emerg Med 2017 Aug 18. Epub 2017 Aug 18.
    Vanderbilt University, Department of Emergency Medicine, Nashville, TN, USA.
    Objectives: From 2005-2010 healthcare financing shifts in the United States may have affected care transition practices for emergency department (ED) patients with non-specific chest pain (CP) after ED evaluation. Despite being less acutely ill than those with myocardial infarction, these patients' management can be challenging. The risk of missing acute coronary syndrome is considerable enough to often warrant admission. Read More

    The pediatric submersion score predicts children at low risk for injury following submersions.
    Acad Emerg Med 2017 Aug 18. Epub 2017 Aug 18.
    Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
    Introduction: Pediatric submersion victims often require admission. We wanted to identify a cohort of children at low risk for submersion-related injury who can be safely discharged from the emergency department (ED) after a period of observation.

    Methods: This was a single-center retrospective derivation/validation cross-sectional study of children (0-18 years) who presented post-submersion to a tertiary-care, children's hospital ED from 2008-2015. Read More

    Patient and System Factors Related to Missed Opportunities for Screening in an EMR-driven, Opt-out HIV Screening Program in the Emergency Department.
    Acad Emerg Med 2017 Aug 18. Epub 2017 Aug 18.
    Department of Emergency Medicine, University of Illinois Hospital and Health Science Systems, 808 S. Wood St, CMET 472A, Chicago, IL.
    Objective: Emergency Departments (EDs) have implemented HIV screening using a variety of strategies. This study investigates how specific patient and health system factors in the ED impact who is and is not screened in a combined targeted and non-targeted, EMR-driven, opt-out, HIV screening program.

    Methods: This was a retrospective, cross sectional study of ED visits where patients were determined eligible for HIV screening by an EMR algorithm between 11/18/2014 and 7/15/2015. Read More

    Ketamine or Ketofol: Do we have enough evidence to know which one to use?
    Acad Emerg Med 2017 Aug 12. Epub 2017 Aug 12.
    Department of Emergency Medicine, University of Minnesota, Hennepin County Medical Center, Minneapolis, Mn.
    Ketamine and propofol are both commonly used emergency department (ED) procedural sedation agents. Their concurrent administration, often referred to as "ketofol", is widely used for procedural sedation. A simple google search can lead to a lot of opinions on why we should use propofol, ketamine, or ketofol in a given situation for moderate or deep procedural sedation in the ED, but finding evidence that supports differences these opinions assume is much harder to come by. Read More

    Understanding Emergency Care Delivery through Computer Simulation Modeling.
    Acad Emerg Med 2017 Aug 10. Epub 2017 Aug 10.
    University of Florida, Department of Emergency Medicine.
    In 2017, Academic Emergency Medicine convened a consensus conference entitled, "Catalyzing System Change through Health Care Simulation: Systems, Competency, and Outcomes." This manuscript, a product of the breakout session on "understanding complex interactions through systems modeling," explores the role that computer simulation modeling can and should play in research and development of emergency care delivery systems. This manuscript discusses areas central to the use of computer simulation modeling in emergency care research. Read More

    Emergency Department Provider Perspectives on Benzodiazepine-Opioid Coprescribing: A Qualitative Study.
    Acad Emerg Med 2017 Aug 9. Epub 2017 Aug 9.
    Department of Communication Studies, Northwestern University Feinberg School of Medicine, Chicago, IL.
    Objective: Benzodiazepines and opioids are prescribed simultaneously (i.e., "coprescribed") in many clinical settings, despite guidelines advising against this practice and mounting evidence that concomitant use of both medications increases overdose risk. Read More

    Predicting Short-Term Risk of Arrhythmia among Patients with Syncope: The Canadian Syncope Arrhythmia Risk Score.
    Acad Emerg Med 2017 Aug 9. Epub 2017 Aug 9.
    Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.
    Background: Syncope can be caused by serious occult arrhythmias not evident during initial emergency department (ED) evaluation. We sought to develop a risk-tool for predicting 30-day arrhythmia or death after ED disposition.

    Methods: We conducted a multicenter prospective cohort study at six tertiary-care EDs and included adults (≥16 years) with syncope. Read More

    Maintenance of Oxygenation during Rapid Sequence Intubation in the Emergency Department.
    Acad Emerg Med 2017 Aug 9. Epub 2017 Aug 9.
    Department of Emergency Medicine, University of Arizona College of Medicine.
    Rapid sequence intubation (RSI) is the most common method of airway control in the emergency department (ED).(1,2) Administration of an anesthetic agent and a neuromuscular blocking agent (NMBA) optimizes conditions for tracheal intubation and is thought to minimize the risk of aspiration.(3-10) Evidence suggests that RSI improves first pass success and reduces complications in the critically ill. Read More

    EmergeNcy Department use of Apneic Oxygenation versus usual care during rapid sequence intubation: A randomized controlled trial (The ENDAO Trial).
    Acad Emerg Med 2017 Aug 9. Epub 2017 Aug 9.
    Weill Medical College of Cornell University, Department of Emergency Medicine, Lincoln Medical Center, Bronx, NY.
    Objectives: Desaturation leading to hypoxemia may occur during rapid sequence intubation (RSI). Apneic oxygenation (AO) was developed to prevent the occurrence of oxygen desaturation during the apnea period. The purpose of this study was to determine if the application of AO increases the average lowest oxygen saturation during RSI when compared to usual care (UC) in the emergency setting. Read More

    Pulmonary Embolism Testing Among Emergency Department Patients Who Are Pulmonary Embolism Rule-out Criteria Negative.
    Acad Emerg Med 2017 Aug 8. Epub 2017 Aug 8.
    Division of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT.
    Objective: Previous studies have demonstrated that rates of pulmonary embolism (PE) testing have increased without a concomitant decrease in PE-related mortality. The Pulmonary Embolism Rule-out Criteria (PERC) intend to reduce testing for PE in the emergency department (ED) by identifying low-risk patients ("PERC-negative") who do not require D-dimer, computed tomography pulmonary angiogram (CTPA), or ventilation/perfusion (VQ) scan for PE. This study assesses PE testing rates among PERC-negative patients presenting to an urban academic ED. Read More

    Current Status of Gender and Racial/ Ethnic Disparities Among Academic Emergency Medicine Physicians.
    Acad Emerg Med 2017 Aug 5. Epub 2017 Aug 5.
    Department of Emergency Medicine, Yale University, New Haven, CT.
    Objective: A 2010 survey identified disparities in salaries by gender and underrepresented minorities (URM). With an increase in the EM workforce since, we aimed to 1) Describe the current status of academic EM workforce by gender, race and rank, and 2) Evaluate if disparities still exist in salary or rank by gender.

    Methods: Information on demographics, rank, clinical commitment, and base and total annual salary for full-time faculty members in U. Read More

    The Emergency Department's Impact on Inpatient Critical Care Resources.
    Acad Emerg Med 2017 Aug 3. Epub 2017 Aug 3.
    Department of Emergency Medicine Michigan Medicine, 1500 East Medical Center Drive, SPC 5303,B1-354N Taubman Center, Ann Arbor, MI 48109-5303, Michigan, USA.
    Critical care is an expensive and limited resource in the United States. Estimates from more than a decade ago suggest that over $100 billion a year is spent on critical care services.(1) Over the past two decades, the number of patients presenting to the Emergency Department (ED) requiring critical care services has increased at a much higher rate than the growth in overall ED volume. Read More

    Patient and Surrogate Views of Community Consultation for Emergency Research.
    Acad Emerg Med 2017 Jul 30. Epub 2017 Jul 30.
    Emory University School of Medicine, Division of Cardiology, ECCRI, Emory University Rollins School of Public Health, Dept. of Epidemiology, 1462 Clifton Road #508, Atlanta, GA, 30322.
    Objective: Pre-trial community consultation (CC) is required for emergency research conducted under an exception from informed consent (EFIC) in the United States. CC remains controversial and challenging, and minimal data exist regarding the views of individuals enrolled in EFIC trials on this process. It is important to know whether participants perceive CC to be meaningful and, if so, whom they believe should be consulted. Read More

    The HII Score - A Novel Tool to Assess Impairment from Alcohol in Emergency Department Patients.
    Acad Emerg Med 2017 Jul 30. Epub 2017 Jul 30.
    Department of Emergency Medicine, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI.
    Background: Over 35 million alcohol impaired (AI) patients are cared for in Emergency Departments (EDs) annually. Emergency physicians are charged with ensuring AI patients' safety by identifying resolution of alcohol induced impairment. The most common standard evaluation is an extemporized clinical examination, as ethanol levels are not reliable or predictive of clinical symptoms. Read More

    In Reply: Comparing Direct and Video Laryngoscopy for Prehospital Intubation: Can Meta-Analysis Provide and Exact Solution?
    Acad Emerg Med 2017 Jul 28. Epub 2017 Jul 28.
    University of California, San Francisco School of Medicine.
    We thank the authors for this letter and appreciate the opportunity to respond to the comments and clarify our position. We agree with the authors in a number of their specific comments, and will attempt to address each of them. The first comment refers to the difference in video laryngoscopy devices and how "… pooling of results from studies evaluating performance of different VLs for prehospital intubation may lead to intrinsic inconsistencies in the primary endpoints. Read More

    Comparing Direct and Video Laryngoscopy for Prehospital Intubation: Can Meta-Analysis Provide an Exact Solution?
    Acad Emerg Med 2017 Jul 28. Epub 2017 Jul 28.
    Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
    The recent systemic review and meta-analysis by Savino et al.(1) comparing performance of video versus direct laryngoscopy for prehospital intubation was of great interested to us. They conclude that among physician intubators with significant direct laryngoscopy (DL) experience, video laryngoscopy (VL) does not increase overall or first-pass success rate and may lead to worsening performance. Read More

    Multiple Risk Factor Counseling to Promote Heart-healthy Lifestyles in the Chest Pain Observation Unit: Pilot Randomized Controlled Trial.
    Acad Emerg Med 2017 Aug 29;24(8):968-982. Epub 2017 Jul 29.
    Department of Psychological and Brain Sciences, University of Iowa College of Liberal Arts, Iowa City, IA.
    Objective: Admission to the chest pain observation unit (CPOU) may be an advantageous time for patients to consider heart-healthy lifestyle changes while undergoing diagnostic evaluation to rule out myocardial ischemia. The aim of this pragmatic trial was to assess the effectiveness of a multiple risk factor intervention in changing CPOU patients' health beliefs and readiness to change health behaviors. A secondary aim was to obtain preliminary estimates of the intervention's effect on diet, physical activity, and smoking. Read More

    Depression and anxiety among emergency department patients:Utilization and barriers to care.
    Acad Emerg Med 2017 Jul 25. Epub 2017 Jul 25.
    University of Rochester Medical Center, 265 Crittenden Blvd, Box 655c, Rochester, NY, 14620.
    Background: Anxiety and depression rates among ED patients are substantially higher than in the general population. Additionally, those with mental health issues often have difficulty accessing care. Unfortunately, issues of anxiety and depression are frequently not addressed in the ED due to competing care priorities. Read More

    Changing Systems Through Effective Teams: A Role for Simulation.
    Acad Emerg Med 2017 Jul 20. Epub 2017 Jul 20.
    Department of Psychology, University of Maryland.
    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. Read More

    Speechless.
    Acad Emerg Med 2017 Jul 20. Epub 2017 Jul 20.
    Emergency Medicine, Clinician Educator, Department of Emergency Medicine, Alpert Medical School of Brown University.
    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. Read More

    A simulation-based approach to measuring team situational awareness in emergency medicine: A multicenter, observational study.
    Acad Emerg Med 2017 Jul 17. Epub 2017 Jul 17.
    Division of Emergency Medicine, University of Washington.
    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. Read More

    Bacteremia Prediction Model for Community-Acquired Pneumonia: External Validation in a Multicenter Retrospective Cohort.
    Acad Emerg Med 2017 Jul 16. Epub 2017 Jul 16.
    Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea.
    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). Read More

    Conflicts of Interest in Emergency Medicine.
    Acad Emerg Med 2017 Jul 8. Epub 2017 Jul 8.
    Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA.
    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. Read More

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