Free Open Access Medical Education (FOAM) in Emergency Medicine: The Global Distribution of Users in 2016.

INTRODUCTION: Free open-access medical education (FOAM) is a collection of interactive online medical education resources-free and accessible to students, physicians and other learners. This novel approach to medical education has the potential to reach learners across the globe; however, the extent of its global uptake is unknown. METHODS: This descriptive report evaluates the 2016 web analytics data from a convenience sample of FOAM blogs and websites with a focus on emergency medicine (EM) and critical care. The number of times a site was accessed, or "sessions", was categorized by country of access, cross-referenced with World Bank data for population and income level, and then analyzed using simple descriptive statistics and geographic mapping. RESULTS: We analyzed 12 FOAM blogs published from six countries, with a total reported volume of approximately 18.7 million sessions worldwide in 2016. High-income countries accounted for 73.7% of population-weighted FOAM blog and website sessions in 2016, while upper-middle income countries, lower-middle income countries and low-income countries accounted for 17.5%, 8.5% and 0.3%, respectively. CONCLUSION: FOAM, while largely used in high-income countries, is used in low- and middle-income countries as well. The potential to provide free, online training resources for EM in places where formal training is limited is significant and thus is prime for further investigation.

Acute hematogenous osteomyelitis of the rib identified on bedside ultrasound.

BACKGROUND: Osteomyelitis is a challenging and commonly considered diagnosis in the emergency department. Early recognition and treatment with appropriate antibiotic therapy is crucial to prevent complications. OBJECTIVE: This case reviews relevant literature and typical ultrasound features of osteomyelitis. It highlights a previously undescribed and practical application of emergency department bedside ultrasonography, adding to the diagnostic armamentarium for this disease process. CASE REPORT: A 48-year-old woman presented with fever and left chest wall pain. She had been seen previously for a right axillary abscess requiring incision and drainage. Examination revealed a focal area of chest tenderness without cutaneous changes. Chest x-ray study and laboratory evaluation were nondiagnostic. Bedside ultrasound diagnosed acute hematogenous osteomyelitis of a rib. CONCLUSIONS: Bedside ultrasound holds great promise in investigating osteomyelitis when suspicion is high and traditional initial testing is nondiagnostic. Further study is required to quantify this benefit in the emergency department setting and explore utility of negative results.