The role of mesenchymal stem/stromal cells in the acute clinical setting.

INTRODUCTION: Accumulating evidence supports the use of mesenchymal stem/stromal cells (MSCs), particularly bone marrow derived, as a safe and promising biologic therapy for promoting tissue repair and regeneration in various chronic diseases and disorders. Despite growing evidence that MSCs are potent anti-inflammatory mediators that can provide substantial benefits in acute organ injury, there are limited clinical trials utilizing MSCs in acute care settings, such as in the emergency department (ED) or intensive care unit (ICU). OBJECTIVE: This article reviews the current state of MSC-based therapeutics and further explores the untapped potential role to treat various acute, life-threating injuries in the ED and ICU. DISCUSSION: All clinical trials using MSCs in acute myocardial infarction (AMI), acute respiratory distress syndrome (ARDS), sepsis and acute kidney injury (AKI) demonstrated safety. While some also demonstrate clinical efficacy, efficacy data is inconsistent, with some studies limited by sample size, cell integrity and different dosages, necessitating further studies. CONCLUSION: MSCs are potentially promising novel biologic therapeutics for clinical application in AMI, ARDS, sepsis, AKI and COVID-19 that have demonstrated safety in all clinical trials. More rigorous clinical trials are necessary and warranted to determine the efficacy of MSCs as a novel therapeutic in an acute setting, such as the ED.

Barriers to point-of-care ultrasound utilization during cardiac arrest in the emergency department: a regional survey of emergency physicians.

INTRODUCTION: Though point-of-care ultrasound (POCUS) is recognized as a useful diagnostic and prognostic intervention during cardiac arrest (CA), critics advise caution. The purpose of this survey study was to determine the barriers to POCUS during CA in the Emergency Department (ED). METHODS: Two survey instruments were distributed to emergency medicine (EM) attending and resident physicians at three academic centers in the South Florida. The surveys assessed demographics, experience, proficiency, attitudes and barriers. Descriptive and inferential statistics along with Item Response Theory Logistic Model and the Friedman Test with Wilcoxon Signed Rank tests were used to profile responses and rank barriers. RESULTS: 206 EM physicians were invited to participate in the survey, and 187 (91%) responded. 59% of attending physicians and 47% of resident physicians reported that POCUS is performed in all their cases of CA. 5% of attending physicians and 0% of resident physicians reported never performing POCUS during CA. The top-ranked departmental barrier for attending physicians was "No structured curriculum to educate physicians on POCUS." The top-ranked personal barriers were "I do not feel comfortable with my POCUS skills" and "I do not have sufficient time to dedicate to learning POCUS." The top-ranked barriers for resident physicians were "Time to retrieve and operate the machine" and "Chaotic milieu." CONCLUSIONS: While our study demonstrates that most attending and resident physicians utilize POCUS in CA, barriers to high-quality implementation exist. Top attending physician barriers relate to POCUS education, while the top resident physician barriers relate to logistics and the machines. Interventions to overcome these barriers might lead to optimization of POCUS performance during CA in the ED.

SVI Self-Study Guide: A Study Tool for Independent Preparation for the AAMC Standardized Video Interview.

Introduction: Since 2017, students applying to emergency medicine residencies must take the AAMC Standardized Video Interview (SVI) to assess their knowledge of professional behaviors and interpersonal and communication skills. Due to the SVI's novelty, there are not many study tools available to prepare for it, outside of the resources provided by the AAMC. Methods: The SVI Self-Study Guide is a PowerPoint document that learners can use to prepare for the SVI independently. It is intended for fourth-year medical students who are applying to emergency medicine residencies and therefore planning to take the SVI. The guide was distributed via email and assessed with a pre- and postquiz measuring subjective feelings of preparedness as well as testing knowledge of professionalism and interpersonal and communication skills. Results: Eleven students were invited to use the SVI Self-Study Guide, of whom 10 and eight took the pre- and postquiz, respectively. There was a statistically significant increase in learners' self-rated feelings of preparedness to take the SVI (p < .05). Although there was no significant change in the average score on four knowledge-based questions (p = .29), the average score increased from 72.50% to 93.25%. Discussion: Overall, there was a higher improvement in feelings of preparedness to take the SVI than in performance on knowledge-based questions. This suggests that learners benefited the most from practicing using the SVI testing format. The SVI Self-Study Guide can be distributed via email to supplement existing resources in preparing for the SVI.

Emergency Medicine Standardized Letter of Evaluation (SLOE): Findings From the New Electronic SLOE Format.

BACKGROUND: Emergency medicine (EM) uses a standardized template for residency application letters of recommendations. In 1997, the Standardized Letter of Recommendation was developed with categories for applicant comparison. Now named the Standardized Letter of Evaluation (SLOE), it is a universal requirement in the EM residency application process. In 2016, a website called "eSLOE" was launched for credentialed academic EM faculty to enter applicant data, which generates a SLOE. OBJECTIVE: This article outlines website creation for the eSLOE and its successful national implementation in the 2016-2017 EM residency application cycle. We analyzed current trends in applicant assessments from the eSLOE data and compared them to prior data. METHODS: Data from 2016-2017 were sorted and analyzed for each question on the eSLOE. An analysis of Global Assessment and Qualifications for EM rankings, clerkship grade, and comparison with prior SLOE data was performed. RESULTS: Analysis of 6715 eSLOEs for 3138 unique applicants revealed the following Global Assessment rankings: top 10%, top one-third, middle one-third, and lower one-third. There was less spread with the distribution for clerkship grade and Qualifications for EM. The 2011-2012 standard letter of recommendation global assessment data, with top 10%, top one-third, middle one-third, and lower one-third, also revealed top-clustered results with less spread compared with the ranking usage in 2016-2017. CONCLUSIONS: Results indicate an improved spread of all rank categories for Global Assessment, enhancing the eSLOE's applicant discrimination. There has been an overall improvement in rank designation when compared with previously published data.