The Current Status of Ultrasound Education in United States Medical Schools.

OBJECTIVES: Ultrasound is used by nearly every medical specialty. Medical schools are integrating ultrasound education into their curriculum but studies show this to be inconsistent. The purpose of this study was to provide an updated description of ultrasound in the curricula of United States Accredited Medical Schools (USAMS). METHODS: In 2019, USAMS curricular offices were contacted. Institutions were asked about the presence of ultrasound curriculum and for contact information for faculty involved with education. Schools reporting ultrasound curriculum were surveyed regarding details of their curriculum. RESULTS: Two hundred USAMS were contacted with a response rate of 84%. Of 168 schools, 72.6% indicated they have an ultrasound curriculum. For schools with a curriculum, 79 (64.8%) completed our survey. The majority of survey respondents, 66 (83.5%), indicated having mandatory ultrasound. Ultrasound is primarily integrated into courses (73.8% in basic science courses, 66.2% in clinical skills courses, and 35.4% in clinical rotations). Emergency medicine physicians accounted for 54.7% of course directors. Ten or fewer faculty participate in education in 68.4% of schools and mostly as volunteers. Dedicated machines for education were reported by 78.5% of schools. CONCLUSIONS: Compared to prior studies, this study had a higher response rate at 84%, and more schools reported ultrasound in their curricula. Emergency medicine represents the majority of leadership in ultrasound education. Despite increased integration of ultrasound into American medical school curricula, its instruction is still inconsistent.

Mass-gathering medical care: retrospective analysis of patient presentations over five years at a multi-day mass gathering.

INTRODUCTION: There is a scarcity of analytical data regarding mass-gathering medical care. The purpose of this study was to identify and evaluate the range and nature of illness and injury for patrons of an annual, multi-day, mass gathering. METHODS: Encounter data from all patients seen by emergency physicians at the New York State Fair Infirmary during the past five years were analyzed. From these data, a category list was consolidated to 36 reasons for the visit based on chief complaint, nursing notes, and physician notes. The most common reasons for being seen by a physician were analyzed to determine age and gender discrepancies. RESULTS: The average number of attendees at the Fair per year from 2004-2008 was 950,973. Emergency physicians evaluated a total of 2,075 patients from 2004-2008. The average patient presentation rate over the past four years (2005-2008) was 4.8 +/-1.1/10,000 patrons. The average transport to hospital rate over the past four years was 2.7 +/-1.1/100,000 patrons. The average age of all patients seen was 34.4 +/-21.6 years, and 58.1% of the patients were female. The most common reasons to seek medical attention included: dehydration/heat-related illness (11.4%); abrasion/laceration (10.6%); and fall-related injury (10.2%). Two groups, dehydration/heat-related illness 74% (t (4) = 2.90, p <0.05), and fall-related injury (68%; t (4) = 5.17, p <0.05) were disproportionately female. There also was a direct relationship between age and female gender within the fall-related injury category (X(2) (1, n = 213) = 11.41, p <0.05). CONCLUSIONS: Patron data from fairs and expositions is a valuable resource for studying mass-gathering medical care. A majority (58%) of patients seen at the infirmary were female. The most common reason for being seen was dehydration/heat-related illness, which heavily favored females, but favored no age groups. The abrasion/laceration category did not contribute to the gender discrepancy. Patients who fell tended to be females >40 years of age. Further analysis is required to determine the reason for the gender discrepancies. Planners of multi-day mass gatherings should develop public education programs and evaluate their impact on the at-risk populations identified by this analysis.

Hyperglycemia in ED patients with no history of diabetes.

INTRODUCTION: The purpose of this study was to determine the prevalence of incidentally discovered hyperglycemia in patients with non-glucose-related complaints and to consider the potential care implications. METHODS: A retrospective chart review identified patients older than 18 years with obtained serum glucose levels. Patients with diabetic ketoacidosis were excluded. Three levels of hyperglycemia (> or = 126, > or = 140, and > or = 200 mg/dL) were considered. RESULTS: Of 2473 adult patients, 290 patients (11.7%) had serum glucose values greater than or equal to 126 mg/dL. There were 154 patients with hyperglycemia and no prior history of diabetes (6.2% of the emergency department [ED] population, 53.1% of those with hyperglycemia). CONCLUSION: More than half of the patients found to be hyperglycemic had no known history of diabetes and were being seen for a non-glucose-related complaint. The reason for this prevalence and its impact on the health of these patients is unclear. Whether ED intervention would be helpful remains unanswered.

Patient perceptions of emergency physicians: the gender gap still exists.

This study examines whether female emergency physicians are less likely than male emergency physicians to be recognized by patients as physicians. A convenience sample of adult patients seen while a trained observer was on duty in an academic Emergency Department constituted the study population. After the first physician contact, the observer asked the patient if a physician had seen the patient yet. The observer recorded the physician's sex, the patient's response, sex, age, and race. The frequencies that male and female physicians were recognized as physicians were compared. For the 184 physician-patient contacts evaluated, 98/105 (93.3%) of males were recognized as physicians and 62/79 (78.5%) of females were recognized as physicians. Females were significantly less likely than males to be recognized as physicians (chi-square, p = 0.003). Female emergency physicians are less likely than male emergency physicians to be recognized by patients as physicians.

Creutzfeldt-Jakob disease: an emergency department presentation of a rare disease.

Creutzfeldt-Jakob Disease (CJD) is one of a group of neurodegenerative disorders causing spongiform encephalopathies. CJD is the most common human transmissible spongiform encephalopathy, or prion disease, but has an annual incidence of only 0.4-1.8 cases per million population worldwide. The prognosis for this disease is very poor and there is currently no cure. Patients typically present with non-specific neurological or psychiatric complaints and often have multiple physician visits before diagnosis, which requires histological examination of brain tissue. This patient had serial presentations to our Emergency Department, with progressive symptoms and multiple laboratory and radiological tests as well as consults, but her diagnosis remained unclear until her disease rapidly progressed and a brain biopsy was performed. With increasing concerns about prion diseases such as bovine spongiform encephalopathy (BSE)-or mad cow disease-and CJD, awareness of the symptoms and diagnostic challenges associated with these diseases will be helpful to emergency physicians.