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1.
AEM Educ Train ; 4(Suppl 1): S13-S21, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32072104

RESUMO

Emergency medicine (EM) has expanded rapidly since its inception in 1979. Workforce projections from current data demonstrate a rapid rise in the number of accredited EM residency programs and trainee positions. Based on these trends, the specialty may soon reach a point of saturation, particularly in urban areas. This could negatively impact future trainees entering the job market as well as the career plans of medical students. More time and resources should be devoted to obtaining accurate projections, assessing the distribution of emergency physicians in rural versus urban settings, and implementing central workforce planning to protect the future of graduating trainees.

2.
Acad Emerg Med ; 27(3): 247-251, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31797457

RESUMO

The Association of Academic Chairs of Emergency Medicine Chair Development Program (CDP) was started in 2014 to provide emergency medicine (EM) chairs and leaders who aspired to become academic chairs with EM-specific leadership training. Each class participated in a 1-year program, with five sessions taught primarily by EM leaders. Data from the first 5 years of the CDP are provided. A total of 81 participants completed the program (16% women). Twenty participants who were not chairs at entry have become EM chairs. Ratings of the CDP based on a survey of participants with a 94% response rate were very favorable. The CDP has been a popular and successful vehicle to increase leadership skills and prepare EM leaders for academic chair positions.


Assuntos
Medicina de Emergência/educação , Liderança , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Masculino , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários , Estados Unidos
3.
MedEdPORTAL ; 15: 10838, 2019 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-31773064

RESUMO

Introduction: Medical schools are increasingly attempting to prepare future physicians for diverse new leadership roles in the health care system. Many schools have implemented didactic leadership curricula, with varying levels of structure and success. Project-based learning via completion of real-world projects using a team-based approach remains an underutilized approach to developing student leadership skills. Methods: We designed and implemented the Medical Educational Consulting Group (Med ECG)-a student-run consulting program that provides medical students with opportunities to develop leadership skills by completing consulting projects with local clients. We provide an overview of the Med ECG model, including a combination of didactic training sessions and project-based learning via both simulation and real-world projects. Surveys were used to evaluate the value of Med ECG to clients, the community, and students. Results: Fourteen medical students (eight first-years, two second-years, three third-years, and one fourth-year, including five dual-degree candidates) completed the Med ECG program. Client feedback pointed to the value of Med ECG's projects and their impact on the community through partner organizations. Finally, linear regression analysis showed a strong positive correlation (R 2 = .61) between the amount of effort devoted to various leadership attributes and the perceived improvement while working with Med ECG. Discussion: Med ECG's experiences show that a medical student-led project-based learning program is a novel way to develop leadership skills for future physician leaders. Efforts to replicate these types of programs will help additional students develop their leadership and business skills, making a positive impact outside of the classroom.


Assuntos
Comércio/tendências , Atenção à Saúde/organização & administração , Educação Médica/métodos , Estudantes de Medicina/estatística & dados numéricos , Comércio/estatística & dados numéricos , Consultores/estatística & dados numéricos , Currículo/tendências , Atenção à Saúde/economia , Eficiência Organizacional/estatística & dados numéricos , Humanos , Liderança , Modelos Lineares , Percepção/fisiologia , Determinantes Sociais da Saúde/estatística & dados numéricos , Habilidades Sociais , Estudantes de Medicina/psicologia
4.
Acad Emerg Med ; 26(3): 347-349, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29858543
5.
Acad Emerg Med ; 2018 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-29858525

RESUMO

Life sometimes creates interesting confluences, and these should not be ignored. I was the Chair who sat on the other side of the desk during the job interview of the author of this remarkable essay. I hired her, and her husband. I was pleased to bring them both on board as promising new faculty members. This article is protected by copyright. All rights reserved.

6.
AEM Educ Train ; 2(Suppl Suppl 1): S68-S78, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30607381

RESUMO

There is a paucity of literature providing guidance to physicians hoping to attain a position as a medical school dean. Realizing this gap, the Society for Academic Emergency Medicine (SAEM) Faculty Development Committee organized an educational session focused on offering faculty guidance for obtaining a position in medical school leadership. The session involved panelists who are nationally known leaders in medical school administration and was successfully presented at the SAEM 2018 annual meeting in Indianapolis, Indiana. Knowledge and perspective gained both during this session and through literature review was analyzed using a conceptual thinking skills framework. This process offered insights that promoted the development of a conceptual model informed by current evidence and expert insight and rooted in educational, economic, and cognitive theory. This model provides a step-by-step guide detailing a process that physicians can use to create a plan for professional development that is informed, thoughtful, and individualized to their own needs to optimize their future chances of advancing to a career in medical school leadership.

7.
J Eval Clin Pract ; 24(3): 629-634, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29280244

RESUMO

INTRODUCTION: The specialty of emergency medicine is experiencing the convergence of a number of transformational forces in the United States, including health care reform, technological advancements, and societal shifts. These bring both opportunity and uncertainty. 21ST CENTURY CHALLENGES: Persistent challenges such as the opioid epidemic, rising health care costs, misaligned incentives, patients with multiple chronic diseases, and emergency department crowding continue to plague the acute, unscheduled care system. REDUCTIONISM AND COMPLEX SYSTEMS THINKING: The traditional approach to health care practice and improvement-reductionism-is not adequate for the complexity of the twenty-first century. Reductionist thinking will likely continue to produce unintended consequences and suboptimal outcomes. Complex systems thinking provides a perspective and set of tools better suited for the challenges and opportunities facing public health in general, and emergency medicine more specifically. IMPLICATIONS FOR EMERGENCY MEDICINE: This article introduces complex systems thinking and argues for its application in the context of emergency medicine by drawing on the history of the circumstances surrounding the formation of the specialty and by providing examples of its application to several practice challenges.


Assuntos
Medicina de Emergência/organização & administração , Análise de Sistemas , Inovação Organizacional , Incerteza , Estados Unidos
8.
Acad Emerg Med ; 25(3): 366-367, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29265548
9.
Acad Emerg Med ; 24(10): 1193-1203, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28756645

RESUMO

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. There is no standard assessment of ED AI patients. OBJECTIVE: The objective was to evaluate a novel standardized ED assessment of alcohol impairment, Hack's Impairment Index (HII score), in a busy urban ED. METHODS: A retrospective chart review was performed for all AI patients seen in our busy urban ED over 24 months. Trained nurses evaluated AI patients with both "usual" and HII score every 2 hours. Patients were stratified by frequency of visits for AI during this time: high (≥ 6), medium (2-5), and low (1). Within each category, comparisons were made between HII scores, measured ethanol levels, and usual nursing assessment of AI. Changes in HII scores over time were also evaluated. RESULTS: A total of 8,074 visits from 3,219 unique patients were eligible for study, including 7,973 (98.7%) with ethanol levels, 5,061 (62.7%) with complete HII scores, and 3,646 (45.2%) with health care provider assessments. Correlations between HII scores and ethanol levels were poor (Pearson's R2  = 0.09, 0.09, and 0.17 for high-, medium-, and low-frequency strata). HII scores were excellent at discriminating nursing assessment of AI, while ethanol levels were less effective. Omitting extrema, HII scores fell consistently an average 0.062 points per hour, throughout patients' visits. CONCLUSIONS: The HII score applied a quantitative, objective assessment of alcohol impairment. HII scores were superior to ethanol levels as an objective clinical measure of impairment. The HII declines in a reasonably predictable manner over time, with serial evaluations corresponding well with health care provider evaluations.


Assuntos
Intoxicação Alcoólica/diagnóstico , Serviço Hospitalar de Emergência , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação em Enfermagem/métodos , Valor Preditivo dos Testes , Estudos Retrospectivos
10.
J Neurotrauma ; 33(1): 49-57, 2016 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-25794137

RESUMO

No routine tests currently exist to objectively diagnose mild traumatic brain injury (mTBI)/concussion. Previously reported biomarkers for mTBI represented proteins released from damaged neurons or glia. However, low levels of these proteins, and/or the complexity of assays used for their detection, limits implementation of these biomarkers in routine practice. Here, we sought to identify proteins whose synthesis is altered post-mTBI and whose blood levels could be measured using standard immunoassays. Adult patients sustaining a concussion within the past 24 h were enrolled. Controls were uninjured subjects and patients with orthopedic injury (OI). Four candidate biomarkers were identified: copeptin; galectin 3 (LGALS3); matrix metalloproteinase 9 (MMP9); and occludin (OCLN). A 3.4-fold decrease (p<0.0001) in plasma concentration of copeptin was found in mTBI patients within 8 h after accident, compared to uninjured controls. Plasma levels of LGALS3, MMP9, and OCLN increased 3.6- to 4.5-fold (p<0.0001) within the same time frame postinjury. Levels of at least two biomarkers were altered beyond their respective cut-off values in 90% of mTBI patients, whereas in none of uninjured controls were levels of two biomarkers simultaneously changed. A positive correlation (r=0.681; p<0.001) between plasma levels of LGALS3 and OCLN was also found in mTBI patients, whereas in OI patients or uninjured subjects, these variables did not correlate. This panel of biomarkers discerns, with high accuracy, patients with isolated concussion from uninjured individuals within the first 8 h after accident. These biomarkers can also aid in diagnosing concussion in the presence of OI.


Assuntos
Biomarcadores/sangue , Concussão Encefálica/sangue , Galectina 3/sangue , Glicopeptídeos/sangue , Metaloproteinase 9 da Matriz/sangue , Ocludina/sangue , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
Am J Drug Alcohol Abuse ; 40(2): 111-7, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24555813

RESUMO

BACKGROUND: Emergency Departments (EDs) care for thousands of alcohol-intoxicated patients annually. No clinically relevant bedside measures currently exist to describe degree of impairment. OBJECTIVES: To assess a group of bedside tests ("Hack's Impairment Index [HII] score") that applies a numerical value to the degree of alcohol-induced impairment in ED patients. METHODS: A six-month retrospective review of HII score data was performed in a convenience sample of 293 intoxicated ED patients. Patients were scored 0-4 on five tasks, divided by the maximum score (20 if all tasks completed), every 2 hours; and classified by the number of visits: Low-frequency (1 visit); Medium-frequency (2 visits); High-frequency (≥3 visits). Correlations were assessed between HII score, healthcare provider judgment of intoxication, and measured alcohol levels. RESULTS: Study patients had 513 visits; 236 were low-frequency, 26 middle-frequency and 31 high-frequency. Clinical assessment and HII score were strongly correlated (Spearman's rho = 0.82, p << 0.001); clinical assessment and alcohol level less strongly so (rho = 0.49, p << 0.001). Among low-frequency patients, HII score and alcohol level were weakly correlated (r = 0.324, p < 0.001), with no such correlation among high-frequency visitors (r = -0.04, p = 0.89). The mean decline between serial HII scores was 0.126 (95% CI: 0.098-0.154). CONCLUSION: This pilot study shows the HII score can be performed at the bedside of alcohol-intoxicated patients. The HII declines in a reasonably predictable manner over time; and applies a quantitative, objective assessment of alcohol impairment.


Assuntos
Intoxicação Alcoólica/diagnóstico , Adulto , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Ann Emerg Med ; 62(5): 498-505.e3, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23623558

RESUMO

This article evaluates current evidence on the cost of emergency care. First, we reviewed data from national data sets and found that aggregate spending on emergency care is 5% to 6% of national health expenditures but could be as high as 10%. These figures are significantly higher than those previously published. Second, we reviewed the literature on economic models of the cost of emergency care and found that the results are inconclusive and incomplete. As an alternative, we discussed activity-based cost accounting and concluded that it is a promising research methodology for emergency medicine. We conclude by advocating for a strategy to demonstrate the value and strategic importance of emergency medicine rather than minimizing its role in national health care costs.


Assuntos
Serviços Médicos de Emergência/economia , Serviço Hospitalar de Emergência/economia , Custos de Cuidados de Saúde , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Humanos , Escalas de Valor Relativo , Estados Unidos , United States Agency for Healthcare Research and Quality
17.
Am J Emerg Med ; 30(7): 1224-8, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22056060

RESUMO

OBJECTIVE: Alcohol-intoxicated individuals account for a significant proportion of emergency department care and may be eligible for care at alternative sobering facilities. This pilot study sought to examine intermediate-level emergency medical technician (EMT) ability to identify intoxicated individuals who may be eligible for diversion to an alternative sobering facility. METHODS: Intermediate-level EMTs in an urban fire department completed patient assessment surveys for individual intoxicated patients between May and August 2010. Corresponding patient medical records were retrospectively reviewed for diagnosis, disposition, and blood alcohol content. Statistical analysis was conducted to determine correlates of survey response, diagnosis, and disposition; and survey sensitivity and specificity were calculated. RESULTS: One hundred ninety-seven patient transports and medical records were analyzed. Emergency medical technicians indicated 139 patients (71%) needed hospital-based care, and 155 patients (79%) had a primary ethanol diagnosis. Fourteen patients (7%) were admitted to the hospital, and EMTs identified 93% of admitted patients as requiring hospital-based care. Overall sensitivity and specificity of the survey were 93% (95% confidence interval, 66.1-99.8) and 40% (95% confidence interval, 33.3-47.9), respectively. CONCLUSION: Intermediate-level EMTs may be able to play an important role in facilitating triage of intoxicated patients to alternate sobering facilities.


Assuntos
Intoxicação Alcoólica/terapia , Auxiliares de Emergência , Serviço Hospitalar de Emergência , Intoxicação Alcoólica/diagnóstico , Coleta de Dados , Humanos , Projetos Piloto , Estudos Prospectivos , Triagem
18.
J Cereb Blood Flow Metab ; 32(1): 93-104, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21829211

RESUMO

The invasion of inflammatory cells occurring after ischemic or traumatic brain injury (TBI) has a detrimental effect on neuronal survival and functional recovery after injury. We have recently demonstrated that not only the blood-brain barrier, but also the blood-cerebrospinal fluid (CSF) barrier (BCSFB), has a role in posttraumatic recruitment of neutrophils. Here, we show that TBI results in a rapid increase in synthesis and release into the CSF of a major chemoattractant for monocytes, CCL2, by the choroid plexus epithelium, a site of the BCSFB. Using an in vitro model of the BCSFB, we also show that CCL2 is released across the apical and basolateral membranes of the choroidal epithelium, a pattern of chemokine secretion that promotes leukocyte migration across epithelial barriers. Immunohistochemical and electron microscopic analyses of choroidal tissue provide evidence for the movement of monocytes, sometimes in tandem with neutrophils, along the paracellular pathways between adjacent epithelial cells. These data further support the pathophysiological role of BCSFB in promoting the recruitment of inflammatory cells to the injured brain.


Assuntos
Barreira Hematoencefálica/imunologia , Lesões Encefálicas/imunologia , Líquido Cefalorraquidiano/imunologia , Plexo Corióideo/imunologia , Monócitos/citologia , Animais , Membrana Basal/imunologia , Membrana Basal/ultraestrutura , Barreira Hematoencefálica/ultraestrutura , Western Blotting , Lesões Encefálicas/sangue , Lesões Encefálicas/líquido cefalorraquidiano , Células Cultivadas , Líquido Cefalorraquidiano/citologia , Quimiocina CCL2/imunologia , Quimiocina CCL2/metabolismo , Quimiotaxia de Leucócito/imunologia , Plexo Corióideo/irrigação sanguínea , Plexo Corióideo/ultraestrutura , Modelos Animais de Doenças , Ensaio de Imunoadsorção Enzimática , Células Epiteliais/imunologia , Junções Intercelulares/imunologia , Junções Intercelulares/ultraestrutura , Masculino , Microscopia Eletrônica de Transmissão , Monócitos/imunologia , Monócitos/ultraestrutura , Infiltração de Neutrófilos/imunologia , Ratos , Ratos Long-Evans , Reação em Cadeia da Polimerase em Tempo Real , Reação em Cadeia da Polimerase Via Transcriptase Reversa
19.
Acad Emerg Med ; 18(3): 301-4, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21352399

RESUMO

In 1979 Peter Rosen, MD, a leading academic figure in the developing field of emergency medicine (EM), wrote an article, "The Biology of Emergency Medicine," in response to criticism from other specialties and medical leaders that there was no unique biology of EM that would qualify it as a legitimate medical specialty. This essay received much attention at the time and served as rallying cry for emergency physicians (EPs) who were trying to find their places in the house of medicine and especially in medical schools and academic teaching hospitals. Thirty years later, the opposition that prompted many of Rosen's strongly worded impressions and observations on the biology of EM, clinical emergency department (ED) practice, education, and research has largely faded. Many of Rosen's predictions on the eventual success of EM have come true. However, core issues that existed then continue to present challenges for academic EM and clinical emergency practice.


Assuntos
Medicina de Emergência/história , Publicações Periódicas como Assunto/história , Pesquisa Biomédica/história , Medicina de Emergência/educação , História do Século XX , História do Século XXI , Humanos , Medicina , Papel do Médico/história , Estados Unidos
20.
J Cereb Blood Flow Metab ; 31(1): 47-51, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20959854

RESUMO

Previous studies have indicated that the primary targets for vasopressin actions on the injured brain are the cerebrovascular endothelium and astrocytes, and that vasopressin amplifies the posttraumatic production of proinflammatory mediators. Here, the controlled cortical impact model of traumatic brain injury in rats was used to identify the sources of vasopressin in the injured brain. Injury increased vasopressin synthesis in the hypothalamus and cerebral cortex adjacent to the posttraumatic lesion. In the cortex, vasopressin was predominantly produced by activated microglia/macrophages, and, to a lesser extent, by the cerebrovascular endothelium. These data further support the pathophysiological role of vasopressin in brain injury.


Assuntos
Química Encefálica/fisiologia , Lesões Encefálicas/metabolismo , Vasopressinas/biossíntese , Animais , Arginina Vasopressina/biossíntese , Lesões Encefálicas/patologia , Córtex Cerebral/lesões , Córtex Cerebral/metabolismo , Córtex Cerebral/patologia , Endotélio Vascular/fisiologia , Hipernatremia/metabolismo , Hipotálamo/lesões , Hipotálamo/metabolismo , Hipotálamo/patologia , Imuno-Histoquímica , Macrófagos/fisiologia , Masculino , Microglia/fisiologia , Microscopia Confocal , RNA Mensageiro/biossíntese , RNA Mensageiro/genética , Ratos , Ratos Long-Evans , Reação em Cadeia da Polimerase Via Transcriptase Reversa
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