{"count":38464,"next":"https://eartharxiv.org/api/articles/?format=json&limit=100&offset=22600","previous":"https://eartharxiv.org/api/articles/?format=json&limit=100&offset=22400","results":[{"pk":9115,"title":"Primary Epiploic Appendagitis","subtitle":null,"abstract":"N/A","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Epiploic Appendagitis"},{"word":"computed tomography"}],"section":"Diagnostic Acumen","is_remote":true,"remote_url":"https://escholarship.org/uc/item/74k6b3mg","frozenauthors":[{"first_name":"Po-Jen","middle_name":"","last_name":"Yang","name_suffix":"","institution":"E-Da Hospital, I-Shou University, Department of Emergency Medicine, Kaohsiung, Taiwan","department":"None"},{"first_name":"Yu-Sung","middle_name":"","last_name":"Lee","name_suffix":"","institution":"Chi-Mei Medical Center, Department of Emergency Medicine, Tainan, Taiwan","department":"None"},{"first_name":"Chung-Hsun","middle_name":"","last_name":"Chuang","name_suffix":"","institution":"Chang-Gung Memorial Hospital, Department of Emergency Medicine, Taoyuan, Taiwan","department":"None"}],"date_submitted":"2015-07-04T06:14:53-04:00","date_accepted":"2015-07-04T06:14:53-04:00","date_published":"2015-12-01T13:52:53-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/9115/galley/5113/download/"}]},{"pk":9126,"title":"Direct Versus Video Laryngoscopy for Intubating Adult Patients with Gastrointestinal Bleeding","subtitle":null,"abstract":"Introduction: \nVideo laryngoscopy (VL) has been advocated for several aspects of emergency airway management; however, there are still concerns over its use in select patient populations such as those with large volume hematemesis secondary to gastrointestinal (GI) bleeds. Given the relatively infrequent nature of this disease process, we sought to compare intubation outcomes between VL and traditional direct laryngoscopy (DL) in patients intubated with GI bleeding, using the third iteration of the National Emergency Airway Registry (NEARIII).\nMethods: \nWe performed a retrospective analysis of a prospectively collected national database (NEARIII) of intubations performed in United States emergency departments (EDs) from July 1, 2002, through December 31, 2012. All cases where the indication for intubation was “GI bleed” were analyzed. We included patient, provider and intubation characteristics. We compared data between intubation attempts initiated as DL and VL using parametric and non-parametric tests when appropriate.\nResults: \nWe identified 325 intubations, 295 DL and 30 VL. DL and VL cases were similar in terms of age, sex, weight, difficult airway predictors, operator specialty (emergency medicine, anesthesia or other) and level of operator training (post-graduate year 1, 2, etc). Proportion of successful first attempts (DL 261/295 (88.5%) vs. VL 28/30 (93.3%) p=0.58) and Cormack-Lehane grade views (p=0.89) were similar between devices. The need for device change was similar between DL [2/295 (0.7%) and VL 1/30 (3.3%); p=0.15].\nConclusion: \nIn this national registry of intubations performed in the ED for patients with GI bleeds, both DL and VL had similar rates of success, glottic views and need to change devices.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"video laryngoscopy, intubation, gastrointestinal hemorrhage"}],"section":"Technology in Emergency Medicine","is_remote":true,"remote_url":"https://escholarship.org/uc/item/36k6k24z","frozenauthors":[{"first_name":"Jestin","middle_name":"N.","last_name":"Carlson","name_suffix":"","institution":"Saint Vincent Hospital, Department of Emergency Medicine, Erie, Pennsylvania","department":"None"},{"first_name":"Jason","middle_name":"","last_name":"Crofts","name_suffix":"","institution":"Saint Vincent Hospital, Department of Emergency Medicine, Erie, Pennsylvania","department":"None"},{"first_name":"Ron","middle_name":"M.","last_name":"Walls","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Calvin","middle_name":"A.","last_name":"Brown III","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"}],"date_submitted":"2015-07-09T11:51:57-04:00","date_accepted":"2015-07-09T11:51:57-04:00","date_published":"2015-12-01T13:50:44-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/9126/galley/5117/download/"}]},{"pk":9014,"title":"Computed Tomography Following Body Stuffing Heroin","subtitle":null,"abstract":"N/A","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Body stuffing"},{"word":"Heroin"},{"word":"Illicit substances"},{"word":"Computerized Tomography"}],"section":"Diagnostic Acumen","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3tb4n6s1","frozenauthors":[{"first_name":"Sean Patrick","middle_name":"","last_name":"Nordt","name_suffix":"","institution":"University of Southern California","department":"None"},{"first_name":"Marissa","middle_name":"","last_name":"Camilon","name_suffix":"","institution":"LAC+USC, Department of Emergency Medicine, Los Angeles, California","department":"None"}],"date_submitted":"2015-05-12T14:47:12-04:00","date_accepted":"2015-05-12T14:47:12-04:00","date_published":"2015-12-01T13:49:07-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/9014/galley/5087/download/"}]},{"pk":9331,"title":"Staying in the Room","subtitle":null,"abstract":"N/A","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Humanism","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8jf2p7zb","frozenauthors":[{"first_name":"Jesse","middle_name":"Z.","last_name":"Kellar","name_suffix":"","institution":"Lakeland Health Emergency Medicine Residency, Department of Emergency Medicine, St Joseph, Michigan","department":"None"}],"date_submitted":"2015-09-01T14:52:32-04:00","date_accepted":"2015-09-01T14:52:32-04:00","date_published":"2015-12-01T13:45:53-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/9331/galley/5256/download/"}]},{"pk":21001,"title":"In Memoriam: Edward W. Soja, 1940-2015","subtitle":null,"abstract":"Ed Soja died in the evening of Sunday November 1st, 2015, after an extended illness. His departure represents a huge loss to his many friends and colleagues both here in Los Angeles and all over the world.","language":"en","license":{"name":"none","short_name":"none","text":"","url":"https://escholarship.org/terms"},"keywords":[{"word":"Soja, memoriam"}],"section":"Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1bx1t6q4","frozenauthors":[{"first_name":"Allen","middle_name":"J.","last_name":"Scott","name_suffix":"","institution":"Department of Geography and Department of Policy Studies, UCLA","department":"None"}],"date_submitted":"2016-02-05T14:35:01-05:00","date_accepted":"2016-02-05T14:35:01-05:00","date_published":"2015-12-01T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/criticalplanning/article/21001/galley/10691/download/"}]},{"pk":41629,"title":"Materials collected by the southern branch of the UC Africa Expedition with a report on previously unpublished Plio-Pleistocene fossil localities","subtitle":null,"abstract":"From 1947 to 1948, paleontologists from the University of California Museum of Paleontology (UCMP), Charles Camp and Frank Peabody, led the southern branch of the University of California’s Africa Expedition. While in South Africa, Camp and Peabody collected thousands of specimens excavated from more than 70 sites, 40 of which make up the Plio-Pleistocene South African assemblage at the UCMP. Materials collected by researchers accompanying the expedition are held at numerous repositories on the University of California Berkeley campus including the UCMP, the Museum of Vertebrate Zoology (MVZ), the Phoebe A. Hearst Museum of Anthropology and the University of California’s Botanical Gardens.\nIn 2013, we curated the Plio-Pleistocene paleontological assemblage of the UCMP South Africa collection and cataloged 5,082 specimens from four primary areas: Bolt’s Farm, Buxton Limeworks, Gladysvale and Witkrans. Both invertebrates and vertebrates are found in the South African assemblage, with every vertebrate class represented, including mammals, birds, fish, reptiles, and amphibians. We provide a detailed report of the taxonomic diversity of the assemblage and describe three sites that have not yet been reported in the scientific literature: New Cave and Jackal Cave at Bolt’s Farm, and Tunnel Wall excavation at Buxton Limeworks. We also offer a historical review of the Africa Expedition and report on the current location of materials collected by members of the southern branch of the expedition and brought to the University of California at Berkeley (UCB) for holding.","language":"en","license":null,"keywords":[{"word":"Buxton"},{"word":"Bolt's Farm"},{"word":"Taung"},{"word":"Charles C. Camp"},{"word":"Frank E. Peabody"},{"word":"UCMP"}],"section":"Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8p91285n","frozenauthors":[{"first_name":"Tesla","middle_name":"A","last_name":"Monson","name_suffix":"","institution":"Department of Integrative Biology and University of California Museum of Paleontology, University of California, Berkeley, CA","department":"None"},{"first_name":"Marianne","middle_name":"F","last_name":"Brasil","name_suffix":"","institution":"Department of Integrative Biology, University of California Museum of Paleontology, and Human Evolution Research Center, University of California, Berkeley, CA","department":"None"},{"first_name":"Leslea","middle_name":"J","last_name":"Hlusko","name_suffix":"","institution":"Department of Integrative Biology, University of California Museum of Paleontology, and Human Evolution Research Center, University of California, Berkeley, CA","department":"None"}],"date_submitted":"2015-12-01T17:02:38-05:00","date_accepted":"2015-12-01T17:02:38-05:00","date_published":"2015-12-01T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/ucmp_paleobios/article/41629/galley/31160/download/"}]},{"pk":20989,"title":"Sustainable Orientalism: Hegemonic discourses for environmental sustainability and their transmission to non-Western habitats","subtitle":null,"abstract":"This paper analyses the construction of the hegemonic methods for the evaluation and representation of sustainable development and their translation into non-Western habitats. The concept Sustainable Orientalism pursues to examine the adaptation and translation of contemporary dominant discourses, methods and representations that shape the idea of a sustainable development in cities and regions around the world, and their translation to growing economies of non-Western societies. A correlation of Orientalism and sustainable development determines that the study and knowledge of non-Western environments by advanced assessment frameworks do not merely reproduce the outlying territories: it works them out, or animate them, using narrative techniques, and historical and exploratory attitudes of scientific ideas generated in the West. The paper questions the pursuit of environmental justice in the 21st century based on the distortion and degradation of knowledge that is implied in the exercise of a Sustainable Orientalism.","language":"en","license":{"name":"none","short_name":"none","text":"","url":"https://escholarship.org/terms"},"keywords":[{"word":"Orientalism"},{"word":"environmental justice"},{"word":"Mexico"},{"word":"North-South divide"},{"word":"Edward Said, Edward Soja"},{"word":"sustainability"},{"word":"ecology"}],"section":"Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/7ww6h030","frozenauthors":[{"first_name":"Ernesto","middle_name":"","last_name":"Valero Thomas","name_suffix":"","institution":"The University of Edinburgh","department":"None"}],"date_submitted":"2015-02-05T07:10:59-05:00","date_accepted":"2015-02-05T07:10:59-05:00","date_published":"2015-12-01T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/criticalplanning/article/20989/galley/10688/download/"}]},{"pk":20990,"title":"Tension at the Heart of a Shifting City","subtitle":null,"abstract":"Decades of population loss, intensified after Germany reunification, forced decision-makers in Leipzig to re-examine their planning approach. This resulted in a paradigm shift away from traditional growth-oriented planning and the adoption of a shrinking cities model. The innovative and participatory approach taken by the local government was recognized and heralded by many as musicians, artists and students began to migrate to the city. In turn, neighborhoods have begun to gentrify. Leipzig is at once growing, shrinking, developing and declining. An industrial history, a political revolution, population loss, economic decline, and controversial policy have all contributed to Leipzig’s incongruous identity.","language":"en","license":{"name":"none","short_name":"none","text":"","url":"https://escholarship.org/terms"},"keywords":[{"word":"Shrinking City, Gentrification"}],"section":"Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/87j67456","frozenauthors":[{"first_name":"Maxwell","middle_name":"Douglas","last_name":"Hartt","name_suffix":"","institution":"University of Waterloo","department":"None"}],"date_submitted":"2015-02-05T20:55:44-05:00","date_accepted":"2015-02-05T20:55:44-05:00","date_published":"2015-12-01T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/criticalplanning/article/20990/galley/10689/download/"}]},{"pk":57213,"title":"The Chechen it-cleft construction","subtitle":null,"abstract":"This paper presents a biclausal construction in Chechen, arguing that it can be analyzed as an \nit\n-cleft. The construction consists of a main copula clause with a covert or pronominal subject, and a temporal complement that co-indexes with an adjunct position in a relative clause that does not form a constituent with the subject or the complement. A study of the construction in a corpus of newspaper and journal texts shows characteristics that make it stand out in terms of syntax and function: the cleft clause can appear both clause-finally as well as clause-initially, and its function is limited to text-structuring (it is mostly used to mark the start of a text or the transition to a new paragraph). This latter characteristic is exceptional: \nit\n-clefts in other languages (such as English and Norwegian) are known to be used for text-structuring to some extent, but Chechen is the first language known to only use it for this purpose. This prompts the question whether there are perhaps other language (e.g. from the Nakh-Daghestan family) with similar characteristics.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Chechen, it-cleft, focus, text structure, discourse"}],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/71k2t23k","frozenauthors":[{"first_name":"Erwin","middle_name":"R.","last_name":"Komen","name_suffix":"","institution":"","department":""}],"date_submitted":"2016-01-01T20:09:19-05:00","date_accepted":"2016-01-01T20:09:19-05:00","date_published":"2015-12-01T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/languagesofcaucasus/article/57213/galley/43402/download/"}]},{"pk":20987,"title":"Understanding the City through Crisis. Neoliberalization in Post-Wall Berlin","subtitle":null,"abstract":"Over the past 25 years, Berlin has undergone a rapid process of neoliberalization. This article argues that the city’s transformation has been heavily crisis-driven and fueled by a strong political agenda. Two watershed events are crucial for an in-depth understanding of the dynamics at work: The collapse of the German Democratic Republic (GDR) in 1989, followed by a neo-conservative and nationalist, entrepreneurial strategy for the reunified German Capital; and the financial crisis of 2001, which brought a coalition between Social-Democrats and Socialists into power that strongly emphasized Berlin’s (sub-)cultural and cosmopolitan identity, but effectively put the city on a fierce austerity track.","language":"en","license":{"name":"none","short_name":"none","text":"","url":"https://escholarship.org/terms"},"keywords":[{"word":"Urban Politics, Neoliberalism, Berlin, Crisis, Restructuring"}],"section":"Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0cj1q5h5","frozenauthors":[{"first_name":"Henrik","middle_name":"","last_name":"Lebuhn","name_suffix":"","institution":"Humboldt University Berlin","department":"None"}],"date_submitted":"2015-01-28T03:46:59-05:00","date_accepted":"2015-01-28T03:46:59-05:00","date_published":"2015-12-01T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/criticalplanning/article/20987/galley/10686/download/"}]},{"pk":20998,"title":"UNEVEN EFFECTS: THE MIXED STORY OF TRANSIT-ORIENTED GENTRIFICATION IN LOS ANGELES","subtitle":null,"abstract":"Transit-oriented gentrification studies in Los Angeles record contrasting findings, but yield consistent implications for station area planning. As these cases demonstrates, simply building transit will not gentrify neighborhoods; a blend of built environment factors, development, and governmental support are needed to catalyze gentrification. This paper reveals the importance of government involvement as both the precursor of gentrification and protector of residents. Given this, cities should enact multi-pronged and context-sensitive policies to protect incumbent residents from gentrification’s potentially negative effects. A mix of housing policies can help residents weather rising housing costs, remain in neighborhoods, and capitalize on increased local amenities.","language":"en","license":{"name":"none","short_name":"none","text":"","url":"https://escholarship.org/terms"},"keywords":[{"word":"Gentrification, Transit, Los Angeles"}],"section":"Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/83k795fc","frozenauthors":[{"first_name":"Anne","middle_name":"E","last_name":"Brown","name_suffix":"","institution":"UCLA","department":"None"}],"date_submitted":"2015-03-05T17:26:46-05:00","date_accepted":"2015-03-05T17:26:46-05:00","date_published":"2015-12-01T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/criticalplanning/article/20998/galley/10690/download/"}]},{"pk":20988,"title":"Urban Mobility and Economic Shock: How Bangkok’s Transportation System Weathered the 1997 Financial Crisis","subtitle":null,"abstract":"Bangkok is a rising global city, home to nearly 20 million people and notorious traffic congestion. Constrained mobility and accessibility have long underscored the centrality of transportation issues to managing growth. Historically, the preponderance of Bangkok’s transportation network interventions have expanded road capacity to alleviate traffic; however, major investments in the city’s mass transit network began in the late 1980’s and early 1990’s. This was also a time of massive economic growth and frenzied international investment. But, in 1997, a financial crisis (centered in Thailand) contaminated economies across the region and devastated economic growth in Bangkok. While many economic indicators confirm that the crisis was a troublesome era for the city, fortunes were varied across income groups and mobility profiles. This paper examines how the financial crisis impacted Bangkok’s transportation system, tracking changes in urban accessibility before and after the crash. Lessons from the resilience and evolution of the city’s mobility patterns are instructive in adjusting transportation planning efforts today.","language":"en","license":{"name":"none","short_name":"none","text":"","url":"https://escholarship.org/terms"},"keywords":[{"word":"Bangkok"},{"word":"Financial Crisis"},{"word":"transportation"},{"word":"mobility"}],"section":"Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1cq879dc","frozenauthors":[{"first_name":"David","middle_name":"","last_name":"Leipziger","name_suffix":"","institution":"UCLA","department":"None"}],"date_submitted":"2015-01-31T02:36:26-05:00","date_accepted":"2015-01-31T02:36:26-05:00","date_published":"2015-12-01T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/criticalplanning/article/20988/galley/10687/download/"}]},{"pk":44088,"title":"Mycobacterium chelonae Olecranon Bursitis Infection","subtitle":null,"abstract":null,"language":"eng","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[{"word":"Clinical Vignette"}],"section":"Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6n31k60f","frozenauthors":[{"first_name":"Stephen","middle_name":"C.","last_name":"Ross","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"}],"date_submitted":null,"date_accepted":null,"date_published":"2015-11-30T16:19:55-05:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/44088/galley/32891/download/"}]},{"pk":44087,"title":"Hemorrhagic Renal Angiomyolipoma as Initial Presentation of Lymphangioleiomyomatosis","subtitle":null,"abstract":null,"language":"eng","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[{"word":"Clinical Vignette"}],"section":"Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/82t4p6jw","frozenauthors":[{"first_name":"Jennifer","middle_name":"","last_name":"Michael","name_suffix":"MD, MPH","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"David","middle_name":"","last_name":"Scott","name_suffix":"MD","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2015-11-30T15:53:00-05:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/44087/galley/32890/download/"}]},{"pk":8839,"title":"Inpatient Readmissions and Emergency Department Visits within 30 Days of a Hospital Admission","subtitle":null,"abstract":"Introduction:\n Inpatient hospital readmissions have become a focus for healthcare reform and cost-containment efforts. Initiatives targeting unanticipated readmissions have included care coordination for specific high readmission diseases and patients and health coaching during the post-discharge transition period. However, little research has focused on emergency department (ED) visits following an inpatient admission. The objective of this study was to assess 30-day ED utilization and all-cause readmissions following a hospital admission.\nMethods:\n This was a retrospective study using inpatient and ED utilization data from two hospitals with a shared patient population in 2011. We assessed the 30-day ED visit rate and 30-day readmission rate and compared patient characteristics among individuals with 30-day inpatient readmissions, 30-day ED discharges, and no 30-day visits.\nResults:\n There were 13,449 patients who met the criteria of an index visit. Overall, 2,453 (18.2%) patients had an ED visit within 30 days of an inpatient stay. However, only 55.6% (n=1,363) of these patients were admitted at one of these 30-day visits, resulting in a 30-day all-cause readmission rate of 10.1%.\nConclusion:\n Approximately one in five patients presented to the ED within 30 days of an inpatient hospitalization and over half of these patients were readmitted. Readmission measures that incorporate ED visits following an inpatient stay might better inform interventions to reduce avoidable readmissions.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Public health"},{"word":"policy"},{"word":"ED administration"}],"section":"Healthcare Utilization","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6j7676qq","frozenauthors":[{"first_name":"Jesse","middle_name":"J.","last_name":"Brennan","name_suffix":"","institution":"University of California, San Diego, Department of Emergency Medicine, San Diego, California","department":"None"},{"first_name":"Theodore","middle_name":"C.","last_name":"Chan","name_suffix":"","institution":"University of California, San Diego, Department of Emergency Medicine, San Diego, California","department":"None"},{"first_name":"James","middle_name":"P.","last_name":"Killeen","name_suffix":"","institution":"University of California, San Diego, Department of Emergency Medicine, San Diego, California","department":"None"},{"first_name":"Edward","middle_name":"M.","last_name":"Castillo","name_suffix":"","institution":"University of California, San Diego, Department of Emergency Medicine, San Diego, California","department":"None"}],"date_submitted":"2015-04-03T14:35:23-04:00","date_accepted":"2015-04-03T14:35:23-04:00","date_published":"2015-11-30T15:28:48-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8839/galley/5040/download/"}]},{"pk":39438,"title":"Review: La Frontera: Forests and Ecological Conflict in Chile’s Frontier Territory","subtitle":null,"abstract":"Book Review","language":"en","license":{"name":"none","short_name":"none","text":"","url":"https://escholarship.org/terms"},"keywords":[{"word":"Forests and forestry"},{"word":"Chile"},{"word":"environmental history"}],"section":"Reviews","is_remote":true,"remote_url":"https://escholarship.org/uc/item/7nk345c6","frozenauthors":[{"first_name":"Jan","middle_name":"","last_name":"Kunnas","name_suffix":"","institution":"KTH Royal Institute of Technology, Stockholm, Sweden","department":"None"}],"date_submitted":"2015-11-28T17:04:17-05:00","date_accepted":"2015-11-28T17:04:17-05:00","date_published":"2015-11-28T17:06:51-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/egj/article/39438/galley/29772/download/"}]},{"pk":39437,"title":"Review: British Columbia's Inland Rainforest: Ecology, Conservation, and Management","subtitle":null,"abstract":"Book Review","language":"en","license":{"name":"none","short_name":"none","text":"","url":"https://escholarship.org/terms"},"keywords":[{"word":"Temperate rain forests"},{"word":"ecology"},{"word":"management"}],"section":"Reviews","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0f0415w0","frozenauthors":[{"first_name":"Daniel","middle_name":"S.","last_name":"Helman","name_suffix":"","institution":"Prescott College; Winkle Institute","department":"None"}],"date_submitted":"2015-11-28T10:56:07-05:00","date_accepted":"2015-11-28T10:56:07-05:00","date_published":"2015-11-28T10:59:02-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/egj/article/39437/galley/29771/download/"}]},{"pk":39435,"title":"Review:  Thinking like a Mall","subtitle":null,"abstract":"Book review","language":"en","license":{"name":"none","short_name":"none","text":"","url":"https://escholarship.org/terms"},"keywords":[],"section":"Reviews","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6tc1h8hw","frozenauthors":[{"first_name":"Byron","middle_name":"P.","last_name":"Anderson","name_suffix":"","institution":"Retired/Northern Illinois University","department":"None"}],"date_submitted":"2015-11-08T18:35:11-05:00","date_accepted":"2015-11-08T18:35:11-05:00","date_published":"2015-11-28T10:19:09-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/egj/article/39435/galley/29770/download/"}]},{"pk":44085,"title":"Long-term survival in non-visceral metastatic hormone receptor positive breast cancer","subtitle":null,"abstract":null,"language":"eng","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[{"word":"Clinical Vignette"}],"section":"Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/886764zj","frozenauthors":[{"first_name":"Merry","middle_name":"L.","last_name":"Tetef","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"}],"date_submitted":null,"date_accepted":null,"date_published":"2015-11-27T15:52:00-05:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/44085/galley/32888/download/"}]},{"pk":44084,"title":"Intestinal Malrotation in an Adult Patient","subtitle":null,"abstract":null,"language":"eng","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[{"word":"Clinical Vignette"}],"section":"Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1xm7b8t0","frozenauthors":[{"first_name":"Michael","middle_name":"J.","last_name":"Albertson","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"David","middle_name":"","last_name":"Chen","name_suffix":"MD","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2015-11-23T15:51:02-05:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/44084/galley/32887/download/"}]},{"pk":44083,"title":"Lambda Light Chain Myeloma Presenting with Asymptomatic Hypercalcemia","subtitle":null,"abstract":null,"language":"eng","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[{"word":"Clinical Vignette"}],"section":"Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3b25d8qh","frozenauthors":[{"first_name":"Nicholas","middle_name":"","last_name":"Tangchaivang","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Rumi","middle_name":"","last_name":"Cader","name_suffix":"MD, MPH, FACP","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2015-11-20T17:53:27-05:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/44083/galley/32886/download/"}]},{"pk":9181,"title":"Simulation in Pre-departure Training for Residents  Planning Clinical Work in a Low-Income Country","subtitle":null,"abstract":"Introduction: \nIncreasingly, pediatric and emergency medicine (EM) residents are pursuing clinical rotations in low-income countries. Optimal pre-departure preparation for such rotations has not yet been established. High-fidelity simulation represents a potentially effective modality for such preparation. This study was designed to assess whether a pre-departure high-fidelity medical simulation curriculum is effective in helping to prepare residents for clinical rotations in a low-income country. \nMethods: \n43 pediatric and EM residents planning clinical rotations in Liberia, West Africa, participated in a simulation-based curriculum focused on severe pediatric malaria and malnutrition and were then assessed by survey at three time points: pre-simulation, post-simulation, and after returning from work abroad.\nResults: \nPrior to simulation, 1/43 (2%) participants reported they were comfortable with the diagnosis and management of severe malnutrition; this increased to 30/42 (71%) after simulation and 24/31 (77%) after working abroad. Prior to simulation, 1/43 (2%) of residents reported comfort with the diagnosis and management of severe malaria; this increased to 26/42 (62%) after simulation and 28/31 (90%) after working abroad; 36/42 (86%) of residents agreed that a simulation-based global health curriculum is more useful than a didactic curriculum alone, and 41/42 (98%) felt a simulator-based curriculum should be offered to all residents planning a clinical trip to a low-income country.\nConclusion: \nHigh-fidelity simulation is effective in increasing residents’ self-rated comfort in management of pediatric malaria and malnutrition and a majority of participating residents feel it should be included as a component of pre-departure training for all residents rotating clinically to low-income countries.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Global Health"},{"word":"Simulation"},{"word":"malaria"},{"word":"Malnutrition"},{"word":"Pre-departure"}],"section":"Education","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0c9933ns","frozenauthors":[{"first_name":"Kevin","middle_name":"R.","last_name":"Schwartz","name_suffix":"","institution":"Massachusetts General Hospital, Harvard Medical School, Department of Pediatrics and Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Kimball","middle_name":"A.","last_name":"Prentiss","name_suffix":"","institution":"Baystate Medical Center, Tufts University School of Medicine, Department of Emergency Medicine, Springfield, Massachusetts","department":"None"}],"date_submitted":"2015-07-17T11:55:54-04:00","date_accepted":"2015-07-17T11:55:54-04:00","date_published":"2015-11-18T20:02:56-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/9181/galley/5166/download/"}]},{"pk":9130,"title":"An Unusual Case of Angiotensin-Converting-Enzyme Inhibitor-Related Penile Angioedema with Evolution to the Oropharynx","subtitle":null,"abstract":"A 52-year-old African American male with a long history of poorly controlled hypertension presented to the emergency department (ED) with two days of genital edema and pain. During ED work-up, the patient developed sudden onset of non-pitting, non-pruritic, and non-urticarial upper lip edema. Review of his antihypertensive medication list revealed that he normally took benazepril, highly suggestive of a diagnosis of angiotensin-converting-enzyme inhibitor-related angioedema (ACEI-RA). We present the first reported case of penile ACEI-RA that progressed to involve the oropharynx. The ED management of the condition and some of the newer treatment options available for ACEI-RA is also briefly discussed.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Angioedema, ACEI, penile swelling, ACEI related angioedema"}],"section":"Diagnostic Acumen","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6sz1k5r3","frozenauthors":[{"first_name":"Jonathan","middle_name":"G.","last_name":"Wagner","name_suffix":"","institution":"Keck School of Medicine of the University of Southern California, Los Angeles County + University of Southern California (LAC+USC), Department of Emergency Medicine, Los Angeles, California","department":"None"},{"first_name":"Elias","middle_name":"M.","last_name":"Bench","name_suffix":"","institution":"Keck School of Medicine of the University of Southern California, Los Angeles County + University of Southern California (LAC+USC), Department of Emergency Medicine, Los Angeles, California","department":"None"},{"first_name":"Lee","middle_name":"","last_name":"Plantmason","name_suffix":"","institution":"Keck School of Medicine of the University of Southern California, Los Angeles County + University of Southern California (LAC+USC), Department of Emergency Medicine, Los Angeles, California","department":"None"}],"date_submitted":"2015-07-12T15:38:52-04:00","date_accepted":"2015-07-12T15:38:52-04:00","date_published":"2015-11-18T19:03:21-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/9130/galley/5119/download/"}]},{"pk":44082,"title":"Cautions with Warfarin","subtitle":null,"abstract":null,"language":"eng","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[{"word":"Clinical Vignette"}],"section":"Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/16r017rv","frozenauthors":[{"first_name":"Evangelia","middle_name":"","last_name":"Kirimis","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Steven","middle_name":"","last_name":"Applebaum","name_suffix":"MD","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2015-11-18T17:52:04-05:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/44082/galley/32885/download/"}]},{"pk":9378,"title":"Transformative Leadership: Emergency Physicians Lead AOA and AMA","subtitle":null,"abstract":"N/A","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Societal Impact on Emergency Care","is_remote":true,"remote_url":"https://escholarship.org/uc/item/398582sc","frozenauthors":[{"first_name":"Chadd","middle_name":"K.","last_name":"Kraus","name_suffix":"","institution":"University of Missouri-Columbia, Department of Emergency Medicine, Columbia, Missouri","department":"None"}],"date_submitted":"2015-09-29T16:06:12-04:00","date_accepted":"2015-09-29T16:06:12-04:00","date_published":"2015-11-16T18:19:35-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/9378/galley/5274/download/"}]},{"pk":8749,"title":"Epidemiology of Advance Directives in Extended Care Facility Patients Presenting to the Emergency Department","subtitle":null,"abstract":"Introduction:\n We conducted an epidemiologic evaluation of advance directives and do-not-resuscitate (DNR) prevalence among residents of extended care facilities (ECF) presenting to the emergency department (ED).\nMethods:\n We performed a retrospective medical record review on ED patients originating from an ECF. Data were collected on age, sex, race, triage acuity, ED disposition, DNR status, power-of attorney (POA) status, and living will (LW) status. We generated descriptive statistics, and used logistic regression to evaluate predictors of DNR status.\nResults:\n A total of 754 patients over 20 months met inclusion criteria; 533 (70.7%) were white, 351 (46.6%) were male, and the median age was 66 years (IQR 54-78). DNR orders were found in 124 (16.4%, 95% CI [13.9-19.1%]) patients. In univariate analysis, there was a significant difference in DNR by gender (10.5% female vs. 6.0% male with DNR, p=0.013), race (13.4% white vs. 3.1% non-white with DNR, p=0.005), and age (4.0% <65 years; 2.9% 65-74 years, p=0.101; 3.3% 75-84 years, p=0.001; 6.2% >84 years, p<0.001). Using multivariate logistic regression, we found that factors associated with DNR status were gender (OR 1.477, p=0.358, note interaction term), POA status (OR 6.612, p<0.001), LW (18.032, p<0.001), age (65-74 years OR 1.261, p=0.478; 75-84 years OR 1.737, p=0.091, >84 years OR 5.258, P<0.001), with interactions between POA and gender (OR 0.294, P=0.016) and between POA and LW (OR 0.227, p<0.005). Secondary analysis demonstrated that DNR orders were not significantly associated with death during admission (p=0.084).\nConclusion:\n Age, gender, POA, and LW use are predictors of ECF patient DNR use. Further, DNR presence is not a predictor of death in the hospital.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Advance Directive"},{"word":"DNR"},{"word":"Extended Care Facility"},{"word":"Emergency Medicine"}],"section":"Ethical and Legal Issues","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8548j6wd","frozenauthors":[{"first_name":"Jessica","middle_name":"","last_name":"Wall","name_suffix":"","institution":"Penn Presbyterian Medical Center, Department of Emergency Medicine, Philadelphia, Pennsylvania","department":"None"},{"first_name":"Brain","middle_name":"","last_name":"Hiestand","name_suffix":"","institution":"Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina","department":"None"},{"first_name":"Jeffrey","middle_name":"","last_name":"Caterino","name_suffix":"","institution":"Ohio State University, Department of Emergency Medicine, Columbus, Ohio","department":"None"}],"date_submitted":"2015-02-08T17:23:27-05:00","date_accepted":"2015-02-08T17:23:27-05:00","date_published":"2015-11-16T18:14:15-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8749/galley/5011/download/"}]},{"pk":9052,"title":"Emergency Department Visits by Older Adults with Mental Illness in North Carolina","subtitle":null,"abstract":"Introduction:\n We analyzed emergency department (ED) visits by patients with mental health disorders (MHDs) in North Carolina from 2008-2010 to determine frequencies and characteristics of ED visits by older adults with MHDs.\nMethods:\n We extracted ED visit data from the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT). We defined mental health visits as visits with a mental health ICD-9-CM diagnostic code, and organized MHDs into clinically similar groups for analysis.\nResults:\n Those ≥65 with MHDs accounted for 27.3% of all MHD ED visits, and 51.2% were admitted. The most common MHD diagnoses for this age group were psychosis, and stress/anxiety/depression.\nConclusion:\n Older adults with MHDs account for over one-quarter of ED patients with MHDs, and their numbers will continue to increase as the “boomer” population ages. We must anticipate and prepare for the MHD-related needs of the elderly.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Mental Health"},{"word":"Geriatrics"},{"word":"Geriatric Emergency Medicine"}],"section":"Behavioral Health","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8qk313bz","frozenauthors":[{"first_name":"Anne","middle_name":"M.","last_name":"Hakenewerth","name_suffix":"","institution":"North Carolina Department of Health and Human Services, Division of Public Health, Raleigh, North Carolina","department":"None"},{"first_name":"Judith","middle_name":"E.","last_name":"Tintinalli","name_suffix":"","institution":"University of North Carolina at Chapel Hill, Department of Emergency Medicine, Chapel Hill, North Carolina","department":"None"},{"first_name":"Anna","middle_name":"E.","last_name":"Waller","name_suffix":"","institution":"University of North Carolina at Chapel Hill, Carolina Center for Health Informatics, Department of Emergency Medicine, Chapel Hill, North Carolina","department":"None"},{"first_name":"Amy","middle_name":"","last_name":"Ising","name_suffix":"","institution":"University of North Carolina at Chapel Hill, Carolina Center for Health Informatics, Department of Emergency Medicine, Chapel Hill, North Carolina","department":"None"}],"date_submitted":"2015-06-01T16:13:09-04:00","date_accepted":"2015-06-01T16:13:09-04:00","date_published":"2015-11-16T18:05:11-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/9052/galley/5100/download/"}]},{"pk":9047,"title":"Written Informed Consent for Computed Tomography of the Abdomen/Pelvis is Associated with Decreased CT Utilization in Low-Risk Emergency Department Patients","subtitle":null,"abstract":"Introduction:\n The increasing rate of patient exposure to radiation from computerized tomography (CT) raises questions about appropriateness of utilization. There is no current standard to employ informed consent for CT (ICCT). Our study assessed the relationship between informed consent and CT utilization in emergency department (ED) patients.\nMethods:\n An observational multiphase before-after cohort study was completed from 4/2010-5/2011. We assessed CT utilization before and after (Time I/ Time II) the implementation of an informed consent protocol. Adult patients were included if they presented with symptoms of abdominal/pelvic pathology or completed ED CT. We excluded patients with pregnancy, trauma, or altered mental status. Data on history, exam, diagnostics, and disposition were collected via standard abstraction tool. We generated a multivariate logistic model via stepwise regression, to assess CT utilization across risk groups. Logistic models, stratified by risk, were generated to include study phase and a propensity score that controlled for potential confounders of CT utilization.\nResults:\n 7,684 patients met inclusion criteria. In PHASE 2, there was a 24% (95% CI [10-36%]) reduction in CT utilization in the low-risk patient group (p<0.002). ICCT did not affect CT utilization in the high-risk group (p=0.16). In low-risk patients, the propensity score was significant (p<0.001). There were no adverse events reported during the study period.\nConclusion:\n The implementation of ICCT was associated with reduced CT utilization in low-risk ED patients. ICCT has the potential to increase informed, shared decision making with patients, as well as to reduce the risks and cost associated with CT.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Emergency Medicine, Ethics, CT Scan, Computerized Tomography"}],"section":"Healthcare Utilization","is_remote":true,"remote_url":"https://escholarship.org/uc/item/7t36f8dt","frozenauthors":[{"first_name":"Lisa","middle_name":"H.","last_name":"Merck","name_suffix":"","institution":"The Warren Alpert Medical School of Brown University, Department of Emergency Medicine and Diagnostic Imaging, Providence, Rhode Island","department":"None"},{"first_name":"Laura","middle_name":"A.","last_name":"Ward","name_suffix":"","institution":"Rollins School of Public Health, Department of Biostatistics, Emory University, Atlanta, Georgia","department":"None"},{"first_name":"Kimberly","middle_name":"E.","last_name":"Applegate","name_suffix":"","institution":"Emory University School of Medicine, Department of Radiology and Imaging Sciences, Atlanta, Georgia","department":"None"},{"first_name":"Esther","middle_name":"","last_name":"Choo","name_suffix":"","institution":"The Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island","department":"None"},{"first_name":"Douglas","middle_name":"W.","last_name":"Lowery-North","name_suffix":"","institution":"Emory University School of Medicine and Grady Memorial Hospital, Department of Emergency Medicine, Atlanta, Georgia","department":"None"},{"first_name":"Katherine","middle_name":"L.","last_name":"Heilpern","name_suffix":"","institution":"Emory University School of Medicine and Grady Memorial Hospital, Department of Emergency Medicine, Atlanta, Georgia","department":"None"}],"date_submitted":"2015-05-29T11:56:37-04:00","date_accepted":"2015-05-29T11:56:37-04:00","date_published":"2015-11-16T17:35:45-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/9047/galley/5098/download/"}]},{"pk":2040,"title":"Using a Corpus-Informed Pedagogical Intervention to Develop Language Awareness toward Appropriate Lexicogrammatical Choices","subtitle":null,"abstract":"The corpus-informed pedagogical intervention described in this article was developed for an advanced English as a Second Language (ESL) course designed for prospective International Teaching Assistants (ITAs) and implemented over the course of two class periods. Its primary goal was to offer students opportunities to gain language awareness of “smallwords” (Hasselgren, 2002b), with the broader goal of developing their ability to make pragmatically appropriate lexicogrammatical choices and to enhance their communication as ITAs. The article situates this pedagogical unit vis-à-vis the goals of the class in which this unit was implemented, describes the progression of activities, and provides an appraisal of the unit.","language":"en","license":null,"keywords":[{"word":"Small words"},{"word":"Corpus"},{"word":"International Teaching Assistants"}],"section":"Teachers' Forum","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8436d8qx","frozenauthors":[{"first_name":"Julieta","middle_name":"","last_name":"Fernandez","name_suffix":"","institution":"Northern Arizona University","department":"None"},{"first_name":"Aziz","middle_name":"","last_name":"Yuldashev","name_suffix":"","institution":"Northern Arizona University","department":"None"}],"date_submitted":"2014-12-18T22:08:21-05:00","date_accepted":"2014-12-18T22:08:21-05:00","date_published":"2015-11-16T13:25:26-05:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/l2/article/2040/galley/1345/download/"}]},{"pk":2038,"title":"Introducing Genre into Japanese-as-a-Foreign-Language: Toward a Genre-Specific Approach to Elementary/Intermediate Writing","subtitle":null,"abstract":"Despite the social turn in views of language and the increasing attention to an application of genre theory in teaching languages, the field of Japanese-as-a-Foreign-Language (JFL) has not yet found genre a valuable resource for approaching learners’ writing ability. Writing is still practiced as a psycholinguistic space to check learners’ understanding of grammar structures and \nkanji\n, and writing assignment prompts are often designed to fit into the corresponding grammatical units. Part I of this paper, by employing a functional linguistics-oriented genre theory, maps elementary/intermediate JFL grammatical units into \nregister\n, which is the primary contextual parameters that construe social meanings, and illustrates the process of transferring grammatical resources into \ngenre\n so that language instructors can make their own model texts and can approach their learners’ writing from a genre-specific perspective. Part II of this paper illustrates a practical implementation as the form of pedagogic report. It illustrates how the constructed model text was used in an actual JFL classroom and argues its potential for a curricular context. In essence, the present study intends to lay the groundwork for creating an applicable genre approach in a JFL curriculum that contextualizes elementary/intermediate learners’ writing as a way to represent their social views.","language":"en","license":null,"keywords":[{"word":"Japanese as a Foreign Language (JFL)"},{"word":"Systemic Functional Linguistics (SFL)"},{"word":"Genre Theory"},{"word":"Foreign Language Writing"},{"word":"Janru"}],"section":"Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2q74p58q","frozenauthors":[{"first_name":"Shinji","middle_name":"","last_name":"Kawamitsu","name_suffix":"","institution":"University of Massachusetts Amherst","department":"None"}],"date_submitted":"2014-11-13T14:37:26-05:00","date_accepted":"2014-11-13T14:37:26-05:00","date_published":"2015-11-16T13:25:06-05:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/l2/article/2038/galley/1343/download/"}]},{"pk":9182,"title":"A Simulation-based Randomized Controlled Study of Factors Influencing Chest Compression Depth","subtitle":null,"abstract":"Introduction:\n Current resuscitation guidelines emphasize a systems approach with a strong emphasis on quality cardiopulmonary resuscitation (CPR). Despite the American Heart Association (AHA) emphasis on quality CPR for over 10 years, resuscitation teams do not consistently meet recommended CPR standards. The objective is to assess the impact on chest compression depth of factors including bed height, step stool utilization, position of the rescuer’s arms and shoulders relative to the point of chest compression, and rescuer characteristics including height, weight, and gender.\nMethods:\n Fifty-six eligible subjects, including physician assistant students and first-year emergency medicine residents, were enrolled and randomized to intervention (bed lowered and step stool readily available) and control (bed raised and step stool accessible, but concealed) groups. We instructed all subjects to complete all interventions on a high-fidelity mannequin per AHA guidelines. Secondary end points included subject arm angle, height, weight group, and gender.\nResults:\n Using an intention to treat analysis, the mean compression depths for the intervention and control groups were not significantly different. Subjects positioning their arms at a 90-degree angle relative to the sagittal plane of the mannequin’s chest achieved a mean compression depth significantly greater than those compressing at an angle less than 90 degrees. There was a significant correlation between using a step stool and achieving the correct shoulder position. Subject height, weight group, and gender were all independently associated with compression depth. \nConclusion: \nRescuer arm position relative to the patient’s chest and step stool utilization during CPR are modifiable factors facilitating improved chest compression depth.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"cardiopulmonary resuscitation"},{"word":"chest compression depth"},{"word":"heart massage"},{"word":"Simulation"},{"word":"acls"}],"section":"Critical Care","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0374238b","frozenauthors":[{"first_name":"Kelsey","middle_name":"P.","last_name":"Mayrand","name_suffix":"","institution":"Boonshoft School of Medicine, Wright State University, Fairborn, Ohio","department":"None"},{"first_name":"Eric","middle_name":"J.","last_name":"Fischer","name_suffix":"","institution":"Boonshoft School of Medicine, Wright State University, Fairborn, Ohio","department":"None"},{"first_name":"Raymond","middle_name":"P.","last_name":"Ten Eyck","name_suffix":"","institution":"Boonshoft School of Medicine, Wright State University, Fairborn, Ohio","department":"None"}],"date_submitted":"2015-07-18T14:55:01-04:00","date_accepted":"2015-07-18T14:55:01-04:00","date_published":"2015-11-13T19:13:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/9182/galley/5167/download/"}]},{"pk":9275,"title":"Posterior Reversible Encephalopathy Syndrome (PRES) After Acute Pancreatitis","subtitle":null,"abstract":"Posterior reversible encephalopathy syndrome (PRES) is an unusual condition typified by acute visual impairment caused by sudden, marked parieto-occipital vasogenic edema. Thought to be inflammatory in origin, it has been described in patients undergoing chemotherapy, with autoimmune disease, and in some infections. We report a case of PRES that occurred one week after an episode of acute pancreatitis in an otherwise healthy 40-year-old female. There was progressive visual impairment over a 24-hour period with almost complete visual loss, with characteristic findings on magnetic resonance imaging. After treatment with steroids, the visual loss recovered. Clinicians should retain an index of suspicion of this rare condition in patients with visual impairment after acute pancreatitis.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"PRES, acute pancreatitis, encephalopathy"}],"section":"Diagnostic Acumen","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3pt580n3","frozenauthors":[{"first_name":"Tara","middle_name":"","last_name":"Murphy","name_suffix":"","institution":"Dalhousie Medical School, Nova Scotia, Canada","department":"None"},{"first_name":"Khalid","middle_name":"","last_name":"Al-Sharief","name_suffix":"","institution":"Upper River Valley Hospital, Waterville, New Brunswick, Canada","department":"None"},{"first_name":"Vineeta","middle_name":"","last_name":"Sethi","name_suffix":"","institution":"Upper River Valley Hospital, Waterville, New Brunswick, Canada","department":"None"},{"first_name":"Gurpreet","middle_name":"S.","last_name":"Ranger","name_suffix":"","institution":"Upper River Valley Hospital, Waterville, New Brunswick, Canada","department":"None"}],"date_submitted":"2015-08-04T19:08:53-04:00","date_accepted":"2015-08-04T19:08:53-04:00","date_published":"2015-11-12T18:40:22-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/9275/galley/5239/download/"}]},{"pk":41395,"title":"The psorosis disease of citrus: a pale light at the end of the tunnel","subtitle":null,"abstract":"Abstract First reported in 1896, psorosis was the first citrus disease proven to be graft transmissible and also the first for which eradication and budwood certification programs were launched to prevent its economic damage. For many years psorosis etiology remained elusive and only in 1986 it was associated with the presence of virus-like particles in infected plants. However, in the last two decades a virus with unusual morphology (\nCitrus psorosis virus\n, CPsV) was characterized and closely associated with psorosis disease as previously defined by field symptoms and by biological indexing in sensitive indicator plants. With a tripartite, negative-sense, RNA genome and a ~48 kDa coat protein, CPsV, the presumed causal agent of psorosis, is the type member of the genus \nOphiovirus\n, within the new family \nOphioviridae\n. Availability of the complete genomic sequence of two CPsV isolates and partial sequences of many others has enabled i) setting up rapid and sensitive RNA-based detection methods, ii) testing different citrus and relatives for resistance to CPsV, iii) identification of the two components (psorosis A and psorosis B) traditionally associated with non-scaled and scaled bark inoculum, respectively, from psorosis-infected plants and study their interactions, iv) analysis of genetic variation and evolutionary forces shaping the CPsV populations, v) preliminary studies on the interactions between virus and host factors and vi) development of transgenic citrus plants expressing variable degrees of resistance to CPsV. In summary, 120 years after the first report on psorosis we start seeing a pale light at the end of the tunnel.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"psorosis A, psorosis B, Citrus psorosis virus (CPsV), Ophiovirus, symptoms, detection, characterization, genetic variation, citrus resistance to CPsV."}],"section":"Reviews","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0tn7m65m","frozenauthors":[{"first_name":"Pedro","middle_name":"","last_name":"Moreno","name_suffix":"","institution":"Instituto Valenciano de Investigaciones Agrarias (IVIA)","department":"None"},{"first_name":"José","middle_name":"","last_name":"Guerri","name_suffix":"","institution":"Instituto Valenciano de Investigaciones Agrarias (IVIA)","department":"None"},{"first_name":"María","middle_name":"Laura","last_name":"García","name_suffix":"","institution":"Universidad Nacional de la Plata (UNLP)","department":"None"}],"date_submitted":"2015-10-05T10:42:58-04:00","date_accepted":"2015-10-05T10:42:58-04:00","date_published":"2015-11-12T17:05:43-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/iocv_journalcitruspathology/article/41395/galley/30993/download/"}]},{"pk":9343,"title":"Mistaken ST-Elevation Myocardial Infarction","subtitle":null,"abstract":"N/A","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"EKG changes, Digoxin"}],"section":"Diagnostic Acumen","is_remote":true,"remote_url":"https://escholarship.org/uc/item/404710jk","frozenauthors":[{"first_name":"Brian","middle_name":"J.","last_name":"Wolk","name_suffix":"","institution":"Loma Linda University School of Medicine, Department of Emergency Medicine, Loma Linda, California","department":"None"}],"date_submitted":"2015-09-09T19:06:09-04:00","date_accepted":"2015-09-09T19:06:09-04:00","date_published":"2015-11-12T15:01:40-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/9343/galley/5260/download/"}]},{"pk":8938,"title":"Assessing EM Patient Safety and Quality Improvement Milestones Using a Novel Debate Format","subtitle":null,"abstract":"Graduate medical education is increasingly focused on patient safety and quality improvement; training programs must adapt their curriculum to address these changes. We propose a novel curriculum for emergency medicine (EM) residency training programs specifically addressing patient safety, systems-based management, and practice-based performance improvement, called “EM Debates.” Following implementation of this educational curriculum, we performed a cross-sectional study to evaluate the curriculum through resident self-assessment. Additionally, a cross-sectional study to determine the ED clinical competency committee’s (CCC) ability to assess residents on specific competencies was performed. Residents were overall very positive towards the implementation of the debates. Of those participating in a debate, 71% felt that it improved their individual performance within a specific topic, and 100% of those that led a debate felt that they could propose an evidence-based approach to a specific topic. The CCC found that it was easier to assess milestones in patient safety, systems-based management, and practice-based performance improvement (sub-competencies 16, 17, and 19) compared to prior to the implementation of the debates. The debates have been a helpful venue to teach EM residents about patient safety concepts, identifying medical errors, and process improvement.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Emergency Medicine"},{"word":"Patient Safety and Quality Improvement"},{"word":"Residency Education"},{"word":"Emergency Medicine Milestones"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2pq0g6qw","frozenauthors":[{"first_name":"Mira","middle_name":"","last_name":"Mamtani","name_suffix":"","institution":"University of Pennsylvania Perelman School of Medicine, Department of Emergency Medicine, Philadelphia, Pennsylvania","department":"None"},{"first_name":"Kevin","middle_name":"R.","last_name":"Scott","name_suffix":"","institution":"University of Pennsylvania Perelman School of Medicine, Department of Emergency Medicine, Philadelphia, Pennsylvania","department":"None"},{"first_name":"Francis","middle_name":"J.","last_name":"DeRoos","name_suffix":"","institution":"University of Pennsylvania Perelman School of Medicine, Department of Emergency Medicine, Philadelphia, Pennsylvania","department":"None"},{"first_name":"Lauren","middle_name":"W.","last_name":"Conlon","name_suffix":"","institution":"University of Pennsylvania Perelman School of Medicine, Department of Emergency Medicine, Philadelphia, Pennsylvania","department":"None"}],"date_submitted":"2015-04-30T23:38:39-04:00","date_accepted":"2015-04-30T23:38:39-04:00","date_published":"2015-11-12T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8938/galley/5062/download/"}]},{"pk":8930,"title":"Combined Versus Detailed Evaluation Components in  Medical Student Global Rating Indexes","subtitle":null,"abstract":"Introduction:\n To determine if there is any correlation between any of the 10 individual components of a global rating index on an emergency medicine (EM) student clerkship evaluation form. If there is correlation, to determine if a weighted average of highly correlated components loses predictive value for the final clerkship grade.\nMethods:\n This study reviewed medical student evaluations collected over two years of a required fourth-year rotation in EM. Evaluation cards, comprised of a detailed 10-part evaluation, were completed after each shift. We used a correlation matrix between evaluation category average scores, using Spearman’s rho, to determine if there was any correlation of the grades between any of the 10 items on the evaluation form.\nResults:\n A total of 233 students completed the rotation over the two-year period of the study. There were strong correlations (>0.80) between assessment components of medical knowledge, history taking, physical exam, and differential diagnosis. There were also strong correlations between assessment components of team rapport, patient rapport, and motivation. When these highly correlated were combined to produce a four-component model, linear regression demonstrated similar predictive power in terms of final clerkship grade (R2=0.71, CI95=0.65–0.77 and R2=0.69, CI95=0.63–0.76 for the full and reduced models respectively).\nConclusion:\n This study revealed that several components of the evaluation card had a high degree of correlation. Combining the correlated items, a reduced model containing four items (clinical skills, interpersonal skills, procedural skills, and documentation) was as predictive of the student’s clinical grade as the full 10-item evaluation. Clerkship directors should be aware of the performance of their individual global rating scales when assessing medical student performance, especially if attempting to measure greater than four components.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"global rating indexes"},{"word":"medical student education"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5wn2v26b","frozenauthors":[{"first_name":"Kim","middle_name":"L.","last_name":"Askew","name_suffix":"","institution":"Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina","department":"None"},{"first_name":"James","middle_name":"C.","last_name":"O'Neill","name_suffix":"","institution":"Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina","department":"None"},{"first_name":"Brian","middle_name":"","last_name":"Hiestand","name_suffix":"","institution":"Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina","department":"None"},{"first_name":"David","middle_name":"E.","last_name":"Manthey","name_suffix":"","institution":"Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina","department":"None"}],"date_submitted":"2015-04-30T11:18:25-04:00","date_accepted":"2015-04-30T11:18:25-04:00","date_published":"2015-11-12T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8930/galley/5061/download/"}]},{"pk":9337,"title":"Competency Assessment in Senior Emergency Medicine Residents for Core Ultrasound Skills","subtitle":null,"abstract":"Introduction:\n Quality resident education in point-of-care ultrasound (POC US) is becoming increasingly important in emergency medicine (EM); however, the best methods to evaluate competency in graduating residents has not been established. We sought to design and implement a rigorous assessment of image acquisition and interpretation in POC US in a cohort of graduating residents at our institution. \nMethods:\n We evaluated nine senior residents in both image acquisition and image interpretation for five core US skills (focused assessment with sonography for trauma (FAST), aorta, echocardiogram (ECHO), pelvic, central line placement). Image acquisition, using an observed clinical skills exam (OSCE) directed assessment with a standardized patient model. Image interpretation was measured with a multiple-choice exam including normal and pathologic images. \nResults:\n Residents performed well on image acquisition for core skills with an average score of 85.7% for core skills and 74% including advanced skills (ovaries, advanced ECHO, advanced aorta). Residents scored well but slightly lower on image interpretation with an average score of 76%. \nConclusion:\n Senior residents performed well on core POC US skills as evaluated with a rigorous assessment tool. This tool may be developed further for other EM programs to use for graduating resident evaluation.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Ultrasound, Resident Education, Competency"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5d48j72b","frozenauthors":[{"first_name":"Jessica","middle_name":"N.","last_name":"Schmidt","name_suffix":"","institution":"University of Wisconsin School of Medicine and Public Health, Department of Emergency Medicine, Madison, Wisconsin","department":"None"},{"first_name":"John","middle_name":"","last_name":"Kendall","name_suffix":"","institution":"Denver Health Medical Center, Department of Emergency Medicine, Denver, Colorado","department":"None"},{"first_name":"Courtney","middle_name":"","last_name":"Smalley","name_suffix":"","institution":"University of Colorado School of Medicine, Department of Emergency Medicine, Denver, Colorado","department":"None"}],"date_submitted":"2015-09-04T10:52:02-04:00","date_accepted":"2015-09-04T10:52:02-04:00","date_published":"2015-11-12T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/9337/galley/5257/download/"}]},{"pk":8881,"title":"Correlation of Simulation Examination to Written Test Scores for Advanced Cardiac Life Support Testing: Prospective Cohort Study","subtitle":null,"abstract":"Introduction:\n Traditional Advanced Cardiac Life Support (ACLS) courses are evaluated using written multiple-choice tests. High-fidelity simulation is a widely used adjunct to didactic content, and has been used in many specialties as a training resource as well as an evaluative tool. There are no data to our knowledge that compare simulation examination scores with written test scores for ACLS courses. Objective: To compare and correlate a novel high-fidelity simulation-based evaluation with traditional written testing for senior medical students in an ACLS course.\nMethods:\n We performed a prospective cohort study to determine the correlation between simulation-based evaluation and traditional written testing in a medical school simulation center. Students were tested on a standard acute coronary syndrome/ventricular fibrillation cardiac arrest scenario. Our primary outcome measure was correlation of exam results for 19 volunteer fourth-year medical students after a 32-hour ACLS-based Resuscitation Boot Camp course. Our secondary outcome was comparison of simulation-based vs. written outcome scores.\nResults:\n The composite average score on the written evaluation was substantially higher (93.6%) than the simulation performance score (81.3%, absolute difference 12.3%, 95% CI [10.6-14.0%], p<0.00005). We found a statistically significant moderate correlation between simulation scenario test performance and traditional written testing (Pearson r=0.48, p=0.04), validating the new evaluation method.\nConclusion: \nSimulation-based ACLS evaluation methods correlate with traditional written testing and demonstrate resuscitation knowledge and skills. Simulation may be a more discriminating and challenging testing method, as students scored higher on written evaluation methods compared to simulation.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Simulation, simulation training, Advanced Cardiac Life Support, education, evaluation tool"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/89m374cg","frozenauthors":[{"first_name":"Suzanne","middle_name":"L.","last_name":"Strom","name_suffix":"","institution":"University of California Irvine School of Medicine, Department of Anesthesia and Perioperative Care, Irvine, California","department":"None"},{"first_name":"Craig","middle_name":"L.","last_name":"Anderson","name_suffix":"","institution":"University of California Irvine School of Medicine, Department of Emergency Medicine, Irvine, California","department":"None"},{"first_name":"Luanna","middle_name":"","last_name":"Yang","name_suffix":"","institution":"University of California Irvine, Irvine, California","department":"None"},{"first_name":"Cecilia","middle_name":"","last_name":"Canales","name_suffix":"","institution":"University of California Irvine, Irvine, California","department":"None"},{"first_name":"Alpesh","middle_name":"","last_name":"Amin","name_suffix":"","institution":"University of California Irvine School of Medicine, Department of Medicine, Irvine, California","department":"None"},{"first_name":"Shahram","middle_name":"","last_name":"Lotfipour","name_suffix":"","institution":"University of California Irvine School of Medicine, Department of Emergency Medicine, Irvine, California","department":"None"},{"first_name":"C. Eric","middle_name":"","last_name":"McCoy","name_suffix":"","institution":"University of California Irvine School of Medicine, Department of Emergency Medicine, Irvine, California","department":"None"},{"first_name":"Megan","middle_name":"Boysen","last_name":"Osborn","name_suffix":"","institution":"University of California Irvine School of Medicine, Department of Emergency Medicine, Irvine, California","department":"None"},{"first_name":"Mark","middle_name":"I.","last_name":"Langdorf","name_suffix":"","institution":"University of California Irvine School of Medicine, Department of Emergency Medicine, Irvine, California","department":"None"}],"date_submitted":"2015-04-23T15:16:39-04:00","date_accepted":"2015-04-23T15:16:39-04:00","date_published":"2015-11-12T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8881/galley/5052/download/"}]},{"pk":8963,"title":"Correlation of the National Board of Medical Examiners Emergency Medicine Advanced Clinical Examination Given in July to Intern American Board of Emergency Medicine in-training Examination Scores: A Predictor of Performance?","subtitle":null,"abstract":"Introduction:\n There is great variation in the knowledge base of Emergency Medicine (EM) interns in July. The first objective knowledge assessment during residency does not occur until eight months later, in February, when the American Board of EM (ABEM) administers the in-training examination (ITE). In 2013, the National Board of Medical Examiners (NBME) released the EM Advanced Clinical Examination (EM-ACE), an assessment intended for fourth-year medical students. Administration of the EM-ACE to interns at the start of residency may provide an earlier opportunity to assess the new EM residents’ knowledge base. The primary objective of this study was to determine the correlation of the NBME EM-ACE, given early in residency, with the EM ITE. Secondary objectives included determination of the correlation of the United States Medical Licensing Examination (USMLE) Step 1 or 2 scores with early intern EM-ACE and ITE scores and the effect, if any, of clinical EM experience on examination correlation.\nMethods:\n This was a multi-institutional, observational study. Entering EM interns at six residencies took the EM-ACE in July 2013 and the ABEM ITE in February 2014. We collected scores for the EM-ACE and ITE, age, gender, weeks of clinical EM experience in residency prior to the ITE, and USMLE Step 1 and 2 scores. Pearson’s correlation and linear regression were performed.\nResults:\n Sixty-two interns took the EM-ACE and the ITE. The Pearson’s correlation coefficient between the ITE and the EM-ACE was 0.62. R-squared was 0.5 (adjusted 0.4). The coefficient of determination was 0.41 (95% CI [0.3-0.8]). For every increase of one in the scaled EM-ACE score, we observed a 0.4% increase in the EM in-training score. In a linear regression model using all available variables (EM-ACE, gender, age, clinical exposure to EM, and USMLE Step 1 and Step 2 scores), only the EM-ACE score was significantly associated with the ITE (p<0.05). We observed significant colinearity among the EM-ACE, ITE and USMLE scores. Gender, age and number of weeks of EM prior to the ITE had no effect on the relationship between EM-ACE and the ITE.\nConclusion:\n Given early during intern year, the EM-ACE score showed positive correlation with ITE. Clinical EM experience prior to the in-training exam did not affect the correlation.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Emergency Medicine Advanced Clinical Examination (EM-ACE)"},{"word":"National Board of Medical Examiners (NBME), American Board of Emergency Medicine  (ABEM) in-training examination, Emergency Medicine,"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8qc901r6","frozenauthors":[{"first_name":"Katherine","middle_name":"","last_name":"Hiller","name_suffix":"","institution":"University of Arizona, Department of Emergency Medicine, Tucson, Arizona","department":"None"},{"first_name":"Doug","middle_name":"","last_name":"Franzen","name_suffix":"","institution":"University of Washington, Department of Emergency Medicine, Seattle, Washington","department":"None"},{"first_name":"Corey","middle_name":"","last_name":"Heitz","name_suffix":"","institution":"Virginia Tech Carilion, Department of Emergency Medicine, Roanoke, Virginia","department":"None"},{"first_name":"Matthew","middle_name":"","last_name":"Emery","name_suffix":"","institution":"Michigan State University College of Human Medicine, Department of Emergency Medicine, East Lansing, Michigan","department":"None"},{"first_name":"Stacy","middle_name":"","last_name":"Poznanski","name_suffix":"","institution":"Wright State University, Department of Emergency Medicine, Dayton, Ohio","department":"None"}],"date_submitted":"2015-05-01T12:20:49-04:00","date_accepted":"2015-05-01T12:20:49-04:00","date_published":"2015-11-12T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8963/galley/5069/download/"}]},{"pk":9389,"title":"Effect of a Novel Engagement Strategy Using Twitter on Test Performance","subtitle":null,"abstract":"Introduction:\n Medical educators in recent years have been using social media for more penetrance to technologically-savvy learners. The utility of using Twitter for curriculum content delivery has not been studied. We sought to determine if participation in a social media-based educational supplement would improve student performance on a test of clinical images at the end of the semester.\nMethods:\n 116 second-year medical students were enrolled in a lecture-based clinical medicine course, in which images of common clinical exam findings were presented. An additional, optional assessment was performed on Twitter. Each week, a clinical presentation and physical exam image (not covered in course lectures) were distributed via Twitter, and students were invited to guess the exam finding or diagnosis. After the completion of the course, students were asked to participate in a slideshow “quiz” with 24 clinical images, half from lecture and half from Twitter.\nResults: \nWe conducted a one-way analysis of variance to determine the effect Twitter participation had on total, Twitter-only, and lecture-only scores. Twitter participation data was collected from the end-of-course survey and was defined as submitting answers to the Twitter-only questions “all or most of the time”, “about half of the time”, and “little or none of the time.” We found a significant difference in overall scores (p<0.001) and in Twitter-only scores (p<0.001). There was not enough evidence to conclude a significant difference in lecture-only scores (p=0.124). Students who submitted answers to Twitter “all or most of the time” or “about half the time” had significantly higher overall scores and Twitter-only scores (p<0.001 and p<0.001, respectively) than those students who only submitted answers “little or none of the time.”\nConclusion:\n While students retained less information from Twitter than from traditional classroom lecture, some retention was noted. Future research on social media in medical education would benefit from clear control and experimental groups in settings where quantitative use of social media could be measured. Ultimately, it is unlikely for social media to replace lecture in medical curriculum; however, there is a reasonable role for social media as an adjunct to traditional medical education.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"social media"},{"word":"Medical Education"},{"word":"Twitter"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/49z065s3","frozenauthors":[{"first_name":"Amanda","middle_name":"L.","last_name":"Webb","name_suffix":"","institution":"University of Kentucky College of Medicine, Lexington, Kentucky","department":"None"},{"first_name":"Adam","middle_name":"","last_name":"Dugan","name_suffix":"","institution":"University of Kentucky","department":"None"},{"first_name":"Woodrow","middle_name":"","last_name":"Burchett","name_suffix":"","institution":"University of Kentucky, Department of Statistics, Lexington, Kentucky","department":"None"},{"first_name":"Kelly","middle_name":"","last_name":"Barnett","name_suffix":"","institution":"University of Kentucky, Department of Statistics, Lexington, Kentucky","department":"None"},{"first_name":"Nishi","middle_name":"","last_name":"Patel","name_suffix":"","institution":"University of Kentucky, Department of Statistics, Lexington, Kentucky","department":"None"},{"first_name":"Scott","middle_name":"","last_name":"Morehead","name_suffix":"","institution":"University of Kentucky, Department of Statistics, Lexington, Kentucky","department":"None"},{"first_name":"Mark","middle_name":"","last_name":"Silverberg","name_suffix":"","institution":"University of Kentucky, Department of Emergency Medicine, Lexington, Kentucky","department":"None"},{"first_name":"Christopher","middle_name":"","last_name":"Doty","name_suffix":"","institution":"University of Kentucky, Department of Emergency Medicine, Lexington, Kentucky","department":"None"},{"first_name":"Brian","middle_name":"","last_name":"Adkins","name_suffix":"","institution":"University of Kentucky, Department of Emergency Medicine, Lexington, Kentucky","department":"None"},{"first_name":"Lauren","middle_name":"","last_name":"Falvo","name_suffix":"","institution":"University of Kentucky College of Medicine, Lexington, Kentucky","department":"None"}],"date_submitted":"2015-10-05T23:38:47-04:00","date_accepted":"2015-10-05T23:38:47-04:00","date_published":"2015-11-12T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/9389/galley/5278/download/"}]},{"pk":8991,"title":"Effect of Doximity Residency Rankings on Residency Applicants’ Program Choices","subtitle":null,"abstract":"Introduction:\n Choosing a residency program is a stressful and important decision. Doximity released residency program rankings by specialty in September 2014. This study sought to investigate the impact of those rankings on residency application choices made by fourth year medical students.\nMethods:\n A 12-item survey was administered in October 2014 to fourth year medical students at three schools. Students indicated their specialty, awareness of and perceived accuracy of the rankings, and the rankings’ impact on the programs to which they chose to apply. Descriptive statistics were reported for all students and those applying to Emergency Medicine (EM). \nResults:\n A total of 461 (75.8%) students responded, with 425 applying in one of the 20 Doximity ranked specialties. Of the 425, 247 (58%) were aware of the rankings and 177 looked at them. On a 1-100 scale (100=very accurate), students reported a mean ranking accuracy rating of 56.7 (SD 20.3). Forty-five percent of students who looked at the rankings modified the number of programs to which they applied. The majority added programs. Of the 47 students applying to EM, 18 looked at the rankings and 33% changed their application list with most adding programs.\nConclusion:\n The Doximity rankings had real effects on students applying to residencies as almost half of students who looked at the rankings modified their program list. Additionally, students found the rankings to be moderately accurate. Graduating students might benefit from emphasis on more objective characterization of programs to assess in light of their own interests and personal/career goals.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Internship and Residency"},{"word":"Students, Medical"},{"word":"Education, Medical"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/70n3n49x","frozenauthors":[{"first_name":"Aimee","middle_name":"","last_name":"Rolston","name_suffix":"","institution":"","department":"None"},{"first_name":"Sarah","middle_name":"E.","last_name":"Hartley","name_suffix":"","institution":"University of Michigan Medical School, Department of Internal Medicine, Ann Arbor, Michigan","department":"None"},{"first_name":"Sorabh","middle_name":"","last_name":"Khandelwal","name_suffix":"","institution":"Ohio State University, Department of Emergency Medicine, Columbus, Ohio","department":"None"},{"first_name":"Jenny","middle_name":"G.","last_name":"Christner","name_suffix":"","institution":"Upstate Medical University, Department of Pediatrics, Syracuse, New York; Baylor College of Medicine, Houstion, Texas","department":"None"},{"first_name":"Debbie","middle_name":"F.","last_name":"Cheng","name_suffix":"","institution":"University of Michigan Medical School, Ann Arbor, Michigan","department":"None"},{"first_name":"Rachel","middle_name":"M.","last_name":"Caty","name_suffix":"","institution":"University of Michigan, School of Public Health, Ann Arbor, Michigan","department":"None"},{"first_name":"Sally","middle_name":"A.","last_name":"Santen","name_suffix":"","institution":"University of Michigan Medical School, Department of Emergency Medicine, Ann Arbor, Michigan","department":"None"}],"date_submitted":"2015-05-02T22:11:17-04:00","date_accepted":"2015-05-02T22:11:17-04:00","date_published":"2015-11-12T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8991/galley/5076/download/"}]},{"pk":8923,"title":"Emergency Medicine Residents Consistently Rate Themselves Higher than Attending Assessments on ACGME Milestones","subtitle":null,"abstract":"Introduction:\n In 2012 the Accreditation Council for Graduate Medical Education (ACGME) introduced the Next Accreditation System (NAS), which implemented milestones to assess the competency of residents and fellows. While attending evaluation and feedback is crucial for resident development, perhaps equally important is a resident’s self-assessment. If a resident does not accurately self-assess, clinical and professional progress may be compromised. The objective of our study was to compare emergency medicine (EM) resident milestone evaluation by EM faculty with the same resident’s self-assessment. \nMethods:\n This is an observational, cross-sectional study that was performed at an academic, four-year EM residency program. Twenty-five randomly chosen residents completed milestone self-assessment using eight ACGME sub-competencies deemed by residency leadership as representative of core EM principles. These residents were also evaluated by 20 faculty members. The milestone levels were evaluated on a nine-point scale. We calculated the average difference between resident self-ratings and faculty ratings, and used sample t-tests to determine statistical significance of the difference in scores.\nResults:\n Eighteen residents evaluated themselves. Each resident was assessed by an average of 16 attendings (min=10, max=20). Residents gave themselves statistically significant higher milestone ratings than attendings did for each sub-competency examined (p<0.0001).\nConclusion:\n Residents over-estimated their abilities in every sub-competency assessed. This underscores the importance of feedback and assessment transparency. More attention needs to be paid to methods by which residency leadership can make residents’ self-perception of their clinical ability more congruent with that of their teachers and evaluators. The major limitation of our study is small sample size of both residents and attendings.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Emergency Medicine Milestones, Resident Education, Resident Assessment , Resident self-assessment"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4z389720","frozenauthors":[{"first_name":"Katja","middle_name":"","last_name":"Goldflam","name_suffix":"","institution":"Yale University School of Medicine, Department of Emergency Medicine, New Haven, Connecticut","department":"None"},{"first_name":"Jessica","middle_name":"","last_name":"Bod","name_suffix":"","institution":"Yale University School of Medicine, Department of Emergency Medicine, New Haven, Connecticut","department":"None"},{"first_name":"David","middle_name":"","last_name":"Della- Giustina","name_suffix":"","institution":"Yale University School of Medicine, Department of Emergency Medicine, New Haven, Connecticut","department":"None"},{"first_name":"Alina","middle_name":"","last_name":"Tsyrulnik","name_suffix":"","institution":"Yale University School of Medicine, Department of Emergency Medicine, New Haven, Connecticut","department":"None"}],"date_submitted":"2015-04-29T18:38:22-04:00","date_accepted":"2015-04-29T18:38:22-04:00","date_published":"2015-11-12T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8923/galley/5058/download/"}]},{"pk":8919,"title":"How Does Emergency Department Crowding Affect Medical Student Test Scores and Clerkship Evaluations?","subtitle":null,"abstract":"Introduction:\n The effect of emergency department (ED) crowding has been recognized as a concern for more than 20 years; its effect on productivity, medical errors, and patient satisfaction has been studied extensively. Little research has reviewed the effect of ED crowding on medical education. Prior studies that have considered this effect have shown no correlation between ED crowding and resident perception of quality of medical education.\nObjective:\n To determine whether ED crowding, as measured by the National ED Overcrowding Scale (NEDOCS) score, has a quantifiable effect on medical student objective and subjective experiences during emergency medicine (EM) clerkship rotations.\nMethods:\n We collected end-of-rotation examinations and medical student evaluations for 21 EM rotation blocks between July 2010 and May 2012, with a total of 211 students. NEDOCS scores were calculated for each corresponding period. Weighted regression analyses examined the correlation between components of the medical student evaluation, student test scores, and the NEDOCS score for each period.\nResults:\n When all 21 rotations are included in the analysis, NEDOCS scores showed a negative correlation with medical student tests scores (regression coefficient= -0.16, p=0.04) and three elements of the rotation evaluation (attending teaching, communication, and systems-based practice; p<0.05). We excluded an outlying NEDOCS score from the analysis and obtained similar results. When the data were controlled for effect of month of the year, only student test score remained significantly correlated with NEDOCS score (p=0.011). No part of the medical student rotation evaluation attained significant correlation with the NEDOCS score (p≥0.34 in all cases).\nConclusion:\n ED overcrowding does demonstrate a small but negative association with medical student performance on end-of-rotation examinations. Additional studies are recommended to further evaluate this effect.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"ED overcrowding, medical student education"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1dv102dm","frozenauthors":[{"first_name":"Grant","middle_name":"","last_name":"Wei","name_suffix":"","institution":"Rutgers Robert Wood Johnson Medical School, Department of Emergency Medicine, New Brunswick, New Jersey","department":"None"},{"first_name":"Rajiv","middle_name":"","last_name":"Arya","name_suffix":"","institution":"Rutgers Robert Wood Johnson Medical School, Department of Emergency Medicine, New Brunswick, New Jersey","department":"None"},{"first_name":"Z.","middle_name":"Trevor","last_name":"Ritz","name_suffix":"","institution":"Rutgers Robert Wood Johnson Medical School, Department of Emergency Medicine, New Brunswick, New Jersey","department":"None"},{"first_name":"Albert","middle_name":"S.","last_name":"He","name_suffix":"","institution":"Rutgers Robert Wood Johnson Medical School, Department of Emergency Medicine, New Brunswick, New Jersey","department":"None"},{"first_name":"Pamela","middle_name":"A.","last_name":"Ohman-Strickland","name_suffix":"","institution":"Rutgers School of Public Health, Department of Biostatistics, New Brunswick, New Jersey","department":"None"},{"first_name":"Jonathan","middle_name":"V.","last_name":"McCoy","name_suffix":"","institution":"Rutgers Robert Wood Johnson Medical School, Department of Emergency Medicine, New Brunswick, New Jersey","department":"None"}],"date_submitted":"2015-04-30T01:02:20-04:00","date_accepted":"2015-04-30T01:02:20-04:00","date_published":"2015-11-12T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8919/galley/5057/download/"}]},{"pk":8836,"title":"Implementation of an Education Value Unit (EVU)  System to Recognize Faculty Contributions","subtitle":null,"abstract":"Introduction:\n Faculty educational contributions are hard to quantify, but in an era of limited resources it is essential to link funding with effort. The purpose of this study was to determine the feasibility of an educational value unit (EVU) system in an academic emergency department and to examine its effect on faculty behavior, particularly on conference attendance and completion of trainee evaluations.\nMethods: \nA taskforce representing education, research, and clinical missions was convened to develop a method of incentivizing productivity for an academic emergency medicine faculty. Domains of educational contributions were defined and assigned a value based on time expended. A 30-hour EVU threshold for achievement was aligned with departmental goals. Targets included educational presentations, completion of trainee evaluations and attendance at didactic conferences. We analyzed comparisons of performance during the year preceding and after implementation.\nResults:\n Faculty (N=50) attended significantly more didactic conferences (22.7 hours v. 34.5 hours, p<0.005) and completed more trainee evaluations (5.9 v. 8.8 months, p<0.005). During the pre-implementation year, 84% (42/50) met the 30-hour threshold with 94% (47/50) meeting post-implementation (p=0.11). Mean total EVUs increased significantly (94.4 hours v. 109.8 hours, p=0.04) resulting from increased conference attendance and evaluation completion without a change in other categories.\nConclusion:\n In a busy academic department there are many work allocation pressures. An EVU system integrated with an incentive structure to recognize faculty contributions increases the importance of educational responsibilities. We propose an EVU model that could be implemented and adjusted for differing departmental priorities at other academic departments.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Residency, evaluation, faculty, incentive, education"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6t29728n","frozenauthors":[{"first_name":"Joseph","middle_name":"","last_name":"House","name_suffix":"","institution":"University of Michigan Medical School, Department of Emergency Medicine Children’s Emergency Services, Ann Arbor, Michigan","department":"None"},{"first_name":"Sally","middle_name":"A.","last_name":"Santen","name_suffix":"","institution":"University of Michigan Medical School, Department of Emergency Medicine, Department of Learning Health Sciences, Ann Arbor, Michigan","department":"None"},{"first_name":"Michele","middle_name":"","last_name":"Nypaver","name_suffix":"","institution":"University of Michigan Medical School, Department of Emergency Medicine Children’s Emergency Services, Ann Arbor, Michigan","department":"None"},{"first_name":"Michele","middle_name":"","last_name":"Carney","name_suffix":"","institution":"University of Michigan Medical School, Department of Emergency Medicine Children’s Emergency Services, Ann Arbor, Michigan","department":"None"},{"first_name":"Jonathan","middle_name":"P.","last_name":"Fischer","name_suffix":"","institution":"University of Michigan, School of Public Health, Ann Arbor, Michigan","department":"None"},{"first_name":"Laura","middle_name":"R.","last_name":"Hopson","name_suffix":"","institution":"University of Michigan Medical School, Department of Emergency Medicine Children’s Emergency Services, Ann Arbor, Michigan; University of Michigan Medical School, Department of Emergency Medicine, Ann Arbor, Michigan","department":"None"}],"date_submitted":"2015-04-01T10:33:05-04:00","date_accepted":"2015-04-01T10:33:05-04:00","date_published":"2015-11-12T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8836/galley/5039/download/"}]},{"pk":8897,"title":"Integration of a Blog into an Emergency Medicine Residency Curriculum","subtitle":null,"abstract":"N/A","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"blog"},{"word":"graduate medical education, FOAM"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/7b37k7wh","frozenauthors":[{"first_name":"Jay","middle_name":"","last_name":"Khadpe","name_suffix":"","institution":"SUNY Downstate Medical Center, Department of Emergency Medicine, Brooklyn, New York","department":"None"},{"first_name":"James","middle_name":"","last_name":"Willis","name_suffix":"","institution":"SUNY Downstate Medical Center, Department of Emergency Medicine, Brooklyn, New York","department":"None"},{"first_name":"Mark","middle_name":"A.","last_name":"Silverberg","name_suffix":"","institution":"SUNY Downstate Medical Center, Department of Emergency Medicine, Brooklyn, New York","department":"None"},{"first_name":"Andrew","middle_name":"","last_name":"Grock","name_suffix":"","institution":"SUNY Downstate Medical Center, Department of Emergency Medicine, Brooklyn, New York","department":"None"},{"first_name":"Teresa","middle_name":"","last_name":"Smith","name_suffix":"","institution":"SUNY Downstate Medical Center, Department of Emergency Medicine, Brooklyn, New York","department":"None"}],"date_submitted":"2015-04-27T14:01:28-04:00","date_accepted":"2015-04-27T14:01:28-04:00","date_published":"2015-11-12T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8897/galley/5055/download/"}]},{"pk":8928,"title":"Introducing Medical Students into the Emergency Department: The Impact upon Patient Satisfaction","subtitle":null,"abstract":"Introduction:\n Performance on patient satisfaction surveys is becoming increasingly important for practicing emergency physicians and the introduction of learners into a new clinical environment may impact such scores. This study aimed to quantify the impact of introducing fourth-year medical students on patient satisfaction in two university-affiliated community emergency departments (EDs).\nMethods:\n Two community-based EDs in the Indiana University Health (IUH) system began hosting medical students in March 2011 and October 2013, respectively. We analyzed responses from patient satisfaction surveys at each site for seven months before and after the introduction of students. Two components of the survey, “Would you recommend this ED to your friends and family?” and “How would you rate this facility overall?” were selected for analysis, as they represent the primary questions reviewed by the Center for Medicare Services (CMS) as part of value-based purchasing. We evaluated the percentage of positive responses for adult, pediatric, and all patients combined.\nResults:\n Analysis did not reveal a statistically significant difference in the percentage of positive response for the “would you recommend” question at both clinical sites with regards to the adult and pediatric subgroups, as well as the all-patient group. At one of the sites, there was significant improvement in the percentage of positive response to the “overall rating” question following the introduction of medical students when all patients were analyzed (60.3% to 68.2%, p=0.038). However, there was no statistically significant difference in the “overall rating” when the pediatric or adult subgroups were analyzed at this site and no significant difference was observed in any group at the second site. \nConclusion:\n The introduction of medical students in two community-based EDs is not associated with a statistically significant difference in overall patient satisfaction, but was associated with a significant positive effect on the overall rating of the ED at one of the two clinical sites studied. Further study is needed to evaluate the effect of medical student learners upon patient satisfaction in settings outside of a single health system.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"patient satisfaction"},{"word":"Emergency Medicine"},{"word":"students"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2cv696q0","frozenauthors":[{"first_name":"Christopher","middle_name":"","last_name":"Kiefer","name_suffix":"","institution":"West Virginia University School of Medicine, Department of Emergency Medicine, Morgantown, West Virginia","department":"None"},{"first_name":"Joseph","middle_name":"S.","last_name":"Turner","name_suffix":"","institution":"Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana","department":"None"},{"first_name":"Shelley","middle_name":"M.","last_name":"Layman","name_suffix":"","institution":"West Virginia University School of Medicine, Department of Emergency Medicine, Morgantown, West Virginia","department":"None"},{"first_name":"Stephen","middle_name":"M.","last_name":"Davis","name_suffix":"","institution":"West Virginia University School of Medicine, Department of Emergency Medicine, Morgantown, West Virginia","department":"None"},{"first_name":"Bart","middle_name":"R.","last_name":"Besinger","name_suffix":"","institution":"Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana","department":"None"},{"first_name":"Aloysius","middle_name":"","last_name":"Humbert","name_suffix":"","institution":"Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana","department":"None"}],"date_submitted":"2015-05-01T10:49:25-04:00","date_accepted":"2015-05-01T10:49:25-04:00","date_published":"2015-11-12T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8928/galley/5059/download/"}]},{"pk":9459,"title":"Masthead November 2015","subtitle":null,"abstract":"","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Masthead","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4kh9j4wd","frozenauthors":[{"first_name":"Patrick","middle_name":"","last_name":"Penalosa","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2015-11-11T20:03:23-05:00","date_accepted":"2015-11-11T20:03:23-05:00","date_published":"2015-11-12T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/9459/galley/5298/download/"}]},{"pk":8965,"title":"Medical Student Performance on the National Board of Medical Examiners Emergency Medicine Advanced Clinical Examination and the National Emergency Medicine M4 Exams","subtitle":null,"abstract":"Introduction:\n In April 2013, the National Board of Medical Examiners (NBME) released an Advanced Clinical Examination (ACE) in emergency medicine (EM). In addition to this new resource, CDEM (Clerkship Directors in EM) provides two online, high-quality, internally validated examinations. National usage statistics are available for all three examinations, however, it is currently unknown how students entering an EM residency perform as compared to the entire national cohort. This information may help educators interpret examination scores of both EM-bound and non-EM-bound students.\nObjectives:\n The objective of this study was to compare EM clerkship examination performance between students who matched into an EM residency in 2014 to students who did not. We made comparisons were made using the EM-ACE and both versions of the National fourth year medical student (M4) EM examinations.\nMethod:\n In this retrospective multi-institutional cohort study, the EM-ACE and either Version 1 (V1) or 2 (V2) of the National EM M4 examination was given to students taking a fourth-year EM rotation at five institutions between April 2013 to February 2014. We collected examination performance, including the scaled EM-ACE score, and percent correct on the EM M4 exams, and 2014 NRMP Match status. Student t-tests were performed on the examination averages of students who matched in EM as compared with those who did not.\nResults:\n A total of 606 students from five different institutions took both the EM-ACE and one of the EM M4 exams; 94 (15.5%) students matched in EM in the 2014 Match. The mean score for EM-bound students on the EM-ACE, V1 and V2 of the EM M4 exams were 70.9 (n=47, SD=9.0), 84.4 (n=36, SD=5.2), and 83.3 (n=11, SD=6.9), respectively. Mean scores for non-EM-bound students were 68.0 (n=256, SD=9.7), 82.9 (n=243, SD=6.5), and 74.5 (n=13, SD=5.9). There was a significant difference in mean scores in EM-bound and non-EM-bound student for the EM-ACE (p=0.05) and V2 (p<0.01) but not V1 (p=0.18) of the National EM M4 examination.\nConclusion:\n Students who successfully matched in EM performed better on all three exams at the end of their EM clerkship.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"National Board of Medical Examiners (NBME) Advanced Clinical Examination (EM-ACE)"},{"word":"National EM M4 examination, emergency medicine, emergency medicine clerkship, National Residency Matching Program (NRMP)"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1tc3s876","frozenauthors":[{"first_name":"Katherine","middle_name":"","last_name":"Hiller","name_suffix":"","institution":"University of Arizona School of Medicine, Department of Emergency Medicine, Tucson, Arizona","department":"None"},{"first_name":"Joseph","middle_name":"","last_name":"House","name_suffix":"","institution":"University of Michigan School of Medicine, Department of Emergency Medicine, Ann Arbor, Michigan","department":"None"},{"first_name":"Luan","middle_name":"","last_name":"Lawson","name_suffix":"","institution":"East Carolinas University Brody School of Medicine, Department of Emergency Medicine, Greenville, North Carolina","department":"None"},{"first_name":"Stacey","middle_name":"","last_name":"Poznanski","name_suffix":"","institution":"Wright State University School of Medicine, Department of Emergency Medicine, Dayton, Ohio","department":"None"},{"first_name":"Thomas","middle_name":"K.","last_name":"Morrissey","name_suffix":"","institution":"University of Florida School of Medicine-Jacksonville, Department of Emergency Medicine, Jacksonville, Florida","department":"None"}],"date_submitted":"2015-05-01T13:01:50-04:00","date_accepted":"2015-05-01T13:01:50-04:00","date_published":"2015-11-12T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8965/galley/5071/download/"}]},{"pk":8886,"title":"Mentoring during Medical School and Match Outcome among Emergency Medicine Residents","subtitle":null,"abstract":"Introduction:\n Few studies have documented the value of mentoring for medical students, and research has been limited to more subjective (e.g., job satisfaction, perceived career preparation) rather than objective outcomes. This study examined whether having a mentor is associated with match outcome (where a student matched based on their rank order list [ROL]).\nMethods:\n We sent a survey link to all emergency medicine (EM) program coordinators to distribute to their residents. EM residents were surveyed about whether they had a mentor during medical school. Match outcome was assessed by asking residents where they matched on their ROL (e.g., first choice, fifth choice). They were also asked about rank in medical school, type of degree (MD vs. DO), and performance on standardized tests. Residents who indicated having a mentor completed the Mentorship Effectiveness Scale (MES), which evaluates behavioral characteristics of the mentor and yields a total score. We assessed correlations among these variables using Pearson’s correlation coefficient. Post-hoc analysis using independent sample t-test was conducted to compare differences in the MES score between those who matched to their first or second choice vs. third or higher choice.\nResults:\n Participants were a convenience sample of 297 EM residents. Of those, 199 (67%) reported having a mentor during medical school. Contrary to our hypothesis, there was no significant correlation between having a mentor and match outcome (r=0.06, p=0.29). Match outcome was associated with class rank (r=0.13, p=0.03), satisfaction with match outcome (r= -0.37, p<0.001), and type of degree (r=0.12, p=0.04). Among those with mentors, a t-test revealed that the MES score was significantly higher among those who matched to their first or second choice (M=51.31, SD=10.13) compared to those who matched to their third or higher choice (M=43.59, SD=17.12), t(194)=3.65, p<0.001, d=0.55.\nConclusion:\n Simply having a mentor during medical school does not impact match outcome, but having an effective mentor is associated with a more favorable match outcome among medical students applying to EM programs.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"mentoring, emergency medicine, residents"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/87w3x2p1","frozenauthors":[{"first_name":"Erin","middle_name":"","last_name":"Dehon","name_suffix":"","institution":"University of Mississippi Medical Center, Department of Emergency Medicine, Jackson, Mississippi","department":"None"},{"first_name":"Margaret","middle_name":"H.","last_name":"Cruse","name_suffix":"","institution":"University of Mississippi Medical Center, Department of Emergency Medicine, Jackson, Mississippi","department":"None"},{"first_name":"Brandon","middle_name":"","last_name":"Dawson","name_suffix":"","institution":"University of Mississippi Medical Center, Department of Emergency Medicine, Jackson, Mississippi","department":"None"},{"first_name":"Loretta","middle_name":"","last_name":"Jackson-Williams","name_suffix":"","institution":"University of Mississippi Medical Center, Department of Emergency Medicine, Jackson, Mississippi","department":"None"}],"date_submitted":"2015-04-24T16:44:22-04:00","date_accepted":"2015-04-24T16:44:22-04:00","date_published":"2015-11-12T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8886/galley/5053/download/"}]},{"pk":8966,"title":"Model for Developing Educational Research Productivity:  The Medical Education Research Group","subtitle":null,"abstract":"Introduction:\n Education research and scholarship are essential for promotion of faculty as well as dissemination of new educational practices. Educational faculty frequently spend the majority of their time on administrative and educational commitments and as a result educators often fall behind on scholarship and research. The objective of this educational advance is to promote scholarly productivity as a template for others to follow.\nMethods:\n We formed the Medical Education Research Group (MERG) of education leaders from our emergency medicine residency, fellowship, and clerkship programs, as well as residents with a focus on education. First, we incorporated scholarship into the required activities of our education missions by evaluating the impact of programmatic changes and then submitting the curricula or process as peer-reviewed work. Second, we worked as a team, sharing projects that led to improved motivation, accountability, and work completion. Third, our monthly meetings served as brainstorming sessions for new projects, research skill building, and tracking work completion. Lastly, we incorporated a work-study graduate student to assist with basic but time-consuming tasks of completing manuscripts.\nResults:\n The MERG group has been highly productive, achieving the following scholarship over a three-year period: 102 abstract presentations, 46 journal article publications, 13 MedEd Portal publications, 35 national didactic presentations and five faculty promotions to the next academic level.\nConclusion:\n An intentional focus on scholarship has led to a collaborative group of educators successfully improving their scholarship through team productivity, which ultimately leads to faculty promotions and dissemination of innovations in education.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9cd0b46m","frozenauthors":[{"first_name":"Marcia","middle_name":"","last_name":"Perry","name_suffix":"","institution":"University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan","department":"None"},{"first_name":"Laura","middle_name":"","last_name":"Hopson","name_suffix":"","institution":"University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan","department":"None"},{"first_name":"Joseph","middle_name":"B.","last_name":"House","name_suffix":"","institution":"University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan","department":"None"},{"first_name":"Jonathan","middle_name":"P.","last_name":"Fischer","name_suffix":"","institution":"University of Michigan, Department of Public Health, Ann Arbor, Michigan","department":"None"},{"first_name":"Suzanne","middle_name":"","last_name":"Dooley-Hash","name_suffix":"","institution":"University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan","department":"None"},{"first_name":"Samantha","middle_name":"","last_name":"Hauff","name_suffix":"","institution":"University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan","department":"None"},{"first_name":"Margaret","middle_name":"S.","last_name":"Wolff","name_suffix":"","institution":"University of Michigan, Department of Emergency Medicine, Children’s Emergency Services, Ann Arbor, Michigan","department":"None"},{"first_name":"Cemal","middle_name":"","last_name":"Sozener","name_suffix":"","institution":"University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan","department":"None"},{"first_name":"Michele","middle_name":"","last_name":"Nypaver","name_suffix":"","institution":"University of Michigan, Department of Emergency Medicine, Children’s Emergency Services, Ann Arbor, Michigan","department":"None"},{"first_name":"Joel","middle_name":"","last_name":"Moll","name_suffix":"","institution":"University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan","department":"None"},{"first_name":"Eve","middle_name":"D.","last_name":"Losman","name_suffix":"","institution":"University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan","department":"None"},{"first_name":"Michele","middle_name":"","last_name":"Carney","name_suffix":"","institution":"University of Michigan, Department of Emergency Medicine, Children’s Emergency Services, Ann Arbor, Michigan","department":"None"},{"first_name":"Sally","middle_name":"A.","last_name":"Santen","name_suffix":"","institution":"University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan","department":"None"}],"date_submitted":"2015-05-01T14:53:19-04:00","date_accepted":"2015-05-01T14:53:19-04:00","date_published":"2015-11-12T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8966/galley/5072/download/"}]},{"pk":8961,"title":"Ready for Discharge? A Survey of Discharge Transition-of-Care Education and Evaluation in Emergency  Medicine Residency Programs","subtitle":null,"abstract":"This study aimed to assess current education and practices of emergency medicine (EM) residents as perceived by EM program directors to determine if there are deficits in resident discharge handoff training. This survey study was guided by the Kern model for medical curriculum development. A six-member Council of EM Residency Directors (CORD) Transitions of Care task force of EM physicians performed these steps and constructed a survey. The survey was distributed to program residency directors via the CORD listserve and/or direct contact. There were 119 responses to the survey, which were collected using an online survey tool. Over 71% of the 167 American College of Graduate Medical Education (ACGME) accredited EM residency programs were represented. Of those responding, 42.9% of programs reported formal training regarding discharges during initial orientation and 5.9% reported structured curriculum outside of orientation. A majority (73.9%) of programs reported that EM residents were not routinely evaluated on their discharge proficiency. Despite the ACGME requirements requiring formal handoff curriculum and evaluation, many programs do not provide formal curriculum on the discharge transition of care or evaluate EM residents on their discharge proficiency.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"discharge, transitions of care"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8p68w77q","frozenauthors":[{"first_name":"Fiona","middle_name":"E.","last_name":"Gallahue","name_suffix":"","institution":"The University of Washington, Division of Emergency Medicine, Seattle, Washington","department":"None"},{"first_name":"Amy","middle_name":"E.","last_name":"Betz","name_suffix":"","institution":"The University of Washington, Division of Emergency Medicine, Seattle, Washington","department":"None"},{"first_name":"Jeffrey","middle_name":"","last_name":"Druck","name_suffix":"","institution":"The University of Mississippi Medical Center, Department of Emergency Medicine, Jackson, Mississippi","department":"None"},{"first_name":"Jonathan","middle_name":"S.","last_name":"Jones","name_suffix":"","institution":"The University of Mississippi Medical Center, Department of Emergency Medicine, Jackson, Mississippi","department":"None"},{"first_name":"Boyd","middle_name":"","last_name":"Burns","name_suffix":"","institution":"The University of Oklahoma School of Community Medicine,Tulsa, Oklahoma","department":"None"},{"first_name":"Gene","middle_name":"","last_name":"Hern","name_suffix":"","institution":"Alameda Hospital System-Highland Hospital, Department of Emergency Medicine, Oakland, California","department":"None"}],"date_submitted":"2015-05-01T02:27:29-04:00","date_accepted":"2015-05-01T02:27:29-04:00","date_published":"2015-11-12T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8961/galley/5068/download/"}]},{"pk":9458,"title":"Table of Contents","subtitle":null,"abstract":"n/a","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Table of Contents","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9tz2q7z0","frozenauthors":[{"first_name":"Patrick","middle_name":"","last_name":"Penalosa","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2015-11-11T19:40:42-05:00","date_accepted":"2015-11-11T19:40:42-05:00","date_published":"2015-11-12T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/9458/galley/5297/download/"}]},{"pk":8964,"title":"Teaching Emotional Intelligence: A Control Group Study of a Brief Educational Intervention for Emergency Medicine Residents","subtitle":null,"abstract":"Introduction:\n Emotional Intelligence (EI) is defined as an ability to perceive another’s emotional state combined with an ability to modify one’s own. Physicians with this ability are at a distinct advantage, both in fostering teams and in making sound decisions. Studies have shown that higher physician EI’s are associated with lower incidence of burn-out, longer careers, more positive patient-physician interactions, increased empathy, and improved communication skills. We explored the potential for EI to be learned as a skill (as opposed to being an innate ability) through a brief educational intervention with emergency medicine (EM) residents.\nMethods:\n This study was conducted at a large urban EM residency program. Residents were randomized to either EI intervention or control groups. The intervention was a two-hour session focused on improving the skill of social perspective taking (SPT), a skill related to social awareness. Due to time limitations, we used a 10-item sample of the Hay 360 Emotional Competence Inventory to measure EI at three time points for the training group: before (pre) and after (post) training, and at six-months post training (follow up); and at two time points for the control group: pre- and follow up. The preliminary analysis was a four-way analysis of variance with one repeated measure: Group x Gender x Program Year over Time. We also completed post-hoc tests.\nResults:\n Thirty-three EM residents participated in the study (33 of 36, 92%), 19 in the EI intervention group and 14 in the control group. We found a significant interaction effect between Group and Time (p<0.05). Post-hoc tests revealed a significant increase in EI scores from Time 1 to 3 for the EI intervention group (62.6% to 74.2%), but no statistical change was observed for the controls (66.8% to 66.1%, p=0.77). We observed no main effects involving gender or level of training.\nConclusion:\n Our brief EI training showed a delayed but statistically significant positive impact on EM residents six months after the intervention involving SPT. One possible explanation for this finding is that residents required time to process and apply the EI skills training in order for us to detect measurable change. More rigorous measurement will be needed in future studies to aid in the interpretation of our findings.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Education, Medical, Graduate"},{"word":"Emotional Intelligence"},{"word":"program evaluation"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2w96q80g","frozenauthors":[{"first_name":"Diane","middle_name":"L.","last_name":"Gorgas","name_suffix":"","institution":"Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio","department":"None"},{"first_name":"Sarah","middle_name":"","last_name":"Greenberger","name_suffix":"","institution":"Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio","department":"None"},{"first_name":"David","middle_name":"P.","last_name":"Bahner","name_suffix":"","institution":"Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio","department":"None"},{"first_name":"David","middle_name":"P.","last_name":"Way","name_suffix":"","institution":"Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio","department":"None"}],"date_submitted":"2015-05-01T13:04:26-04:00","date_accepted":"2015-05-01T13:04:26-04:00","date_published":"2015-11-12T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8964/galley/5070/download/"}]},{"pk":8954,"title":"Ultrasound Training in the Emergency Medicine Clerkship","subtitle":null,"abstract":"Introduction: \nThe curriculum in most emergency medicine (EM) clerkships includes very little formalized training in point-of-care ultrasound. Medical schools have begun to implement ultrasound training in the pre-clinical curriculum, and the EM clerkship is an appropriate place to build upon this training. The objectives are (1) to evaluate the effectiveness of implementing a focused ultrasound curriculum within an established EM clerkship and (2) to obtain feedback from medical students regarding the program.\nMethods:\n We conducted a prospective cohort study of medical students during an EM clerkship year from July 1, 2011, to June 30, 2012. Participants included fourth-year medical students (n=45) enrolled in the EM clerkship at our institution. The students underwent a structured program focused on the focused assessment with sonography for trauma exam and ultrasound-guided vascular access. At the conclusion of the rotation, they took a 10-item multiple choice test assessing knowledge and image interpretation skills. A cohort of EM residents (n=20) also took the multiple choice test but did not participate in the training with the students. We used an independent samples t-test to examine differences in test scores between the groups.\nResults:\n The medical students in the ultrasound training program scored significantly higher on the multiple-choice test than the EM residents, t(63)=2.3, p<0.05. The feedback from the students indicated that 82.8% were using ultrasound on their current rotations and the majority (55.2%) felt that the one-on-one scanning shift was the most valuable aspect of the curriculum.\nDiscussion: \nOur study demonstrates support for an ultrasound training program for medical students in the EM clerkship. After completing the training, students were able to perform similarly to EM residents on a knowledge-based exam.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Ultrasound, Emergency Medicine Clerkship"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/19j3c2fq","frozenauthors":[{"first_name":"Mark","middle_name":"","last_name":"Favot","name_suffix":"","institution":"Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan","department":"None"},{"first_name":"Cheryl","middle_name":"","last_name":"Courage","name_suffix":"","institution":"Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan","department":"None"},{"first_name":"Jacob","middle_name":"","last_name":"Manteuffel","name_suffix":"","institution":"Henry Ford Health System, Department of Emergency Medicine, Detroit, Michigan","department":"None"},{"first_name":"David","middle_name":"","last_name":"Amponsah","name_suffix":"","institution":"Henry Ford Health System, Department of Emergency Medicine, Detroit, Michigan","department":"None"}],"date_submitted":"2015-04-30T22:29:27-04:00","date_accepted":"2015-04-30T22:29:27-04:00","date_published":"2015-11-12T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8954/galley/5066/download/"}]},{"pk":4693,"title":"Violence","subtitle":null,"abstract":"Throughout time, Egyptian sources display divergent attitudes towards violence expressing the belief that some situations of violence were positive and to be encouraged, while others were to be avoided. Sanctioned violence could be employed for a variety of reasons—the severity of which ranged from inflicting blows to gruesome death. Violence was part of the preternatural realm, notably as Egyptians attempted to thwart potential violence in the afterlife. While the average Egyptian was supposed to eschew violence, kings and their representatives were expected to engage in violent acts in many circumstances. Improper violence disturbed order while sanctioned violence restored it. While the types of sanctioned violence employed and the reasons for employing it changed over time, some attitudes about violence remained constant.","language":"en","license":null,"keywords":[{"word":"punishment, murder, rebellion, foreigner"}],"section":"Individual and Society","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9661n6rn","frozenauthors":[{"first_name":"Kerry","middle_name":"","last_name":"Muhlestein","name_suffix":"","institution":"Brigham Young University","department":"None"}],"date_submitted":"2009-03-28T12:55:29-04:00","date_accepted":"2009-03-28T12:55:29-04:00","date_published":"2015-11-12T03:00:00-05:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/nelc_uee/article/4693/galley/2657/download/"}]},{"pk":44081,"title":"A Case of Bilateral Diaphragmatic Paralysis","subtitle":null,"abstract":null,"language":"eng","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[{"word":"Clinical Vignette"}],"section":"Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8zw035tx","frozenauthors":[{"first_name":"David","middle_name":"","last_name":"Scott","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Jennifer","middle_name":"","last_name":"Michael","name_suffix":"MD","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2015-11-09T17:50:50-05:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/44081/galley/32884/download/"}]},{"pk":5357,"title":"A need for individual data analyses for assessments of temporal control: Invertebrate fixed interval performance","subtitle":null,"abstract":"We outline several experimental variables and addressed the inconsistencies of these variables within the invertebrate fixed interval literature. We posit previous inconsistencies within the invertebrate fixed interval literature may be due to the utilization of aggregate versus individual analyses and contend individual analyses are critical in order for conclusions to be made about species’ abilities to emit responses that can come under temporal control. To exemplify these statements, we exposed honey bees \nApis mellifera lingustica \n(N=13) to either an FI 15-sec or FI 30-sec schedule of reinforcement and analyzed subjects’ cumulative response records, response bin levels, quarter lives, inter-response time patterns, response duration patterns, and trial durations. No measures clearly indicated individual subjects’ responding came under temporal control of the fixed interval schedules; however, pooled group analyses did produce seemingly clear evidence of temporal control.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Honey bee"},{"word":"Apis mellifera lingustica"},{"word":"invertebrate"},{"word":"fixed interval"},{"word":"temporal control"},{"word":"timing"},{"word":"Observation Oriented Modeling"}],"section":"Special Issue on Timing and Time Perception","is_remote":true,"remote_url":"https://escholarship.org/uc/item/847557dt","frozenauthors":[{"first_name":"David","middle_name":"Philip Arthur","last_name":"Craig","name_suffix":"","institution":"Oklahoma State University","department":"None"},{"first_name":"Charles","middle_name":"I","last_name":"Abramson","name_suffix":"","institution":"Oklahoma State University","department":"None"}],"date_submitted":"2015-03-29T18:19:02-04:00","date_accepted":"2015-03-29T18:19:02-04:00","date_published":"2015-11-05T18:25:11-05:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uclapsych_ijcp/article/5357/galley/3214/download/"}]},{"pk":44080,"title":"Asymptomatic Colonic Tuberculosis in an Immunocompetent Patient","subtitle":null,"abstract":null,"language":"eng","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[{"word":"Clinical Vignette"}],"section":"Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1r38d6hd","frozenauthors":[{"first_name":"Nimah","middle_name":"N.","last_name":"Jamaluddin","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Guy","middle_name":"A.","last_name":"Weiss","name_suffix":"MD","institution":"","department":""},{"first_name":"Wendy","middle_name":"","last_name":"Ho","name_suffix":"MD, MPH","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2015-11-04T17:49:20-05:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/44080/galley/32883/download/"}]},{"pk":5359,"title":"Continuous Spontaneous Alternation and Turn Alternation in Artemia sp.","subtitle":null,"abstract":"Free-running spontaneous alternation\n refers to the animal’s tendency to prefer the least recently visited locations in successive spatial choices, which is attributed to the animals’ choice between stimuli based on prior experience.  \nTurn alternation\n, which is observed in directional choices preceded by a forced turn in one direction, also reflects the animals’ tendency to alternate between directional choices but this tendency has been assumed to rely on other cues (e.g., proprioceptive cues) derived from the prior responses (e.g., forced turn in one direction).  Based on previous studies, the turn alternation appears to rely on more primitive (lower-form) information features and to be a more frequently observed empirical phenomenon than the spontaneous alternation.  We investigated these two behavioral alternation tendencies in \nArtemia sp\n. Experiment 1 tested the continuous spontaneous alternation (cSAB) performance of \nArtemia\n \nsp.\n in two different mazes: t-maze (three options) and plus maze (four options).  Experiment 2 tested the turn alternation performance of \nArtemia\n \nsp. \ncounter-balancing the direction of initial forced-turn between subjects.  Our results showed that \nArtemia sp.\n had nearly chance level spontaneous alternation performance in the t-maze and plus maze whereas a higher than chance level turn alternation performance.  These results support the ubiquity of turn alternation tendency across species and point at the lack of spontaneous alternation in \nArtemia sp.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Artemia sp."},{"word":"Plus-maze"},{"word":"spontaneous alternation"},{"word":"T-maze"},{"word":"Turn Alternation"}],"section":"Research Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6pd1q4hh","frozenauthors":[{"first_name":"Can","middle_name":"","last_name":"Çarkoğlu","name_suffix":"","institution":"Koç University, Department of Psychology","department":"None"},{"first_name":"Meltem","middle_name":"","last_name":"Yılmaz","name_suffix":"","institution":"Koç University, Department of Psychology","department":"None"},{"first_name":"Fuat","middle_name":"","last_name":"Balcı","name_suffix":"","institution":"Koç University, Department of Psychology","department":"None"}],"date_submitted":"2015-04-08T10:38:27-04:00","date_accepted":"2015-04-08T10:38:27-04:00","date_published":"2015-11-04T11:05:48-05:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uclapsych_ijcp/article/5359/galley/3216/download/"}]},{"pk":5361,"title":"Subjective and Real Time: Coding Under Different Drug States","subtitle":null,"abstract":"Organisms are constantly extracting information from the temporal structure of the environment, which allows them to select appropriate actions and predict impending changes.  Several lines of research have suggested that interval timing is modulated by the dopaminergic system.  It has been proposed that higher levels of dopamine cause an internal clock to speed up, whereas less dopamine causes a deceleration of the clock.  In most experiments the subjects are first trained to perform a timing task while drug free.  Consequently, most of what is known about the influence of dopaminergic modulation of timing is on well-established timing performance.  In the current study the impact of altered DA on the acquisition of temporal control was the focal question.  Thirty male Sprague-Dawley rats were distributed randomly into three different groups (haloperidol, d-amphetamine or vehicle).  Each animal received an injection 15 min prior to the start of every session from the beginning of interval training.  The subjects were trained in a Fixed Interval (FI) 16s schedule followed by training on a peak procedure in which 64s non-reinforced peak trials were intermixed with FI trials.  In a final test session all subjects were given vehicle injections and 10 consecutive non-reinforced peak trials to see if training under drug conditions altered the encoding of time.  The current study suggests that administration of drugs that modulate dopamine do not alter the encoding temporal durations but do acutely affect the initiation of responding.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"timing"},{"word":"Temporal Information Processing"},{"word":"acquisition"},{"word":"Recall"},{"word":"Haloperidol"},{"word":"methamphetamine"},{"word":"dopamine"}],"section":"Special Issue on Timing and Time Perception","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6hf5t7zz","frozenauthors":[{"first_name":"Hugo","middle_name":"","last_name":"Sanchez-Castillo","name_suffix":"","institution":"Universidad Nacional Autonoma de Mexico","department":"None"},{"first_name":"Kathleen","middle_name":"M.","last_name":"Taylor","name_suffix":"","institution":"Department of Psychology\nColumbia University","department":"None"},{"first_name":"Ryan","middle_name":"D.","last_name":"Ward","name_suffix":"","institution":"Department of Psychology\nUniversity of Otago","department":"None"},{"first_name":"Diana","middle_name":"B.","last_name":"Paz-Trejo","name_suffix":"","institution":"Neuropsychopharmacology and Timing Lab.\nDepto. de Psicobiología y Neurociencias\nUniversidad Nacional Autónoma de México","department":"None"},{"first_name":"Maria","middle_name":"","last_name":"Arroyo-Araujo","name_suffix":"","institution":"Neuropsychopharmacology and Timing Lab.\nDepto. de Psicobiología y Neurociencias\nUniversidad Nacional Autónoma de México","department":"None"},{"first_name":"Oscar","middle_name":"","last_name":"Galicia Castillo","name_suffix":"","institution":"Laboratorio de Neurociencias\nUniversidad Iberoamericana","department":"None"},{"first_name":"Peter","middle_name":"D.","last_name":"Balsam","name_suffix":"","institution":"New York State Psychiatric Institute\nDepartment of Psychiatry\nColumbia University","department":"None"}],"date_submitted":"2015-04-14T15:05:41-04:00","date_accepted":"2015-04-14T15:05:41-04:00","date_published":"2015-11-02T17:26:36-05:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uclapsych_ijcp/article/5361/galley/3217/download/"}]},{"pk":44079,"title":"Urgent Renal Artery Stenting as Successful Treatment of Rapidly Progressive Anuric Renal Artery Stenosis in a Single-Kidney Patient","subtitle":null,"abstract":null,"language":"eng","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[{"word":"Clinical Vignette"}],"section":"Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1sr1v8g2","frozenauthors":[{"first_name":"Shanon","middle_name":"","last_name":"Peter","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"}],"date_submitted":null,"date_accepted":null,"date_published":"2015-10-30T18:47:57-04:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/44079/galley/32882/download/"}]},{"pk":44078,"title":"Iatrogenic Pulmonary Artery Rupture due to Pulmonary Artery Catheter Inflation","subtitle":null,"abstract":null,"language":"eng","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[{"word":"Clinical Vignette"}],"section":"Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8jv6k659","frozenauthors":[{"first_name":"Praveen","middle_name":"","last_name":"Panguluri","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Janki","middle_name":"","last_name":"Shah","name_suffix":"MD","institution":"","department":""},{"first_name":"Samuel","middle_name":"","last_name":"Daneshvar","name_suffix":"MD","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2015-10-29T18:46:12-04:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/44078/galley/32881/download/"}]},{"pk":44077,"title":"An Interesting Case of Cecal Bascule Causing Intestinal Obstruction","subtitle":null,"abstract":null,"language":"eng","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[{"word":"Clinical Vignette"}],"section":"Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4zc8375k","frozenauthors":[{"first_name":"Ramya","middle_name":"","last_name":"Malchira","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Rajan","middle_name":"H.","last_name":"Patel","name_suffix":"MD","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2015-10-28T18:44:22-04:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/44077/galley/32880/download/"}]},{"pk":9426,"title":"Sponsors and Advertising September 2015","subtitle":null,"abstract":"n/a","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Sponsors and Advertising","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5hj3f4h4","frozenauthors":[{"first_name":"Vincent","middle_name":"","last_name":"Lam","name_suffix":"","institution":"UC Irvine","department":"None"}],"date_submitted":"2015-10-23T18:35:22-04:00","date_accepted":"2015-10-23T18:35:22-04:00","date_published":"2015-10-23T18:37:09-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/9426/galley/5290/download/"}]},{"pk":9425,"title":"Masthead September 2015","subtitle":null,"abstract":"n/a","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Masthead","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2002c2gn","frozenauthors":[{"first_name":"Vincent","middle_name":"","last_name":"Lam","name_suffix":"","institution":"UC Irvine","department":"None"}],"date_submitted":"2015-10-23T18:30:57-04:00","date_accepted":"2015-10-23T18:30:57-04:00","date_published":"2015-10-23T18:31:12-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/9425/galley/5289/download/"}]},{"pk":9424,"title":"Table of Contents","subtitle":null,"abstract":"n/a","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Table of Contents","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0rb7s5xq","frozenauthors":[{"first_name":"Vincent","middle_name":"","last_name":"Lam","name_suffix":"","institution":"UC Irvine","department":"None"}],"date_submitted":"2015-10-23T18:17:03-04:00","date_accepted":"2015-10-23T18:17:03-04:00","date_published":"2015-10-23T18:17:34-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/9424/galley/5288/download/"}]},{"pk":8942,"title":"Are Live Ultrasound Models Replaceable? Traditional versus Simulated Education Module for FAST Exam","subtitle":null,"abstract":"Introduction:\n The focused assessment with sonography for trauma (FAST) is a commonly used and life-saving tool in the initial assessment of trauma patients. The recommended emergency medicine (EM) curriculum includes ultrasound and studies show the additional utility of ultrasound training for medical students. EM clerkships vary and often do not contain formal ultrasound instruction. Time constraints for facilitating lectures and hands-on learning of ultrasound are challenging. Limitations on didactics call for development and inclusion of novel educational strategies, such as simulation. The objective of this study was to compare the test, survey, and performance of ultrasound between medical students trained on an ultrasound simulator versus those trained via traditional, hands-on patient format.\nMethods:\n This was a prospective, blinded, controlled educational study focused on EM clerkship medical students. After all received a standardized lecture with pictorial demonstration of image acquisition, students were randomized into two groups: control group receiving traditional training method via practice on a human model and intervention group training via practice on an ultrasound simulator. Participants were tested and surveyed on indications and interpretation of FAST and training and confidence with image interpretation and acquisition before and after this educational activity. Evaluation of FAST skills was performed on a human model to emulate patient care and practical skills were scored via objective structured clinical examination (OSCE) with critical action checklist.\nResults:\n There was no significant difference between control group (N=54) and intervention group (N=39) on pretest scores, prior ultrasound training/education, or ultrasound comfort level in general or on FAST. All students (N=93) showed significant improvement from pre- to post-test scores and significant improvement in comfort level using ultrasound in general and on FAST (p<0.001). There was no significant difference between groups on OSCE scores of FAST on a live model. Overall, no differences were demonstrated between groups trained on human models versus simulator.Discussion: There was no difference between groups in knowledge based ultrasound test scores, survey of comfort levels with ultrasound, and students’ abilities to perform and interpret FAST on human models.\nConclusion:\n These findings suggest that an ultrasound simulator is a suitable alternative method for ultrasound education. Additional uses of ultrasound simulation should be explored in the future.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Simulation, ultrasound, trauma, emergency medicine"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3t9847h9","frozenauthors":[{"first_name":"Suzanne","middle_name":"","last_name":"Bentley","name_suffix":"","institution":"Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York City, New York; Elmhurst Hospital Center, Department of Emergency Medicine, Elmhurst, New York","department":"None"},{"first_name":"Gurpreet","middle_name":"","last_name":"Mudan","name_suffix":"","institution":"Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York City, New York","department":"None"},{"first_name":"Christopher","middle_name":"","last_name":"Strother","name_suffix":"","institution":"Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York City, New York","department":"None"},{"first_name":"Nelson","middle_name":"","last_name":"Wong","name_suffix":"","institution":"Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"}],"date_submitted":"2015-04-30T17:25:59-04:00","date_accepted":"2015-04-30T17:25:59-04:00","date_published":"2015-10-22T03:00:00-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8942/galley/5064/download/"}]},{"pk":9004,"title":"Assessing the Impact of Video-based Training on Laceration Repair: A Comparison to the Traditional Workshop Method","subtitle":null,"abstract":"N/A","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"suture"},{"word":"suturing"},{"word":"video"},{"word":"education"},{"word":"workshop"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/64c6k7kv","frozenauthors":[{"first_name":"Nicholas","middle_name":"","last_name":"Chien","name_suffix":"","institution":"University of Kentucky, Department of Emergency Medicine, Lexington, Kentucky","department":"None"},{"first_name":"Terren","middle_name":"","last_name":"Trott","name_suffix":"","institution":"University of Kentucky, Department of Emergency Medicine, Lexington, Kentucky","department":"None"},{"first_name":"Christopher","middle_name":"","last_name":"Doty","name_suffix":"","institution":"University of Kentucky, Department of Emergency Medicine, Lexington, Kentucky","department":"None"},{"first_name":"Brian","middle_name":"","last_name":"Adkins","name_suffix":"","institution":"University of Kentucky, Department of Emergency Medicine, Lexington, Kentucky","department":"None"}],"date_submitted":"2015-05-05T10:37:42-04:00","date_accepted":"2015-05-05T10:37:42-04:00","date_published":"2015-10-22T03:00:00-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/9004/galley/5084/download/"}]},{"pk":8857,"title":"Coordinating a Team Response to Behavioral Emergencies in the Emergency Department: A Simulation-Enhanced Interprofessional Curriculum","subtitle":null,"abstract":"Introduction:\n While treating potentially violent patients in the emergency department (ED), both patients and staff may be subject to unintentional injury. Emergency healthcare providers are at the greatest risk of experiencing physical and verbal assault from patients. Preliminary studies have shown that a team-based approach with targeted staff training has significant positive outcomes in mitigating violence in healthcare settings. Staff attitudes toward patient aggression have also been linked to workplace safety, but current literature suggests that providers experience fear and anxiety while caring for potentially violent patients. The objectives of the study were (1) to develop an interprofessional curriculum focusing on improving teamwork and staff attitudes toward patient violence using simulation-enhanced education for ED staff, and (2) to assess attitudes towards patient aggression both at pre- and post-curriculum implementation stages using a survey-based study design.\nMethods: \nFormal roles and responsibilities for each member of the care team, including positioning during restraint placement, were pre­defined in conjunction with ED leadership. Emergency medicine residents, nurses and hospital police officers were assigned to interprofessional teams. The curriculum started with an introductory lecture discussing de-escalation techniques and restraint placement as well as core tenets of interprofessional collaboration. Next, we conducted two simulation scenarios using standardized participants (SPs) and structured debriefing. The study consisted of a survey-based design comparing pre-­ and post-­intervention responses via a paired Student t-test to assess changes in staff attitudes. We used the validated Management of Aggression and Violence Attitude Scale (MAVAS) consisting of 30 Likert­-scale questions grouped into four themed constructs.\nResults:\n One hundred sixty-two ED staff members completed the course with >95% staff participation, generating a total of 106 paired surveys. Constructs for internal/biomedical factors, external/staff factors and situational/interactional perspectives on patient aggression significantly improved (p<0.0001, p<0.002, p<0.0001 respectively). Staff attitudes toward management of patient aggression did not significantly change (p=0.542). Multiple quality improvement initiatives were successfully implemented, including the creation of an interprofessional crisis management alert and response protocol. Staff members described appreciation for our simulation-based curriculum and welcomed the interaction with SPs during their training.\nConclusion:\n A structured simulation-enhanced interprofessional intervention was successful in improving multiple facets of ED staff attitudes toward behavioral emergency care.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Emergency Department violence"},{"word":"injury prevention"},{"word":"agitation"},{"word":"Agitated"},{"word":"De-escalation"},{"word":"Team Training"},{"word":"Interprofessional Education"},{"word":"IPE"},{"word":"Simulation"},{"word":"Medical Simulation"},{"word":"Simulation-Based Education"},{"word":"Emergency Medicine"},{"word":"Behavioral Emergencies"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1ps3c2hz","frozenauthors":[{"first_name":"Ambrose","middle_name":"H.","last_name":"Wong","name_suffix":"","institution":"Yale University School of Medicine, Department of Emergency Medicine, New Haven, Connecticut","department":"None"},{"first_name":"Lisa","middle_name":"","last_name":"Wing","name_suffix":"","institution":"Bellevue Hospital Center, Adult Emergency Services, New York, New York","department":"None"},{"first_name":"Brenda","middle_name":"","last_name":"Weiss","name_suffix":"","institution":"Bellevue Hospital Center, Hospital Police, New York, New York","department":"None"},{"first_name":"Maureen","middle_name":"","last_name":"Gang","name_suffix":"","institution":"New York University School of Medicine, Department of Emergency Medicine, New York, New York","department":"None"}],"date_submitted":"2015-04-10T17:04:47-04:00","date_accepted":"2015-04-10T17:04:47-04:00","date_published":"2015-10-22T03:00:00-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8857/galley/5045/download/"}]},{"pk":8957,"title":"Development and Implementation of an Emergency Medicine Podcast for Medical Students: EMIGcast","subtitle":null,"abstract":"N/A","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Emergency Medicine"},{"word":"Podcast"},{"word":"education"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5ds9v3kb","frozenauthors":[{"first_name":"Andrew","middle_name":"","last_name":"Lichtenheld","name_suffix":"","institution":"Oregon Health & Science University, Department of Emergency Medicine, Portland, Oregon","department":"None"},{"first_name":"Mari","middle_name":"","last_name":"Nomura","name_suffix":"","institution":"Oregon Health & Science University, Department of Emergency Medicine, Portland, Oregon","department":"None"},{"first_name":"Nicholas","middle_name":"","last_name":"Chapin","name_suffix":"","institution":"Oregon Health & Science University, Department of Emergency Medicine, Portland, Oregon","department":"None"},{"first_name":"Trenton","middle_name":"","last_name":"Burgess","name_suffix":"","institution":"Oregon Health & Science University, Department of Emergency Medicine, Portland, Oregon","department":"None"},{"first_name":"Joshua","middle_name":"","last_name":"Kornegay","name_suffix":"","institution":"Oregon Health & Science University, Department of Emergency Medicine, Portland, Oregon","department":"None"}],"date_submitted":"2015-05-01T00:33:57-04:00","date_accepted":"2015-05-01T00:33:57-04:00","date_published":"2015-10-22T03:00:00-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8957/galley/5067/download/"}]},{"pk":8967,"title":"Development of an Objective Structured Clinical  Examination for Assessment of Clinical Skills in an Emergency Medicine Clerkship","subtitle":null,"abstract":"N/A","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Objective Structured Clinical Exam, Emergency Medicine, Undergraduate Medical Education, Milestones"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4k76h35n","frozenauthors":[{"first_name":"Sharon","middle_name":"","last_name":"Bord","name_suffix":"","institution":"Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland","department":"None"},{"first_name":"Rodica","middle_name":"","last_name":"Retezar","name_suffix":"","institution":"Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland","department":"None"},{"first_name":"Pamela","middle_name":"","last_name":"McCann","name_suffix":"","institution":"Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland","department":"None"},{"first_name":"Julianna","middle_name":"","last_name":"Jung","name_suffix":"","institution":"Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland","department":"None"}],"date_submitted":"2015-05-01T22:28:52-04:00","date_accepted":"2015-05-01T22:28:52-04:00","date_published":"2015-10-22T03:00:00-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8967/galley/5073/download/"}]},{"pk":8939,"title":"Direct Observation Assessment of Milestones: Problems with Reliability","subtitle":null,"abstract":"Introduction:\n Emergency medicine (EM) milestones are used to assess residents’ progress. While some milestone validity evidence exists, there is a lack of standardized tools available to reliably assess residents. Inherent to this is a concern that we may not be truly measuring what we intend to assess. The purpose of this study was to design a direct observation milestone assessment instrument supported by validity and reliability evidence. In addition, such a tool would further lend validity evidence to the EM milestones by demonstrating their accurate measurement.\nMethods:\n This was a multi-center, prospective, observational validity study conducted at eight institutions. The Critical Care Direct Observation Tool (CDOT) was created to assess EM residents during resuscitations. This tool was designed using a modified Delphi method focused on content, response process, and internal structure validity. Paying special attention to content validity, the CDOT was developed by an expert panel, maintaining the use of the EM milestone wording. We built response process and internal consistency by piloting and revising the instrument. Raters were faculty who routinely assess residents on the milestones. A brief training video on utilization of the instrument was completed by all. Raters used the CDOT to assess simulated videos of three residents at different stages of training in a critical care scenario. We measured reliability using Fleiss’ kappa and interclass correlations.\nResults:\n Two versions of the CDOT were used: one used the milestone levels as global rating scales with anchors, and the second reflected a current trend of a checklist response system. Although the raters who used the CDOT routinely rate residents in their practice, they did not score the residents’ performances in the videos comparably, which led to poor reliability. The Fleiss’ kappa of each of the items measured on both versions of the CDOT was near zero.\nConclusion:\n The validity and reliability of the current EM milestone assessment tools have yet to be determined. This study is a rigorous attempt to collect validity evidence in the development of a direct observation assessment instrument. However, despite strict attention to validity evidence, inter-rater reliability was low. The potential sources of reducible variance include rater- and instrument-based error. Based on this study, there may be concerns for the reliability of other EM milestone assessment tools that are currently in use.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Emergency Medicine"},{"word":"Milestones, Validity, Reliability, Assessment Tools ABSTRACT: Objectives: The Emergency Medicine Milestones are being used to assess residents’ progress. Some validity evidence was collected when co.."},{"word":"however"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5qv670gp","frozenauthors":[{"first_name":"Meghan","middle_name":"","last_name":"Schott","name_suffix":"","institution":"University of California, San Francisco, Department of Emergency Medicine, San Francisco, California","department":"None"},{"first_name":"Raashee","middle_name":"","last_name":"Kedia","name_suffix":"","institution":"Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York","department":"None"},{"first_name":"Susan","middle_name":"B.","last_name":"Promes","name_suffix":"","institution":"University of California, San Francisco, Department of Emergency Medicine, San Francisco, California","department":"None"},{"first_name":"Thomas","middle_name":"","last_name":"Swoboda","name_suffix":"","institution":"Louisiana State University Health Sciences Center – Shreveport, Department of Emergency Medicine, Shreveport, Louisiana","department":"None"},{"first_name":"Kevin","middle_name":"","last_name":"O'Rourke","name_suffix":"","institution":"New York Methodist Hospital, Department of Emergency Medicine, Brooklyn, New York","department":"None"},{"first_name":"Walter","middle_name":"","last_name":"Green","name_suffix":"","institution":"Parkland Memorial Hospital, Department of Emergency Medicine, Dallas, Texas","department":"None"},{"first_name":"Rachel","middle_name":"","last_name":"Liu","name_suffix":"","institution":"Yale University, Department of Emergency Medicine, New Haven, Connecticut","department":"None"},{"first_name":"Brent","middle_name":"","last_name":"Stansfield","name_suffix":"","institution":"University of Michigan Medical School, Department of Medical Education, Ann Arbor, Michigan","department":"None"},{"first_name":"Sally","middle_name":"A.","last_name":"Santen","name_suffix":"","institution":"University of Michigan Medical School, Department of Medical Education, Ann Arbor, Michigan","department":"None"}],"date_submitted":"2015-04-30T16:24:43-04:00","date_accepted":"2015-04-30T16:24:43-04:00","date_published":"2015-10-22T03:00:00-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8939/galley/5063/download/"}]},{"pk":8929,"title":"Does the Concept of the “Flipped Classroom” Extend to the Emergency Medicine Clinical Clerkship?","subtitle":null,"abstract":"Introduction:\n Linking educational objectives and clinical learning during clerkships can be difficult. Clinical shifts during emergency medicine (EM) clerkships provide a wide variety of experiences, some of which may not be relevant to recommended educational objectives. Students can be directed to standardize their clinical experiences, and this improves performance on examinations. We hypothesized that applying a “flipped classroom” model to the clinical clerkship would improve performance on multiple-choice testing when compared to standard learning.\nMethods:\n Students at two institutions were randomized to complete two of four selected EM clerkship topics in a “flipped fashion,” and two others in a standard fashion. For flipped topics, students were directed to complete chief complaint-based asynchronous modules prior to a shift, during which they were directed to focus on the chief complaint. For the other two topics, modules were to be performed at the students’ discretion, and shifts would not have a theme. At the end of the four-week clerkship, a 40-question multiple-choice examination was administered with 10 questions per topic. We compared performance on flipped topics with those performed in standard fashion. Students were surveyed on perceived effectiveness, ability to follow the protocol, and willingness of preceptors to allow a chief-complaint focus.\nResults:\n Sixty-nine students participated; examination scores for 56 were available for analysis. For the primary outcome, no difference was seen between the flipped method and standard (p=0.494.) A mixed model approach showed no effect of flipped status, protocol adherence, or site of rotation on the primary outcome of exam scores. Students rated the concept of the flipped clerkship highly (3.48/5). Almost one third (31.1%) of students stated that they were unable to adhere to the protocol.\nConclusion:\n Preparation for a clinical shift with pre-assigned, web-based learning modules followed by an attempt at chief-complaint-focused learning during a shift did not result in improvements in performance on a multiple-choice assessment of knowledge; however, one third of participants did not adhere strictly to the protocol. Future investigations should ensure performance of pre-assigned learning as well as clinical experiences, and consider alternate measures of knowledge.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"flipped classroom"},{"word":"Asynchronous learning"},{"word":"Emergency Medicine"},{"word":"medical student"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2q83j70b","frozenauthors":[{"first_name":"Corey","middle_name":"","last_name":"Heitz","name_suffix":"","institution":"Virginia Tech Carilion School of Medicine, Department of Emergency Medicine, Roanoke, Virginia","department":"None"},{"first_name":"Melanie","middle_name":"","last_name":"Prusakowski","name_suffix":"","institution":"Virginia Tech Carilion School of Medicine, Department of Emergency Medicine, Roanoke, Virginia","department":"None"},{"first_name":"George","middle_name":"","last_name":"Willis","name_suffix":"","institution":"University of Maryland College of Medicine, Department of Emergency Medicine, Baltimore, Maryland","department":"None"},{"first_name":"Christopher","middle_name":"","last_name":"Franck","name_suffix":"","institution":"Virginia Polytechnic Institute and State University, Department of Statistics, Blacksburg, Virginia","department":"None"}],"date_submitted":"2015-04-30T22:07:45-04:00","date_accepted":"2015-04-30T22:07:45-04:00","date_published":"2015-10-22T03:00:00-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8929/galley/5060/download/"}]},{"pk":8997,"title":"Education Scholarship and its Impact on  Emergency Medicine Education","subtitle":null,"abstract":"Emergency medicine (EM) education is becoming increasingly challenging as a result of changes to North American medical education and the growing complexity of EM practice. Education scholarship (ES) provides a process to develop solutions to these challenges. ES includes both research and innovation. ES is informed by theory, principles and best practices, is peer reviewed, and is disseminated and archived for others to use. Digital technologies have improved the discovery of work that informs ES, broadened the scope and timing of peer review, and provided new platforms for the dissemination and archiving of innovations. This editorial reviews key steps in raising an education innovation to the level of scholarship. It also discusses important areas for EM education scholars to address, which include the following: the delivery of competency-based medical education programs, the impact of social media on learning, and the redesign of continuing professional development.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"education"},{"word":"scholarship"},{"word":"research"},{"word":"technology"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0442r81d","frozenauthors":[{"first_name":"Jonathan","middle_name":"","last_name":"Sherbino","name_suffix":"","institution":"McMaster University, Department of Emergency Medicine, Hamilton, Ontario, Canada","department":"None"}],"date_submitted":"2015-05-04T15:16:09-04:00","date_accepted":"2015-05-04T15:16:09-04:00","date_published":"2015-10-22T03:00:00-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8997/galley/5079/download/"}]},{"pk":9290,"title":"Emergency Medicine: On the Frontlines of Medical Education Transformation","subtitle":null,"abstract":"Emergency medicine (EM) has always been on the frontlines of healthcare in the United States. I experienced this reality first hand as a young general medical officer assigned to an emergency department (ED) in a small naval hospital in the 1980s. For decades the ED has been the only site where patients could not be legally denied care. Despite increased insurance coverage for millions of Americans as a result of the Affordable Care Act, ED directors report an increase in patient volumes in a recent survey.1 EDs care for patients from across the socioeconomic spectrum suffering from a wide range of clinical conditions. As a result, the ED is still one of few components of the American healthcare system where social justice is enacted on a regular basis. Constant turbulence in the healthcare system, major changes in healthcare delivery, technological advances and shifting demographic trends necessitate that EM constantly adapt and evolve as a discipline in this complex environment.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9624k4d8","frozenauthors":[{"first_name":"Eric","middle_name":"S.","last_name":"Holmboe","name_suffix":"","institution":"Accreditation Council for Graduate Medical Education, Chicago, Illinois","department":"None"}],"date_submitted":"2015-08-11T18:31:13-04:00","date_accepted":"2015-08-11T18:31:13-04:00","date_published":"2015-10-22T03:00:00-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/9290/galley/5245/download/"}]},{"pk":9348,"title":"Growing a Specialty-Specific Community of  Practice in Education Scholarship","subtitle":null,"abstract":"N/A","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8jt2700q","frozenauthors":[{"first_name":"Jeffrey","middle_name":"N.","last_name":"Love","name_suffix":"","institution":"Georgetown University School of Medicine, Department of Emergency Medicine, Washington, D.C.","department":"None"},{"first_name":"Douglas","middle_name":"S.","last_name":"Ander","name_suffix":"","institution":"Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia","department":"None"}],"date_submitted":"2015-09-11T16:21:34-04:00","date_accepted":"2015-09-11T16:21:34-04:00","date_published":"2015-10-22T03:00:00-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/9348/galley/5263/download/"}]},{"pk":8872,"title":"Morbidity and Mortality Conference in Emergency  Medicine Residencies and the Culture of Safety","subtitle":null,"abstract":"Introduction:\n Morbidity and mortality conferences (M+M) are a traditional part of residency training and mandated by the Accreditation Counsel of Graduate Medical Education. This study’s objective was to determine the goals, structure, and the prevalence of practices that foster strong safety cultures in the M+Ms of U.S. emergency medicine (EM) residency programs.\nMethods:\n The authors conducted a national survey of U.S. EM residency program directors. The survey instrument evaluated five domains of M+M (Organization and Infrastructure; Case Finding; Case Selection; Presentation; and Follow up) based on the validated Agency for Healthcare Research & Quality Safety Culture survey. \nResults:\n There was an 80% (151/188) response rate. The primary objectives of M+M were discussing adverse outcomes (53/151, 35%), identifying systems errors (47/151, 31%) and identifying cognitive errors (26/151, 17%). Fifty-six percent (84/151) of institutions have anonymous case submission, with 10% (15/151) maintaining complete anonymity during the presentation and 21% (31/151) maintaining partial anonymity. Forty-seven percent (71/151) of programs report a formal process to follow up on systems issues identified at M+M. Forty-four percent (67/151) of programs report regular debriefing with residents who have had their cases presented.\nConclusion:\n The structure and goals of M+Ms in EM residencies vary widely. Many programs lack features of M+M that promote a non-punitive response to error, such as anonymity. Other programs lack features that support strong safety cultures, such as following up on systems issues or reporting back to residents on improvements. Further research is warranted to determine if M+M structure is related to patient safety culture in residency programs.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Quality Assessment"},{"word":"Health care Safety"},{"word":"Morbidity and Mortality"},{"word":"Health care Quality"},{"word":"Graduate Medical Education"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8fb093nd","frozenauthors":[{"first_name":"Emily","middle_name":"L.","last_name":"Aaronson","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts; Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Kathleen","middle_name":"A.","last_name":"Wittels","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts; Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Eric","middle_name":"S.","last_name":"Nadel","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts; Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts; Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Jeremiah","middle_name":"D.","last_name":"Schuur","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts; Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts","department":"None"}],"date_submitted":"2015-04-20T18:07:30-04:00","date_accepted":"2015-04-20T18:07:30-04:00","date_published":"2015-10-22T03:00:00-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8872/galley/5051/download/"}]},{"pk":8722,"title":"Results from the First Year of Implementation of CONSULT: Consultation with Novel Methods and Simulation for UME Longitudinal Training","subtitle":null,"abstract":"Introduction:\n An important area of communication in healthcare is the consultation. Existing literature suggests that formal training in consultation communication is lacking. We aimed to conduct a targeted needs assessment of third-year students on their experience calling consultations, and based on these results, develop, pilot, and evaluate the effectiveness of a consultation curriculum for different learner levels that can be implemented as a longitudinal curriculum.\nMethods:\n Baseline needs assessment data were gathered using a survey completed by third-year students at the conclusion of the clinical clerkships. The survey assessed students’ knowledge of the standardized consultation, experience and comfort calling consultations, and previous instruction received on consultation communication. Implementation of the consultation curriculum began the following academic year. Second-year students were introduced to Kessler’s 5 Cs consultation model through a didactic session consisting of a lecture, viewing of “trigger” videos illustrating standardized and informal consults, followed by reflection and discussion. Curriculum effectiveness was assessed through pre- and post- curriculum surveys that assessed knowledge of and comfort with the consultation process. Fourth-year students participated in a consultation curriculum that provided instruction on the 5 Cs model and allowed for continued practice of consultation skills through simulation during the Emergency Medicine clerkship. Proficiency in consult communication in this cohort was assessed using two assessment tools, the Global Rating Scale and the 5 Cs Checklist.\nResults:\n The targetedneeds assessment of third-year students indicated that 93% of students have called a consultation during their clerkships, but only 24% received feedback. Post-curriculum, second-year students identified more components of the 5 Cs model (4.04 vs. 4.81, p<0.001) and reported greater comfort with the consultation process (0% vs. 69%, p<0.001). Post- curriculum, fourth-year students scored higher in all criteria measuring consultation effectiveness (p<0.001 for all) and included more necessary items in simulated consultations (62% vs. 77%, p<0.001).\nConclusion:\n While third-year medical students reported calling consultations, few felt comfortable and formal training was lacking. A curriculum in consult communication for different levels of learners can improve knowledge and comfort prior to clinical clerkships and improve consultation skills prior to residency training.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Consultation Communication"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8fb5000k","frozenauthors":[{"first_name":"Keme","middle_name":"","last_name":"Carter","name_suffix":"","institution":"University of Chicago, Section of Emergency Medicine, Chicago, Illinois","department":"None"},{"first_name":"Andrew","middle_name":"","last_name":"Golden","name_suffix":"","institution":"University of Chicago Pritzker School of Medicine, Chicago, Illinois","department":"None"},{"first_name":"Shannon","middle_name":"","last_name":"Martin","name_suffix":"","institution":"University of Chicago, Section of Emergency Medicine, Chicago, Illinois","department":"None"},{"first_name":"Sarah","middle_name":"","last_name":"Donlan","name_suffix":"","institution":"NorthShore University HealthSystem, Division of Emergency Medicine, Evanston, Illinois","department":"None"},{"first_name":"Sara","middle_name":"","last_name":"Hock","name_suffix":"","institution":"University of Chicago, Section of Emergency Medicine, Chicago, Illinois","department":"None"},{"first_name":"Christine","middle_name":"","last_name":"Babcock","name_suffix":"","institution":"University of Chicago, Section of Emergency Medicine, Chicago, Illinois","department":"None"},{"first_name":"Jeanne","middle_name":"","last_name":"Farnan","name_suffix":"","institution":"University of Chicago, Section of Hospital Medicine, Chicago, Illinois","department":"None"},{"first_name":"Vineet","middle_name":"","last_name":"Arora","name_suffix":"","institution":"University of Chicago, Section of General Internal Medicine, Chicago, Illinois","department":"None"}],"date_submitted":"2015-01-23T12:17:05-05:00","date_accepted":"2015-01-23T12:17:05-05:00","date_published":"2015-10-22T03:00:00-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8722/galley/5004/download/"}]},{"pk":8944,"title":"Teaching and Assessing ED Handoffs: A Qualitative Study Exploring Resident, Attending, and Nurse Perceptions","subtitle":null,"abstract":"Introduction:\n The Accreditation Council for Graduate Medical Education requires that residency programs ensure resident competency in performing safe, effective handoffs. Understanding resident, attending, and nurse perceptions of the key elements of a safe and effective emergency department (ED) handoff is a crucial step to developing feasible, acceptable educational interventions to teach and assess this fundamental competency. The aim of our study was to identify the essential themes of ED-based handoffs and to explore the key cultural and interprofessional themes that may be barriers to developing and implementing successful ED-based educational handoff interventions.\nMethods:\n Using a grounded theory approach and constructivist/interpretivist research paradigm, we analyzed data from three primary and one confirmatory focus groups (FGs) at an urban, academic ED. FG protocols were developed using open-ended questions that sought to understand what participants felt were the crucial elements of ED handoffs. ED residents, attendings, a physician assistant, and nurses participated in the FGs. FGs were observed, hand-transcribed, audio-recorded and subsequently transcribed. We analyzed data using an iterative process of theme and subtheme identification. Saturation was reached during the third FG, and the fourth confirmatory group reinforced the identified themes. Two team members analyzed the transcripts separately and identified the same major themes. \nResults:\n ED providers identified that crucial elements of ED handoff include the following: 1) Culture (provider buy-in, openness to change, shared expectations of sign-out goals); 2) Time (brevity, interruptions, waiting); 3) Environment (physical location, ED factors); 4) Process (standardization, information order, tools). \nConclusion:\n Key participants in the ED handoff process perceive that the crucial elements of intershift handoffs involve the themes of culture, time, environment, and process. Attention to these themes may improve the feasibility and acceptance of educational interventions that aim to teach and assess handoff competency.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Emergency Medicine, Handoffs, Transitions in Care, Resident Education"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/91b1p5fc","frozenauthors":[{"first_name":"Moira","middle_name":"","last_name":"Flanigan","name_suffix":"","institution":"Oregon Health and Science University, Department of Emergency Medicine, Portland, Oregon","department":"None"},{"first_name":"James","middle_name":"A.","last_name":"Heilman","name_suffix":"","institution":"Oregon Health and Science University, Department of Emergency Medicine, Portland, Oregon","department":"None"},{"first_name":"Tom","middle_name":"","last_name":"Johnson","name_suffix":"","institution":"Oregon Health and Science University, Department of Emergency Medicine, Portland, Oregon","department":"None"},{"first_name":"Lalena","middle_name":"M.","last_name":"Yarris","name_suffix":"","institution":"Oregon Health and Science University, Department of Emergency Medicine, Portland, Oregon","department":"None"}],"date_submitted":"2015-04-30T18:07:25-04:00","date_accepted":"2015-04-30T18:07:25-04:00","date_published":"2015-10-22T03:00:00-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8944/galley/5065/download/"}]},{"pk":8979,"title":"The Impact of Medical Student Participation in Emergency Medicine Patient Care on Departmental Press Ganey Scores","subtitle":null,"abstract":"Introduction:\n Press Ganey (PG) scores are used by public entities to gauge the quality of patient care from medical facilities in the United States. Academic health centers (AHCs) are charged with educating the new generation of doctors, but rely heavily on PG scores for their business operation. AHCs need to know what impact medical student involvement has on patient care and their PG scores. Purpose: We sought to identify the impact students have on emergency department (ED) PG scores related to overall visit and the treating physician’s performance.\nMethods:\n This was a retrospective, observational cohort study of discharged ED patients who completed PG satisfaction surveys at one academic, and one community-based ED. Outcomes were responses to questions about the overall visit assessment and doctor’s care, measured on a five-point scale. We compared the distribution of responses for each question through proportions with 95% confidence intervals (CIs) stratified by medical student participation. For each question, we constructed a multivariable ordinal logistic regression model including medical student involvement and other independent variables known to affect PG scores.\nResults:\n We analyzed 2,753 encounters, of which 259 (9.4%) had medical student involvement. For all questions, there were no appreciable differences in patient responses when stratifying by medical student involvement. In regression models, medical student involvement was not associated with PG score for any outcome, including overall rating of care (odds ratio [OR] 1.10, 95% CI [0.90-1.34]) or likelihood of recommending our EDs (OR 1.07, 95% CI [0.86-1.32]). Findings were similar when each ED was analyzed individually.\nConclusion:\n We found that medical student involvement in patient care did not adversely impact ED PG scores in discharged patients. Neither overall scores nor physician-specific scores were impacted. Results were similar at both the academic medical center and the community teaching hospital at our institution.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Education, Medical, Undergraduate"},{"word":"Health Evaluation Mechanisms, Patient Satisfaction"},{"word":"Emergency Medicine"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4h62k0ms","frozenauthors":[{"first_name":"Aaron","middle_name":"W.","last_name":"Bernard","name_suffix":"","institution":"Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, Connecticut","department":"None"},{"first_name":"Daniel","middle_name":"R.","last_name":"Martin","name_suffix":"","institution":"Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio","department":"None"},{"first_name":"Mark","middle_name":"G.","last_name":"Moseley","name_suffix":"","institution":"Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio","department":"None"},{"first_name":"Nicholas","middle_name":"E.","last_name":"Kman","name_suffix":"","institution":"Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio","department":"None"},{"first_name":"Sorabh","middle_name":"","last_name":"Khandelwal","name_suffix":"","institution":"Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio","department":"None"},{"first_name":"Daniel","middle_name":"","last_name":"Carpenter","name_suffix":"","institution":"Ohio State University, Department of Biomedical Informatics, Columbus, Ohio","department":"None"},{"first_name":"David","middle_name":"P.","last_name":"Way","name_suffix":"","institution":"Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio","department":"None"},{"first_name":"Jeffrey","middle_name":"M.","last_name":"Caterino","name_suffix":"","institution":"Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio","department":"None"}],"date_submitted":"2015-05-01T17:15:37-04:00","date_accepted":"2015-05-01T17:15:37-04:00","date_published":"2015-10-22T03:00:00-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8979/galley/5075/download/"}]},{"pk":8999,"title":"What is the Prevalence and Success of Remediation of Emergency Medicine Residents?","subtitle":null,"abstract":"Introduction:\n The primary objective of this study was to determine the prevalence of remediation, competency domains for remediation, the length, and success rates of remediation in emergency medicine (EM).\nMethods:\n We developed the survey in SurveymonkeyTM with attention to content and response process validity. EM program directors responded how many residents had been placed on remediation in the last three years. Details regarding the remediation were collected including indication, length and success. We reported descriptive data and estimated a multinomial logistic regression model.  \nResults:\n We obtained 126/158 responses (79.7%). Ninety percent of programs had at least one resident on remediation in the last three years. The prevalence of remediation was 4.4%. Indications for remediation ranged from difficulties with one core competency to all six competencies (mean 1.9). The most common were medical knowledge (MK) (63.1% of residents), patient care (46.6%) and professionalism (31.5%). Mean length of remediation was eight months (range 1-36 months). Successful remediation was 59.9% of remediated residents; 31.3% reported ongoing remediation. In 8.7%, remediation was deemed “unsuccessful.” Training year at time of identification for remediation (post-graduate year [PGY] 1), longer time spent in remediation, and concerns with practice-based learning (PBLI) and professionalism were found to have statistically significant association with unsuccessful remediation. \nConclusion:\n Remediation in EM residencies is common, with the most common areas being MK and patient care. The majority of residents are successfully remediated. PGY level, length of time spent in remediation, and the remediation of the competencies of PBLI and professionalism were associated with unsuccessful remediation.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Medical Education, Emergency Medicine"}],"section":"Educational Research and Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/33h0r84t","frozenauthors":[{"first_name":"Mark","middle_name":"","last_name":"Silverberg","name_suffix":"","institution":"SUNY Downstate/Kings County Hospital, Department of Emergency Medicine, New York, New York","department":"None"},{"first_name":"Moshe","middle_name":"","last_name":"Weizberg","name_suffix":"","institution":"Staten Island University Hospital, Department of Emergency Medicine, Staten Island, New York","department":"None"},{"first_name":"Tiffany","middle_name":"","last_name":"Murano","name_suffix":"","institution":"Rutgers New Jersey Medical School, Department of Emergency Medicine, Newark, New Jersey","department":"None"},{"first_name":"Jessica","middle_name":"L.","last_name":"Smith","name_suffix":"","institution":"Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island","department":"None"},{"first_name":"John","middle_name":"C.","last_name":"Burkhardt","name_suffix":"","institution":"University of Michigan Medical School, Department of Emergency Medicine, Ann Arbor, Michigan","department":"None"},{"first_name":"Sally","middle_name":"A.","last_name":"Santen","name_suffix":"","institution":"University of Michigan Medical School, Department of Emergency Medicine, Ann Arbor, Michigan","department":"None"}],"date_submitted":"2015-05-04T21:32:58-04:00","date_accepted":"2015-05-04T21:32:58-04:00","date_published":"2015-10-22T03:00:00-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8999/galley/5080/download/"}]},{"pk":44076,"title":"Xanthogranulomatous pyelonephritis","subtitle":null,"abstract":null,"language":"eng","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[{"word":"Clinical Vignette"}],"section":"Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/96k2v6jg","frozenauthors":[{"first_name":"Avi","middle_name":"","last_name":"Baskin","name_suffix":"MSIII","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Maria","middle_name":"","last_name":"Romanova","name_suffix":"MD","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2015-10-21T18:15:38-04:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/44076/galley/32879/download/"}]},{"pk":8840,"title":"Emergency Physician Attitudes, Preferences, and Risk Tolerance for Stroke as a Potential Cause of Dizziness Symptoms","subtitle":null,"abstract":"Introduction\n: We evaluated emergency physicians’ (EP) current perceptions, practice, and attitudes towards evaluating stroke as a cause of dizziness among emergency department patients.\nMethods\n: We administered a survey to all EPs in a large integrated healthcare delivery system. The survey included clinical vignettes, perceived utility of historical and exam elements, attitudes about the value of and requisite post-test probability of a clinical prediction rule for dizziness. We calculated descriptive statistics and post-test probabilities for such a clinical prediction rule.\nResults\n: The response rate was 68% (366/535). Respondents’ median practice tenure was eight years (37% female, 92% emergency medicine board certified). Symptom quality and typical vascular risk factors increased suspicion for stroke as a cause of dizziness. Most respondents reported obtaining head computed tomography (CT) (74%). Nearly all respondents used and felt confident using cranial nerve and limb strength testing. A substantial minority of EPs used the Epley maneuver (49%) and HINTS (head-thrust test, gaze-evoked nystagmus, and skew deviation) testing (30%); however, few EPs reported confidence in these tests’ bedside application (35% and 16%, respectively). Respondents favorably viewed applying a properly validated clinical prediction rule for assessment of immediate and 30-day stroke risk, but indicated it would have to reduce stroke risk to <0.5% to be clinically useful.\nConclusion\n: EPs report relying on symptom quality, vascular risk factors, simple physical exam elements, and head CT to diagnose stroke as the cause of dizziness, but would find a validated clinical prediction rule for dizziness helpful. A clinical prediction rule would have to achieve a 0.5% post-test stroke probability for acceptability.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"stroke, clinical prediction rules, dizziness,"}],"section":"Diagnostic Acumen","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2dk9b386","frozenauthors":[{"first_name":"Dustin","middle_name":"W.","last_name":"Ballard","name_suffix":"","institution":"The Permanente Medical Group; Kaiser Permanente San Rafael Medical Center, Department of Emergency Medicine, San Rafael, California; Kaiser Permanente Northern California, Division of Research, Oakland, California","department":"None"},{"first_name":"David","middle_name":"R.","last_name":"Vinson","name_suffix":"","institution":"The Permanente Medical Group; Kaiser Permanente Northern California, Division of Research, Oakland, California; Kaiser Permanente Roseville Medical Center, Department of Emergency Medicine, Roseville, California","department":"None"},{"first_name":"Adina","middle_name":"S.","last_name":"Rauchwerger","name_suffix":"","institution":"Kaiser Permanente Northern California, Division of Research, Oakland, California","department":"None"},{"first_name":"Hilary","middle_name":"R.","last_name":"Iskin","name_suffix":"","institution":"Kaiser Permanente Northern California, Division of Research, Oakland, California","department":"None"},{"first_name":"Anthony","middle_name":"S","last_name":"Kim","name_suffix":"","institution":"Department of Neurology, University of California, San Francisco, San Francisco, California","department":"None"},{"first_name":"Mamata","middle_name":"V.","last_name":"Kene","name_suffix":"","institution":"The Permanente Medical Group; Kaiser Permanente Fremont Medical Center, Department of Emergency Medicine, Fremont, California","department":"None"}],"date_submitted":"2015-04-03T14:09:27-04:00","date_accepted":"2015-04-03T14:09:27-04:00","date_published":"2015-10-20T19:11:46-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8840/galley/5041/download/"}]},{"pk":9045,"title":"Not What It Seems: Deep Tissue Infection  Presenting as Cellulitis","subtitle":null,"abstract":"n/a","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Perirectal Abscess"},{"word":"ultrasound"}],"section":"Diagnostic Acumen","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3h9148p0","frozenauthors":[{"first_name":"Caroline","middle_name":"T.","last_name":"Brandon","name_suffix":"","institution":"Los Angeles County Medical Center+University of Southern California Medical Center, Department of Emergency Medicine, Los Angeles, California","department":"None"},{"first_name":"Tarina","middle_name":"","last_name":"Kang","name_suffix":"","institution":"Los Angeles County Medical Center+University of Southern California Medical Center, Department of Emergency Medicine, Los Angeles, California","department":"None"}],"date_submitted":"2015-05-29T20:10:12-04:00","date_accepted":"2015-05-29T20:10:12-04:00","date_published":"2015-10-20T19:01:26-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/9045/galley/5097/download/"}]},{"pk":8669,"title":"Tension Pneumoperitoneum Caused by Obstipation","subtitle":null,"abstract":"Emergency physicians are often required to evaluate and treat undifferentiated patients suffering acute hemodynamic compromise (AHC). It is helpful to apply a structured approach based on a differential diagnosis including all causes of AHC that can be identified and treated during a primary assessment. Tension pneumoperitoneum (TP) is an uncommon condition with the potential to be rapidly fatal. It is amenable to prompt diagnosis and stabilization in the emergency department. We present a case of a 16-year-old boy with TP to demonstrate how TP should be incorporated into a differential diagnosis when evaluating an undifferentiated patient with AHC.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Emergency Medicine"},{"word":"resuscitation"},{"word":"Diagnosis"}],"section":"Diagnostic Acumen","is_remote":true,"remote_url":"https://escholarship.org/uc/item/51z860k2","frozenauthors":[{"first_name":"Daniel","middle_name":"G","last_name":"Miller","name_suffix":"","institution":"University of Iowa Hospitals and Clinics, Department of Emergency Medicine, Iowa City, Iowa","department":"None"}],"date_submitted":"2014-12-23T18:25:36-05:00","date_accepted":"2014-12-23T18:25:36-05:00","date_published":"2015-10-20T19:00:35-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8669/galley/4980/download/"}]},{"pk":8799,"title":"Ruptured Splenic Artery Aneurysm: Rare Cause of  Shock Diagnosed with Bedside Ultrasound","subtitle":null,"abstract":"Splenic artery aneurysm rupture is rare and potentially fatal. It has largely been reported in pregnant patients and typically not diagnosed until laparotomy. This case reports a constellation of clinical and sonographic findings that may lead clinicians to rapidly diagnose ruptured splenic artery aneurysm at the bedside. We also propose a rapid, but systematic sonographic approach to patients with atraumatic hemoperitoneum causing shock. It is yet another demonstration of the utility of bedside ultrasound in critically ill patients, specifically with undifferentiated shock.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"aneurysm, ultrasound, emergency medicine, hemoperitoneum, shock, splenic artery"}],"section":"Technology in Emergency Medicine","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8sh088hq","frozenauthors":[{"first_name":"Terri","middle_name":"","last_name":"Davis","name_suffix":"","institution":"West Virginia University School of Medicine, Morgantown, West Virginia","department":"None"},{"first_name":"Joseph","middle_name":"","last_name":"Minardi","name_suffix":"","institution":"West Virginia University, Department of Emergency Medicine, Morgantown, West Virginia","department":"None"},{"first_name":"Jennifer","middle_name":"","last_name":"Knight","name_suffix":"","institution":"West Virginia University, Department of Surgery, Morgantown, West Virginia","department":"None"},{"first_name":"Hollynn","middle_name":"","last_name":"Larrabee","name_suffix":"","institution":"West Virginia University, Department of Emergency Medicine, Morgantown, West Virginia","department":"None"},{"first_name":"Gregory","middle_name":"","last_name":"Schaefer","name_suffix":"","institution":"West Virginia University, Department of Surgery, Morgantown, West Virginia","department":"None"}],"date_submitted":"2015-03-12T14:05:54-04:00","date_accepted":"2015-03-12T14:05:54-04:00","date_published":"2015-10-20T18:51:42-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8799/galley/5026/download/"}]},{"pk":8823,"title":"Interposed Abdominal Compression CPR for an Out-of-Hospital Cardiac Arrest Victim Failing Traditional CPR","subtitle":null,"abstract":"Interposed abdominal compression CPR is an alternative technique to traditional CPR that can improve perfusion and lead to restoration of circulation in patients with chest wall deformity either acquired through vigorous CPR or co-morbidity such as COPD.  We report a case of out-of-hospital cardiac arrest where IAC-CPR allowed for restoration of spontaneous circulation and eventual full neurologic recovery when traditional CPR was failing to generate adequate pulses with chest compression alone.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"interposed abdominal compression"},{"word":"abdominal compression"},{"word":"CPR"},{"word":"resuscitation"},{"word":"coronary artery perfusion pressure"},{"word":"cardiac output"},{"word":"return of spontaneous circulation"},{"word":"neurologic recovery"}],"section":"Critical Care","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8h1265pz","frozenauthors":[{"first_name":"Christian","middle_name":"D.","last_name":"McClung","name_suffix":"","institution":"Keck School of Medicine of the University of Southern California, Department of Emergency Medicine, Los Angeles, California","department":"None"},{"first_name":"Alexander","middle_name":"J.","last_name":"Anshus","name_suffix":"","institution":"School of Medicine, University of California Irvine, Irvine, California","department":"None"}],"date_submitted":"2015-03-24T21:59:36-04:00","date_accepted":"2015-03-24T21:59:36-04:00","date_published":"2015-10-20T18:50:02-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8823/galley/5034/download/"}]},{"pk":8792,"title":"ST-Elevation Myocardial Infarction After Sumitriptan Ingestion in Patient with Normal Coronary Arteries","subtitle":null,"abstract":"Sumitriptan has been used by millions as a migraine abortant; however, there have been studies showing angina pectoris, coronary vasospasm, and even myocardial infarction in patients with predisposing cardiac risk factors. The majority are patients using the injectable form subcutaneously. We present the case of a patient who presents with ST-elevation myocardial infarction, with no cardiovascular risk factors, after ingesting oral sumitriptan for her typical migraine.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Sumitriptan, myocardial infarction, coronary vasospasm"}],"section":"Diagnostic Acumen","is_remote":true,"remote_url":"https://escholarship.org/uc/item/50b7h439","frozenauthors":[{"first_name":"Christian","middle_name":"","last_name":"Jensen","name_suffix":"","institution":"Carl R. Darnall Army Medical Center, Department of Emergency Medicine, Fort Hood, Texas","department":"None"},{"first_name":"Mark","middle_name":"","last_name":"Riddle","name_suffix":"","institution":"Carl R. Darnall Army Medical Center, Department of Emergency Medicine, Fort Hood, Texas","department":"None"}],"date_submitted":"2015-03-08T20:41:04-04:00","date_accepted":"2015-03-08T20:41:04-04:00","date_published":"2015-10-20T18:48:48-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8792/galley/5025/download/"}]},{"pk":9031,"title":"Elderly Woman with Abdominal Pain: Bedside  Ultrasound Diagnosis of Diverticulitis","subtitle":null,"abstract":"n/a","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"ultrasound"},{"word":"diverticulitis"},{"word":"Emergency Medicine"}],"section":"Technology in Emergency Medicine","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6v166647","frozenauthors":[{"first_name":"Jason","middle_name":"D.","last_name":"Heiner","name_suffix":"","institution":"University of Washington, Division of Emergency Medicine, Seattle, Washington; PeaceHealth Peace Island Medical Center, Department of Emergency Medicine, Friday Harbor, Washington","department":"None"}],"date_submitted":"2015-05-20T01:50:32-04:00","date_accepted":"2015-05-20T01:50:32-04:00","date_published":"2015-10-20T18:47:55-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/9031/galley/5092/download/"}]},{"pk":7758,"title":"Comparing an Unstructured Risk Stratification to  Published Guidelines in Acute Coronary Syndromes","subtitle":null,"abstract":"Introduction:\n Guidelines are designed to encompass the needs of the majority of patients with a particular condition. The American Heart Association (AHA) in conjunction with the American College of Cardiology (ACC) and the American College of Emergency Physicians (ACEP) developed risk stratification guidelines to aid physicians with accurate and efficient diagnosis and management of patients with acute coronary syndrome (ACS). While useful in a primary care setting, in the unique environment of an emergency department (ED), the feasibility of incorporating guidelines into clinical workflow remains in question. We aim to compare emergency physicians’ (EP) clinical risk stratification ability to AHA/ACC/ACEP guidelines for ACS, and assessed each for accuracy in predicting ACS.\nMethods:\n We conducted a prospective observational cohort study in an urban teaching hospital ED. All patients presenting to the ED with chest pain who were evaluated for ACS had two risk stratification scores assigned: one by the treating physician based on clinical evaluation and the other by the AHA/ACC/ACEP guideline aforementioned. The patient’s ACS risk stratification classified by the EP was compared to AHA/ACC/ACEP guidelines. Patients were contacted at 30 days following the index ED visit to determine all cause mortality, unscheduled hospital/ED revisits, and objective cardiac testing performed.\nResults: \nWe enrolled 641 patients presenting for evaluation by 21 different EPs. There was a difference between the physician’s clinical assessment used in the ED, and the AHA/ACC/ACEP task force guidelines. EPs were more likely to assess patients as low risk (40%), while AHA/ACC/ACEP guidelines were more likely to classify patients as intermediate (45%) or high (45%) risk. Of the 119 (19%) patients deemed high risk by EP evaluation, 38 (32%) were diagnosed with ACS. AHA/ACC/ACEP guidelines classified only 57 (9%) patients low risk with 56 (98%) of those patients diagnosed with no ACS.\nConclusion:\n In the ED, physicians are more efficient at correctly placing patients with underlying ACS into a high-risk category. A small percentage of patients were considered low risk when applying AHA/ACC/ACEP guidelines, which demonstrates how clinical insight is often required to make an efficient assessment of cardiac risk and established criteria may be overly conservative when applied to an acute care population.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"ACS"},{"word":"acute coronary syndrome"},{"word":"Coronary artery disease"},{"word":"AHA/ACC/ACEP Guidelines"},{"word":"emergency department"}],"section":"Treatment Protocol Assessment","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0148m1g3","frozenauthors":[{"first_name":"Ann-Jean","middle_name":"CC.","last_name":"Beck","name_suffix":"","institution":"New York Methodist Hospital, Department of Emergency Medicine, Brooklyn, New York","department":"None"},{"first_name":"Bess","middle_name":"","last_name":"Tortolani","name_suffix":"","institution":"New York Methodist Hospital, Department of Emergency Medicine, Brooklyn, New York","department":"None"},{"first_name":"Bethany","middle_name":"A.","last_name":"Byrd","name_suffix":"","institution":"New York Methodist Hospital, Department of Emergency Medicine, Brooklyn, New York","department":"None"},{"first_name":"Amisha","middle_name":"","last_name":"Parekh","name_suffix":"","institution":"New York Methodist Hospital, Department of Emergency Medicine, Brooklyn, New York","department":"None"},{"first_name":"Paris","middle_name":"","last_name":"Datillo","name_suffix":"","institution":"New York Methodist Hospital, Department of Emergency Medicine, Brooklyn, New York","department":"None"},{"first_name":"Anouk","middle_name":"","last_name":"Hagemeijer","name_suffix":"","institution":"New York Methodist Hospital, Department of Emergency Medicine, Brooklyn, New York","department":"None"},{"first_name":"Robert","middle_name":"","last_name":"Birkhahn","name_suffix":"","institution":"New York Methodist Hospital, Department of Emergency Medicine, Brooklyn, New York","department":"None"}],"date_submitted":"2014-10-18T09:41:01-04:00","date_accepted":"2014-10-18T09:41:01-04:00","date_published":"2015-10-20T18:45:37-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/7758/galley/4535/download/"}]},{"pk":8805,"title":"Triple Rule Out versus CT Angiogram Plus Stress Test for Evaluation of Chest Pain in the Emergency Department","subtitle":null,"abstract":"Introduction:\n Undifferentiated chest pain in the emergency department (ED) is a diagnostic challenge. One approach includes a dedicated chest computed tomography (CT) for pulmonary embolism or dissection followed by a cardiac stress test (TRAD). An alternative strategy is a coronary CT angiogram with concurrent chest CT (Triple Rule Out, TRO). The objective of this study was to describe the ED patient course and short-term safety for these evaluation methods.\nMethods:\n This was a retrospective observational study of adult patients presenting to a large, community ED for acute chest pain who had non-diagnostic electrocardiograms (ECGs) and normal biomarkers. We collected demographics, ED length of stay, hospital costs, and estimated radiation exposures. We evaluated 30-day return visits for major adverse cardiac events.\nResults:\n A total of 829 patients underwent TRAD, and 642 patients had TRO. Patients undergoing TRO tended to be younger (mean 52.3 vs 56.5 years) and were more likely to be male (42.4% vs. 30.4%). TRO patients tended to have a shorter ED length of stay (mean 14.45 vs. 21.86 hours), to incur less cost (median $449.83 vs. $1147.70), and to be exposed to less radiation (median 7.18 vs. 16.6mSv). No patient in either group had a related 30-day revisit.\nConclusion:\n Use of TRO is feasible for assessment of chest pain in the ED. Both TRAD and TRO safely evaluated patients. Prospective studies investigating this diagnostic strategy are needed to further assess this approach to ED chest pain evaluation.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Acute Chest Pain, Imaging, Triple Rule Out, Emergency Cardiac Care, Risk Stratification"}],"section":"Treatment Protocol Assessment","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9423541h","frozenauthors":[{"first_name":"Kelly","middle_name":"N.","last_name":"Sawyer","name_suffix":"","institution":"William Beaumont Hospital, Department of Emergency Medicine, Royal Oak, Michigan","department":"None"},{"first_name":"Payal","middle_name":"","last_name":"Shah","name_suffix":"","institution":"William Beaumont Hospital, Department of Emergency Medicine, Royal Oak, Michigan","department":"None"},{"first_name":"Lihua","middle_name":"","last_name":"Qu","name_suffix":"","institution":"William Beaumont Hospital, Research Institute Center for Outcomes Research, Royal Oak, Michigan","department":"None"},{"first_name":"Michael","middle_name":"C.","last_name":"Kurz","name_suffix":"","institution":"University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama","department":"None"},{"first_name":"Carol","middle_name":"L.","last_name":"Clark","name_suffix":"","institution":"William Beaumont Hospital, Department of Emergency Medicine, Royal Oak, Michigan","department":"None"},{"first_name":"Robert","middle_name":"A.","last_name":"Swor","name_suffix":"","institution":"William Beaumont Hospital, Department of Emergency Medicine, Royal Oak, Michigan","department":"None"}],"date_submitted":"2015-03-12T15:44:19-04:00","date_accepted":"2015-03-12T15:44:19-04:00","date_published":"2015-10-20T18:44:40-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8805/galley/5027/download/"}]},{"pk":8871,"title":"Injuries Following Segway Personal Transporter Accidents: Case Report and Review of the Literature","subtitle":null,"abstract":"The Segway® self-balancing personal transporter has been used as a means of transport for sightseeing tourists, military, police and emergency medical personnel. Only recently have reports been published about serious injuries that have been sustained while operating this device. This case describes a 67-year-old male who sustained an oblique fracture of the shaft of the femur while using the Segway® for transportation around his community. We also present a review of the literature.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Personal Transporter"}],"section":"Injury Prevention and Population Health","is_remote":true,"remote_url":"https://escholarship.org/uc/item/37r4387d","frozenauthors":[{"first_name":"John","middle_name":"","last_name":"Ashurst","name_suffix":"","institution":"Conemaugh Memorial Medical Center, Department of Emergency Medicine, Johnstown, Pennsylvania","department":"None"},{"first_name":"Benjamin","middle_name":"","last_name":"Wagner","name_suffix":"","institution":"Conemaugh Memorial Medical Center, Department of Emergency Medicine, Johnstown, Pennsylvania","department":"None"}],"date_submitted":"2015-04-20T16:50:14-04:00","date_accepted":"2015-04-20T16:50:14-04:00","date_published":"2015-10-20T18:44:02-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8871/galley/5050/download/"}]},{"pk":8788,"title":"Sensitivity of a Clinical Decision Rule and Early Computed Tomography in Aneurysmal Subarachnoid Hemorrhage","subtitle":null,"abstract":"Introduction:\n Application of a clinical decision rule for subarachnoid hemorrhage, in combination with cranial computed tomography (CT) performed within six hours of ictus (early cranial CT), may be able to reasonably exclude a diagnosis of aneurysmal subarachnoid hemorrhage (aSAH). This study’s objective was to examine the sensitivity of both early cranial CT and a previously validated clinical decision rule among emergency department (ED) patients with aSAH and a normal mental status.\nMethods:\n Patients were evaluated in the 21 EDs of an integrated health delivery system between January 2007 and June 2013. We identified by chart review a retrospective cohort of patients diagnosed with aSAH in the setting of a normal mental status and performance of early cranial CT. Variables comprising the SAH clinical decision rule (age >40, presence of neck pain or stiffness, headache onset with exertion, loss of consciousness at headache onset) were abstracted from the chart and assessed for inter-rater reliability. \nResults:\n One hundred fifty-five patients with aSAH met study inclusion criteria. The sensitivity of early cranial CT was 95.5% (95% CI [90.9-98.2]). The sensitivity of the SAH clinical decision rule was also 95.5% (95% CI [90.9-98.2]). Since all false negative cases for each diagnostic modality were mutually independent, the combined use of both early cranial CT and the clinical decision rule improved sensitivity to 100% (95% CI [97.6-100.0]). \nConclusion:\n Neither early cranial CT nor the SAH clinical decision rule demonstrated ideal sensitivity for aSAH in this retrospective cohort. However, the combination of both strategies might optimize sensitivity for this life-threatening disease.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Aneurysmal subarachnoid hemorrhage, computed tomography"}],"section":"Treatment Protocol Assessment","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1xd110pq","frozenauthors":[{"first_name":"Dustin","middle_name":"G.","last_name":"Mark","name_suffix":"","institution":"Kaiser Permanente, Department of Emergency Medicine, Oakland, California","department":"None"},{"first_name":"Mamata","middle_name":"V.","last_name":"Kene","name_suffix":"","institution":"Kaiser Permanente, Department of Emergency Medicine, San Leandro, California","department":"None"},{"first_name":"Natalia","middle_name":"","last_name":"Udaltsova","name_suffix":"","institution":"Kaiser Permanente Northern California, Division of Research, Oakland, California","department":"None"},{"first_name":"David","middle_name":"R.","last_name":"Vinson","name_suffix":"","institution":"Kaiser Permanente, Department of Emergency Medicine, Roseville, California \nKaiser Permanente Northern California, Division of Research, Oakland, California","department":"None"},{"first_name":"Dustin","middle_name":"W.","last_name":"Ballard","name_suffix":"","institution":"Kaiser Permanente Northern California, Division of Research, Oakland, California\nKaiser Permanente, Department of Emergency Medicine, San Rafael, California","department":"None"}],"date_submitted":"2015-03-06T17:06:27-05:00","date_accepted":"2015-03-06T17:06:27-05:00","date_published":"2015-10-20T18:43:01-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8788/galley/5023/download/"}]},{"pk":8976,"title":"A Surprising Finding of Remote Ischial Avulsion","subtitle":null,"abstract":"N/A","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Ischial avulsion fracture"},{"word":"snow boarding"}],"section":"Diagnostic Acumen","is_remote":true,"remote_url":"https://escholarship.org/uc/item/26j75195","frozenauthors":[{"first_name":"Jill","middle_name":"","last_name":"Tirabassi","name_suffix":"","institution":"University of Colorado School of Medicine, Department of Family Medicine, Denver, Colorado","department":"None"},{"first_name":"Jessica","middle_name":"","last_name":"Bull","name_suffix":"","institution":"University of Colorado School of Medicine, Department of Family Medicine, Denver, Colorado","department":"None"},{"first_name":"Hannah","middle_name":"M","last_name":"Foley","name_suffix":"","institution":"University of Colorado School of Medicine, Department of Family Medicine, Denver, Colorado","department":"None"},{"first_name":"Morteza","middle_name":"","last_name":"Khodaee","name_suffix":"","institution":"University of Colorado School of Medicine, Department of Family Medicine, Denver, Colorado","department":"None"}],"date_submitted":"2015-05-01T17:59:56-04:00","date_accepted":"2015-05-01T17:59:56-04:00","date_published":"2015-10-20T18:41:53-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8976/galley/5074/download/"}]},{"pk":8741,"title":"Pediatric Tape: Accuracy and Medication Delivery in the National Park Service","subtitle":null,"abstract":"Introduction:\n The objective is to evaluate the accuracy of medication dosing and the time to medication administration in the prehospital setting using a novel length-based pediatric emergency resuscitation tape.\nMethods:\n This study was a two-period, two-treatment crossover trial using simulated pediatric patients in the prehospital setting. Each participant was presented with two emergent scenarios; participants were randomized to which case they encountered first, and to which case used the National Park Service (NPS) emergency medical services (EMS) length-based pediatric emergency resuscitation tape. In the control (without tape) case, providers used standard methods to determine medication dosing (e.g. asking parents to estimate the patient’s weight); in the intervention (with tape) case, they used the NPS EMS length-based pediatric emergency resuscitation tape. Each scenario required dosing two medications (Case 1 [febrile seizure] required midazolam and acetaminophen; Case 2 [anaphylactic reaction] required epinephrine and diphenhydramine). Twenty NPS EMS providers, trained at the Parkmedic/Advanced Emergency Medical Technician level, served as study participants.\nResults:\n The only medication errors that occurred were in the control (no tape) group (without tape: 5 vs. with tape: 0, p=0.024). Time to determination of medication dose was significantly shorter in the intervention (with tape) group than the control (without tape) group, for three of the four medications used. In case 1, time to both midazolam and acetaminophen was significantly faster in the intervention (with tape) group (midazolam: 8.3 vs. 28.9 seconds, p=0.005; acetaminophen: 28.6 seconds vs. 50.6 seconds, p=0.036). In case 2, time to epinephrine did not differ (23.3 seconds vs. 22.9 seconds, p=0.96), while time to diphenhydramine was significantly shorter in the intervention (with tape) group (13 seconds vs. 37.5 seconds, p<0.05).\nConclusion:\n Use of a length-based pediatric emergency resuscitation tape in the prehospital setting was associated with significantly fewer dosing errors and faster time-to-medication administration in simulated pediatric emergencies. Further research in a clinical field setting to prospectively confirm these findings is needed.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"pediatrics"},{"word":"Medication dosing"},{"word":"National Park Service"},{"word":"wilderness medicine"},{"word":"EMS"}],"section":"Patient Safety","is_remote":true,"remote_url":"https://escholarship.org/uc/item/16b6v6p3","frozenauthors":[{"first_name":"Danielle","middle_name":"D.","last_name":"Campagne","name_suffix":"","institution":"University of California, San Francisco – Fresno Medical Education Program, Department of Emergency Medicine, Fresno, California","department":"None"},{"first_name":"Megann","middle_name":"","last_name":"Young","name_suffix":"","institution":"University of California, San Francisco – Fresno Medical Education Program, Department of Emergency Medicine, Fresno, California","department":"None"},{"first_name":"Geoff","middle_name":"","last_name":"Stroh","name_suffix":"","institution":"University of California, San Francisco – Fresno Medical Education Program, Department of Emergency Medicine, Fresno, California","department":"None"},{"first_name":"Jedediah","middle_name":"","last_name":"Wheeler","name_suffix":"","institution":"University of California, San Francisco – Fresno Medical Education Program, Department of Emergency Medicine, Fresno, California","department":"None"}],"date_submitted":"2015-02-03T17:20:40-05:00","date_accepted":"2015-02-03T17:20:40-05:00","date_published":"2015-10-20T18:41:18-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8741/galley/5008/download/"}]},{"pk":8863,"title":"Central Venous Catheter Intravascular Malpositioning: Causes, Prevention, Diagnosis, and Correction","subtitle":null,"abstract":"Despite the level of skill of the operator and the use of ultrasound guidance, central venous catheter (CVC) placement can result in CVC malpositioning, an unintended placement of the catheter tip in an inadequate vessel. CVC malpositioning is not a complication of central line insertion; however, undiagnosed CVC malpositioning can be associated with significant morbidity and mortality. The objectives of this review were to describe factors associated with intravascular malpositioning of CVCs inserted via the neck and chest and to offer ways of preventing, identifying, and correcting such malpositioning. A literature search of PubMed, Cochrane Library, and MD Consult was performed in June 2014. By searching for “Central line malposition” and then for “Central venous catheters intravascular malposition,” we found 178 articles written in English. Of those, we found that 39 were relevant to our objectives and included them in our review. According to those articles, intravascular CVC malpositioning is associated with the presence of congenital and acquired anatomical variants, catheter insertion in left thoracic venous system, inappropriate bevel orientation upon needle insertion, and patient’s body habitus variants. Although plain chest radiography is the standard imaging modality for confirming catheter tip location, signs and symptoms of CVC malpositioning even in presence of normal or inconclusive conventional radiography findings should prompt the use of additional diagnostic methods to confirm or rule out CVC malpositioning. With very few exceptions, the recommendation in cases of intravascular CVC malpositioning is to remove and relocate the catheter. Knowing the mechanisms of CVC malpositioning and how to prevent, identify, and correct CVC malpositioning could decrease harm to patients with this condition.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Patient Safety","is_remote":true,"remote_url":"https://escholarship.org/uc/item/14c04124","frozenauthors":[{"first_name":"Carlos","middle_name":"J.","last_name":"Roldan","name_suffix":"","institution":"University of Texas Health Science Center, Department of Emergency Medicine, Houston, Texas","department":"None"},{"first_name":"Linda","middle_name":"","last_name":"Paniagua","name_suffix":"","institution":"University of Texas Health Science Center, Department of Emergency Medicine, Houston, Texas","department":"None"}],"date_submitted":"2015-04-13T16:52:45-04:00","date_accepted":"2015-04-13T16:52:45-04:00","date_published":"2015-10-20T18:40:12-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8863/galley/5047/download/"}]},{"pk":9030,"title":"Splenic Rupture Diagnosed with Bedside Ultrasound in a  Patient with Shock in the Emergency Department  Following Colonoscopy","subtitle":null,"abstract":"n/a","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"splenic injury"},{"word":"Splenic Rupture"},{"word":"Colonoscopy"},{"word":"bedside ultrasound"},{"word":"FAST ultrasound exam"}],"section":"Technology in Emergency Medicine","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5z88g009","frozenauthors":[{"first_name":"William","middle_name":"","last_name":"Mulkerin","name_suffix":"","institution":"Stanford University Medical Center, Department of Emergency Medicine, Fellow Physician, Stanford, California","department":"None"},{"first_name":"Tsuyoshi","middle_name":"","last_name":"Mitarai","name_suffix":"","institution":"Stanford University Medical Center, Department of Emergency Medicine, Clinical Assistant Professor, Stanford, California","department":"None"},{"first_name":"Laleh","middle_name":"","last_name":"Gharahbaghian","name_suffix":"","institution":"Stanford University Medical Center, Department of Emergency Medicine, Clinical Associate Professor, Stanford, California","department":"None"},{"first_name":"Philips","middle_name":"","last_name":"Perera","name_suffix":"","institution":"Stanford University Medical Center, Department of Emergency Medicine, Clinical Associate Professor, Stanford, California","department":"None"}],"date_submitted":"2015-05-19T23:22:45-04:00","date_accepted":"2015-05-19T23:22:45-04:00","date_published":"2015-10-20T18:38:43-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/9030/galley/5091/download/"}]},{"pk":9039,"title":"Hydrocele of the Canal of Nuck","subtitle":null,"abstract":"n/a","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Hydrocele, Canal of Nuck"}],"section":"Diagnostic Acumen","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9916t8g6","frozenauthors":[{"first_name":"Jagdipak","middle_name":"","last_name":"Heer","name_suffix":"","institution":"University of California Los Angeles Kern Medical Center, Department of Emergency Medicine, Los Angeles, California","department":"None"},{"first_name":"Rick","middle_name":"","last_name":"McPheeters","name_suffix":"","institution":"University of California Los Angeles Kern Medical Center, Department of Emergency Medicine, Los Angeles, California","department":"None"},{"first_name":"Asha","middle_name":"Eryn","last_name":"Atwell","name_suffix":"","institution":"University of California Los Angeles Kern Medical Center, Department of Emergency Medicine, Los Angeles, California","department":"None"},{"first_name":"Phillip","middle_name":"","last_name":"Aguiniga","name_suffix":"","institution":"Kern Medical Center, Department of Emergency Medicine, Bakersfield, California","department":"None"},{"first_name":"Jason","middle_name":"","last_name":"Blake","name_suffix":"","institution":"Kern Medical Center, Department of Emergency Medicine, Bakersfield, California","department":"None"}],"date_submitted":"2015-05-27T14:27:16-04:00","date_accepted":"2015-05-27T14:27:16-04:00","date_published":"2015-10-20T18:33:06-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/9039/galley/5094/download/"}]},{"pk":8673,"title":"Accuracy of ‘My Gut Feeling:’ Comparing System 1 to System 2 Decision-Making for Acuity Prediction, Disposition and Diagnosis in an Academic Emergency Department","subtitle":null,"abstract":"Introduction:\n Current cognitive sciences describe decision-making using the dual-process theory, where a System 1 is intuitive and a System 2 decision is hypothetico-deductive. We aim to compare the performance of these systems in determining patient acuity, disposition and diagnosis.\nMethods:\n Prospective observational study of emergency physicians assessing patients in the emergency department of an academic center. Physicians were provided the patient’s chief complaint and vital signs and allowed to observe the patient briefly. They were then asked to predict acuity, final disposition (home, intensive care unit (ICU), non-ICU bed) and diagnosis. A patient was classified as sick by the investigators using previously published objective criteria.\nResults:\n We obtained 662 observations from 289 patients. For acuity, the observers had a sensitivity of 73.9% (95% CI [67.7-79.5%]), specificity 83.3% (95% CI [79.5-86.7%]), positive predictive value 70.3% (95% CI [64.1-75.9%]) and negative predictive value 85.7% (95% CI [82.0-88.9%]). For final disposition, the observers made a correct prediction in 80.8% (95% CI [76.1-85.0%]) of the cases. For ICU admission, emergency physicians had a sensitivity of 33.9% (95% CI [22.1-47.4%]) and a specificity of 96.9% (95% CI [94.0-98.7%]). The correct diagnosis was made 54% of the time with the limited data available.\nConclusion:\n System 1 decision-making based on limited information had a sensitivity close to 80% for acuity and disposition prediction, but the performance was lower for predicting ICU admission and diagnosis. System 1 decision-making appears insufficient for final decisions in these domains but likely provides a cognitive framework for System 2 decision-making.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"decision making"},{"word":"dual process theory"},{"word":"emergency department"}],"section":"Patient Safety","is_remote":true,"remote_url":"https://escholarship.org/uc/item/7c1267gw","frozenauthors":[{"first_name":"Daniel","middle_name":"","last_name":"Cabrera","name_suffix":"","institution":"Mayo Clinic College of Medicine, Department of Emergency Medicine, Rochester, Minnesota","department":"None"},{"first_name":"Jonathan","middle_name":"F.","last_name":"Thomas","name_suffix":"","institution":"Mayo Clinic College of Medicine, Department of Emergency Medicine, Rochester, Minnesota","department":"None"},{"first_name":"Jeffrey","middle_name":"L.","last_name":"Wiswell","name_suffix":"","institution":"Mayo Clinic College of Medicine, Department of Emergency Medicine, Rochester, Minnesota","department":"None"},{"first_name":"James","middle_name":"M.","last_name":"Walston","name_suffix":"","institution":"Mayo Clinic College of Medicine, Department of Emergency Medicine, Rochester, Minnesota","department":"None"},{"first_name":"Joel","middle_name":"R.","last_name":"Anderson","name_suffix":"","institution":"Mayo Clinic College of Medicine, Department of Emergency Medicine, Rochester, Minnesota","department":"None"},{"first_name":"Erik","middle_name":"P.","last_name":"Hess","name_suffix":"","institution":"Mayo Clinic College of Medicine, Department of Emergency Medicine, Rochester, Minnesota","department":"None"},{"first_name":"M.","middle_name":"Fernanda","last_name":"Bellolio","name_suffix":"","institution":"Mayo Clinic College of Medicine, Department of Emergency Medicine, Rochester, Minnesota","department":"None"}],"date_submitted":"2014-12-27T12:53:06-05:00","date_accepted":"2014-12-27T12:53:06-05:00","date_published":"2015-10-20T18:32:17-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8673/galley/4982/download/"}]},{"pk":8761,"title":"Invasive Mechanical Ventilation in California Over  2000-2009: Implications for Emergency Medicine","subtitle":null,"abstract":"Introduction: \nPatients who require invasive mechanical ventilation (IMV) often represent a sequence of care between the emergency department (ED) and intensive care unit (ICU). Despite being the most populous state, little information exists to define patterns of IMV use within the state of California.\nMethods:\n We examined data from the masked Patient Discharge Database of California’s Office of Statewide Health Planning and Development from 2000-2009. Adult patients who received IMV during their stay were identified using the International Classification of Diseases 9th Revision and Clinical Modification procedure codes (96.70, 96.71, 96.72). Patients were divided into age strata (18-34yr, 35-64yr, and >65yr). Using descriptive statistics and regression analyses, for IMV discharges during the study period, we quantified the number of ED vs. non-ED based admissions; changes in patient characteristics and clinical outcome; evaluated the marginal costs for IMV; determined predictors for prolonged acute mechanical ventilation (PAMV, i.e. IMV>96hr); and projected the number of IMV discharges and ED-based admissions by year 2020.\nResults:\n There were 696,634 IMV discharges available for analysis. From 2000–2009, IMV discharges increased by 2.8%/year: n=60,933 (293/100,000 persons) in 2000 to n=79,868 (328/100,000 persons) in 2009. While ED-based admissions grew by 3.8%/year, non-ED-based admissions remained stable (0%). During 2000-2009, fastest growth was noted for 1) the 35–64 year age strata; 2) Hispanics; 3) patients with non-Medicare public insurance; and 4) patients requiring PAMV. Average total patient cost-adjusted charges per hospital discharge increased by 29% from 2000 (from $42,528 to $60,215 in 2014 dollars) along with increases in the number of patients discharged to home and skilled nursing facilities. Higher marginal costs were noted for younger patients (ages 18-34yr), non-whites, and publicly insured patients. Some of the strongest predictors for PAMV were age 35-64 years (OR=1.12; 95% CI [1.09-1.14], p<0.05); non-Whites; and non-Medicare public insurance. Our models suggest that by 2020, IMV discharges will grow to n=153,153 (377 IMV discharges/100,000 persons) with 99,095 admitted through the ED.\nConclusion:\n Based on sustained growth over the past decade, by the year 2020, we project a further increase to 153,153 IMV discharges with 99,095 admitted through the ED. Given limited ICU bed capacities, ongoing increases in the number and type of IMV patients have the potential to adversely affect California EDs that often admit patients to ICUs.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"invasive mechanical ventilation, intensive care unit, emergency department, epidemiology, outcomes, health policy, California"}],"section":"Healthcare Utilization","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1j2799f7","frozenauthors":[{"first_name":"Seshadri","middle_name":"C.","last_name":"Mudumbai","name_suffix":"","institution":"Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System; Stanford University School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford, California","department":"None"},{"first_name":"Juli","middle_name":"","last_name":"Barr","name_suffix":"","institution":"Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System; Stanford University School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford, California","department":"None"},{"first_name":"Jennifer","middle_name":"","last_name":"Scott","name_suffix":"","institution":"Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System","department":"None"},{"first_name":"Edward","middle_name":"R.","last_name":"Mariano","name_suffix":"","institution":"Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System; Stanford University School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford, California","department":"None"},{"first_name":"Edward","middle_name":"","last_name":"Bertaccini","name_suffix":"","institution":"Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System; Stanford University School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford, California","department":"None"},{"first_name":"Hieu","middle_name":"","last_name":"Nguyen","name_suffix":"","institution":"George Washington School of Medicine, Washington, DC","department":"None"},{"first_name":"Stavros","middle_name":"G.","last_name":"Memtsoudis","name_suffix":"","institution":"Hospital for Special Surgery, Weill Medical College of Cornell University","department":"None"},{"first_name":"Brian","middle_name":"","last_name":"Cason","name_suffix":"","institution":"Anesthesia Service, Veterans Affairs San Francisco Health Care System; University of California, San Francisco, Department of Anesthesiology and Perioperative Care, California","department":"None"},{"first_name":"Ciaran","middle_name":"S.","last_name":"Phibbs","name_suffix":"","institution":"Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System; Stanford University School of Medicine, Department of Pediatrics","department":"None"},{"first_name":"Todd","middle_name":"","last_name":"Wagner","name_suffix":"","institution":"Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System","department":"None"}],"date_submitted":"2015-02-17T01:07:27-05:00","date_accepted":"2015-02-17T01:07:27-05:00","date_published":"2015-10-20T18:29:41-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/8761/galley/5013/download/"}]}]}