Department Resources Research Articles

Supporting Communication Between Individuals With Disabilities and First Responders: A Preliminary Case-Based Interview Study

Purpose: During a crisis, an individual with a communication disability or difference is at risk of communication breakdowns that could unintentionally escalate the crisis. The goal of this preliminary study was to identify how first responders from various organizations may respond given scenarios presenting potential interactions with an individual with a communication impairment or difference. Method: Three adult participants currently serving as first responders completed semistructured interviews. Participants were asked how they would react in different hypothetical scenarios, all incorporating aspects of communication disorders and differences that could be misinterpreted. Data analysis consisted of transcribing the responses to each scenario and identifying the themes. Results: Participants across organizations receive general communication and disability training, rely on established procedures, problem-solving, open-mindedness, and use of departmental resources in their interactions. Conclusions: This preliminary study illustrates awareness of existing protocols and organizational supports that may support interactions with individuals with communication disorders and differences. Potential areas for additional resources and training include the use of augmentative and alternative communication and disability-specific education.

Transitioning From Training to Breast Imaging Practice: Building an Academic Career.

Launching an academic career in breast imaging presents both challenges and opportunities for the newly graduated trainee. A strategic plan aligned with one's personal strengths and interests facilitates career success and professional satisfaction. Academic departments offer multiple tracks to accommodate diverse faculty goals. The specific requirements of various tracks vary across institutions. The clinician-educator track typically encourages a focus on medical education and educational scholarship. The clinician-investigator or clinician-scholar track supports original research and grant-funded clinical trials. Finally, the clinical and clinician-administrator tracks allow for emphasis on clinical program development and leadership. As definitions of scholarship broaden, many opportunities are accessible to demonstrate excellence in the traditional areas of clinical practice, education, and research, as well as the broader fields of leadership and administration. Departmental and national society resources that advance knowledge in one's chosen area of interest are available and should be explored. Mentorship and sponsorship can provide valuable insight into identifying such resources and devising a plan for sustainable career success and work-life integration.

Development of an Abbreviated Longitudinal Approach for Medical Student Learning in Perioperative Medicine: Teaching the Perioperative Surgical Home.

Leaders in anesthesiology are promoting increased involvement of anesthesiologists in perioperative medicine (POM). Academic leaders are calling for a corresponding increase in resident and medical student education in this evolving medical discipline. Formalized POM programs are new to most academic anesthesiology programs, and very little has been written about development of these programs for anesthesiology residents or medical students. We describe the creation of a longitudinal medical student clerkship in POM using established curriculum design methods with minimal capital resources. This is a descriptive account of the process of clerkship design. It includes a qualitative analysis of participants' satisfaction with the novel clerkship. Design and implementation of a new, advanced medical student clerkship in POM using no additional capital resources was successful. Medical students indicated appreciation for the unique longitudinal design. Students also demonstrated understanding of the expanding role of anesthesiology in perioperative care of patients, a primary goal of the educational process. The principles of the American Society of Anesthesiology's Perioperative Surgical Home can be taught systematically and successfully to advanced medical students with little additional expenditure of departmental resources.

Technical note: A wearable radiation measurement system for collection of patient-specific time-activity data in radiopharmaceutical therapy: system design and Monte Carlo simulation results.

Purpose: A high level of personalization in Molecular Radiotherapy (MRT) could bring advantages in terms of treatment effectiveness and toxicity reduction. Individual organ‐level dosimetry is crucial to describe the radiopharmaceutical biodistribution expressed by the patient, to estimate absorbed doses to normal organs and target tissue(s). This paper presents a proof‐of‐concept Monte Carlo simulation study of “WIDMApp” (Wearable Individual Dose Monitoring Apparatus), a multi‐channel radiation detector and data processing system for in vivo patient measurement and collection of radiopharmaceutical biokinetic data (i.e., time‐activity data). Potentially, such a system can increase the amount of such data that can be collected while reducing the need to derive it via nuclear medicine imaging. Methods: a male anthropomorphic MIRD phantom was used to simulate photons (i.e., gamma‐rays) propagation in a patient undergoing a 131I thyroid treatment. The administered activity was set to the amount usually administered for the treatment of differentiated carcinoma while its initial distribution in different organs was assigned following the ICRP indications for the 131I biokinetics. Using this information, the simulation computes the Time‐dependent Counts Curves (TCCs) that would have been measured by seven WIDMApp‐like sensors placed and oriented to face each one of five emitting organs plus two thyroid lobes. A deconvolution algorithm was then applied on this simulated data set to reconstruct the Time‐Activity Curve (TAC) of each organ. Deviations of the reconstructed TACs parameters from values used to generate them were studied as a function of the deconvolution algorithm initialization parameters and assuming non‐Poisson fluctuation of the TCCs data points. Results: This study demonstrates that it is possible, at least in the simple simulated scenario, to reconstruct the organ cumulated activity by measuring the time dependence of counts recorded by several detectors placed at selected positions on the patient's body. The ability to perform in vivo sampling more frequently than conventional biokinetic studies increases the number of time points and therefore the accuracy in TAC estimates. In this study, an accuracy on cumulated activity of 5% is obtained even with a 20% error on the TCC data points and a 50% error on the initial guess on the parameters of the deconvolution algorithm. Conclusions: the WIDMApp approach could provide an effective tool to characterize more accurately the radiopharmaceutical biokinetics in MRT patients, reducing the need of resources of nuclear medicine departments, such as technologist and scanner time, to perform individualized biokinetics studies. The relatively simple hardware for the approach proposed would allow its application to large numbers of patients. The results obtained justify development of an actual prototype system to characterize this technique under realistic conditions.

Automated hybrid volumetric modulated arc therapy (HVMAT) for whole-breast irradiation with simultaneous integrated boost to lumpectomy area : Atreatment planning study.

To develop anautomated treatment planning approach for whole breast irradiation with simultaneous integrated boost using an automated hybrid VMAT class solution (HVMAT). Twenty-five consecutive patients with left breast cancer received 50 Gy (2 Gy/fraction) to the whole breast and an additional simultaneous 10 Gy (2.4 Gy/fraction) to the tumor cavity. Ipsilateral lung, heart, and contralateral breast were contoured as main organs-at-risk. HVMAT plans were inversely optimized by combining two open fields with aVMAT semi-arc beam. Open fields were setup to include the whole breast with a2 cm flash region and to carry 80% of beams weight. HVMAT plans were compared with three tangential techniques: conventional wedged-field tangential plans (SWF), field-in-field forward planned tangential plans (FiF), and hybrid-IMRT plans (HMRT). Dosimetric differences among the plans were evaluated using Kruskal-Wallis one-way analysis of variance. Dose accuracy was validated using the PTW Octavius-4D phantom together with the 15002D-array. No significant differences were found among the four techniques for both targets coverage. HVMAT plans showed consistently better PTVs dose contrast, conformity, and homogeneity (p < 0.001 for all metrics) and statistically significant reduction of high-dose breast irradiation. V55 and V60 decreased by 30.4, 26.1, and 20.8% (p < 0.05) and 12.3, 9.9, and 6.0% (p < 0.05) for SWF, FIF, and HMRT, respectively. Pretreatment dose verification reported agamma pass-rate greater than the acceptance threshold of 95% for all HVMAT plans. In addition, HVMAT reduced the time for full planning optimization to about 20 min. HVMAT plans resulted in superior target dose conformity and homogeneity compared to other tangential techniques. Due to fast planning time HVMAT can be applied for all patients, minimizing the impact on human or departmental resources.

Information and analytical support as an element of organization of economic security of entrepreneurial activity

The article describes the importance of information and analytical support for the formation of organizational support for economic security of business. The stages and principles of formation of information-analytical support for creation of system of economic safety of the enterprise are analyzed. The connection and the nature of the influence of information-analytical activity and organizational support of economic security of the enterprise are investigated.&#x0D; It is important for the management of each organization to develop an individual mode of working with information, especially at the stage of its accumulation and analysis. Only a detailed and step-by-step definition of the process of working with information resources of various departments and officials increases the effectiveness of organizational support of economic security of the enterprise. The quality of analytical support is the basis for building an effective system of economic security of the enterprise and one of the key factors in its development.&#x0D; The harmonious combination of information-analytical work and the organization of economic security is a problem for the management of the business structure and requires a constant, operational study of the economic efficiency of the existing organizational structure.Adjusting the organizational structure directly affects the company's ability to withstand threats and risks from the external and internal environment.&#x0D; Modernity puts forward specific conditions for the economic security of the enterprise, especially given the deepening of the role and increase the amount of available information. The information array, which is freely available, is constantly replenished, which requires decision-makers to find new methods of information processing.&#x0D; The article analyzes the features of using the results of information support and analytical research to form an effective organizational structure of economic security of the enterprise. The study demonstrates the need for reliable and effective information and analytical support to improve the organizational support of economic security of the enterprise.

Disparities in emergency department access, resource allocation, and outcomes between migrants and the local population.

To characterize a group of migrant emergency department (ED) patients regarding demographics, access to the ED, mode of referral, use of resources, and short-term outcomes, and to compare them to a group of local ED patients. Prospective cohort study with consecutive enrollment of adult patients presenting to the ED of a Swiss tertiary care hospital from October 21st to November 11th, 2013 and February 1st to February 23rd, 2015. In accordance with the International Organization for Migration, we defined migrants as persons who have changed their country of usual residence, irrespective of their legal status. The primary outcome was defined as the number of resources allocated to migrants, as compared to local patients, using uni- and multivariable quasi-Poisson regressions. Acute morbidity, hospitalization, intensive care unit (ICU) admission, and 30-day mortality were assessed as secondary outcomes. Migrant patients were younger, more often male and self-presenters, and of lower acuity. After adjustment for age, gender and acuity, we observed a non-significant difference of 3.6% in the mean number of resources allocated to migrant patients as compared to local patients (adjusted RR 0.964, CI 0.923-1.006). No difference in 30-day mortality (adjusted OR 0.777, CI 0.346-1.559) was observed between the two patient groups, but migrant patients had lower odds of acute morbidity (adjusted OR 0.652, CI 0.560-0.759), hospitalization (adjusted OR 0.666, CI 0.555-0.799), and ICU admission (adjusted OR 0.649, CI 0.456-0.910). ED access approximation, resource allocation, and mortality were comparable between migrant patients and local patients. Lower admission rates to wards and the ICU may raise concerns but can be explained by lower acute morbidity in migrant patients.

Impact of Age on Emergency Resource Utilization and Outcomes in Pediatric and Young Adult Patients Supported with a Ventricular Assist Device.

There are minimal data describing outcomes in ambulatory pediatric and young adult ventricular assist device (VAD)-supported patient populations. We performed a retrospective analysis of encounter-level data from 2006 to 2017 Nationwide Emergency Department Sample (NEDS) to compare emergency department (ED) resource utilization and outcomes for pediatric (≤18 years, n = 494) to young adult (19-29 years, n = 2,074) VAD-supported patient encounters. Pediatric encounters were more likely to have a history of congenital heart disease (11.3% vs. 4.8%). However, Pediatric encounters had lower admission/transfer rates (37.8% vs. 57.8%) and median charges ($3,334 (IQR $1,473-$19,818) vs. $13,673 ($3,331-$45,884)) (all p < 0.05). Multivariable logistic regression modeling revealed that age itself was not a predictor of admission, instead high acuity primary diagnoses and medical complexity were: (adjusted odds ratio; 95% confidence intervals): cardiac (3.0; 1.6-5.4), infection (3.4; 1.7-6.5), bleeding (3.9; 1.7-8.8), device complication (7.2; 2.7-18.9), and ≥1 chronic comorbidity (4.1; 2.5-6.7). In this largest study to date describing ED resource use and outcomes for pediatric and young adult VAD-supported patients, we found that, rather than age, high acuity presentations and comorbidities were primary drivers of clinical outcomes. Thus, reducing morbidity in this population should target comorbidities and early recognition of VAD-related complications.

Positive career shocks and career optimism: testing the mediating role of career decision-making self-efficacy

PurposeThis study examines the relationship of positive career shocks and career optimism. The mediating role of career decision-making self-efficacy (CDSE) between positive career shocks and career optimism and the moderating role of consideration of future consequences – immediate (CFC-I) between CDSE and career optimism are checked.Design/methodology/approachThrough cluster sampling, cross-sectional data from 192 professionals of electronic media industry were collected via an electronically administered questionnaire. For preliminary descriptive data analysis, SPSS version 21 was used. SmartPLS version 3.0 was used for testing the proposed hypotheses.FindingsThe results showed that positive career shocks have a relationship with career optimism via CDSE. Also, CFC-I moderated the relationship of CDSE and career optimism such that the relationship of CDSE and career optimism was stronger at higher level of CFC-I.Practical implicationsThe study provides implications for the career consultants, human resource professionals and senior management of organizations. All these stakeholders can strive to build an inventory of positive career shocks. Also, shifting to a surprised business model of announcing compensations and promotions is another area to work on. The results of this study further suggest disengaging the fresh potential employees in the initial processes of recruitment. Interdepartmental coordination of health and safety department and human resource management department is also a very important implication for this study to highlight the positive aspects of being optimistic.Originality/valueThe study is among the few empirical studies which investigates the relationship between positive career shocks and career optimism via CDSE. Also, in light of the latest call of various empirical works in the domain, this study adds a moderating variable, i.e. CFC-I in predicting career optimism. Furthermore, contrary to the conventional approach of applying students' data on career models, this study tests the proposed career model on data collected from professionals.

Adequate emergency department resource usage: Applying simulation-based workshop to improve teaching competence among elementary and junior high school teachers in Taiwan.

Introduction:More than 80% of patients who visited Emergency Department (ED) was not urgent in Taiwan in 2019. It causes insufficient medical services and a latent fiscal threat to the Nation Health Insurance (NHI). This study adopted simulation-based educating modules to explore the effect in teaching competence among primary and middle school teachers for efficient AEDRU (adequate emergency department resource usage) education in the future.Method:The subjects were 414 elementary and junior high school teachers in Taiwan. 214 participants attended the simulation-based workshop as the simulation-based group, whereas 200 participants took an online self-learning module as the self-learning group. The workshop was created by an expert panel for decreasing the unnecessary usage amount of ED medial resources. The materials are lecture, board games, miniature ED modules, and simulation-based scenarios. A teaching competence questionnaire including ED knowledge, teaching attitude, teaching skills, and teaching self-efficacy was conducted among participants before and after the intervention. Data were analyzed via McNemar, paired t test and the generalized estimating equations (GEE).Results:The study showed that teachers who participated in the simulation-based workshop had improved more in teaching competence than those who received the online self-learning module. In addition, there were significant differences between the pre-test and post-test among the two groups in teaching competence.Conclusion:The simulation-based workshop is effective and it should be spread out. When students know how to use ED medical resources properly, they could affect their families. It can help the ED service to be used properly and benefits the finance of the NHI. The health care cost will be managed while also improving health.

CORR Insights®: Do Disparities in Wait Times to Operative Fixation for Pathologic Fractures of the Long Bones and 30-day Complications Exist Between Black and White Patients? A Study Using the NSQIP Database.

CORR Insights®: Do Disparities in Wait Times to Operative Fixation for Pathologic Fractures of the Long Bones and 30-day Complications Exist Between Black and White Patients? A Study Using the NSQIP Database.

Domestic Violence Police Reporting and Resources During the 2020 COVID-19 Stay-at-Home Order in Chicago, Illinois

Domestic violence (DV) has become a growing public health concern during the COVID-19 pandemic because individuals may be sheltering in place with abusers and facing mounting economic and health-related stresses. To analyze associations of the 2020 COVID-19 stay-at-home (SH) order with DV police reporting and resource availability, including differences by community area racial/ethnic composition. This longitudinal cohort study assessed DV police reports (January-June 2020) obtained from the Chicago, Illinois, Police Department and DV resource availability (March and August 2020) obtained from the NowPow community resource database, both for 77 community areas in Chicago. Data were analyzed July through December 2020. The COVID-19 SH order effective March 21, 2020. Monthly rates of DV police reports and DV resource availability per 100 000 persons. Of 77 community areas in Chicago, 28 (36.4%) were majority Black, 19 (24.7%) majority Hispanic/Latinx, 18 (23.4%) majority White, and 12 (15.6%) a different or no majority race/ethnicity, representing an estimated population of 2 718 555 individuals. For each community area, the SH order was associated with a decrease in the rate of DV police reports by 21.8 (95% CI, -30.48 to -13.07) crimes per 100 000 persons per month relative to the same months in 2019. Compared with White majority community areas, Black majority areas had a decrease in the rate of DV police reports by 40.8 (95% CI, -62.93 to -18.75) crimes per 100 000 persons per month relative to the same months in 2019. The SH order was also associated with a decrease in DV resource availability at a rate of 5.1 (95% CI, -7.55 to -2.67) resources per 100 000 persons, with the largest decreases for mental health (-4.3 [95% CI, -5.97 to -2.66] resources per 100 000 persons) and personal safety (-2.4 [95% CI, -4.40 to -0.41] resources per 100 000 persons). The Black majority south side of Chicago had a larger decrease in resource availability (-6.7 [95% CI, -12.92 to -0.46] resources per 100 000 persons) than the White majority north side. In this longitudinal cohort study, the rate of DV police reports decreased after the SH order was implemented in Chicago. This decrease was largely observed in Black majority communities, whereas there was no significant change in White majority communities. These findings may reflect decreased DV incidence but may also reflect an exacerbation of underreporting. In addition, DV resource availability decreased disproportionately on the predominantly Black south side of Chicago.

Proficiency-based progression training: implementing a novel approach to training for epidural analgesia in labour

BackgroundEpidural insertion is a challenging anaesthetic procedural skill to learn and may require up to 75 attempts to achieve competency. Proficiency-based progression (PbP) training based on unambiguously defined metrics was associated with a 53% reduction in epidural failure rate. The aim of this observational study was to examine the feasibility of implementation of innovative PbP training for labour epidural insertion performed by novices in a busy tertiary hospital. MethodsAll trainees who were scheduled to commence their obstetric anaesthesia training were invited to participate. Novices undertook intensive PbP training with one-to-one supervision by an anaesthetist trained in PbP. Trainees proceeded to the clinical phase only after attaining the pre-defined proficiency benchmark. All subsequent attempts at labour epidural catheter placement were evaluated. ResultsAll 12 novice trainees who were scheduled for their initial exposure to obstetric anaesthesia completed PbP training in epidural catheter insertion successfully. The average duration of the training courses was 70 (SD 11) min. Trainee characteristics were broadly similar. They performed a total of 180 labour epidural catheter placements with an overall epidural failure rate of 12.2% (22/180). The proportion of supervisor takeover was 6% (11/179). The incidence of complications was 4% (8/180) and difficulty in epidural catheter insertion due to patient factors was 16% (29/180). Patient satisfaction rates were 80% (satisfied or very satisfied), with 20% unsatisfied with their experience of epidural insertion. ConclusionIn our experience, PbP training in epidural placement is feasible within existing departmental resources in a busy tertiary teaching hospital setting.

Use of a Unique Mobile Medical Asset in COVID Monoclonal Antibody Treatment.

The COVID-19 pandemic and the subsequent surge of patients presented to emergency departments has forever changed the paradigm of delivering emergency care. The highly infectious nature of the 2019 Novel Coronavirus, or COVID-19, mandated strict environmental changes, novel patient care, and flexible strategies to continue to deliver efficient emergency care while maintaining appropriate physical distancing between suspect and non-suspect COVID-19 patients. The engagement of a unique rapidly deployable Mobile Satellite Emergency Department (MSED) with scalable capability from prompt care to resuscitation level allowed the emergency care team to optimize patient care and throughput. The MSED was strategically located adjacent to the ambulance entrance. While initially deployed to increase Emergency Department surge capacity, the MSED was repurposed to cohort and treat COVID patients with the monoclonal antibody, Bamlanivimab, who were expected to be discharged after treatment. This allowed for more efficient use of Emergency Department resources, including physical space and staffing.

Optimising educational opportunities for trainees during the pandemic.

Trainees around the world have experienced significant challenges to their personal life and training as a result of the COVID-19 pandemic. Many have felt the psychological and physical impacts of working during the COVID-19 pandemic. Training-specific challenges have included redeployment, cancellation of operative lists, cancellation of educational opportunities and loss of exposure to training as a result of shielding. This article describes the impact of infection with COVID-19 on psychological wellbeing and training. It discusses general measures the trainee can take to mitigate the challenges this has caused, categorised into personal, planning and educational resources, and measures focussed on certain challenges. Finally, the vital importance of support for trainees is described, including peer support, departmental resources and the growing array of online material.

The Holy Month of Ramadan: Mass-Gathering Event Implications for Hospital Surge Capacity Planning in Saudi Arabia.

The goal of this study is to determine the impact of the Holy Month of Ramadan on emergency department (ED) and hospital resource utilization in comparison to the time of Hajj and the rest of the year, so as to better define future resource needs of hospitals responding to events of this large size and duration. A retrospective chart review was conducted of electronic medical records, ED visits, and hospital admissions during Ramadan, Hajj, and all other months over a three-year period on the Hijra calendar (1438-1440) or Gregorian (2016-2019). Primary outcomes were the change in the number of ED visits, hospital admissions, and intensive care unit (ICU) admissions during Ramadan in comparison to during Hajj and other months. Secondary outcomes included mortality; number of surgeries by specialty; and admissions to cardiac, respiratory, orthopedic, and neurosurgery wards. During the three years, ED visits increased during Ramadan by 83.0%, 74.8%, and 40.3%, respectively, when compared to non-Hajj, non-Ramadan months. Hospital admissions rose by 21.05%, 50.96% and 48.22%. Combined ED and in-hospital mortality rose by 15.21%, 21.47%, and 1.39%. While there was a large increase in ICU admissions during Ramadan of 1440 (May 2019), this was not a trend seen in other years. Despite there only being two years of data for comparison, there was a trend towards increased admissions to all specialty wards. There was an average 46.69% increase in admissions to the general surgery ward during Ramadan months compared to other months, a 31.06% increase in admissions to the orthopedic surgery ward, and a 44.05% increase in admissions to the cardiac care unit. Ramadan is associated with a significant increase in the population of Makkah (Mecca), Saudi Arabia. Despite this study only focusing on a three-year period, and some variables with only two years of data available, it demonstrates a significant increase in ED visits, hospital admissions, and mortality during Ramadan compared to non-Hajj/non-Ramadan months. During mass gatherings of this size, it would benefit local and regional hospital systems to devote increased resources to patient care, especially to the ED, to prevent morbidity and mortality.

Improving Emergency Room Utilization During the COVID-19 Pandemic: A Telemedicine Social Determinants of Health Outreach Approach

ABSTRACT High-risk patients over the age of 65, who had chronic medical conditions, and had not yet had a primary care visit within 2020 were identified. A subgroup of patients participated in a survey to assess social determinants of health (SDOH) in the setting of a pandemic. Outcomes of those who participated in the survey, and those who did not participate were compared. Notably, those who were surveyed and lived within zip codes with low socioeconomic status had significantly decreased emergency department visits, which we defined as a discharge from the emergency department without hospitalization, as compared to those who did not receive outreach. Rates of inpatient hospitalization did not differ significantly. These findings suggest that patient outreach to evaluate SDOH during a pandemic leads to more appropriate emergency department and hospital resource utilization. This finding is particularly impactful given the current pandemic, which may place a strain on emergency department, and healthcare resources.

Heat stroke: knowledge and practices of medical professionals in pediatric emergency medicine departments \u2013 a survey study

Background and importanceHeat stroke is a life-threatening condition affecting children worldwide. Rapid cooling remains the most important feature of emergency management. The accepted preferred method of evaporative cooling in the ED as listed by the reference text book endorsed by the Israeli Society of Pediatric Emergency Medicine (PEMI), is actively cooling the patient by spraying him with water and positioning fans to blow air across the body.ObjectiveThis study aimed to assess Israeli health care workers (HCWs) medical professionals’ knowledge and preparedness of treating heat stroke and recommend policy changes to ensure better treatment based on survey results.Design, settings and participantsA cross-sectional survey of all HCWs working in an ED that accepts children was conducted. An online questionnaire was utilized to assess heat stroke management practices and available resources in all Israeli pediatric emergency departments (PEDs).Main resultsData from 208 health care workers was analyzed. Only 30% of the participants reported ever treating a patient with exertional heat stroke. Two scenarios were presented to the participants: motor vehicle-related child hyperthermia (MVRCH) in an infant and an adolescent with exertional heat stroke. One hundred twenty-five (60%) and 83 (40%) participants, respectively, listed cool water with a fan as the primary mode of cooling, which is considered the appropriate preferred method of evaporative cooling in the PED. Certificated pediatric emergency medicine (PEM) physicians answered significantly more correctly regarding both scenarios’ management (P < 0.001). Participants who were trained via simulation in the past, answered significantly more correctly regarding the exertional heat stroke scenario (P < 0.01), however no difference was found regarding the MVRCH case.Conclusions: The present study exposes weaknesses in HCW knowledge, PED resources, and published PED policies for appropriate management of children following heat stroke. Our finding emphasizes the importance of both certificated PEM physicians attendance and simulation performance for implementing proper management of patients with heat stroke. A policy change should be performed among the Israeli PED community, with respect to establishing and implementing guidelines for treatment of exertional heat stroke. A future study, following an interventional simulation program is planned to be performed.

Research Self-Efficacy and Productivity in Communication Sciences and Disorders Faculty

IntroductionIn the field of Communication Sciences and Disorders (CSD) emphasis is placed on advancing research to inform evidence based practice. However, there is little information about the research support and productivity of current faculty members in the discipline. The aims of this study are: to describe the resources and workload of faculty at different types of institutions; to examine whether self-perception of research self-efficacy differs between faculty across institution types; and to investigate whether self-efficacy, institutional factors, or workload characteristics predict research productivity. MethodsCSD faculty (N = 144) completed an online survey about their institutions, departments, and research resources. Respondents rated their research self-efficacy using the Quantitative and/or Qualitative Research Self Efficacy Inventory. Total Research Productivity was tallied using the Total Research Productivity Index. Responses were analyzed according to the respondent institution's Carnegie Classification and faculty rank to provide a more comprehensive picture of faculty experiences at different kinds of institutions. ResultsFaculty across institution types are equally confident in their research abilities and their confidence is related to similar tasks overall. Departmental resources for research are aligned with Carnegie Classifications of institutions. Faculty at research-focused institutions showed overall higher research productivity but also reported spending similar time on departmental service and teaching. Research productivity was predicted by Carnegie Classification and time spent in advisement and clinic supervision. Limited opportunities for doctoral funding and engagement of post-doctoral research fellows were noted. ConclusionsThe results of this study further our understanding of the resources and limitations for research in different types of programs that offer CSD degrees. This information is necessary to inform policy decisions regarding academic careers in CSD, provide context for students considering an academic career, and enhance the research productivity of the field.

Ecstasy and related drug consumption and the effect on emergency department resource use

BackgroundEcstasy and other recreational related drug use and substance related presentations to the emergency department (ED) are increasing. The aim of this study was to identify, quantify, and describe the ED resources used to care for patients diagnosed with ecstasy and related drug (ERD) use. MethodA retrospective case study design. ResultsEighty-nine patients (89%) needed one to one (n=25) and/or one to two nursing care (n=83). Security presence was required for 37 patients (37%) and the Emergency Psychiatric Service team reviewed 29 patients (29%). Most patients (n=80, 80%) received an Emergency Short Stay Unit admission, but continued to receive care in the ED, and were not transferred to the short stay unit (n=74, 92.5%). Most patients (n=86, 86%) were discharged home, after 5hr 49mins (median) in ED. ConclusionExtensive human resources were required to care for patients diagnosed with ERD use. Nursing staffing levels required to care for this patient cohort during times of peak presentations should be reviewed. It is important the government acknowledges the National Emergency Access Target is not suitable for all presenting patients. A dedicated model of care is recommended to support care requirements and reduce pressure on busy EDs.