Emergency Medicine Experience Research Articles

More Than a Joke: The Intersection of Gender-Based Humor and Gender Inequities Experienced by Women Department Chairs in Academic Medicine.

Purpose: The purpose of this qualitative descriptive study is to describe how women academic department chairs in emergency medicine, surgery, and anesthesiology experience humor in the workplace. Method: Interviews were conducted with 35 women department chairs in academic medicine from 27 institutions that aimed to describe women's leadership emergence. The data from the primary study yielded rich and revealing themes involving participants' experiences with humor in the context of their leadership roles, justifying a secondary analysis focusing specifically on these experiences. Relevant remarks were extracted, coded, and summarized. Results: Participants discussed two broad types of humor-related experiences. First, they described how they responded to aggressive gender-based humor directed at themselves or their colleagues by tolerating it or expressing disapproval. This humor includes demeaning quips, insulting monikers, sexist jokes, and derogatory stories. Participants often did not confront this humor directly as they feared being rejected or ostracized by colleagues. Second, they described how they initiated humor to address gender-related workplace issues by highlighting gender inequalities, coping with sexual harassment and assault, and managing gender-based leadership challenges. Participants felt constrained in their own use of humor because of the need to be taken seriously as women leaders. Conclusion: Women leaders in academic medicine use humor to confront gender-related issues and experience aggressive gender-based humor in the workplace. The constraints placed on women leaders discourage them from effectively confronting this aggressive gender-based humor and perpetuating gender inequities. Eliminating aggressive gender-based humor is needed to create safe and equitable work environments in academic medicine.

"Cold feet": A qualitative study of medical students who seriously considered emergency medicine but chose another specialty.

Emergency medicine (EM) has historically been among the most competitive specialties in the United States. However, in 2022 and 2023, 219 of 2921 and 554 of 3010 respective National Resident Matching Program positions were initially unfilled. Medical students' selection of a medical specialty is a complex process. To better understand recent trends in the EM residency match, this qualitative study explored through one-on-one interviews the rationale of senior medical students who seriously considered EM but ultimately pursued another specialty. A convenience sample of senior medical students from across the United States was recruited via multiple mechanisms after the 2023 match. Participant characteristics were collected via an online survey. Qualitative data were generated through a series of one-on-one semistructured interviews and thematic analysis of the data was performed using a constant comparative approach. Sixteen senior medical students from 12 different institutions participated in the study. Thematic saturation was reached after 12 interviews but data from all 16 interviews were included for qualitative analyses. Five major themes emerged as important in students' consideration but ultimate rejection of EM as a career: (1) innate features of EM attracted or dissuaded students, (2) widespread awareness of a recent workforce report, (3) burnout in EM, (4) their perception of EM's standing in the health care landscape, and (5) early EM experience and exposure. This qualitative study identified five major themes in the career decisions of senior medical students who seriously considered EM but chose another specialty. These findings may help inform the perceptions of students and guide future EM recruitment efforts.

Society of Critical Care Medicine Clinical Practice Guidelines for Rapid Sequence Intubation in the Critically Ill Adult Patient.

Controversies and practice variations exist related to the pharmacologic and nonpharmacologic management of the airway during rapid sequence intubation (RSI). To develop evidence-based recommendations on pharmacologic and nonpharmacologic topics related to RSI. A guideline panel of 20 Society of Critical Care Medicine members with experience with RSI and emergency airway management met virtually at least monthly from the panel's inception in 2018 through 2020 and face-to-face at the 2020 Critical Care Congress. The guideline panel included pharmacists, physicians, a nurse practitioner, and a respiratory therapist with experience in emergency medicine, critical care medicine, anesthesiology, and prehospital medicine; consultation with a methodologist and librarian was available. A formal conflict of interest policy was followed and enforced throughout the guidelines-development process. Panelists created Population, Intervention, Comparison, and Outcome (PICO) questions and voted to select the most clinically relevant questions for inclusion in the guideline. Each question was assigned to a pair of panelists, who refined the PICO wording and reviewed the best available evidence using predetermined search terms. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework was used throughout and recommendations of "strong" or "conditional" were made for each PICO question based on quality of evidence and panel consensus. Recommendations were provided when evidence was actionable; suggestions, when evidence was equivocal; and best practice statements, when the benefits of the intervention outweighed the risks, but direct evidence to support the intervention did not exist. From the original 35 proposed PICO questions, 10 were selected. The RSI guideline panel issued one recommendation (strong, low-quality evidence), seven suggestions (all conditional recommendations with moderate-, low-, or very low-quality evidence), and two best practice statements. The panel made two suggestions for a single PICO question and did not make any suggestions for one PICO question due to lack of evidence. Using GRADE principles, the interdisciplinary panel found substantial agreement with respect to the evidence supporting recommendations for RSI. The panel also identified literature gaps that might be addressed by future research.

“You may think that the consultants are great, and they know everything, but they don’t”: exploring how new emergency medicine consultants experience uncertainty

BackgroundUncertainty is particularly obvious in emergency medicine (EM) due to the characteristics of the patient cohort, time constraints, and busy environment. Periods of transition are thought to add to uncertainty....

The Status of Pediatric Critical Care (PCC) Experience in Emergency Medicine (EM) Residency Training Programs

The Status of Pediatric Critical Care (PCC) Experience in Emergency Medicine (EM) Residency Training Programs

Virtual Reality for Emergency Medicine Training in Medical School: Prospective, Large-Cohort Implementation Study.

Virtual reality (VR)-based simulation is being increasingly used to train medical students in emergency medicine. However, because the usefulness of VR may depend on various factors, the best practices for implementing this technology in the medical school curriculum are yet to be determined. The overall objective of our study was to assess the perceptions of a large cohort of students toward VR-based training and to identify the associations between these attitudes and individual factors, such as gender and age. The authors implemented a voluntary, VR-based teaching session in the emergency medicine course at the Medical Faculty in Tübingen, Germany. Fourth-year medical students were invited to participate on a voluntary basis. Afterward, we asked the students about their perceptions, collected data on individual factors, and assessed the test scores achieved by them in the VR-based assessment scenarios. We used ordinal regression analysis and linear mixed-effects analysis to detect the impact of individual factors on the questionnaire answers. A total of 129 students participated in our study (mean age 24.7, SD 2.9 years; n=51, 39.8% male; n=77, 60.2% female). No student had previously used VR for learning, and only 4.7% (n=6) of the students had prior experience with VR. Most of the students agreed that VR can convey complex issues quickly (n=117, 91%), that VR is a useful addition to mannequin-based courses (n=114, 88%) or could even replace them (n=93, 72%), and that VR simulations should also be used for examinations (n=103, 80%). However, female students showed significantly less agreement with these statements. Most students perceived the VR scenario as realistic (n=69, 53%) and intuitive (n=62, 48%), with a relatively lower agreement for the latter among female respondents. We found high agreement among all participants (n=88, 69%) for immersion but strong disagreement (n=69, 54%) for empathy with the virtual patient. Only 3% (n=4) of the students felt confident regarding the medical content. Responses for the linguistic aspects of the scenario were largely mixed; however, most of the students were confident with the English language (not native) scenarios and disagreed that the scenario should be offered in their native language (female students agreed more strongly than male students). Most of the students would not have felt confident with the scenarios in a real-world context (n=69, 53%). Although physical symptoms during VR sessions were reported by 16% (n=21) of the respondents, this did not lead to the termination of the simulation. The regression analysis revealed that the final test scores were not influenced by gender, age, or prior experience in emergency medicine or with virtual reality. In this study, we observed a strong positive attitude in medical students toward VR-based teaching and assessment. However, this positivity was comparatively lower among female students, potentially indicating that gender differences need to be addressed when VR is implemented in the curriculum. Interestingly, gender, age, or prior experience did not influence the final test scores. Furthermore, confidence regarding the medical content was low, which suggests that the students may need further training in emergency medicine.

Scheduling doesn't matter! A noninferiority study of block versus longitudinal scheduling for emergency medicine resident pediatric procedural training experience.

Emergency medicine (EM) residencies offer a wide variety of scheduling models for pediatric patient experience, including blocked weeks in pediatric emergency departments and longitudinal models with pediatric emergency pod/department shifts integrated within other clinical experiences. Concerns with autonomy, attending entrustment, and resident comfort imply that these different scheduling models may impact EM residents' pediatric procedure volumes. The purpose of this study is to quantitatively compare EM residents' pediatric procedure experience and volumes between block versus longitudinal scheduling models. We hypothesize noninferiority between the scheduling models. A retrospective review characterized the numbers and types of procedures performed by The Ohio State Emergency Medicine residents at the tertiary care pediatric hospital where residents' receive their pediatric emergency medicine clinical experience. Procedure numbers and variety were compared across six academic years: four with a block model, one reorganization year, and one integrated longitudinal year. 2552 procedures were performed by 266 resident academic years over the 6-year period. Overall, no statistically significant differences in the number of procedures performed per year or the variety of types of procedures performed per year were found when comparing the block and longitudinal models. Differences were seen in experience of PGY1 versus PGY3 residents between scheduling models and the overall experience and volumes of the PGY2 residents during the reorganization year. Our study quantitatively concluded that the longitudinal scheduling model is noninferior to the more traditional block scheduling model for emergency medicine residents' pediatric emergency medicine clinical experience when reviewing volumes and types of procedures performed in a pediatric emergency department. This suggests that procedural opportunities do not need to dictate scheduling models.

Physician Men Leaders in Emergency Medicine Bearing Witness to Gender-Based Discrimination

Approximately 60% of women physicians in emergency medicine (EM) experience gender-based discrimination (GBD). Women physicians are also more likely to experience GBD than men physicians, particularly from patients, other physicians, or nursing staff. To describe the responses of men who are academic department chairs in EM to GBD directed toward a woman colleague. This qualitative study was a secondary data analysis drawn from interviews of men EM academic department chairs at 18 sites who participated in a qualitative descriptive study between April 2020 and February 2021 on their perceptions of the influence of gender and leadership in academic medicine. Narrative data related to GBD were extracted and coded using conventional content analysis. Codes were clustered into themes and subthemes and summarized. Data were analyzed from November to December 2021. Semistructured interviews conducted via teleconferencing. Qualitative findings identifying experiences witnessing or learning about incidents of GBD against women colleagues, the impact of these observations, and personal or leadership actions taken in response to their observations. All 18 men participants (mean [SD] age, 52.2 [7.5] years; mean [SD] time as a department chair, 7.2 [5.1] years) discussed witnessing or learning about incidents of GBD against women colleagues. The participant narratives revealed 3 themes: emotional responses to GBD, actions they took to address GBD, and reasons for not taking action to address GBD. When witnessing GBD, participants felt anger, disbelief, guilt, and shame. To take action, they served as upstanders, confronted and reported discrimination, provided faculty development on GBD, or enforced "zero-tolerance" policies. At times they did not take action because they did not believe the GBD warranted a response, perceived a power differential or an unsupportive institutional culture, or sought self-preservation. In this qualitative study of men physician leaders, we found all participants reported feeling troubled by GBD against women colleagues and, if possible, took action to address the discrimination. At times they did not take action because of unsupportive workplace cultures. These findings suggest that institutional culture change that supports the interventions of upstanders and does not tolerate GBD is needed.

Factors associated with a basic common drug-drug interaction knowledge among emergency department medical personnel

BackgroundDrug-drug interactions (DDIs) are common but less concerning in clinical practice of time-sensitive situations. We aimed to identify factors associated with a basic common DDI knowledge among an emergency physician (EP), an emergency medicine resident (EMR), and an emergency care nurse (ECN).MethodsThis was a prospective cross-sectional study. EP, EMR, and ECN did the examination (multiple-choice questions, 40 points) about common DDI. Prespecified factors associated with examination scores were profession, longer emergency medicine experience, pharmacological training, last advanced cardiovascular life support (ACLS) training, DDI checker book, and application user experience. The outcome was an examination score to evaluate the ability of DDI knowledge. Univariable and multivariable means regressions were used.ResultsA total of 244 participants were enrolled. Factors associated with high examination score were EP (unadjusted mean difference 3.3 points, 95% confidence interval [CI] 2.1 to 4.5, p < 0.001), EMR (2.1, 95% CI 0.7 to 3.5, p 0.005) compared to ECN. Last ACLS training within 2 years (3.7, 95% CI 0.7 to 6.6, p 0.015), 2–4 years (3.4, 95% CI 0.4 to 6.5, p 0.027), and ≥4 years (4.4, 95% CI 1.2 to 7.6, p 0.007) were higher score than no ACLS training. Moreover, the DDI checker application experience user (1.7, 95% CI 0.6 to 2.8, p 0.003) also had a high score compared to the non-experienced user. After adjustment for all factors, EP (adjusted mean difference 3.3 points, 95% CI 1.8 to 4.7, p < 0.001), EMR (2.5, 95% CI 0.6 to 4.3, p 0.010) were higher scores compared to ECN. Meanwhile, the last ACLS training ≥4 years (3.3, 95% CI 0.1 to 6.6, p 0.042) was a higher score than no ACLS training.ConclusionEP, EMR, and the last ACLS training ≥4 years were associated with higher DDI knowledge than ECN and no ACLS training, respectively.

Self-Stigmatization of Healthcare Workers in Intensive Care, Acute, and Emergency Medicine.

This quantitative study examines whether employees in the fields of intensive care or acute and emergency medicine experience psychological distress because of their daily work. In addition, it was examined if self-stigmatization tendencies can significantly influence the willingness to seek help, and therefore psychological problems are not being treated adequately. These problems lead to various difficulties in professional and private contexts and ultimately endanger patient safety. From May to June 2021, an online questionnaire survey was conducted. This questionnaire combined two validated measuring instruments (PHQ-D and SSDS). To ensure high participation, the departments of anesthesia and/or intensive care medicine in 68 German hospitals were contacted, of which 5 responded positively. A total of 244 people participated in the questionnaire survey. On average, depressive symptoms were of mild severity. At the same time, self-stigmatization regarding depressive symptoms was high. These results highlight the practical need to prepare staff who work in the field of intensive care or acute and emergency medicine at the early onset for potentially traumatic and emotionally demanding events during their university education or studies. Adequate, evaluated, and continuously available support services from the psychosocial field should become an integral part of every staff care structure.

Simulation-based randomized trial of medical emergency cognitive aids

BackgroundMedical emergencies are complex and stressful, especially for the young and inexperienced. Cognitive aids (CA) have been shown to facilitate management of simulated medical emergencies by experienced teams. In this randomized trial we evaluated guideline adherence and treatment efficacy in simulated medical emergencies managed by residents with and without CA.MethodsPhysicians attending educational courses executed simulated medical emergencies. Teams were randomly assigned to manage emergencies with or without CA. Primary outcome was risk reduction of essential working steps. Secondary outcomes included prior experience in emergency medicine and CA, perceptions of usefulness, clinical relevance, acceptability, and accuracy in CA selection. Participants were grouped as “medical” (internal medicine and neurology) and “perioperative” (anesthesia and surgery) regarding their specialty. The study was designed as a prospective randomized single-blind study that was approved by the ethical committee of the University Duisburg-Essen (19-8966-BO). Trial registration: DRKS, DRKS00024781. Registered 16 March 2021—Retrospectively registered, http://www.drks.de/DRKS00024781.ResultsEighty teams participated in 240 simulated medical emergencies. Cognitive aid usage led to 9% absolute and 15% relative risk reduction. Per protocol analysis showed 17% absolute and 28% relative risk reduction. Wrong CA were used in 4%. Cognitive aids were judged as helpful by 94% of the participants. Teams performed significantly better when emergency CA were available (p < 0.05 for successful completion of critical work steps). Stress reduction using CA was more likely in “medical” than in “perioperative” subspecialties (3.7 ± 1.2 vs. 2.9 ± 1.2, p < 0.05).ConclusionsIn a high-fidelity simulation study, CA usage was associated with significant reduction of incorrect working steps in medical emergencies management and was characterized by high acceptance. These findings suggest that CA for medical emergencies may have the potential to improve emergency care.

Resident attitudes, experiences, and preferences on initiating buprenorphine in the emergency department: A national survey.

The objective was to describe emergency medicine (EM) resident attitudes, preferences, and experiences around the knowledge and skills around the evidence-based treatment of opioid use disorder (OUD) in the emergency department (ED). We created an online survey that was distributed by the Emergency Medicine Residents' Association research committee listserv to approximately 6600 resident physicians at all levels of EM residency training. Data were collected between June 2020 and October 2020. This 12-question voluntary, anonymous survey included questions exploring EM resident preferences and experiences around the education and exposure to the evidence-based management of patients with OUD in the ED setting. Descriptive statistics were used. A total of 288 of 6600 invited EM residents (response rate 4.4%) from 127 different EM residency programs across 38 states in the United States, District of Columbia, and Puerto Rico completed the survey. Most respondents (165/288; 57.3%) reported that it was "very important" for emergency physicians to have training to initiate buprenorphine treatment for patients with OUD. Just under half (140/288; 48.6%) reported they have or will receive X-waiver training during residency and 46.9% (135/288) reported experience prescribing buprenorphine in the ED. The estimated proportions of EM faculty at responding residents' primary teaching hospital with an X-waiver was "most or all" (48/285; 16.8%), "about half" (23/285; 8.1%), "a handful" (79/285; 27.7%), "one or two" (33/285; 11.6%), "none" (19/285; 6.7%), or "not sure" (83/285; 29.1%). Survey results suggest that resident emergency physicians perceive the evidence-based management of OUD to be relevant to EM residency training and are interested in receiving training on initiating medications for OUD treatment in the ED. Opportunities to improve resident education and clinical use of buprenorphine during ED residency training were identified.

Workplace violence toward emergency medicine physicians in the hospitals of Taif city, Saudi Arabia: a cross-sectional survey

BackgroundWorkplace violence against health care workers is an emerging concern in various global health settings and the documentation of physical and verbal attacks against physicians in tertiary hospitals in Saudi Arabia is uncommon. This study aimed to determine the incidence of workplace violence against physicians in the emergency department of selected tertiary hospitals in Taif City, Saudi Arabia from June to July 2021. Associations between the incidence of violence and interventions and type of physicians and years of experience were also investigated.MethodologyUsing a cross-sectional design, a total of 96 physicians were recruited to answer the World Health Organization Questionnaire on Violence against Health Care Workers last June to July 2021.ResultsIt was found out that 75 physicians (78.1%) experienced verbal violence while 14 physicians (14.6%) experienced physical violence. Most of the workplace violence happened within hospital premises (84.4%). Despite having an experience of verbal and physical violence, only 44.8% of the respondents reported the incidents. The most common instigators were patients (55.21%), their relatives (78.00%), external colleagues (9.37%) and staff members (6.25%). Most respondents took no action, or reported the incidence to the police or senior staff member. The incidence of workplace violence and type of physician showed significant association. The number of years of practice in emergency medicine also exhibited statistically significant association with the incidence of verbal attack, frequency of violence, and location of incident.ConclusionThere is high incidence of workplace violence among physicians in tertiary hospitals, and younger physicians with less experience in emergency medicine were the most susceptible to both verbal and physical violence. There is a need to strengthen policies to protect physicians against workplace violence.

Work environment in emergency medicine needs to be improved

Background: Emergency medicine (EM) is a novel specialty in Denmark. So far there are only 111 board certified specialists in EM in Denmark ~5 per Emergency department (ED). We hypothesize that stressful ED work environment may impact EM recruitment. The aim of our analysis was to evaluate the rate of applicants for EM junior and senior residency and relate it to ED patient complaint rate and work environment.&#x0D; Methods: We evaluated EM junior residency applications; and we calculated the rate of unfilled versus posted EM senior residency appointments In Denmark in 2020. As received by The Danish Agency for Patient Complaints we compared complaints from patients received over a 3-year period for EM, Respiratory medicine (RM), Cardiology (Card) and Endocrinology (Endo). One-way analysis of variance was performed to assess overall significance which was followed by a Tukey studentized range test procedure to locate the possible differences. We anonymously asked affiliated EM junior residents to qualify the reason for their application and whether they intend to apply for senior residency.Results We found a surplus of EM junior residency applications. Thus, positions were easily filled. Conversely unfilled senior EM residency appointments in Denmark amounted to 31 out of 52 posted appointments, meaning that 59% of EM senior residency appointments were unfilled. Patient complaints amounted to (means±SEM) EM 333±55; RM 88±9; Card 113±17; Endo 58±8, meaning a 3 to 5fold higher patient complaint rate in EM (p &lt; 0.0006). There were no statistical differences in patient complaints among RM, Card and Endo. Among 8 EM junior residents 63% expressed interest in an EM career as the reason for their application but following EM experience none intended to apply for senior residency.&#x0D; Conclusion: More than half of posted senior residency positions in EM remain vacant. Patient complaints are significantly frequent in EM compared to other medical specialties. Junior residents are reluctant to pursue senior residency. Stressful ED working environment needs to be improved to facilitate EM recruitment.

The place of smartphone applications ın emergency medicine

Medical mobile applications help improve patient care quality, reduce medical errors, and help physicians make faster, evidence-based decisions in patient care, follow-up and rehabilitation. In this study, it was aimed to determine the usage level of smart phone applications among emergency physicians, to investigate the effects of these applications on diagnosis and treatment, to examine their benefits, to determine the expectations regarding these applications, and to raise awareness on ethical issues. Between 02/25/2018 and 03/25/2018 emergency medicine residents in many provinces of Turkey, emergency medicine specialists, were investigated smartphone app to be used in practice with academics. A statistically significant difference was found between emergency medicine experience and mobile application use (p: 0.020). Most of the physicians surveyed had started using their first mobile apps 4 years ago. It was determined that most of the participants using mobile applications in the medical field were using them as a clinical decision tool. It was observed that those with visual expressions were mostly preferred in the use of mobile applications in the medical field (63.1%). It was determined that 75% of the participants found instant messaging applications useful in the professional field. The biggest problem identified in terms of medical ethics of mobile medical applications; was the thought of a violation of patient privacy. Although technological devices make our lives easier in many ways, examination is of great importance in the patient-physician relationship. Medical mobile applications should be prepared professionally and the content quality should be checked by experts. Due to the nature of current research, it is inevitable that technologies become outdated. There is a need for more comprehensive and up-to-date studies on this subject that appeal to large audiences.

Qualitative description of sexual harassment and discrimination of women in emergency medicine: Giving the numbers a voice.

Gender disparities in medicine are well documented; however, little qualitative data exist. This study sought to provide a qualitative assessment of harassment and discrimination experienced by female physicians in emergency medicine (EM) specifically by colleagues or supervisors. An electronic survey was distributed to female EM physicians on October 18, 2018, asking if they have felt harassed, diminished, uncomfortable, or discriminated against by a male colleague or supervisor at work based on a sexual comment or unwanted advance. Space for descriptive experiences was provided. A data abstraction tool was developed, and experiences were placed into thematic categories. The survey was closed on December 18, 2018, and data were analyzed. There were 1280 responses. Responses that were incomplete, not attributable to women, and outside of EM were excluded leaving 1144 to be analyzed. Respondents were primarily White (81%) and working in nonacademic environments (53.5%). The majority (57.3%) felt harassed, diminished, uncomfortable, or discriminated against by a male colleague or superior at work based on sexual comment or innuendo; 22.3% experienced an unwanted sexual act or advance. There were 482 descriptive experiences reported, most frequently focusing on patronizing behavior (16.5%), pregnancy/maternity leave (15.9%), and physical appearance (12.5%). Women in EM experience sexual harassment and discrimination at work by their peers and supervisors. Exploring the themes of their shared experiences can guide and focus efforts on both prevention and intervention. Further studies are needed to determine if these experiences contribute to disparities in earnings, promotion, and leadership roles of women in medicine.

Towards enhanced telephone triage for chest pain: a Delphi study to define life-threatening conditions that must be identified

BackgroundImproving telephone triage for patients with chest pain has been identified as a national research priority. However, there is a lack of strong evidence to define the life-threatening conditions (LTCs) that telephone triage ought to identify. Therefore, we aimed to build consensus for the LTCs associated with chest pain that ought to be identified during telephone triage for emergency calls.MethodsWe conducted a Delphi study in three rounds. Twenty experts in pre-hospital care and emergency medicine experience from the UK were invited to participate. In round I, experts were asked to list all LTCs that would require priority 1, 2, and 4 ambulance responses. Round II was a ranking evaluation, and round III was a consensus round. Consensus level was predefined at > = 70%.ResultsA total of 15 participants responded to round one and 10 to rounds two and three. Of 185 conditions initially identified by the experts, 26 reached consensus in the final round. Ten conditions met consensus for requiring priority 1 response: oesophageal perforation/rupture; ST elevation myocardial infarction; non-ST elevation myocardial infarction with clinical compromise (defined, also by consensus, as oxygen saturation < 90%, heart rate < 40/min or systolic blood pressure < 90 mmHg); acute heart failure; cardiac tamponade; life-threatening asthma; cardiac arrest; tension pneumothorax and massive pulmonary embolism. An additional six conditions met consensus for priority 2 response, and three for priority 4 response.ConclusionUsing expert consensus, we have defined the LTCs that may present with chest pain, which ought to receive a high-priority ambulance response. This list of conditions can now form a composite primary outcome for future studies to derive and validate clinical prediction models that will optimise telephone triage for patients with a primary complaint of chest pain.

Emergency Medicine Physicians Would Prefer Using Cannabis Over Opioids for First-Line Treatment of a Medical Condition if Provided With Medical Evidence: A National Survey.

Objective: To determine emergency medicine (EM) physicians’ preferences for using medical cannabis versus opioids if medical cannabis was legalized.Methods: We surveyed US physicians at the largest national EM conference (American College of Emergency Physicians’ Annual Conference) held in San Diego, CA from October 1 to 4, 2018. Of the thousands of conference participants approached, 539 US physicians completed the anonymous written survey, which represented 15.2% of the US physicians attending the conference.Results: The mean age of the participants was 39.6 ± 10.9 years, men composed 57.5% of the participants, and whites made up 72.8% of the respondents. Participants practicing in medically legal (54.8%) and medically plus adult-use legal cannabis states (23.1%) totaled 77.9%. A majority (70.7%) of the participants believed that cannabis has medical value. EM physicians preferred cannabis over opioids as a first-line treatment addressing a medical condition provided that medical studies found that cannabis was equally effective (p < 0.001, X2 = 36.8 [95% CI 2, 415]), and overwhelmingly preferred cannabis over opioids if it were more effective (p < 0.001, X2 = 90.8 [95% CI 2, 415]). Physicians appeared to prefer opioids over cannabis if medical studies found that cannabis was less effective though it was not significant (p > 0.05). Subgroup analyses showed that belief in the medical value of cannabis significantly increased the odds ratio of choosing cannabis over opioids if cannabis was equally or more effective than opioids.Conclusion: Our study shows that EM physicians believe cannabis has medical value and would prefer using cannabis over opioids if provided with equivalent findings. We believe our findings reflect EM physicians’ experience of the opioid epidemic and suggest the need for further study of this potential therapeutic.

Актуализация данных по артериальной гипертензии к 2020 году (часть 1)

Артериальная гипертензия (АГ) — это хроническое повышение артериального давления (АД). АД — сила, которой кровь воздействует на стенки кровеносных сосудов, в частности артерий, когда она выбрасывается сердцем. Чем выше АД, тем больше усилий нужно сердцу для того, чтобы перекачивать кровь. Последние рекомендации по АГ — ACC/AHA 2017, ESC/ESH 2018 и NICE 2019 — подробнее всего освещают вопросы, связанные с данным широко распространенным во всем мире заболеванием. В рекомендациях ACC/AHA 2017 г. и ESH/ERC 2018 г. применительно к сегодняшней медицинской работе в Украине можно заметить отличие в классификации АГ. Такое отличие, по-видимому, обусловлено особым вниманием профессионалов отрасли к специфике и территории исследования и является ярким показателем того, что невозможно автоматическое внедрение неких универсальных международных протоколов и стандартов (они могут носить лишь рекомендательный характер). Вероятно, тут не лишним будет упомянуть принципы современной медицины как профессии (наука и искусство в рамках закона), основы которой изложены Всемирной медицинской ассоциацией и ВОЗ. В результате высокого или повышенного АД, тем более если оно уже перешло в АГ и не контролируется врачом, отрицательные последствия для здоровья могут усугубляться следующими факторами риска, которые повышают вероятность развития осложнений и прогрессирования данного состояния: потребление табака, неправильное питание, злоупотребление алкоголем, незначительная физическая активность и воздействие непрерывного стресса, так же как и ожирение, высокий уровень холестерина и сахарный диабет. В условиях украинской первичной медико-санитарной помощи собственный опыт авторов работы в экстренной медицине показывает, что по болезням органов кровообращения фиксируется до 41 % вызовов (АГ, чаще всего в виде сопутствующего диагноза, отмечается практически во всех этих вызовах), основную часть которых составляют вызовы по АГ с кризами.

A qualitative assessment of emergency medicine residents' receptivity to feedback.

Effective feedback is the cornerstone of competency-based education. The emergency department (ED) is a unique learning and feedback environment. Developing our understanding of emergency medicine (EM) residents' experiences around feedback will improve resident training and inform EM faculty development programs. This qualitative study explores the feedback culture and practices in EM and resident's experiences and attitudes toward feedback in this specific training environment. At a large categorical EM program, 15 residents voluntarily participated in semistructured interviews regarding feedback. These individual interviews were performed by a nonphysician investigator and transcripts underwent an inductive multistep coding process. Transcripts were analyzed to identify common factors influencing feedback and then comparisons were made between residents to explore the interconnectedness of identified factors and further categorize consistent themes. Factors inherent to the ED environment make the delivery of effective feedback challenging. Residents also revealed that feedback-seeking/-avoidant behavior and receptivity to feedback are multifactorial. Residents actively seek feedback when they feel that they performed well but tend to avoid feedback interactions when they expect constructive feedback. Finally, residents filter feedback based on attending personality and perceived practice style as well as their own desired practice style. It is important for program leaders to understand their residents' experiences with feedback and engage both faculty and residents in conversations around feedback delivery and receptivity. An improved understanding of these experiences might also reveal barriers to performance assessment and guide efforts to improve the accuracy and reliability of resident evaluations.