Ian B.K. Martin

Missed Opportunities for Concurrent HIV-STD Testing in an Academic Emergency Department

Objectives. We evaluated emergency department (ED) provider adherence to guidelines for concurrent HIV-sexually transmitted disease (STD) testing within an expanded HIV testing program and assessed demographic and clinical factors associated with concurrent HIV-STD testing. Methods. We examined concurrent HIV-STD testing in a suburban academic ED with a targeted, expanded HIV testing program. Patients aged 18–64 years who were tested for syphilis, gonorrhea, or chlamydia in 2009 were evaluated for concurrent HIV testing. We analyzed demographic and clinical factors associated with concurrent HIV-STD testing using multivariate logistic regression with a robust variance estimator or, where applicable, exact logistic regression. Results. Only 28.3% of patients tested for syphilis, 3.8% tested for gonorrhea, and 3.8% tested for chlamydia were concurrently tested for HIV during an ED visit. Concurrent HIV-syphilis testing was more likely among younger patients aged 25–34 years (adjusted odds ratio [AOR] = 0.36, 95% confidence interval [CI] 0.78, 2.10) and patients with STD-related chief complaints at triage (AOR=11.47, 95% CI 5.49, 25.06). Concurrent HIV-gonorrhea/chlamydia testing was more likely among men (gonorrhea: AOR=3.98, 95% CI 2.25, 7.02; chlamydia: AOR=3.25, 95% CI 1.80, 5.86) and less likely among patients with STD-related chief complaints at triage (gonorrhea: AOR=0.31, 95% CI 0.13, 0.82; chlamydia: AOR=0.21, 95% CI 0.09, 0.50). Conclusions. Concurrent HIV-STD testing in an academic ED remains low. Systematic interventions that remove the decision-making burden of ordering an HIV test from providers may increase HIV testing in this high-risk population of suspected STD patients.

Guidelines for Safety of Trainees Rotating Abroad: Consensus Recommendations from the Global Emergency Medicine Academy of the Society for Academic Emergency Medicine, Council of Emergency Medicine Residency Directors, and the Emergency Medicine Residents' Association

The goal of a global health elective is for residents and medical students to have safe, structured, and highly educational experiences. In this article, the authors have laid out considerations for establishing a safe clinical site; ensuring a travelers personal safety, health, and wellness; and mitigating risk during a global health rotation. Adequate oversight, appropriate mentorship, and a well-defined safety and security plan are all critical elements to a successful and safe experience.

Society for Academic Emergency Medicine's Global Emergency Medicine Academy: Global Health Elective Code of Conduct

Resumen El numero de residentes y estudiantes de medicina que participan en asignaturas optativas de salud global en medicina de urgencias y emergencias (MUE) se ha incrementado exponencialmente en los ultimos anos. Las asignaturas optativas de salud global siguen siendo un instrumento fuerte de reclutamiento y pueden contribuir a la formacion de los alumnos. Sin embargo, segun crece el numero de estudiantes que llevan a cabo experiencias internacionales en el campo de la MUE global, se tiene la necesidad de desarrollar estandares aceptables de comportamiento en el escenario internacional. Los miembros de la Global Emergency Medicine Academy (GEMA) se dieron cuenta de la ausencia de recomendaciones internacionales o guias para estas experiencias.[1-3] Un grupo de miembros voluntarios de la GEMA se comprometieron con la tarea de crear un documento que pudiese usarse por los estudiantes cuando llevaran a cabo asignaturas optativas de salud global. Los autores procedian de diversas instituciones y tenian distintos niveles de formacion y experiencia internacional. En el desarrollo de este documento, se llevo a cabo una revision sistematica en la literatura de cualquier informacion en codigos de conducta/profesionalidad[4, 5] cuando se trabaja en el escenario internacional; tambien se revisaron documentos similares de numerosas instituciones[6, 7] de diferentes especialidades[8] y se busco ent la literatura gris.[9] Las referencias clave seleccionadas se muestran mas abajo. Esta informacion se combino para producir un unico documento, que se reviso usando una metodologia de consenso hasta que alcanzo un acuerdo por parte de todos los miembros del grupo. El documento resultante se muestra en la figura de mas abajo. Se anima a las instituciones comprometidas con la formacion de estudiantes a adoptar este como estandar de su formacion en salud global.

Executive Summary: Global Health and Emergency Care—What Do We Need to Know to Address the Burden of Illness and Injury?

Emergency physicians are uniquely poised to address challenges in health services, health care systems development and management, and emerging global disease burdens (both communicable and noncommunicable). This special issue of Academic Emergency Medicine reports the results of the 2013 consensus conference, which included eight focus areas that are intended to advance emergency care research. Advancing our understanding of cardiac and injury resuscitation, ethics of research, health systems development, and the education of our future leaders in global health will ultimately affect the populations of all nations across the globe.

Global Health and Emergency Care: A Postgraduate Medical Education Consensus‐based Research Agenda

Global emergency medicine (EM) is a rapidly growing field within EM, as evidenced by the increasing number of trainees and clinicians pursuing additional experiences in global health and emergency care. In particular, many trainees now desire opportunities at the postgraduate level by way of global EM fellowship programs. Despite this growing popularity, little is known of the effects of postgraduate training in global health and emergency care on learners and patients in the United States and abroad. During the 2013 Academic Emergency Medicine consensus conference on global health and emergency care, a group of leading educators at the postgraduate medical education level convened to generate a research agenda of pressing questions to be answered in this area. The consensus-based research agenda is presented in this article.

Implementation of a collaborative HIV testing model between an emergency department and infectious disease clinic

were floating population coming from all over the country (including 5%–10% from Hong Kong), and 50% have stayed in Shenzhen for less than 1 year. This implies that Shenzhen has become the most important gathering place for MSM from all over the country, and this huge group of floating MSM in Shenzhen will serve as an important vehicle for transmission of HIV-1 CRF55_01B and even other subtypes from Shenzhen to other regions of China. Furthermore, majority of Chinese MSM engage in bisexual behaviors, which provides more chance for CRF55_01B transmission from MSM to heterosexuals through their female partners. We detected 1 CRF55_01B strain from Shenzhen heterosexuals sampled in 2007, indicating that the MSM-to-heterosexuals transmission of CRF55_01B occurred very soon after its generation (Figure 1B). In summary, we predict that CRF55_01B will become a new HIV-1 recombinant most commonly transmitted among MSM after the prevalence of CRF07_BC and CRF08_BC among IDUs in China. Recently, sporadic detection of CRF55_01B in Dongguan, Hunan, Shanghai, and Beijing might be a prelude of CRF55_01B outbreak among MSM in these city/provinces and even other regions of China in the near future.

A case of reactive arthritis: a great masquerader

Reactive arthritis is an inflammatory condition with multiorgan system disease potential. Because the standard constellation of symptoms in Reiter syndrome (arthritis, conjunctivitis, and urethritis) is not typically present in all patients, the disease can be easily overlooked if clinical suspicion is not high upon presentation. To highlight the importance of recognizing the potential of this disease in patients with a history of either gastrointestinal or genitourinary illnesses, we present the case of a young healthy male presented on multiple occasions later diagnosed with Reiter syndrome in the setting of a recent diagnosis of prostatitis. He was noted to have classical symptoms including conjunctivitis and arthritis. He was treated with nonsteroidal anti-inflammatory drugs during a brief hospital stay and did well. Although reactive arthritis is an easily managed disease, it is easily missed particularly in young otherwise healthy patients who may not present with classic symptoms. Vigilance with regard to patients with vague seemingly unrelated complaints particularly with a history of gastrointestinal- or genitourinary-related illnesses deserves consideration for this disease process.