Julie L. Welch

Hyperbaric Oxygen Therapy in Acute Ischemic Stroke: Results of the Hyperbaric Oxygen in Acute Ischemic Stroke Trial Pilot Study

Background and Purpose— Hyperbaric oxygen therapy (HBO) has promise as a treatment for acute stroke. This study was conducted to evaluate the efficacy, safety, and feasibility of using HBO in acute ischemic stroke. Methods— We conducted a randomized, prospective, double-blind, sham-controlled pilot study of 33 patients presenting with acute ischemic stroke who did not receive thrombolytics over a 24-month period. Patients were randomized to treatment for 60 minutes in a monoplace hyperbaric chamber pressurized with 100% O2 to 2.5-atm absolute (ATA) in the HBO group or 1.14 ATA in the sham group. Primary outcomes measured included percentage of patients with improvement at 24 hours (National Institutes of Health Stroke Scale [NIHSS]) and 90 days (NIHSS, Barthel Index, modified Rankin Scale, Glasgow Outcome Scale). Secondary measurements included complications of treatment and mortality at 90 days. Results— Baseline demographics were similar in both groups. There were no differences between the groups at 24 hours (P =0.44). At 3 months, however, a larger percentage of the sham patients had a good outcome defined by their stroke scores compared with the HBO group (NIHSS, 80% versus 31.3%;P =0.04; Barthel Index, 81.8% versus 50%;P =0.12; modified Rankin Scale, 81.8% versus 31.3%;P =0.02; Glasgow Outcome Scale, 90.9% versus 37.5%;P =0.01) with loss of statistical significance in a intent-to-treat analysis. Conclusions— Although our HBO protocol appears feasible and safe, it does not appear to be beneficial and may be harmful in patients with acute ischemic stroke.

Pharmacologic prophylaxis for acute mountain sickness: a systematic shortcut review.

STUDY OBJECTIVE Multiple studies have explored pharmacologic interventions to prevent acute mountain sickness. A systematic review of this subject published in 2000 found that both acetazolamide and dexamethasone were effective. Since 2000, a number of other agents have been reported to be beneficial. This EBEM review evaluates the most current evidence on this topic. METHODS We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, SPORTDiscus, Emergency Medical Abstracts, and ClinicalTrials.gov from 2000 to July 2011. Only randomized placebo-controlled trials with an N greater than or equal to 50 and systematic reviews were reviewed. Standard criteria for assessing trial quality were independently assessed by 2 authors. RESULTS Seven hundred eighty-six citations were retrieved, of which 105 were reviewed in their entirety. Eleven randomized controlled trials and 1 systematic review appeared to meet inclusion criteria; however, 4 randomized controlled trials were excluded for high risk of bias. The remaining 7 randomized controlled trials investigated antioxidants, magnesium, sumatriptan, gabapentin, acetazolamide, and Ginkgo biloba. No trials studying dexamethasone met our criteria. Acetazolamide was associated with a reduction in acute mountain sickness symptoms, with a number needed to treat ranging from 8 to 3 among 3 trials and at doses ranging from 250 to 750 mg daily. Sumatriptan showed benefit in 1 trial (number needed to treat=4), as did gabapentin (number needed to treat=6). Antioxidants, magnesium, and G biloba were not efficacious. Reported adverse events included somnolence with gabapentin and paresthesias with acetazolamide. The systematic review affirmed our results but did not capture trials studying antioxidants, magnesium, sumatriptan, or gabapentin. CONCLUSION Acetazolamide is effective for the prevention of acute mountain sickness but may be associated with paresthesias. Sumatriptan and gabapentin are beneficial but require further study.

The Women in Emergency Medicine Mentoring Program: An Innovative Approach to Mentoring

BACKGROUND Women in medicine report many gender-specific barriers to their career success and satisfaction, including a lack of mentors and role models. The literature calls for innovative strategies to enhance mentorship for women in medicine. OBJECTIVE To describe the content, perceived value, and ongoing achievements of a mentoring program for women in emergency medicine. METHODS The program offered mentoring for female faculty and residents in an academic emergency medicine department. Volunteers participated in group mentoring sessions using a mosaic of vertical and peer mentoring. Sessions focused on topics specific to women in medicine. An anonymous, electronic survey was sent to women who participated during 2004-2010 to assess the perceived value of the program and to collect qualitative feedback. Preliminary achievements fulfilling the programs goals were tracked. RESULTS A total of 46 women (64%) completed the survey. The results showed a positive perceived value of the program (average, 4.65 on a 5-point Likert scale) in providing mentors and role models (4.41), in offering a supportive environment (4.39), in providing discussions pertinent to both personal (4.22) and professional development (4.22), while expanding networking opportunities (4.07). Notable achievements included work on the creation of a family leave policy, establishing lactation space, collaboration on projects, awards, and academic advancement. CONCLUSION This innovative model for mentoring women is perceived as a valuable asset to the academic department and residency. It offers the unique combination of expanding a female mentor pool by recruiting alumni and using a mosaic of vertical and peer mentoring.

Flexibility in Faculty Work-Life Policies at Medical Schools in the Big Ten Conference

PURPOSE Women lag behind men in several key academic indicators, such as advancement, retention, and securing leadership positions. Although reasons for these disparities are multifactorial, policies that do not support work-life integration contribute to the problem. The objective of this descriptive study was to compare the faculty work-life policies among medical schools in the Big Ten conference. METHODS Each institutions website was accessed in order to assess its work-life policies in the following areas: maternity leave, paternity leave, adoption leave, extension of probationary period, part-time appointments, part-time benefits (specifically health insurance), child care options, and lactation policy. Institutions were sent requests to validate the online data and supply additional information if needed. RESULTS Each institution received an overall score and subscale scores for family leave policies and part-time issues. Data were verified by the human resources office at 8 of the 10 schools. Work-life policies varied among Big Ten schools, with total scores between 9.25 and 13.5 (possible score: 0-21; higher scores indicate greater flexibility). Subscores were not consistently high or low within schools. CONCLUSIONS Comparing the flexibility of faculty work-life policies in relation to other schools will help raise awareness of these issues and promote more progressive policies among less progressive schools. Ultimately, flexible policies will lead to greater equity and institutional cultures that are conducive to recruiting, retaining, and advancing diverse faculty.

Update: Can Newer Rapid Influenza Tests Rule Out Disease?

Of the 162 studies included for fulltext review, 38 were excluded for not reporting influenza A and B results separately, leaving 124 articles for quantitative analysis. Overall, the new rapid influenza tests, digital immunoassays, and rapid nucleic acid amplification tests demonstrated strikingly higher sensitivities for influenza A and B comparedwith the more traditional rapid influenza diagnostic tests. The pooled sensitivities varied widely between test types (ranging from 53% to 95%), whereas the pooled specificities were consistently greater than 98.3%.

Physician Time Management

Introduction Time management is an essential skill set for physicians. The importance of time management is not routinely emphasized in undergraduate or graduate medical education curricula, often resulting in the development of poor time-management practices early in training. Improving time-management practices may lead to decreased stress, increased productivity, and improved well-being for physicians. Methods This interactive workshop targeted trainees and junior faculty. It aimed to highlight common physician knowledge gaps with respect to cognitive limitations and to teach effective time-management strategies. It also aimed to educate learners about how time management may increase physician career satisfaction. The workshop included a detailed presentation with structured resources to reinforce skill development. Results This workshop was given four times to 54 residents in two different training paradigms. Evaluations were based on a 4-point Likert scale (1 = Strongly Disagree, 4 = Strongly Agree). Overall, participants indicated that the workshop addressed an educational need (M = 3.72) and would recommend this workshop to a colleague (M = 3.83). Follow-up survey results at 4 months indicated that most workshop participants had noticed some degree of improved productivity and well-being, that only a small minority had not incorporated new elements of time management into routine practices. Discussion This workshop offers an effective way to teach time-management strategies to physicians. Our results imply that this workshop meets an early career physician need by addressing a necessary skill set. Effective time-management skills may promote physician career sustainability.

Independent investigator incubator (I 3 ): a comprehensive mentorship program to jumpstart productive research careers for junior faculty

BackgroundIn the highly competitive environment of academic medicine, junior faculty investigators face high attrition rates due to challenges in finding effective mentorship, securing grant funding, and obtaining resources to support their career development and research productivity. The purpose of this study was to describe the centralized, cost-sharing design of the Independent Investigator Incubator (I3) program as a novel approach to junior faculty mentoring and to evaluate quantitative outcomes for program improvement.MethodsIn September 2014, the I3 pilot program, a comprehensive mentorship program targeting junior faculty pursuing research careers, was launched. Participants included junior faculty during the crucial first three years of their research careers or during their transition from career development awards to more independent research. Following initial screening, the I3 mentees were paired with a senior faculty “super-mentor” with expertise in either basic science or clinical research. Mentees were provided with robust traditional one-on-one mentoring, targeted feedback from a super-mentor review committee, as well as biostatistician and grant writing support. To assess the effectiveness of the I3 program, we tracked outcome measures via baseline and 12-month mentee surveys. Data collected assessed program diversity, mentee self-assessments, evaluation of the mentoring relationship, scholarship and productivity metrics. Raw data were analyzed using a paired t-test in Excel (P < 0.05).ResultsResults of the baseline mentee self-assessment survey found that the I3 mentees indicated common “perceive deficits” including navigating the organizational and institutional culture, clear direction in achieving promotion and tenure, among others. When baseline mentee survey responses were compared to 12-month responses, we identified strong “perceived growth” in categories, such as Research and Interpersonal Skills and Career Development Skills. Further, productivity metrics at 12-months revealed that roughly 80% of I3 mentees successfully published a manuscript(s). The I3 program has helped generate roughly

In Patients With ST-Segment Elevation Myocardial Infarction, Which Fibrinolytic Agent Is the Safest and Most Effective?

12.1 million dollars in investigator-initiated funding after two years in the program.ConclusionThe I3 program allows for shared costs between institutions and increased availability of successful subject matter experts. Study results imply that the I3 mentoring program provides transformative mentorship for junior faculty. Using our findings, we developed courses and an annual “snapshot” of mentee performance for mentors.

What Elements Suggest Infectious Mononucleosis

Volume -, no. This is the Shrestha, A the Safest a TAKE-HOME MESSAGE In patients with ST-segment elevation myocardial infarction (STEMI), when percutaneous coronary intervention is not an option, reperfusion therapy with the fibrinolytic agents tenecteplase, reteplase, or accelerated alteplase (90 minutes of infusion) plus parenteral anticoagulation has better overall safety and efficacy than other regimens.

Do α-Blockers Expedite Ureteral Stone Passage?

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