Marina Del Rios

INTER-RATER RELIABILITY OF SONOGRAPHIC MEASUREMENTS OF THE INFERIOR VENA CAVA

BACKGROUND Bedside ultrasound is emerging as a useful tool in the assessment of intravascular volume status by examining measurements of the inferior vena cava (IVC). Many previous studies do not fully describe their scanning protocol. OBJECTIVES The objective of this study was to evaluate which of three commonly reported IVC scanning methods demonstrates the best inter-rater reliability. METHODS Three physicians visualized the IVC in three common views and utilized M-mode to measure the maximal and minimal diameter during quiet respiration. Pairwise correlation coefficients were determined using Pearson product-moment correlation. RESULTS The most reliable pair of measurements (inspiratory and expiratory) was found to be using the anterior midaxillary line longitudinal view with a Kappa value for both at 0.692. CONCLUSION Imaging with the anterior midaxillary longitudinal approach using the liver as an acoustic window provides the best inter-rater reliability when measuring the IVC. Our findings demonstrate that IVC measurements differ based on anatomic location.

Save-a-life at the ballpark: 10-min spectator training achieves proficiency in cardiac arrest response

OBJECTIVE To determine immediate recall, feasibility, and efficiency of a brief out-of-hospital cardiac arrest (OHCA) bystander response training session at a large sporting event. We introduce two new measures of efficiency for training: (i) cardiac arrest training yield (CATY), i.e., number trained/number of spectators, and (ii) the training efficiency index for cardiac arrest (TEICA), i.e., persons trained per volunteer hours. METHODS A convenience sample of baseball fans participated in a 10-min training on OHCA recognition, CPR and automatic external defibrillator (AED) use and completed post-training knowledge surveys. RESULTS Out of 20,000 spectators, 198 participated for a CATY of 1%. Seventy-five volunteers over 3h of training generated a TEICA of 0.88. 90% of respondents identified the proper rate of chest compressions. 90% of respondents recognized an AEDs function; 98% recognized it was easy to use. 83% recognized chest compressions as the next step after calling 911 and 62% included AED as part of the OHCA response. CONCLUSIONS A 10-min training session is feasible and can achieve good recall in cardiac arrest response. However, participant recruitment dominated most of our volunteer effort. Our results can serve as a framework in the development of future health promotion campaigns.

Association of race and socioeconomic status with automatic external defibrillator training prevalence in the United States

AIM OF THE STUDY Automated external defibrillators (AEDs) improve survival from out-of-hospital cardiac arrest (OHCA), however bystander use remains low. Limited AED training may contribute to infrequent use of these devices, yet no studies have assessed AED training nationally. Given previously documented racial disparities among Latinos in CPR provision and OHCA outcomes, we hypothesized that racial and socioeconomic differences exist in AED training, with Whites having increased training compared to Latinos and higher socioeconomic status being associated with increased training. METHODS We administered a random digit dial survey to a nationally-representative adult sample. Using survey-weighted logistic regression adjusted for location, we assessed race and socioeconomic status of individuals trained in AEDs compared to never-trained individuals. RESULTS From 09/2015-11/2015, 9022 individuals completed the survey. Of those, 68% had never been AED trained. Self-identified Whites and Blacks were more likely to have AED training compared to Latinos (OR: 1.90, 95% CI: 1.43-2.53 and OR: 1.73, 95% CI: 1.39-2.15, respectively). Higher educational attainment was associated with an increased likelihood of training, with an OR of 4.36 (95% CI: 2.57-7.40) for graduate school compared to less than high school education. Increased household income was not associated with an increase in AED training (p = .08). CONCLUSIONS The minority of respondents reported AED training. Whites and Blacks were more likely to be trained than Latinos. Higher educational attainment was associated with an increased likelihood of training. These findings highlight an important opportunity to improve training disparities and layperson response to OHCA.

Correlation between Subclinical Heart Disease and Cardiovascular Risk Profiles in an Urban Emergency Department Population with Elevated Blood Pressures: A Pilot Study

BACKGROUND Uncontrolled hypertension is a primary risk factor for development of cardiovascular complications. OBJECTIVE Determine the point prevalence of left ventricular hypertrophy (LVH) and diastolic dysfunction in an urban emergency department (ED) population with elevated blood pressures (BP) and examine correlations between subclinical disease and patient cardiovascular risk profiles. METHODS A convenience sample of patients with EBP (>140/90 on two measurements) had limited bedside echocardiograms (LBE). Subclinical hypertensive heart disease was classified as the presence of: LVH, abnormal ejection fraction (EF), or diastolic dysfunction. RESULTS Thirty-nine patients with EBP were enrolled. The mean age was 46 years (SD = 10.9), 59% were women, 21% were smokers, and 92% had a history of hypertension. The average body mass index was 30.7 (SD = 8.7). Patients were 67% African American, 23% Latino, 5% Caucasian, 3% Asian, and 3% Native American. Subclinical disease was found in 39%: 31% had LVH, 15% had diastolic dysfunction, and 8% had abnormal EF. On bivariate analysis, elevated BP (p = 0.039) and blood urea nitrogen (p = 0.016) were correlated with subclinical heart disease. After adjusting for other covariates, receiving oral/intravenous antihypertensive medications in the ED (p = 0.005) was associated with subclinical heart disease. CONCLUSIONS We found a point prevalence of subclinical heart disease of 39% in this urban ED population, using LBE. Real-time identification of subclinical heart disease at early stages in the ED in conjunction with abnormal renal function can help emergency physicians identify those patients in need of more aggressive therapy and urgent follow-up.

Acquiring credentials in bedside ultrasound: a cross-sectional survey.

Objective Although there are training guidelines to credential emergency physicians in bedside ultrasound, many faculty groups have members who completed residency without a mandatory curriculum. These physicians are therefore required to learn bedside ultrasound while out in practice. The objective of this descriptive report is to illustrate a single academic facilitys experience with acquiring credentials for emergency physicians in bedside ultrasound and the facultys impressions on the motivators of and barriers to completion of the requirements. Design Cross-sectional survey. Setting Two urban teaching hospitals with a combined volume of 170 000 visits a year. Participants 41 emergency medicine attending physicians. Intervention Emergency medicine attending physicians underwent training and credentialing in the applications of aorta and pelvic ultrasound over a 9-month period. Outcome measure After the credentialing period, we conducted a survey to evaluate the physicians’ perceptions of this process. Results There were 41 faculty members during the credentialing survey period. 11 of the faculty members were exempt from ultrasound training. We asked attending physicians (N=41 exempt and non-exempt) to complete a web-based survey after the completion of the credentialing period. Questions about the potential barriers and incentives were listed and responders were asked to rank answers on a five-point Likert scale. Of the 31 respondents, 21 (67.7%) completed the credentialing requirements by the 9-month deadline. 19 of 26 emergency medicine residency trained physicians completed the requirements compared with 2/5 of those that were not emergency medicine residency trained. Our pilot study data suggest an association between fewer years in practice and completion of the requirements. Conclusions This is a report on a single academic institutions experience with a faculty credentialing programme in bedside ultrasound for physicians with a diversity of prior experience in bedside ultrasonography. We describe the success of the credentialing process and identify survey-based faculty characteristics associated with fulfilling the requirements.

Pay it forward: High school video-based instruction can disseminate CPR knowledge in priority neighborhoods

Introduction The implementation of creative new strategies to increase layperson cardiopulmonary resuscitation (CPR) and defibrillation may improve resuscitation in priority populations. As more communities implement laws requiring CPR training in high schools, there is potential for a multiplier effect and reach into priority communities with low bystander-CPR rates. Methods We investigated the feasibility, knowledge acquisition, and dissemination of a high school-centered, CPR video self-instruction program with a “pay-it-forward” component in a low-income, urban, predominantly Black neighborhood in Chicago, Illinois with historically low bystander-CPR rates. Ninth and tenth graders followed a video self-instruction kit in a classroom setting to learn CPR. As homework, students were required to use the training kit to “pay it forward” and teach CPR to their friends and family. We administered pre- and post-intervention knowledge surveys to measure knowledge acquisition among classroom and “pay-it-forward” participants. Results Seventy-one classroom participants trained 347 of their friends and family, for an average of 4.9 additional persons trained per kit. Classroom CPR knowledge survey scores increased from 58% to 93% (p < 0.0001). The pay-it-forward cohort saw an increase from 58% to 82% (p < 0.0001). Conclusion A high school-centered, CPR educational intervention with a “pay-it-forward” component can disseminate CPR knowledge beyond the classroom. Because schools are centrally-organized settings to which all children and their families have access, school-based interventions allow for a broad reach that encompasses all segments of the population and have potential to decrease disparities in bystander CPR provision.

The CHAMPIONS NETWork: Training Chicago High School Students as Health Advocates to Improve Health Equity:

In Chicago, major disparities exist across ethnic groups, income levels, and education levels for common chronic conditions and access to care. Concurrently, many of Chicago’s youth are unemployed, and the number of minorities pursuing health professions is low. In an effort to eliminate this health equity gap, the University of Illinois at Chicago convened a community–university–hospital partnership to implement the CHAMPIONS NETWork (Community Health And eMPowerment through Integration Of Neighborhood-specific Strategies using a Novel Education & Technology-leveraged Workforce). This innovative workforce training program is a “High School to Career Training Academy” to empower underserved youth to improve population health in their communities, expose them to careers in the health sciences, and provide resources for them to become community and school advocates for healthy lifestyles. This program differs from other traditional pipeline programs because it gives its students a paid experience, extends beyond the summer, and broadens the focus to population health with patient contact. The CHAMPIONS NETWork creates a new type of health workforce that is both sustainable and replicable throughout the United States.

A hypertension emergency department intervention aimed at decreasing disparities: Design of a randomized clinical trial

Effective interventions to identify and treat uncontrolled hypertension (HTN), particularly in underrepresented populations that use the emergency department (ED) for primary care, are critically needed. Uncontrolled HTN contributes significantly to cardiovascular morbidity and mortality and is more frequently encountered among patients presenting to the ED as compared to the primary care setting. EDs serve as the point of entry into the health care system for high-risk patient populations, including minority and low-income patients. Previous studies have demonstrated that the prevalence of uncontrolled/undiagnosed HTN in patients presenting to the ED is alarmingly high. Thus ED engagement and early risk assessment/stratification is a feasible innovation to help close health disparity gaps in HTN. A Hypertension Emergency Department Intervention Aimed at Decreasing Disparities (AHEAD2) trial, funded by the National Heart, Lung, and Blood Institute (NHLBI) is a three-arm single site randomized clinical pilot trial of adults presenting to the ED with Stage 2 hypertension (blood pressure [BP]>160/100) comparing (1) an ED-initiated Screening, Brief Intervention, and Referral for Treatment (SBIRT) focused on HTN, (2) the same ED-initiated SBIRT coupled with a Post-Acute Care Hypertension Transition Consultation by ED Clinical Pharmacists, and (3) usual care. The primary outcome is mean BP differences between study arms. Secondary outcomes are proportion of participants with BP control (BP<140/90mmHg), and improvements in HTN knowledge and medication adherence scores between study arms. The objective of this report is to describe the development of the AHEAD2 trial, including the methods, research infrastructure, and other features of the randomized clinical trial design.

Major League Soccer Provides a Captive Audience for Promoting Bystander CPR and AED Use Among Hispanics

OBJECTIVE Rates of bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use are lower in Hispanic compared to non-Hispanic white communities. Novel instructional methods that focus on population subgroups most likely to benefit must be explored. The purpose of this study was to determine the feasibility, efficiency, and participant demographics of 10-minute educational intervention on bystander CPR and AED use delivered at a pre-match festival for Major League Soccer (MLS) fans. METHODS Results are reported with descriptive statistics. The primary outcomes included: (1) Training efficiency index for cardiac arrest (TEICA) defined as persons trained/volunteer hours; (2) cardiac arrest training yield (CATY) defined as percent participation by the target audience; and (3) percent of participants of Hispanic origin. Our secondary outcome was average post intervention knowledge survey score. RESULTS CATY was 16% and TEICA was 3.81. Survey participation was 48.3% and 38.9% of survey participants were Hispanic. Average knowledge score post training was 87.5%. CONCLUSION Soccer matches may be a suitable setting for provision of CPR and AED training to Hispanics. This intervention gives insight into a novel way of providing health education to Hispanics that can be applied to other behaviors.