Shannon Toohey

There's an App for That? Highlighting the Difficulty in Finding Clinically Relevant Smartphone Applications.

Introduction The use of personal mobile devices in the medical field has grown quickly, and a large proportion of physicians use their mobile devices as an immediate resource for clinical decision-making, prescription information and other medical information. The iTunes App Store (Apple, Inc.) contains approximately 20,000 apps in its “Medical” category, providing a robust repository of resources for clinicians; however, this represents only 2% of the entire App Store. The App Store does not have strict criteria for identifying content specific to practicing physicians, making the identification of clinically relevant content difficult. The objective of this study is to quantify the characteristics of existing medical applications in the iTunes App Store that could be used by emergency physicians, residents, or medical students. Methods We found applications related to emergency medicine (EM) by searching the iTunes App Store for 21 terms representing core content areas of EM, such as “emergency medicine,” “critical care,” “orthopedics,” and “procedures.” Two physicians independently reviewed descriptions of these applications in the App Store and categorized each as the following: Clinically Relevant, Book/Published Source, Non-English, Study Tools, or Not Relevant. A third physician reviewer resolved disagreements about categorization. Descriptive statistics were calculated. Results We found a total of 7,699 apps from the 21 search terms, of which 17.8% were clinical, 9.6% were based on a book or published source, 1.6% were non-English, 0.7% were clinically relevant patient education resources, and 4.8% were study tools. Most significantly, 64.9% were considered not relevant to medical professionals. Clinically relevant apps make up approximately 6.9% of the App Store’s “Medical” Category and 0.1% of the overall App Store. Conclusion Clinically relevant apps represent only a small percentage (6.9%) of the total App volume within the Medical section of the App Store. Without a structured search-and-evaluation strategy, it may be difficult for the casual user to identify this potentially useful content. Given the increasing adoption of devices in healthcare, national EM associations should consider curating these resources for their members.

Ten Tips for Engaging the Millennial Learner and Moving an Emergency Medicine Residency Curriculum into the 21st Century

Introduction Millennial learners are changing the face of residency education because they place emphasis on technology with new styles and means of learning. While research on the most effective way to teach the millennial learner is lacking, programs should consider incorporating educational theories and multimedia design principles to update the curriculum for these new learners. The purpose of the study is to discuss strategies for updating an emergency medicine (EM) residency program’s curriculum to accommodate the modern learner. Discussion These 10 tips provide detailed examples and approaches to incorporate technology and learning theories into an EM curriculum to potentially enhance learning and engagement by residents. Conclusion While it is unclear whether technologies actually promote or enhance learning, millennials use these technologies. Identifying best practice, grounded by theory and active learning principles, may help learners receive quality, high-yield education. Future studies will need to evaluate the efficacy of these techniques to fully delineate best practices.

National differences between ED and ambulatory visits for suicidal ideation and attempts and depression

BACKGROUND Many suicidal and depressed patients are seen in emergency departments (EDs), whereas outpatient visits for depression remain high. STUDY OBJECTIVE The primary objective of the study is to determine a relationship between the incidence of suicidal and depressed patients presenting to EDs and the incidence of depressed patients presenting to outpatient clinics. The secondary objective is to analyze trends among suicidal patients. METHODS The National Hospital Ambulatory Medical Care Survey and the National Ambulatory Medical Care Survey were screened to provide a sampling of ED and outpatient visits, respectively. Suicidal and depressed patients presenting to EDs were compared with depressed patients presenting to outpatient clinics. Subgroup analyses included age, sex, race/ethnicity, method of payment, regional variation, and urban verses rural distribution. RESULTS Emergency department visits for depression (1.16% of visits in 2002) and suicide attempts (0.51% of visits in 2002) remained stable over the years. Office visits for depression decreased from 3.14% of visits in 2002 to 2.65% of visits in 2008. Non-Latino whites had a higher percentage of ED visits for depression and suicide attempt and office visits for depression than other groups. The percentage of ED visits for suicide attempt resulting in hospital admission decreased by 2.06% per year. CONCLUSION From 2002 to 2008, the percentage of outpatient visits for depression decreased, whereas ED visits for depression and suicide remained stable. When examined in the context of a decreasing prevalence of depression among adults, we conclude that an increasing percentage of the total patients with depression are being evaluated in the ED, vs outpatient clinics.

Who to Interview? Low Adherence by U.S. Medical Schools to Medical Student Performance Evaluation Format Makes Resident Selection Difficult.

Introduction The Medical Student Performance Evaluation (MSPE) appendices provide a program director with comparative performance for a student’s academic and professional attributes, but they are frequently absent or incomplete. Methods We reviewed MSPEs from applicants to our emergency medicine residency program from 134 of 136 (99%) U.S. allopathic medical schools, over two application cycles (2012–13, 2014–15). We determined the degree of compliance with each of the five recommended MSPE appendices. Results Only three (2%) medical schools were compliant with all five appendices. The medical school information page (MSIP, appendix E) was present most commonly (85%), followed by comparative clerkship performance (appendix B, 82%), overall performance (appendix D, 59%), preclinical performance (appendix A, 57%), and professional attributes (appendix C, 18%). Few schools (7%) provided student-specific, comparative professionalism assessments. Conclusion Medical schools inconsistently provide graphic, comparative data for their students in the MSPE. Although program directors (PD) value evidence of an applicant’s professionalism when selecting residents, medical schools rarely provide such useful, comparative professionalism data in their MSPEs. As PDs seek to evaluate applicants based on academic performance and professionalism, rather than standardized testing alone, medical schools must make MSPEs more consistent, objective, and comparative.

Intubating Ebola Patients: Technical Limitations of Extensive Personal Protective Equipment

As hospitals across the nation were preparing for the possibility of Ebola or Middle Eastern respiratory syndrome (MERS-CoV) cases, healthcare workers underwent intricate training in the use of personal protective equipment (PPE). An Ebola or MERS-CoV patient requiring intubation places a healthcare worker at risk for exposure to bodily secretions. The procedure must be performed only after appropriate PPE is donned.1 Intubating while wearing PPE is yet another challenge identified in caring for these patients. Manual dexterity and free movement decreases when wearing PPE, and may increase length of time to successful intubation. We elicited the opinion of subjects performing direct laryngoscopy versus video-assisted laryngoscopy on manikins while wearing PPE. Additionally, we recorded multiple intubation attempts by these clinicians using Google Glass. Two PPE-donned clinicians both agreed that intubation was not technically different between direct versus video-assisted techniques. However, the subjects felt that direct laryngoscopy was noticeably more labor intensive than the video-assisted technique. Subjects also felt more temperature-related discomfort during direct laryngoscopy. For one subject, contamination was more common during direct laryngoscopy, when the PPE hood contacted the patient’s face or endotracheal tube. From this simulation experience, we recommend video laryngoscopy as a preferred method of intubating a patient while donning PPE. Video Ebola intubation video.

Splenic Laceration and Pulmonary Contusion Injury From Bean Bag Weapon

Author(s): Patel, Amar; Toohey, Shannon; Osborn, Megan Boysen | Abstract: [West J Emerg Med. 2014;15(2):118–119.]

Comparison of primary compliance in electronic versus paper prescriptions prescribed from the emergency department

Author(s): Andrusaitis, Jessica Gwynne | Advisor(s): Greenfield, Sheldon | Abstract: The Medicare Improvements for Patients and Providers Act passed by Congress in 2008 has changed prescribing practices in the United States. Electronic prescriptions (e-prescriptions) have now become the most widely used form of prescriptions. The government in fact financially discourages the use of the older more traditional paper prescriptions. Many emergency medicine physicians fear that this blanket policy is not in the best interests of their unique patient population. It is the belief of many of these physicians that emergency patients are more likely to fill paper prescriptions than e-prescriptions. This theory is predicated on the knowledge that many emergency patients are less established in the system and their visits are frequently rushed, chaotic, and unplanned. For these reasons, the e-prescription system is not ideal for them and the theorized consequence is that many e-prescriptions go unfilled, leaving patients to go untreated. A retrospective analysis was conducted at the emergency department of the University of California, Irvine Medical Center to identify insured adult patients who were given a non-controlled substance prescription in either the paper or electronic form. Pharmacy claim data to insurances was used to determine whether these prescriptions were filled. 405 encounters were included, 218 of which included e-prescriptions and 187 of which included paper prescriptions. Our findings showed that paper prescriptions are filled at the same rate as electronic prescriptions (58.3% versus 57.8% p=1). These results were surprising as they contradicted what many physicians believe is the situation. More studies are needed in order to be able to broaden these results to the entire emergency medicine patient population, but these results may begin to alter prescription practices in emergency medicine.

Efficacy of an asynchronous electronic curriculum in emergency medicine education in the United States

Purpose The aim of this study was to measure the effect of an iPad-based asynchronous curriculum on emergency medicine resident performance on the in-training exam (ITE). We hypothesized that the implementation of an asynchronous curriculum (replacing 1 hour of weekly didactic time) would result in non-inferior ITE scores compared to the historical scores of residents who had participated in the traditional 5-hour weekly didactic curriculum. Methods The study was a retrospective, non-inferiority study. conducted at the University of California, Irvine Emergency Medicine Residency Program. We compared ITE scores from 2012 and 2013, when there were 5 weekly hours of didactic content, with scores from 2014 and 2015, when 1 hour of conference was replaced with asynchro-nous content. Examination results were compared using a non-inferiority data analysis with a 10% margin of difference. Results Using a non-inferiority test with a 95% confidence interval, there was no difference between the 2 groups (before and after implementation of asynchronous learning), as the confidence interval for the change of the ITE was −3.5 to 2.3 points, whereas the 10% non-inferiority margin was 7.8 points. Conclusion Replacing 1 hour of didactic conference with asynchronous learning showed no negative impact on resident ITE scores.

Laceration Repair for Emergency Physicians

Audience: This team-based learning (TBL) is appropriate for medical students and all levels of residents. Introduction: Lacerations are one of the most common chief complaints presenting to the emergency department, representing 8.2% of ED visits. Wound management is one of the emergency medicine milestones. As such, it is an essential skill to cover when training emergency physicians. Historically, training programs correlate competency with quantity of procedures, with little focus on the quality. Objectives: By the end of this educational session, the learner will: 1) List the appropriate types and sizes of suture for various locations and types of lacerations. 2) Understand various suturing techniques and their indications, and 3) Show proficiency in performing various suturing techniques including: simple interrupted, horizontal mattress, vertical mattress, and repair of V-shaped lacerations. Method: This is an mTBL (modified team-based learning) session. Topics: Wound repair, lacerations, suturing.