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Hobgood CD, Jarman AF. Resilience Building Practices for Women Physicians. J Womens Health (Larchmt) 2024; 33:532-541. [PMID: 37843899 DOI: 10.1089/jwh.2022.0502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Women now make up more than half of the physician workforce, but they are disproportionately plagued by burnout. Medicine is a fast-paced stressful field, the practice of which is associated with significant chronic stress due to systems issues, crowding, electronic medical records, and patient case mix. Hospitals and health care systems are responsible for mitigating system-based burnout-prone conditions, but often their best efforts fail. Physicians, particularly women, must confront their stressors and the daily burden of significant system strain when this occurs. Those who routinely exceed their cumulative stress threshold may experience burnout, career dissatisfaction, and second victim syndrome and, ultimately, may prematurely leave medicine. These conditions affect women in medicine more often than men and may also produce a higher incidence of health issues, including depression, substance use disorder, and suicide. The individual self-care required to maintain health and raise stress thresholds is not widely ingrained in provider practice patterns or behavior. However, the successful long-term practice of high-stress occupations, such as medicine, requires that physicians, especially women physicians, attend to their wellness. In this article, we address one aspect of health, resilience, and review six practices that can create additional stores of personal resilience when proactively integrated into a daily routine.
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Affiliation(s)
- Cherri D Hobgood
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Angela F Jarman
- Department of Emergency Medicine, University of California, Davis School of Medicine, California, USA
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Hobgood CD, Draucker C. Barriers, Challenges, and Solutions: What Can We Learn About Leadership in Academic Medicine From a Qualitative Study of Emergency Medicine Women Chairs? Acad Med 2022; 97:1656-1664. [PMID: 35703191 DOI: 10.1097/acm.0000000000004772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Women have made significant gains in leadership across all disciplines in academic medicine but have not yet achieved leadership parity as department chairs. The authors investigated the challenges experienced by one cohort of women department chairs in emergency medicine (EM) and the solutions they proposed to address these challenges. METHOD The authors conducted a qualitative descriptive study of 19 of 20 possible current and emeritus emergency medicine women department chairs at academic medical centers between April and December 2020. Participant interviews elicited self-reported demographic characteristics and narrative responses to a semistructured interview template that focused on the role of gender in their leadership and career trajectories. Interviews were transcribed, blinded, and iteratively coded and categorized. RESULTS The analysis demonstrated 4 common challenges and 5 enacted or proposed solutions. The challenges discussed by the participants were: feeling unprepared for the role of department chair, being one of few women in leadership, inheriting unhealthy department cultures, and facing negative faculty reactions. The individual- and institutional-level solutions discussed by the participants were: gaining and maintaining confidence (individual), maintaining accountability and mission alignment (individual), facilitating teamwork (individual), supporting women's leadership (institution), and creating safe leadership cultures (institution). CONCLUSIONS Women department chairs in EM were successful academic leaders despite confronting several challenges to their leadership. Considering the study findings through the lens of the concept of second-generation gender bias further illuminates the influence of gender on leadership in academic medicine. These findings suggest several possible strategies that can combat gender bias, increase gender parity among academic medicine's leadership, and improve the leadership experience for women leaders.
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Affiliation(s)
- Cherri D Hobgood
- C.D. Hobgood is professor of emergency medicine, Indiana University School of Medicine, Indianapolis, Indiana; ORCID: http://orcid.org/0000-0003-4860-1385
| | - Claire Draucker
- C. Draucker is the Angela Barron McBride Professor of Psychiatric Nursing, Indiana University School of Nursing, Indianapolis, Indiana; ORCID: http://orcid.org/0000-0001-9844-351X
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Jarman AF, Hobgood CD, Madsen TE. Moving Beyond Gender Disparities: A Call to Action for Gender Parity and Equity. Ann Emerg Med 2022; 80:65-67. [PMID: 35717113 PMCID: PMC10046989 DOI: 10.1016/j.annemergmed.2022.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Angela F Jarman
- Department of Emergency Medicine, University of California-Davis School of Medicine, Sacramento, CA.
| | - Cherri D Hobgood
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Tracy E Madsen
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI
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Siddle JP, Ryckman SN, Hobgood CD, Kline JA. Positive and Negative Influences on Female First Authorship Emergency Medicine Research. Acad Emerg Med 2019; 26:327-330. [PMID: 30706644 DOI: 10.1111/acem.13705] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/23/2019] [Accepted: 01/25/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Jennica P. Siddle
- Department of Emergency Medicine Indiana University School of Medicine IndianapolisIN
| | - Sydney N. Ryckman
- Department of Emergency Medicine Indiana University School of Medicine IndianapolisIN
| | - Cherri D. Hobgood
- Department of Emergency Medicine Indiana University School of Medicine IndianapolisIN
| | - Jeffrey A. Kline
- Department of Emergency Medicine Indiana University School of Medicine IndianapolisIN
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Pettit KE, Turner JS, Pollard KA, Buente BB, Humbert AJ, Perkins AJ, Hobgood CD, Kline JA. Effect of an Educational Intervention on Medical Student Scripting and Patient Satisfaction: A Randomized Trial. West J Emerg Med 2018; 19:585-592. [PMID: 29760860 PMCID: PMC5942029 DOI: 10.5811/westjem.2018.1.35992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 01/11/2018] [Accepted: 01/17/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Effective communication between clinicians and patients has been shown to improve patient outcomes, reduce malpractice liability, and is now being tied to reimbursement. Use of a communication strategy known as "scripting" has been suggested to improve patient satisfaction in multiple hospital settings, but the frequency with which medical students use this strategy and whether this affects patient perception of medical student care is unknown. Our objective was to measure the use of targeted communication skills after an educational intervention as well as to further clarify the relationship between communication element usage and patient satisfaction. METHODS Medical students were block randomized into the control or intervention group. Those in the intervention group received refresher training in scripted communication. Those in the control group received no instruction or other intervention related to communication. Use of six explicit communication behaviors were recorded by trained study observers: 1) acknowledging the patient by name, 2) introducing themselves as medical students, 3) explaining their role in the patient's care, 4) explaining the care plan, 5) providing an estimated duration of time to be spent in the emergency department (ED), and 6) notifying the patient that another provider would also be seeing them. Patients then completed a survey regarding their satisfaction with the medical student encounter. RESULTS We observed 474 medical student-patient encounters in the ED (231 in the control group and 243 in the intervention group). We were unable to detect a statistically significant difference in communication element use between the intervention and control groups. One of the communication elements, explaining steps in the care plan, was positively associated with patient perception of the medical student's overall communication skills. Otherwise, there was no statistically significant association between element use and patient satisfaction. CONCLUSION We were unable to demonstrate any improvement in student use of communication elements or in patient satisfaction after refresher training in scripted communication. Furthermore, there was little variation in patient satisfaction based on the use of scripted communication elements. Effective communication with patients in the ED is complicated and requires further investigation on how to provide this skill set.
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Affiliation(s)
- Katie E Pettit
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Joseph S Turner
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Katherine A Pollard
- Washington University School of Medicine, Department of Medicine, St. Louis, Missouri
| | - Bryce B Buente
- Marion University College of Osteopathic Medicine, Indianapolis, Indiana
| | - Aloysius J Humbert
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Anthony J Perkins
- Indiana University Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Sciences Institute, Indianapolis, Indiana
| | - Cherri D Hobgood
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Jeffrey A Kline
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
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Lin MP, Probst MA, Puskarich MA, Dehon E, Kuehl DR, Wang RC, Hess EP, Butler K, Runyon MS, Wang H, Courtney DM, Muckley B, Hobgood CD, Hall CL, Kline JA. Improving perceptions of empathy in patients undergoing low-yield computerized tomographic imaging in the emergency department. Patient Educ Couns 2018; 101:717-722. [PMID: 29173841 DOI: 10.1016/j.pec.2017.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 11/17/2017] [Accepted: 11/19/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE We assessed emergency department (ED) patient perceptions of how physicians can improve their language to determine patient preferences for 11 phrases to enhance physician empathy toward the goal of reducing low-value advanced imaging. METHODS Multi-center survey study of low-risk ED patients undergoing computerized tomography (CT) scanning. RESULTS We enroled 305 participants across nine sites. The statement "I have carefully considered what you told me about what brought you here today" was most frequently rated as important (88%). The statement "I have thought about the cost of your medical care to you today" was least frequently rated as important (59%). Participants preferred statements indicating physicians had considered their "vital signs and physical examination" (86%), "past medical history" (84%), and "what prior research tells me about your condition" (79%). Participants also valued statements conveying risks of testing, including potential kidney injury (78%) and radiation (77%). CONCLUSION The majority of phrases were identified as important. Participants preferred statements conveying cognitive reassurance, medical knowledge and risks of testing. PRACTICE IMPLICATIONS Our findings suggest specific phrases have the potential to enhance ED patient perceptions of physician empathy. Further research is needed to determine whether statements to convey empathy affect diagnostic testing rates.
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Affiliation(s)
- Michelle P Lin
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, NY, United States
| | - Marc A Probst
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, NY, United States
| | - Michael A Puskarich
- University of Mississippi, Department of Emergency Medicine, Jackson, MS, United States
| | - Erin Dehon
- University of Mississippi, Department of Emergency Medicine, Jackson, MS, United States
| | - Damon R Kuehl
- Virginia Tech-Carilion, Department of Emergency Medicine, Roanoke, VA, United States
| | - Ralph C Wang
- University of California San Francisco Department of Emergency Medicine, San Francisco, CA, United States
| | - Erik P Hess
- Mayo Clinic, Department of Emergency Medicine, Rochester, MN, United States
| | - Katie Butler
- Carolinas Medical Center, Department of Emergency Medicine, Charlotte, NC, United States
| | - Michael S Runyon
- Carolinas Medical Center, Department of Emergency Medicine, Charlotte, NC, United States
| | - Hao Wang
- John Peter Smith Hospital, Department of Emergency Medicine, Ft. Worth, TX, United States
| | - D Mark Courtney
- Northwestern University School of Medicine, Department of Emergency Medicine, Chicago, IL, United States
| | - Brandon Muckley
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, IN, United States
| | - Cherri D Hobgood
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, IN, United States
| | - Cassandra L Hall
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, IN, United States
| | - Jeffrey A Kline
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, IN, United States.
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Pettit KE, Turner JS, Kindrat JK, Blythe GJ, Hasty GE, Perkins AJ, Ashburn‐Nardo L, Milgrom LB, Hobgood CD, Cooper DD. Effect of Socioeconomic Status Bias on Medical Student-Patient Interactions Using an Emergency Medicine Simulation. AEM Educ Train 2017; 1:126-131. [PMID: 30051022 PMCID: PMC6001723 DOI: 10.1002/aet2.10022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/04/2017] [Accepted: 01/12/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Implicit bias in clinical decision making has been shown to contribute to healthcare disparities and results in negative patient outcomes. Our objective was to develop a high-fidelity simulation model for assessing the effect of socioeconomic status (SES) on medical student (MS) patient care. METHODS Teams of MSs were randomly assigned to participate in a high-fidelity simulation of acute coronary syndrome. Cases were identical with the exception of patient SES, which alternated between a low-SES homeless man and a high-SES executive. Students were blinded to study objectives. Cases were recorded and scored by blinded independent raters using 24 dichotomous items in the following domains: 13 communication, six information gathering, and five clinical care. In addition, quantitative data were obtained on the number of times students performed the following patient actions: acknowledged patient by name, asked about pain, generally conversed, and touching the patient. Fisher's exact test was used to test for differences between dichotomous items. For continuous measures, group differences were tested using a mixed-effects model with a random effect for case to account for multiple observations per case. RESULTS Fifty-eight teams participated in an equal number of high- and low-SES cases. MSs asked about pain control more often (p = 0.04) in patients of high SES. MSs touched the low-SES patient more frequently (p = 0.01). There were no statistically significant differences in clinical care or information gathering measures. CONCLUSIONS This study demonstrates more attention to pain control in patients with higher SES as well as a trend toward better communication. Despite the differences in interpersonal behavior, quantifiable differences in clinical care were not seen. These results may be limited by sample size, and larger cohorts will be required to identify the factors that contribute to SES bias.
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Affiliation(s)
- Katie E. Pettit
- Department of Emergency MedicineIndiana UniversityIndianapolisIN
| | - Joseph S. Turner
- Department of Emergency MedicineIndiana UniversityIndianapolisIN
| | - Jason K. Kindrat
- Department of Emergency MedicineIndiana UniversityIndianapolisIN
| | | | - Greg E. Hasty
- Department of Emergency MedicineIndiana UniversityIndianapolisIN
| | - Anthony J. Perkins
- Indiana University Center for Health Innovation and Implementation ScienceIndiana Clinical and Translational Science InstituteIndianapolisIN
| | | | | | | | - Dylan D. Cooper
- Department of Emergency MedicineIndiana UniversityIndianapolisIN
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LaMantia MA, Messina FC, Jhanji S, Nazir A, Maina M, McGuire S, Hobgood CD, Miller DK. Emergency medical service, nursing, and physician providers' perspectives on delirium identification and management. Dementia (London) 2016; 16:329-343. [PMID: 26112165 DOI: 10.1177/1471301215591896] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose of the study The study objective was to understand providers' perceptions regarding identifying and treating older adults with delirium, a common complication of acute illness in persons with dementia, in the pre-hospital and emergency department environments. Design and methods The authors conducted structured focus group interviews with separate groups of emergency medical services staff, emergency nurses, and emergency physicians. Recordings of each session were transcribed, coded, and analyzed for themes with representative supporting quotations identified. Results Providers shared that the busy emergency department environment was the largest challenge to delirium recognition and treatment. When describing delirium, participants frequently detailed hyperactive features of delirium, rather than hypoactive features. Participants shared that they employed no clear diagnostic strategy for identifying the condition and that they used heterogeneous approaches to treat the condition. To improve care for older adults with delirium, emergency nurses identified the need for more training around the management of the condition. Emergency medical services providers identified the need for more support in managing agitated patients when in transport to the hospital and more guidance from emergency physicians on what information to collect from the patient's home environment. Emergency physicians felt that delirium care would be improved if they could have baseline mental status data on their patients and if they had access to a simple, accurate diagnostic tool for the condition. Implications Emergency medical services providers, emergency nurses, and emergency physicians frequently encounter delirious patients, but do not employ clear diagnostic strategies for identifying the condition and have varying levels of comfort in managing the condition. Clear steps should be taken to improve delirium care in the emergency department including the development of mechanisms to communicate patients' baseline mental status, the adoption of a systematized approach to recognizing delirium, and the institution of a standardized method to treat the condition when identified.
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Affiliation(s)
- Michael A LaMantia
- Indiana University Center for Aging Research and Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Frank C Messina
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shola Jhanji
- Indiana University-Purdue University, Indianapolis, IN, USA
| | - Arif Nazir
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mungai Maina
- Indiana University Center for Aging Research and Regenstrief Institute, Inc., Indianapolis, IN
| | - Siobhan McGuire
- Indiana University Center for Aging Research and Regenstrief Institute, Inc., Indianapolis, IN
| | | | - Douglas K Miller
- Indiana University Center for Aging Research and Regenstrief Institute, Inc., Indianapolis, IN
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LaMantia MA, Messina FC, Hobgood CD, Miller DK. Screening for delirium in the emergency department: a systematic review. Ann Emerg Med 2013; 63:551-560.e2. [PMID: 24355431 DOI: 10.1016/j.annemergmed.2013.11.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 10/09/2013] [Accepted: 11/11/2013] [Indexed: 01/08/2023]
Abstract
Older adults who visit emergency departments (EDs) often experience delirium, but it is infrequently recognized. A systematic review was therefore conducted to identify what delirium screening tools have been used in ED-based epidemiologic studies of delirium, whether there is a validated set of screening instruments to identify delirium among older adults in the ED or prehospital environments, and an ideal schedule during an older adult's visit to perform a delirium evaluation. MEDLINE/EMBASE, Cochrane, PsycINFO, and CINAHL databases were searched from inception through February 2013 for original, English-language research articles reporting on the assessment of older adults' mental status for delirium. Twenty-two articles met all study inclusion criteria. Overall, 7 screening instruments were identified, though only 1 has undergone initial validation for use in the ED environment and a second instrument is currently undergoing such validation. Minimal information was identified to suggest the ideal scheduling of a delirium assessment process to maximize the recognition of this condition in the ED. Study results indicate that several delirium screening tools have been used in investigations in the ED, though validation of these instruments for this particular environment has been minimal to date. The ideal interval(s) during which a delirium screening process should take place has yet to be determined. Research will be needed both to validate delirium screening instruments to be used for investigation and clinical care in the ED and to define the ideal timing and form of the delirium assessment process for older adults.
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Affiliation(s)
- Michael A LaMantia
- Indiana University Center for Aging Research and Regenstrief Institute, Inc., Indianapolis, IN; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN.
| | - Frank C Messina
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Cherri D Hobgood
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Douglas K Miller
- Indiana University Center for Aging Research and Regenstrief Institute, Inc., Indianapolis, IN; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN; Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN.
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Tepper B, Brice JH, Hobgood CD. Evaluation of Radiation Exposure to Pediatric Trauma Patients. J Emerg Med 2013; 44:646-52. [DOI: 10.1016/j.jemermed.2012.09.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 08/30/2012] [Accepted: 09/18/2012] [Indexed: 11/17/2022]
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Biese K, Leacock BW, Osmond CR, Hobgood CD. Engaging senior residents as leaders: a novel structure for multiple chief roles. J Grad Med Educ 2011; 3:236-8. [PMID: 22655148 PMCID: PMC3184899 DOI: 10.4300/jgme-d-10-00045.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2010] [Revised: 09/10/2010] [Accepted: 11/08/2010] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The chief resident's role encompasses administrative, academic, educational, and social responsibilities and is traditionally filled by a small number of residents who are charged with various administrative and educational duties. These duties lay the groundwork that prepares chief residents to assume future leadership positions. INTERVENTION We propose a new model for multiple chief residents. In this system, there are leadership roles for resident and medical student education, ultrasonography, resident research, and high-fidelity simulation in addition to the traditional administrative roles. This model can be modified to match the needs of a given program and the aptitudes of the senior residents. RESULTS We describe the successful implementation of this model at our program, which has resulted in a progressive curriculum, increased resident leadership, and program ownership among the residents. CONCLUSIONS Our intervention offers an alternative model for overcoming some of the limitations of the traditional chief resident model, including some chief residents who become overwhelmed by their duties and are discouraged from pursuing future leadership roles. It also has the potential to offer other senior residents with various skills and leadership abilities the opportunities to contribute to their program.
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Schneider SM, Gardner AF, Weiss LD, Wood JP, Ybarra M, Beck DM, Stauffer AR, Wilkerson D, Brabson T, Jennings A, Mitchell M, McGrath RB, Christopher TA, King B, Muelleman RL, Wagner MJ, Char DM, McGee DL, Pilgrim RL, Moskovitz JB, Zinkel AR, Byers M, Briggs WT, Hobgood CD, Kupas DF, Kruger J, Stratford CJ, Jouriles N. The future of emergency medicine. Acad Emerg Med 2010; 17:998-1003. [PMID: 20836784 DOI: 10.1111/j.1553-2712.2010.00854.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Schneider SM, Gardner AF, Weiss LD, Wood JP, Ybarra M, Beck DM, Stauffer AR, Wilkerson D, Brabson T, Jennings A, Mitchell M, McGrath RB, Christopher TA, King B, Muelleman RL, Wagner MJ, Char DM, McGee DL, Pilgrim RL, Moskovitz JB, Zinkel AR, Byers M, Briggs WT, Hobgood CD, Kupas DF, Kruger J, Stratford CJ, Jouriles N. The Future of Emergency Medicine. Ann Emerg Med 2010; 56:178-83. [DOI: 10.1016/j.annemergmed.2010.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 04/14/2010] [Accepted: 03/30/2010] [Indexed: 11/28/2022]
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Schneider SM, Gardner AF, Weiss LD, Wood JP, Ybarra M, Beck DM, Stauffer AR, Wilkerson D, Brabson T, Jennings A, Mitchell M, McGrath RB, Christopher TA, King B, Muelleman RL, Wagner MJ, Char DM, McGee DL, Pilgrim RL, Moskovitz JB, Zinkel AR, Byers M, Briggs WT, Hobgood CD, Kupas DF, Kruger J, Stratford CJ, Jouriles N. The Future of Emergency Medicine. J Emerg Nurs 2010; 36:330-5. [DOI: 10.1016/j.jen.2010.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Coates WC, Love JN, Santen SA, Hobgood CD, Mavis BE, Maggio LA, Farrell SE. Faculty development in medical education research: a cooperative model. Acad Med 2010; 85:829-836. [PMID: 20520036 DOI: 10.1097/acm.0b013e3181d737bc] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
As the definition of scholarship is clarified, each specialty should develop a cadre of medical education researchers who can design, test, and optimize educational interventions. In 2004, the Association for American Medical Colleges' Group on Educational Affairs developed the Medical Education Research Certificate (MERC) program to provide a curriculum to help medical educators acquire or enhance skills in medical education research, to promote effective collaboration with seasoned researchers, and to create better consumers of medical education scholarship. MERC courses are offered to individuals during educational meetings. Educational leaders in emergency medicine (EM) identified a disparity between the "scholarship of teaching" and medical education research skills, and they collaborated with the MERC steering committee to develop a mentored faculty development program in medical education research. A planning committee comprising experienced medical education researchers who are also board-certified, full-time EM faculty members designed a novel approach to the MERC curriculum: a mentored team approach to learning, grounded in collaborative medical education research projects. The planning committee identified areas of research interest among participants and formed working groups to collaborate on research projects during standard MERC workshops. Rather than focusing on individual questions during the course, each mentored group identified a single study hypothesis. After completing the first three workshops, group members worked under their mentors' guidance on their multiinstitutional research projects. The expected benefits of this approach to MERC include establishing a research community network, creating projects whose enrollments offer a multiinstitutional dimension, and developing a cadre of trained education researchers in EM.
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Affiliation(s)
- Wendy C Coates
- Acute Care College, David Geffen School of Medicine, University of California-Los Angeles (UCLA), Los Angeles, California, USA.
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Love JN, Coates WC, Santen SA, Hobgood CD, Mavis BE, Farrell SE. The MERC at CORD Scholars Program in medical education research: a novel faculty development opportunity for emergency physicians. Acad Emerg Med 2009; 16 Suppl 2:S37-41. [PMID: 20053208 DOI: 10.1111/j.1553-2712.2009.00591.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Medical educators are increasingly charged with the development of outcomes-based "best practices" in medical student and resident education and patient care. To fulfill this mission, a cadre of well-trained, experienced medical education researchers is required. The experienced medical educator is in a prime position to fill this need but often lacks the training needed to successfully contribute to such a goal. Towards this end, the Association of American Medical Colleges (AAMC) Group on Educational Affairs developed a series of content-based workshops that have resulted in Medical Education Research Certification (MERC), promoting skills development and a better understanding of research by educators. Subsequently, the Council of Emergency Medicine Residency Directors (CORD) partnered with the AAMC to take MERC a step further, in the MERC at CORD Scholars Program (MCSP). This venture integrates a novel, mentored, specialty-specific research project with the traditional MERC workshops. Collaborative groups, based on a common area of interest, each develop a multi-institutional project by exploring and applying the concepts learned through the MERC workshops. Participants in the inaugural MCSP have completed three MERC workshops and initiated a project. Upon program completion, each will have completed MERC certification (six workshops) and gained experience as a contributing author on a mentored education research project. Not only does this program serve as a multi-dimensional faculty development opportunity, it is also intended to act as a catalyst in developing a network of education scholars and infrastructure for educational research within the specialty of emergency medicine.
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Affiliation(s)
- Jeffrey N Love
- Georgetown University School of Medicine, Department of Emergency Medicine, Georgetown University Hospital/Washington Hospital Center, Washington, DC, USA.
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Hobgood CD, Tamayo-Sarver JH, Hollar DW, Sawning S. Griev_Ing: death notification skills and applications for fourth-year medical students. Teach Learn Med 2009; 21:207-19. [PMID: 20183340 DOI: 10.1080/10401330903018450] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND AND PURPOSE Our study examined whether GRIEV_ING improved death notification skills of medical students, whether pretesting with simulated survivors primed learners and improved results of the intervention, and whether feedback on the simulated encounter improved student performance. METHODS GRIEV_ING training was given to 138 fourth-year medical students divided into three groups: exposure to simulated survivor (SS) with written feedback, exposure to SS but no feedback, and no exposure to SS before the training. Students were tested on self-confidence before and after the intervention and were rated by SSs on interpersonal communication and death notification skills. ANCOVA was performed, with gender and race covariates. RESULTS All groups improved on death notification competence and confidence at about the same rate. Competence significantly (p =.037) improved for the feedback group. Interpersonal communication scores declined for all groups. CONCLUSIONS GRIEV_ING provides an effective model medical educators can use to train medical students to provide competent death notifications. Senior medical students are primed to learn death notification and do not require a preexposure.
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Affiliation(s)
- Cherri D Hobgood
- Department of Emergency Medicine, UNC School of Medicine, Chapel Hill, North Carolina 27599, USA.
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18
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19
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Moskop JC, Geiderman JM, Hobgood CD, Larkin GL. Emergency physicians and disclosure of medical errors. Ann Emerg Med 2006; 48:523-31. [PMID: 17052552 DOI: 10.1016/j.annemergmed.2006.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2005] [Revised: 03/31/2006] [Accepted: 04/10/2006] [Indexed: 10/24/2022]
Abstract
Error in medicine is a subject of continuing interest among physicians, patients, policymakers, and the general public. This article examines the issue of disclosure of medical errors in the context of emergency medicine. It reviews the concept of medical error; proposes the professional duty of truthfulness as a justification for error disclosure; examines barriers to error disclosure posed by health care systems, patients, physicians, and the law; suggests system changes to address the issue of medical error; offers practical guidelines to promote the practice of error disclosure; and discusses the issue of disclosure of errors made by another physician.
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Affiliation(s)
- John C Moskop
- Department of Medical Humanities, The Brody School of Medicine at East Carolina University, Greenville, NC 27834, USA.
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20
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Abstract
Resident teaching is a competency that must be recognized, developed, and assessed. The ACGME core competencies include the role of physician as educator to "educate patients and families" and to "facilitate the learning of students and other health care professionals." Residents spend a significant proportion of their time in teaching activities, and students report achieving much of their clinical learning from their interactions with residents. Although many residents enjoy their critical role as teacher, many do not feel well prepared to teach. This article summarizes a preliminary curriculum of modules for a resident teacher-training program for emergency medicine residents. The goal of these modules is to provide learning objectives and an initial structure through which residents could improve basic teaching skills. Many of these skills are adaptable to residents' interactions with each other and with students, other healthcare professionals, and patients. Each module and corresponding teaching exercises can be found at http://www.saem.org.
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Affiliation(s)
- Susan E Farrell
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
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21
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Coates WC, Hobgood CD, Birnbaum A, Farrell SE. Faculty development: academic opportunities for emergency medicine faculty on education career tracks. Acad Emerg Med 2003; 10:1113-7. [PMID: 14525747 DOI: 10.1111/j.1553-2712.2003.tb00584.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Medical school faculty members who specialize in the scholarship of teaching have unique requirements for academic advancement in universities with clinician-educator series. While excellence in teaching is the cornerstone of achievement, attention to traditional academic pursuits improves the likelihood of a favorable review by the institution's promotion and tenure committee. The teaching portfolio is an effective means to document performance. Ongoing faculty development and sound mentoring relationships facilitate the academic advancement of clinician-educators.
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Affiliation(s)
- Wendy C Coates
- Harbor-UCLA Medical Center, Department of Emergency Medicine, Torrance, CA 90509-2910, USA.
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22
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Abstract
Excellent communication and interpersonal (C-IP) skills are a universal requirement for a well-rounded emergency physician. This requirement for C-IP skill excellence is a direct outgrowth of the expectations of our patients and a prerequisite to working in the increasingly complex emergency department environment. Directed education and assessment of C-IP skills are critical components of all emergency medicine (EM) training programs and now are a requirement of the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project. In keeping with its mission to improve the quality of EM education and in response to the ACGME Outcome Project, the Council of Emergency Medicine Residency Directors (CORD-EM) hosted a consensus conference focusing on the application of the six core competencies to EM. The objective of this article is to report the results of this consensus conference as it relates to the C-IP competency. There were four primary goals: 1) define the C-IP skills competency for EM, 2) define the assessment methods currently used in other specialties, 3) identify the methods suggested by the ACGME for use in C-IP skills, and 4) analyze the applicability of these assessment techniques to EM. Ten specific communication competencies are defined for EM. Assessment techniques for evaluation of these C-IP competencies and a timeline for implementation are also defined. Standardized patients and direct observation were identified as the criterion standard assessment methods of C-IP skills; however, other methods for assessment are also discussed.
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Affiliation(s)
- Cherri D Hobgood
- Department of Emergency Medicine, UNC School of Medicine, Chapel Hill, NC 27599-7495, USA.
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23
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Abstract
OBJECTIVES To evaluate the error management systems emergency medicine residency directors (EMRDs) use to identify and report clinical errors made by emergency medicine residents and their satisfaction with error-based teaching as an educational tool. METHODS All 112 EMRDs listed by the Accreditation Council for Graduate Medical Education in 1996 were sent a 15-item survey. Five areas of error evaluation and management were assessed: 1) systems for tracking and reporting clinical errors; 2) resident participation in the systems; 3) resident remediation; 4) EMRD-perceived satisfaction with current error-reporting mechanisms, their educational value, and their ability to identify and prevent errors; and 5) EMRDs' perceptions of faculty and resident satisfaction with the systems. RESULTS The response rate was 86%. All EMRDs indicated that methods are in place to track and report errors at their institutions. These include morbidity and mortality conference (94%), quality assurance case review conference (76%), and continuous quality improvement audits (60%). A majority of programs (58%) present resident cases anonymously in order to enhance teaching (39%), to avoid embarrassment (28%), and to avoid individual blame (24%). While mandated resident remediation is not required at 48% of the programs, 24% require lectures, 17% require written reports, and 6% require extra clinical shifts. The EMRDs rated the educational value of morbidity and mortality conference as outstanding (11%) or excellent (53%), and rated their systems for identifying key resident errors as outstanding (0%), excellent (14%), or good (47%). CONCLUSIONS All emergency medicine residency programs have systems to track and report resident errors. Resident participation varies widely, as does resident remediation processes. Most EMRDs are satisfied with their systems but few EMRDs rate them as excellent in the detection or prevention of clinical errors.
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Affiliation(s)
- C D Hobgood
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7594, USA.
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24
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Hobgood CD, Wood JP, Houry DE. A guide to your first employment contract. Ann Emerg Med 2000; 36:530-2. [PMID: 11054210 DOI: 10.1067/mem.2000.110707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- C D Hobgood
- University of North Carolina Chapel Hill Department of Emergency Medicine Chapel Hill, NC 27514, USA.
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25
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Abstract
The data presented in this communication demonstrate preferential colonization of certain biomaterials by Staphylococcus epidermidis. Using a laminar flow biomaterial colonization chamber and surgical-grade biomaterials (stainless steel, aluminium ceramic, methyl methacrylate and high-density polyethylene), the pattern of colonization was quantitated using plate count techniques and electron microscopy. Under comparable conditions, methyl methacrylate was colonized by S. epidermidis in greater numbers than the other biomaterials. Increased bacterial colonization and slime production on methyl methacrylate was time-dependent and 15 times higher than on stainless steel and aluminium and four times higher than on high-density polyethylene. The data reveal that certain biomaterials may promote infection by favouring colonization by potential pathogens. This variable should be explored extensively in an in vivo setting because of its implication in clinical infections.
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Affiliation(s)
- M Oga
- Department of Orthopaedic Surgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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26
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Abstract
This study addresses the problem of antibiotic resistance in adhesive, biomaterial-centred infections. It is suggested that this anionic, extracapsular, polysaccharide slime produced by bacteria protects them from antibiotics and sequesters critical ions from the surface of biomaterials. Biofilm-enclosed bacteria on the surface of stainless steel substrata in a test chamber were challenged with incremental levels of tobramycin. In this setting, the minimum inhibitory concentration and minimum bactericidal level of tobramycin for Staphylococcus epidermis were well above normal.
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Affiliation(s)
- A G Gristina
- Section of Orthopedic Surgery, Wake Forest University Medical Center, Winston-Salem, NC 27103
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Webb LX, Hobgood CD, Meredith JW, Gristina AG. Adhesive bacterial colonization of exposed traumatized tendon. Orthop Rev 1987; 16:304-9. [PMID: 3454942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Recent studies of compromised or damaged tissues, as well as biomaterials, have shown that they provide a particularly fertile substratum for bacterial colonization. Colonization in these environments is mediated by a process of microbial adhesion to surfaces of the substrata. In this report, we present electron microscopic studies of a portion of damaged and infected tendon. These studies demonstrate colonies of bacteria surrounded by a ruthenium red-staining exopolysaccharide biofilm and adhesion to the surface of the tendon by means of an exopolysaccharide polymer. We suggest that this adhesive form of bacterial colonization may partially explain the resistance of exposed tendon to effective debridement by simple mechanical measures and to coverage with granulation tissue, partial-thickness skin grafts, and vascularized tissue grafts.
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Affiliation(s)
- L X Webb
- Department of Surgery, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina
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Webb LX, Myers RT, Cordell AR, Hobgood CD, Costerton JW, Gristina AG. Inhibition of bacterial adhesion by antibacterial surface pretreatment of vascular prostheses. J Vasc Surg 1986; 4:16-21. [PMID: 3723687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Polytetrafluoroethylene grafts were pretreated with oxacillin, with the cationic detergent benzalkonium, or with both substances, either at room temperature or at 90 degrees C. Inhibition zones ranging from 6.4 to 15.2 mm formed around all grafts incubated on Staphylococcus aureus-streaked agar plates except control disks and those treated with oxacillin. Treated grafts were exposed in vitro to S. aureus in high concentration, followed by distilled water lavage. The graft surface was then stained with ruthenium red to stain polysaccharides and studied by scanning and transmission electron microscopy. Colonization of the graft surface by adhesive bacteria was demonstrated in all cases, although it was less prevalent on grafts pretreated with benzalkonium bound at 90 degrees C.
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Webb LX, Myers RT, Cordell AR, Hobgood CD, Costerton JW, Gristina AG. Inhibition of bacterial adhesion by antibacterial surface pretreatment of vascular prostheses. J Vasc Surg 1986. [DOI: 10.1067/mva.1986.avs0040016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Sottile FD, Marrie TJ, Prough DS, Hobgood CD, Gower DJ, Webb LX, Costerton JW, Gristina AG. Nosocomial pulmonary infection: possible etiologic significance of bacterial adhesion to endotracheal tubes. Crit Care Med 1986; 14:265-70. [PMID: 3956213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Biomaterials are essential for life support and monitoring of critically ill patients, but their use increases the risk of nosocomial infection. Of the various plastics used for life support and monitoring devices, polyvinylchloride is one to which bacteria most readily adhere. Through the use of qualitative culture techniques and scanning and transmission electron microscopy, we studied the surfaces of polyvinylchloride endotracheal tubes removed from 25 ICU patients, to determine if bacterial adhesion to those tubes was sufficient to provide a possible source for repeated contamination of the tracheobronchial tree. Of the surfaces studied, 16% were partially covered and 84% were completely covered by an amorphous bacteria-containing matrix. Some biofilm-enclosed bacterial aggregates projected from the matrix into the lumen of the tube. The mechanism by which endotracheal tubes repeatedly inoculate the lungs of intubated patients may prove to be dislodgment of such aggregates by suction apparatus.
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31
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Gristina AG, Price JL, Hobgood CD, Webb LX, Costerton JW. Bacterial colonization of percutaneous sutures. Surgery 1985; 98:12-9. [PMID: 3892744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The direct electron microscopic examination of 15 sutures and 15 staples removed from 10 healed surgical wounds showed, on the intradermal portions, consistent colonization by bacteria growing in adherent biofilms. This clearly demonstrable bacterial colonization of biomaterials within the wound tract had not resulted in infection or perceptible inflammation in any of the wounds. These bacterial cells were of several morphotypes, including gram-positive cocci, and all specimens yielded cultures of the autochthonous (native) skin bacterium, Staphylococcus epidermidis. The bacteria within the wound tracts were enveloped by extracellular material that appeared on scanning electron microscopy to be a condensed amorphous residue and on transmission electron microscopy to be a fibrous extracellular matrix. We suggest that this mode of growth, in which the colonizing bacteria are enveloped in a copious exopolysaccharide glycocalix, protects the bacteria from host defense factors and accounts for their persistence on the suture surfaces until they are removed with the sutures.
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Abstract
Direct scanning electron microscopy of material obtained during surgical debridement of osteomyelitic bone showed that the infecting bacteria grew in coherent microcolonies in an adherent biofilm so extensive it often obscured the infected bone surfaces. Transmission electron microscopy showed this biofilm to have a fibrous matrix, to contain some host cells, and to contain many bacteria around which matrix fibers were often concentrated. Many bacterial morphotypes were present in these biofilms, and each bacterium was surrounded by exopolysaccharide polymers, which are known to mediate formation of microcolonies and adhesion of bacteria to surfaces in natural ecosystems and in infections related biomaterials. The adherent mode of growth may reduce the susceptibility of these organisms to host clearance mechanisms and antibiotic therapy and thus may be a fundamental factor in acute and chronic osteomyelitis.
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