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Hrdy M, Moadel T, Bentley S, Chen T. Designing and Implementing Effective Remote Simulation. Acad Med 2024:00001888-990000000-00744. [PMID: 38266210 DOI: 10.1097/acm.0000000000005644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
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Schembri L, Warraich S, Bentley S, Carr SB, Balfour-Lynn IM. Impact of elexacaftor/tezacaftor/ivacaftor on fat-soluble vitamin levels in children with cystic fibrosis. J Cyst Fibros 2023; 22:843-846. [PMID: 37142523 DOI: 10.1016/j.jcf.2023.04.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/10/2023] [Accepted: 04/23/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Children with cystic fibrosis are at risk of fat-soluble vitamin deficiency. CFTR modulators positively effect nutritional status. This study aimed to assess changes in serum vitamins A, D & E after starting ETI therapy to ensure levels were not abnormally high. METHODS Retrospective review of annual assessment data over 3½ years, before and after starting ETI in a specialist paediatric CF centre, including vitamin levels. RESULTS 54 eligible patients were included, aged 5-15 yrs (median age 11.5). Median time to post measurements was 171 days. Median vitamin A was increased (1.38 to 1.63 µmol/L, p<0.001). Three patients (6%) had high vitamin A post-ETI, compared with none at baseline; and 2 (4%) had low levels compared to 4 (8%) at baseline. No changes in vitamins D&E. CONCLUSIONS This study found increased vitamin A, sometimes to high levels. We recommend testing levels within 3 months of starting ETI.
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Affiliation(s)
- L Schembri
- Department of Paediatric Dietetics, Royal Brompton Hospital, London, UK
| | - S Warraich
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - S Bentley
- Department of Paediatric Pharmacy, Royal Brompton Hospital, London, UK
| | - S B Carr
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - I M Balfour-Lynn
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK.
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Nadir N, Winfield A, Bentley S, Hock SM, Backster A, Bradby C, Rotoli J, Jones N, Falk M. Simulation for diversity, equity and inclusion in emergency medicine residency training: A qualitative study. AEM Educ Train 2023; 7:S78-S87. [PMID: 37383838 PMCID: PMC10294220 DOI: 10.1002/aet2.10870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 10/14/2022] [Accepted: 11/13/2022] [Indexed: 06/30/2023]
Abstract
Background The last few years have seen an increased focus on diversity, equity, and inclusion (DEI) initiatives across organizations. Simulation has been used in varying degrees for teaching about DEI topics with emergency medicine; however, there are no established best practices or guidelines on this subject. To further examine the use of simulation for DEI teachings, the DEISIM work group was created as a collaboration between the Society of Academic Emergency Medicine (SAEM) Simulation Academy and the Academy for Diversity and Inclusion in Emergency Medicine (ADIEM). This study represents their findings. Method This qualitative study was conducted using a three-pronged approach. Initial literature search was conducted followed by a call for submission of simulation curricula. These were then followed by five focus groups. Focus groups were recorded, transcribed by a professional transcription service, and then subjected to thematic analysis. Results Data were analyzed and organized into four broad categories including Learners, Facilitators, Organizational/Leadership, and Technical Issues. Challenges within each of these were identified, as were potential solutions. Select pertinent findings included focused faculty development, a carefully planned approach that utilized DEI content experts and the use of simulation for workplace microaggressions or discriminations. Conclusions There appears to be a clear role for simulation in DEI teachings. Such curricula, however, should be undertaken with careful planning and input from appropriate and representative parties. More research is needed on optimizing and standardizing simulation-based DEI curricula.
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Affiliation(s)
- Nur‐Ain Nadir
- Department of Emergency MedicineKaiser Permanente Central ValleyModestoCaliforniaUSA
- Department of Clinical ScienceKaiser Permanente Bernard Tyson School of MedicinePasadenaCaliforniaUSA
| | | | - Suzanne Bentley
- Emergency Medicine and Medical EducationIcahn School of Medicine at Mount SinaiNew York CityNew YorkUSA
- Emergency MedicineElmhurst Hospital CenterElmhurstNew YorkUSA
| | - Sara M. Hock
- Emergency MedicineRush University Medical CenterChicagoIllinoisUSA
| | | | - Cassandra Bradby
- Emergency MedicineEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Jason Rotoli
- Emergency MedicineUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Nathaniel Jones
- The Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Michael Falk
- Pediatric Emergency MedicineChildren's National Medical CenterWashingtonDistrict of ColumbiaUSA
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Stapleton SN, Cassara M, Moadel T, Munzer BW, Sampson C, Wong AH, Chopra E, Kim J, Bentley S. Procedural task trainer gaps in emergency medicine: A rift in the simulation universe. AEM Educ Train 2022; 6:S32-S42. [PMID: 35783076 PMCID: PMC9222871 DOI: 10.1002/aet2.10749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES We identified and quantified the gap between emergency medicine (EM) procedures currently taught using simulation versus those that educators would teach if they had better procedural task trainers. Additionally, we endeavored to describe which procedures were taught using homemade models and the barriers to creation and use of additional homemade models. METHODS Using a modified Delphi process, we developed a survey and distributed it to a convenience sample of EM simulationists via the Society for Academic Emergency Medicine Simulation Academy listserv. Survey items asked participants to identify procedures they thought should be taught using simulation ("most important"), do teach using simulation ("most frequent"), would teach if a simulator or model were available ("most needed"), and do teach using simulation with "homemade" models ("most frequent homemade"). RESULTS Thirty-seven surveys were completed. The majority of respondents worked at academic medical centers and were involved in simulation-based education for at least 6 years. Three procedures ranked highly in overall teaching importance and currently taught categories. We identified four procedures that ranked highly as both important techniques to teach and would teach via simulation. Two procedures were selected as the most important procedures that the participants do teach via simulation but would like to teach in an improved way. We found 14 procedures that simulationists would teach if an adequate model was available, four of which are of high importance. CONCLUSIONS This study captured data to illuminate the procedural model gap and inform future interventions that may address it and meet the overarching objective to create better and more readily available procedure models for EM simulation educators in the future. It offers an informed way of prioritizing procedures for which additional homemade models should be created and disseminated as well as barriers to be aware of and to work to overcome. Our work has implications for learners, educators, administrators, and industry.
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Affiliation(s)
- Stephanie N. Stapleton
- Department of Emergency MedicineBoston University School of MedicineBoston Medical CenterBostonMassachusettsUSA
| | - Michael Cassara
- Department of Emergency MedicineNorth Shore University HospitalDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellNorthwell Health Patient Safety Institute/Emergency Medical InstituteHempsteadNew YorkUSA
| | - Tiffany Moadel
- Department of Emergency MedicineDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellUniondaleNew YorkUSA
| | - Brendan W. Munzer
- Department of Emergency MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Christopher Sampson
- Department of Emergency MedicineUniversity of Missouri School of MedicineColumbiaMissouriUSA
| | - Ambrose H. Wong
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Eisha Chopra
- Department of Emergency MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Jane Kim
- Department of Emergency MedicineKings County Hospital/SUNY DownstateNew York CityNew YorkUSA
| | - Suzanne Bentley
- Departments of Emergency Medicine & Medical EducationIcahn School of Medicine at Mount SinaiNYC Health + Hospitals/ElmhurstElmhurstNew YorkUSA
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Furuness I, Tavarez MM, McGinty MD, Mendez K, Demree O, Aviles C, Salahuddin M, Coard J, Mandel-Ricci J, Bentley S, Wei E, Flaherty C, Saez M, Indar M, Iavicoli L. Innovations in Fatality Management During the COVID-19 Pandemic. Health Secur 2022; 20:S90-S96. [PMID: 35452259 DOI: 10.1089/hs.2021.0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Inga Furuness
- Inga Furuness, MPA, BSN, RN, is Assistant Director, Emergency Management, New York City Health + Hospitals (NYC H+H)/Central Office, New York City, NY
| | - Madeline M Tavarez
- Madeline M. Tavarez, MPA, CHEP; is Senior Director, Emergency Management Planning and Operations, New York City Health + Hospitals (NYC H+H)/Central Office, New York City, NY
| | - Meghan D McGinty
- Meghan D. McGinty, PhD, MPH, MBA, was Director, Emergency Management, New York City Health + Hospitals (NYC H+H)/Central Office, New York City, NY
| | - Kim Mendez
- Kim Mendez, EdD, ANP, RN, is Senior Vice President/Corporate Chief Information Officer, New York City Health + Hospitals (NYC H+H)/Central Office, New York City, NY
| | - Oliver Demree
- Oliver Demree, BSN, is Associate Director, Emergency Management, New York City Health + Hospitals (NYC H+H)/Central Office, New York City, NY
| | - Charles Aviles
- Charles Aviles is Associate Director of Safety Management, NYC H+H/Lincoln, Bronx, NY
| | - Mohammed Salahuddin
- Mohammed Salahuddin, SSBB, CHEP, is Director, Emergency Management, NYC H+H/Queens, NY
| | - Jennifer Coard
- Jennifer Coard, LCSW, is Associate Director of Executive Administration, NYC H+H/Queens, NY
| | - Jenna Mandel-Ricci
- Jenna Mandel-Ricci, MPH, MPA, is Senior Vice President, Healthcare Systems Resilience, Greater New York Hospital Association, New York City, NY
| | - Suzanne Bentley
- Suzanne Bentley, MD, MPH, FACEP, CHSE, is Medical Director of Simulation Center and Attending Physician Emergency Medicine, NYC H+H/Elmhurst, NY
| | - Eric Wei
- Eric Wei, MD, MBA, is Senior Vice President, Chief Quality Officer, New York City Health + Hospitals (NYC H+H)/Central Office, New York City, NY
| | - Christine Flaherty
- Christine Flaherty is Senior Vice President, Office of Facilities Development, New York City Health + Hospitals (NYC H+H)/Central Office, New York City, NY
| | - Manuel Saez
- Manuel Saez is Assistant Vice President, Facilities Administration, New York City Health + Hospitals (NYC H+H)/Central Office, New York City, NY
| | - Mahendranath Indar
- Mahendranath Indar is Senior Director, Office of Facilities Development, New York City Health + Hospitals (NYC H+H)/Central Office, New York City, NY
| | - Laura Iavicoli
- Laura Iavicoli, MD, FACEP, is Senior Assistant Vice President, Emergency Management, New York City Health + Hospitals (NYC H+H)/Central Office, New York City, NY
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Bentley S, Artin H, Mehaffey E, Liu F, Sojourner K, Bismark A, Printz D, Lee E, Martis B, De Peralta S, Baker D, Mishra J, Ramanathan D. Response to intravenous racemic ketamine after switch from intranasal (S)-ketamine on symptoms of treatment-resistant depression and post-traumatic stress disorder in Veterans: A retrospective case series. Pharmacotherapy 2022; 42:272-279. [PMID: 35122282 PMCID: PMC8934379 DOI: 10.1002/phar.2664] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Racemic (R,S)-ketamine is a glutamatergic drug with potent and rapid acting antidepressant effects. An intranasal formulation of (S)-ketamine was recently approved by the US Food and Drug Administration (FDA) to be used in individuals with treatment-resistant depression (TRD). There are no data directly comparing outcomes on depression or other comorbidities between these two formulations of ketamine. However, recent meta-analyses have suggested that IV racemic ketamine may be more potent than IN-(S)-ketamine. METHODS We retrospectively analyzed clinical outcomes in 15 Veterans with comorbid TRD and post-traumatic stress disorder (PTSD) who underwent ketamine treatment at the VA San Diego Neuromodulation Clinic. All Veterans included in this analysis were given at least 6 intranasal (IN)-(S)-ketamine treatments prior to switching to treatment with IV racemic ketamine. RESULTS Veterans receiving ketamine treatment ( across both IN-(S)-ketamine and IV-(R,S)-ketamine) showed significant reductions in both the Patient Health Questionnaire-9 (PHQ-9), a self-report scale measuring depression symptoms (rm ANOVA F(14,42) = 12.6, p < 0.0001), and in the PTSD checklist for DSM-5 (PCL-5), a self-report scale measuring PSTD symptoms (rm ANOVA F(13,39) = 5.9, p = 0.006). Post hoc testing revealed that PHQ-9 scores were reduced by an average of 2.4 ± 1.2 compared to baseline after (S)-ketamine treatments (p = 0.1) and by an average of 5.6 ± 1 after IV-ketamine treatments (p = 0.0003) compared to pretreatment baseline scores. PCL-5 scores were reduced by an average of 4.3 ± 3.3 after IN (S)-ketamine treatments (p = 0.6) and 11.8 ± 3.5 after IV-ketamine treatments (p = 0.03) compared to pretreatment baseline scores. CONCLUSIONS This work suggests that off-label IV-(R,S)-ketamine could be considered a reasonable next step in patients who do not respond adequately to the FDA-approved IN-(S)-ketamine. Further double-blinded, randomized controlled trials are warranted to assess whether IV racemic ketamine is more effective than IN-(S)-ketamine.
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Affiliation(s)
- S. Bentley
- Dept. of Psychiatry, UC San Diego, La Jolla, CA, 92093
| | - H. Artin
- Dept. of Psychiatry, UC San Diego, La Jolla, CA, 92093
| | - E. Mehaffey
- Dept. of Psychiatry, UC San Diego, La Jolla, CA, 92093
| | - F. Liu
- Dept. of Psychiatry, UC San Diego, La Jolla, CA, 92093
| | - K. Sojourner
- Mental Health Service, VA San Diego Healthcare Syst. (VADHS), San Diego, CA, 92161
| | - A. Bismark
- Mental Health Service, VA San Diego Healthcare Syst. (VADHS), San Diego, CA, 92161,Dept. of Psychiatry, UC San Diego, La Jolla, CA, 92093
| | - D. Printz
- Mental Health Service, VA San Diego Healthcare Syst. (VADHS), San Diego, CA, 92161,Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA 92161,Dept. of Psychiatry, UC San Diego, La Jolla, CA, 92093
| | - E.E Lee
- Mental Health Service, VA San Diego Healthcare Syst. (VADHS), San Diego, CA, 92161,Dept. of Psychiatry, UC San Diego, La Jolla, CA, 92093
| | - B. Martis
- Mental Health Service, VA San Diego Healthcare Syst. (VADHS), San Diego, CA, 92161,Dept. of Psychiatry, UC San Diego, La Jolla, CA, 92093
| | - S. De Peralta
- Mental Health Service, VA San Diego Healthcare Syst. (VADHS), San Diego, CA, 92161,Dept. of Psychiatry, UC San Diego, La Jolla, CA, 92093
| | - D.G. Baker
- Mental Health Service, VA San Diego Healthcare Syst. (VADHS), San Diego, CA, 92161,Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA 92161,Dept. of Psychiatry, UC San Diego, La Jolla, CA, 92093
| | - J. Mishra
- Mental Health Service, VA San Diego Healthcare Syst. (VADHS), San Diego, CA, 92161,Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA 92161
| | - D. Ramanathan
- Mental Health Service, VA San Diego Healthcare Syst. (VADHS), San Diego, CA, 92161,Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA 92161,Dept. of Psychiatry, UC San Diego, La Jolla, CA, 92093
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Bentley S, Feldman N, Boehm L, Zavala M, Dilos B, McIndoe M, Nagaswar L, Walker K, Bell D, Nazarian D, Rabinovich J, Kessler S, Iavicoli L, Fairweather P, Farraye J, Shoirah H. Stroke Code From EMS to Thrombectomy: An Interdisciplinary In Situ Simulation for Prompt Management of Acute Ischemic Stroke. MedEdPORTAL 2021; 17:11177. [PMID: 34504950 PMCID: PMC8380761 DOI: 10.15766/mep_2374-8265.11177] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/26/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Treatment of acute ischemic stroke is challenging because it requires prompt management, interdisciplinary collaboration, and adherence to specific guidelines. This resource addresses these challenges by providing in situ simulated practice with stroke codes by practicing clinicians at unannounced times. METHODS An emergency department team was presented with a 55-year-old simulated patient with speech difficulty and right-sided weakness. The team had to assess her efficiently and appropriately, including activating the stroke team via the hospital paging system. The stroke team responded to collaboratively coordinate evaluation, obtain appropriate imaging, administer thrombolytic therapy, and recognize the need for thrombectomy. Learners moved through the actual steps in the real clinical environment, using real hospital equipment. Upon simulation completion, debriefing was utilized to review the case and team performance. Latent safety threats were recorded, if present. Participants completed an evaluation to gauge the simulation's effectiveness. RESULTS Six simulations involving 40 total participants were conducted and debriefed across New York City Health + Hospitals. One hundred percent of teams correctly identified the presenting condition and assessed eligibility for thrombolytic and endovascular therapy. Evaluations indicated that 100% of learners found the simulation to be an effective clinical, teamwork, and communication teaching tool. Debriefing captured several latent safety threats, which were rectified by collaboration with hospital leadership. DISCUSSION Impromptu, in situ simulation helps develop interdisciplinary teamwork and clinical knowledge and is useful for reviewing crucial times and processes required for best-practice patient care. It is particularly useful when timely management is essential, as with acute ischemic stroke.
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Affiliation(s)
- Suzanne Bentley
- Medical Director, Simulation Center, NYC Health + Hospitals/Elmhurst; Attending Physician, Department of Emergency Medicine, NYC Health + Hospitals/Elmhurst; Associate Professor, Departments of Emergency Medicine and Medical Education, Icahn School of Medicine at Mount Sinai
| | - Nicola Feldman
- Second-Year Medical Student, Icahn School of Medicine at Mount Sinai
| | - Lorraine Boehm
- Simulation Specialist, Simulation Center, NYC Health + Hospitals/Elmhurst; Senior Nurse Educator, NYC Health + Hospitals/Elmhurst
| | - Magda Zavala
- Stroke Coordinator, NYC Health + Hospitals/Elmhurst
| | - Barbara Dilos
- Director of Anesthesiology, NYC Health + Hospitals/Elmhurst; Assistant Professor, Department of Anesthesiology, Icahn School of Medicine at Mount Sinai; Simulation Faculty, Simulation Center, NYC Health + Hospitals/Elmhurst
| | - Mamie McIndoe
- Associate Director of Patient Experience, NYC Health + Hospitals/Elmhurst; Simulation Faculty, Simulation Center, NYC Health + Hospitals/Elmhurst
| | - Latchmi Nagaswar
- Clinical Nurse Educator, Departments of Radiology, Post-Acute Care Unit, and Surgical Services, NYC Health + Hospitals/Elmhurst; Simulation Faculty, Simulation Center, NYC Health + Hospitals/Elmhurst
| | - Katie Walker
- Director, Simulation Center, NYC Health + Hospitals; Assistant Vice President, NYC Health + Hospitals
| | - Donnie Bell
- System Deputy Chief Medical Officer, NYC Health + Hospitals; Attending Physician, Neuroendovascular Service, NYC Health + Hospitals/Kings County; Assistant Professor, Department of Radiology, SUNY Downstate Health Sciences University
| | - Devorah Nazarian
- Associate Director of Emergency Department, NYC Health + Hospitals/Elmhurst; Assistant Professor, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai
| | - Joseph Rabinovich
- Attending Physician, Department of Emergency Medicine, NYC Health + Hospitals/Elmhurst; Assistant Professor, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai
| | - Stuart Kessler
- Director of Emergency Medicine, NYC Health + Hospitals/Elmhurst; Associate Professor and Vice Chairman, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai
| | - Laura Iavicoli
- Associate Director of Emergency Department, NYC Health + Hospitals/Elmhurst; Emergency Medical Services/Emergency Management Director, NYC Health + Hospitals/Elmhurst; Assistant Professor, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai
| | - Phillip Fairweather
- Associate Director of Emergency Department, NYC Health + Hospitals/Elmhurst; Assistant Professor, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai
| | - Joseph Farraye
- Director of Neurology/Stroke, NYC Health + Hospitals/Elmhurst; Associate Professor, Department of Neurology, Icahn School of Medicine at Mount Sinai
| | - Hazem Shoirah
- Director of Cerebrovascular Division, NYC Health + Hospitals/Elmhurst; Director of Stroke Program, NYC Health + Hospitals/Elmhurst; Assistant Professor, Departments of Neurosurgery, Neurology, and Radiology, Icahn School of Medicine at Mount Sinai
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Smith M, Leader A, Roa W, Jaramillo E, Lazala D, Flores J, Cadet C, Vazifedan T, Bentley S, Jensen L. Helping Mothers Survive: Program Evaluation and Early Outcomes of Maternal Care Training in the Dominican Republic. Front Public Health 2021; 9:660908. [PMID: 34222172 PMCID: PMC8242252 DOI: 10.3389/fpubh.2021.660908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/20/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction: In 2017, approximately 295,000 women died during and immediately following pregnancy and childbirth worldwide, with 94% of these deaths occurring in low-resource settings. The Dominican Republic (DR) exhibits one of the highest maternal mortality ratios in the region of Latin America and the Caribbean despite the fact that 99% of registered births in the country are reportedly attended by a skilled birth attendant. This paradox implies that programs to support healthcare worker knowledge and skills improvement are vital to improving maternal health outcomes in the DR. Helping Mothers Survive (HMS) is a provider training program developed by Jhpiego and global partners. The goal of HMS is to combat maternal mortality by contributing to quality improvement efforts that reinforce maternal health skills of local healthcare workers. Methods: An international, multisectoral group of stakeholders collaborated in the implementation of two HMS curricula, Bleeding After Birth (BAB) and pre-eclampsia & eclampsia (PE&E). Demographic information as well as pre- and post-training knowledge scores were recorded for each participant. Knowledge score improvement was assessed in order to support effectiveness of the program on knowledge acquisition of healthcare workers. Results: Three hundred and twenty healthcare workers participated in the HMS training workshops between October 2016–August 2020. Of the 320 participants, 132 were trained as master trainers. The majority of participants identified as attending physicians, followed by residents/interns, nurses, students, and “other.” A significant improvement in knowledge scores was observed for both the BAB and PE&E curricula, with a 21.24 and 30.25% change in average score (pre- to post-test), respectively. In response to COVID-19 pandemic restrictions, flexibility of the local team led to a PE&E virtual training pilot workshop in August 2020. Discussion/Conclusions: Simulation-based training improved the knowledge levels of healthcare workers for both HMS curricula. These results suggest that simulation-based workshops have an impact on knowledge acquisition and skills of healthcare workers immediately following training. For the PE&E curriculum, no significant difference in knowledge acquisition was observed between in-person and virtual training sessions. The ongoing pandemic poses challenges to program implementation; however, these preliminary results provide evidence that conducting virtual workshops may be a viable alternative to in-person training.
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Affiliation(s)
- Meghan Smith
- Graduate Program in Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Alexandra Leader
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Wanny Roa
- Region II, Ministry of Health, Santiago, Dominican Republic
| | - Ericka Jaramillo
- Family Medicine, Natividad Medical Center, Salinas, CA, United States
| | - Davina Lazala
- Region II, Ministry of Health, Santiago, Dominican Republic
| | - Jose Flores
- Department of Family Medicine, University of Washington, Seattle, WA, United States
| | - Claudia Cadet
- Department of Neonatology, WakeMed Health and Hospitals, Raleigh, NC, United States
| | - Turaj Vazifedan
- Department of Pediatrics, Children's Hospital of the King's Daughters, Norfolk, VA, United States
| | - Suzanne Bentley
- Graduate Program in Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Emergency Medicine, Elmhurst Hospital Center, Elmhurst, NY, United States
| | - Lloyd Jensen
- Department of Pediatrics, University of Nevada Las Vegas, Las Vegas, NV, United States
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Bentley S, Davies J, Gastine S, Standing J. EPS3.10 Clinical pharmacokinetics and dose recommendations for posaconazole gastro-resistant tablets in children with cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01027-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Stapleton SN, Wong AH, Ray JM, Rider AC, Moadel T, Bentley S, Cassara M. Virtual Mentoring: Two Adaptive Models for Supporting Early-career Simulation Investigators in the Era of Social Distancing. AEM Educ Train 2021; 5:105-110. [PMID: 33521496 PMCID: PMC7821069 DOI: 10.1002/aet2.10540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Early-career simulation investigators identify limited mentorship as a common barrier to disseminating scholarship and launching a successful academic career in emergency medicine (EM). Conferences often bridge this gap, but the COVID-19 pandemic has forced their indefinite delay. Virtual solutions are needed to capitalize on the breadth of national simulation research experts and grow mentorship in a postpandemic world. METHODS We developed two complementary innovations to facilitate scholarship development and minimize COVID-associated career challenges resulting from social distancing requirements. The e-fellows forum (FF) provides a capstone experience for works-in-progress and the e-consultation service (CS) supports simulation research during the earlier project stages of design and development. In conjunction with the Society for Academic Medicine's Simulation Academy, we applied videoconferencing technology for both of these novel, virtual innovations. We analyzed corresponding chat transcripts and detailed field notes for emerging themes. In addition, we collected quantitative data via participant surveys regarding their experiences and impact on their projects. RESULTS Nine simulation fellows presented at the FF and seven junior simulation investigators participated in the CS sessions. Most preferred the virtual format (56% FF, 66% CS) and found the sessions to be helpful in project advancement (66% FF, 100% CS). COVID-19 affected most projects (89% FF, 67% CS). We identified three themes via qualitative analysis: design concerns and inquiries, validation or support shown by mentors and peers, and professional cohesion. CONCLUSIONS Participants felt that both virtual mentorship innovations advanced their simulation research projects and fostered a sense of professional cohesion within a greater community of practice. These benefits can be powerful at a time where simulation researchers in EM feel disconnected in an era of social distancing. Our future work will include adaptations to a hybrid model with both virtual and in-person modalities as well as creation of more e-mentorship opportunities, thus broadening the early-career simulation research community of practice.
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Affiliation(s)
- Stephanie N. Stapleton
- From theDepartment of Emergency MedicineBoston University School of MedicineBoston Medical CenterBostonMAUSA
| | - Ambrose H. Wong
- theDepartment of Emergency MedicineYale School of MedicineNew HavenCTUSA
| | - Jessica M. Ray
- theDepartment of Emergency MedicineYale School of MedicineNew HavenCTUSA
| | - Ashley C. Rider
- theDepartments of Emergency MedicineStanford UniversityPalo AltoCAUSA
| | - Tiffany Moadel
- theDepartment of Emergency MedicineNorth Shore University HospitalDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellManhassetNYUSA
| | - Suzanne Bentley
- theDepartment of Emergency Medicine & Medical EducationIcahn School of Medicine at Mount SinaiNYC Health + Hospitals/ElmhurstElmhurstNYUSA
| | - Michael Cassara
- and theDepartment of Emergency MedicineNorth Shore University HospitalDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellNorthwell Health Patient Safety Institute/Emergency Medical InstituteLake SuccessNYUSA
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Goodin D, Wong L, Bentley S, Lane R, Loo G. 179 Ethnicity and Symptom Onset in the Emergency Department during the SARS-CoV-2 Pandemic at the “Epicenter of the Epicenter”. Ann Emerg Med 2020. [PMCID: PMC7598891 DOI: 10.1016/j.annemergmed.2020.09.191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Feldman N, Lane R, Iavicoli L, Delgado V, Fairweather P, Kessler S, Bentley S. A snapshot of emergency department volumes in the "epicenter of the epicenter" of the COVID-19 pandemic. Am J Emerg Med 2020; 46:687-689. [PMID: 32917426 PMCID: PMC7443167 DOI: 10.1016/j.ajem.2020.08.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Nicola Feldman
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA.
| | - Rikki Lane
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA; NYC Health + Hospitals/Elmhurst, Department of Emergency Medicine, 79-01 Broadway, Elmhurst, NY 11373, USA
| | - Laura Iavicoli
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA; NYC Health + Hospitals/Elmhurst, Department of Emergency Medicine, 79-01 Broadway, Elmhurst, NY 11373, USA
| | - Veronica Delgado
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA; NYC Health + Hospitals/Elmhurst, Department of Emergency Medicine, 79-01 Broadway, Elmhurst, NY 11373, USA
| | - Phillip Fairweather
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA; NYC Health + Hospitals/Elmhurst, Department of Emergency Medicine, 79-01 Broadway, Elmhurst, NY 11373, USA
| | - Stuart Kessler
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA; NYC Health + Hospitals/Elmhurst, Department of Emergency Medicine, 79-01 Broadway, Elmhurst, NY 11373, USA
| | - Suzanne Bentley
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA; NYC Health + Hospitals/Elmhurst, Department of Emergency Medicine, 79-01 Broadway, Elmhurst, NY 11373, USA
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Walsh BM, Wong AH, Ray JM, Frallicciardi A, Nowicki T, Medzon R, Bentley S, Stapleton S. Practice Makes Perfect. Emerg Med Clin North Am 2020; 38:363-382. [DOI: 10.1016/j.emc.2020.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Bentley S, Stapleton SN, Moschella PC, Ray JM, Zucker SM, Hernandez J, Rosenman ED, Wong AH. Barriers and Solutions to Advancing Emergency Medicine Simulation-based Research: A Call to Action. AEM Educ Train 2020; 4:S130-S139. [PMID: 32072117 PMCID: PMC7011408 DOI: 10.1002/aet2.10406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/04/2019] [Accepted: 10/24/2019] [Indexed: 05/08/2023]
Abstract
Simulation technology has successfully improved patient safety and care quality through training and assessment of individuals, teams, and health care systems. Emergency medicine (EM) continues to be a leader and pioneer of simulation, including administration of simulation-based fellowships and training programs. However, EM simulation-based research has been limited by low rates of publication and poor methodologic rigor. The Society for Academic Emergency Medicine (SAEM) Simulation Academy is leading efforts to improve the quality of scholarship generated by the EM simulation community and to foster successful research careers for future generations of EM simulationists. Through a needs assessment survey of our membership and a year-long consensus-based approach, we identified two main clusters of barriers to simulation-based research: lack of protected time and dedicated resources and limited training and mentorship. As a result, we generated four position statements with implications for education, training, and research in EM simulation and as a call to action for the academic EM community. Recommendations include expansion of funding opportunities for simulation-based research, creation of multi-institutional simulation collaboratives, and development of mentorship and training pathways that promote rigor in design and methodology within EM simulation scholarship.
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Affiliation(s)
- Suzanne Bentley
- Departments of Emergency Medicine and Medical EducationIcahn School of Medicine at Mount SinaiNew YorkNY
- NYC Health + Hospital/ElmhurstElmhurstNY
| | | | | | - Jessica M. Ray
- Department of Emergency MedicineYale School of MedicineNew HavenCT
| | | | - Jessica Hernandez
- Department of Emergency MedicineUniversity of Texas Southwestern Medical CenterDallasTX
| | - Elizabeth D. Rosenman
- Department of Emergency MedicineUniversity of Washington School of MedicineSeattleWA
| | - Ambrose H. Wong
- Department of Emergency MedicineYale School of MedicineNew HavenCT
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Cassara M, Schertzer K, Falk MJ, Wong AH, Hock SM, Bentley S, Paetow G, Conlon LW, Hughes PG, McKenna RT, Hrdy M, Lei C, Kulkarni M, Smith CM, Young A, Romo E, Smith MD, Hernandez J, Strother CG, Frallicciardi A, Nadir N. Applying Educational Theory and Best Practices to Solve Common Challenges of Simulation-based Procedural Training in Emergency Medicine. AEM Educ Train 2020; 4:S22-S39. [PMID: 32072105 PMCID: PMC7011411 DOI: 10.1002/aet2.10418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/15/2019] [Accepted: 11/16/2019] [Indexed: 05/21/2023]
Abstract
OBJECTIVES Procedural competency is an essential prerequisite for the independent practice of emergency medicine. Multiple studies demonstrate that simulation-based procedural training (SBPT) is an effective method for acquiring and maintaining procedural competency and preferred over traditional paradigms ("see one, do one, teach one"). Although newer paradigms informing SBPT have emerged, educators often face circumstances that challenge and undermine their implementation. The goal of this paper is to identify and report on best practices and theory-supported solutions to some of these challenges as derived using a process of expert consensus building and reviews of the existing literature on SBPT. METHODS The Society for Academic Emergency Medicine (SAEM) Simulation Academy SBPT Workgroup convened approximately 8 months prior to the 2019 SAEM Annual Meeting to perform a review of the literature and participate in a consensus-building process to identify solutions (in the form of best practices and educational theory) to these challenges faced by educators engaging in SBPT. RESULTS AND ANALYSIS Thirteen distinct educational challenges to SBPT emerged from the expert group's primary literature reviews and consensus-building processes. Three domains emerged upon further analysis of the 13 challenges: learner, educator, and curriculum. Six challenges within the "learner" domain were selected for comprehensive discussion in this paper, as they were deemed representative of the most common and most significant threats to ideal SBPT. Each of the six challenges aligns with one of the following themes: 1) maximizing active learning, 2) maintaining learner engagement, 3) embracing learner diversity, 4) optimizing cognitive load, 5) promoting mindfulness and reflection, and 6) emphasizing deliberate practice for mastery learning. Over 20 "special treatments" for mitigating the impact of the 13 challenges were derived from the secondary literature search and consensus-building process prior to and during the preconference workshop; 11 of these that best address the six learner-centered challenges are explored, including implications for educators involved in SBPT. CONCLUSIONS/IMPLICATIONS FOR EDUCATORS We propose multiple consensus-generated solutions (in the form of best practices and applied educational theory) that we believe are suitable and well aligned to overcome commonly encountered learner-centered challenges and threats to optimal SBPT.
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Affiliation(s)
| | | | | | | | | | - Suzanne Bentley
- Elmhurst Hospital Center/Icahn School of Medicine at Mt SinaiElmhurstNY
| | | | - Lauren W. Conlon
- University of Pennsylvania/Perelman School of MedicinePhiladelphiaPA
| | - Patrick G. Hughes
- Florida Atlantic University Charles E. Schmidt College of MedicineBoca RatonFL
| | - Ryan T. McKenna
- University of South Florida Morsani College of MedicineTampaFL
| | | | - Charles Lei
- Vanderbilt University School of MedicineNashvilleTN
| | | | - Colleen M. Smith
- Mount Sinai Hospital/Icahn School of Medicine at Mt SinaiNew YorkNY
| | - Amanda Young
- University of Arkansas for Health SciencesLittle RockAR
| | | | | | | | | | | | - Nur‐Ain Nadir
- Kaiser Permanente Central Valley/Kaiser Permanente School of MedicinePasadenaCA
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16
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Nickerson JE, Webb T, Boehm L, Neher H, Wong L, LaMonica J, Bentley S. Difficult Delivery and Neonatal Resuscitation: A Novel Simulation for Emergency Medicine Residents. West J Emerg Med 2019; 21:102-107. [PMID: 31913828 PMCID: PMC6948703 DOI: 10.5811/westjem.2019.10.43913] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 10/07/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction Newborn delivery and resuscitation are rare, but essential, emergency medicine (EM) skills. We evaluated the effect of simulation on EM residents’ knowledge, confidence, and clinical skills in managing shoulder dystocia and neonatal resuscitation. Methods We developed a novel simulation that integrates a shoulder dystocia with neonatal resuscitation and studied a convenience sample of EM residents. Each 15-minute simulation was run with one learner, a simulated nurse, and a standardized patient in situ in the emergency department. The learner was required to reduce a shoulder dystocia and then perform neonatal resuscitation. We debriefed with plus/delta format, standardized teaching points, and individualized feedback. We assessed knowledge with a nine-question multiple choice test, confidence with five-point Likert scales, and clinical performance using a checklist of critical actions. Residents repeated all measures one year after the simulation. Results A total of 23 residents completed all measures. At one-year post-intervention, residents scored 15% higher on the knowledge test. All residents increased confidence in managing shoulder dystocia on a five-point Likert scale (1.4 vs 2.8) and 80% increased confidence in performing neonatal resuscitation (1.8 vs 3.0). Mean scores on the checklist of critical actions improved by 19% for shoulder dystocia and by 27% for neonatal resuscitation. Conclusion Implementing simulation may improve EM residents’ knowledge, confidence, and clinical skills in managing shoulder dystocia and neonatal resuscitation.
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Affiliation(s)
- Jillian Elizabeth Nickerson
- Children's National Medical Center, Department of Emergency Medicine and Trauma Services, Washington, District of Colombia
| | - Taryn Webb
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York
| | - Lorraine Boehm
- Elmhurst Hospital Center, Simulation Center, Elmhurst, New York
| | - Hayley Neher
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York
| | - Lillian Wong
- Elmhurst Hospital Center, Department of Emergency Medicine, Elmhurst, New York
| | - Julia LaMonica
- Elmhurst Hospital Center, Department of Emergency Medicine, Elmhurst, New York
| | - Suzanne Bentley
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York.,Elmhurst Hospital Center, Department of Emergency Medicine, Elmhurst, New York
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Bentley S, Boehm L, Carroll-Bennett R, McIndoe M, Lopez T, Dilos B, Lamonica J, Meshel A, Smith C, Astua A. 248 Education to Fix and Prevent: Use of Latent Safety Threat Analysis of In Situ Code Team Simulation as an Educational Needs Assessment. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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18
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Khan S, Meyers CM, Bentley S, Manini AF. In Reply: “Impact of Targeted Temperature Management on ED Patients with Drug Overdose–Related Cardiac Arrest”. J Med Toxicol 2019; 15:210-211. [DOI: 10.1007/s13181-019-00702-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/14/2019] [Indexed: 12/01/2022] Open
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Bentley S, Iavicoli L, Boehm L, Agriantonis G, Dilos B, LaMonica J, Smith C, Wong L, Lopez T, Galer A, Kessle S. A Simulated Mass Casualty Incident Triage Exercise: SimWars. MedEdPORTAL 2019; 15:10823. [PMID: 31139741 PMCID: PMC6521923 DOI: 10.15766/mep_2374-8265.10823] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 03/26/2019] [Indexed: 05/31/2023]
Abstract
INTRODUCTION This multipatient simulation exercise encompasses triage by hospital medical providers during a mass casualty incident (MCI) involving gas line explosion with building collapse. The SimWars format allows two teams to participate in identical simulations coupled with active audience observation, followed by facilitated group discussion. The exercise requires real-time knowledge application of MCI management and helps learners develop a framework for rapidly classifying and dispositioning MCI patients. METHODS Two teams of provider pairs completed MCI triage of 12 simulated patients in 8 minutes with an objective of quickly and accurately dispositioning within hospital bed availability. Participants included emergency medicine and surgery physicians, with active observation by mixed provider audiences. Observers completed a checklist per patient (category: urgent/emergent/not emergent, disposition: bed type/location). At simulation conclusion, a 45-minute facilitated discussion compared observers' self-assessment of MCI patient management with the simulation teams' decisions. Finally, an expert panel discussed management decisions and MCI triage pearls. RESULTS Team performances (N = 4) and audience responses (N = 164) were similar on seven of 12 patients, allowing robust discussion. Participants completed an evaluation at exercise conclusion; 37% reported good/excellent ability to accomplish MCI initial triage and disposition before this exercise compared to 100% after, a statistically significant 63% increase. All postsurvey respondents agreed or strongly agreed that the exercise would change their MCI clinical practice. DISCUSSION The two-team format allows comparison of how different teams handle MCI triage, and active observation allows comparison of audience and team decision making.
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Affiliation(s)
- Suzanne Bentley
- Medical Director, Simulation Center, NYC Health + Hospitals/Elmhurst
- Attending Physician, Emergency Medicine, NYC Health + Hospitals/Elmhurst
- Associate Professor, Emergency Medicine and Medical Education, Icahn School of Medicine at Mount Sinai
| | - Laura Iavicoli
- Associate Director, Emergency Department, NYC Health + Hospitals/Elmhurst
- Director, Emergency Medical Services/Emergency Management, NYC Health + Hospitals/Elmhurst
- Assistant Professor, Emergency Medicine, Icahn School of Medicine at Mount Sinai
| | - Lorraine Boehm
- Simulation Specialist, Simulation Center, NYC Health + Hospitals/Elmhurst
- Senior Nurse Educator, NYC Health + Hospitals/Elmhurst
| | - George Agriantonis
- Director, Trauma, NYC Health + Hospitals/Elmhurst
- Assistant Professor, Surgery, Icahn School of Medicine at Mount Sinai
| | - Barbara Dilos
- Director, Anesthesia, NYC Health + Hospitals/Elmhurst
| | - Julia LaMonica
- Associate Nurse Practitioner, Emergency Medicine, NYC Health + Hospitals/Elmhurst
| | - Colleen Smith
- Attending Physician, Emergency Medicine, NYC Health + Hospitals/Elmhurst
- Assistant Professor, Emergency Medicine, Icahn School of Medicine at Mount Sinai
- Assistant Program Director, Emergency Medicine Residency, NYC Health + Hospitals/Elmhurst
| | - Lillian Wong
- Attending Physician, Emergency Medicine, NYC Health + Hospitals/Elmhurst
- Assistant Professor, Emergency Medicine, Icahn School of Medicine at Mount Sinai
| | - Tania Lopez
- Assistant Program Director, Pediatric Residency, NYC Health + Hospitals/Elmhurst
- Attending Physician, Pediatrics, NYC Health + Hospitals/Elmhurst
| | - Anju Galer
- Trauma Program Manager, NYC Health + Hospitals/Elmhurst
| | - Stuart Kessle
- Director, Emergency Medicine, NYC Health + Hospitals/Elmhurst
- Associate Professor, Emergency Medicine, Icahn School of Medicine at Mount Sinai
- Vice Chairman, Emergency Medicine, Icahn School of Medicine at Mount Sinai
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Milliner BH, Bentley S, DuCanto J. A pilot study of improvised CPAP (iCPAP) via face mask for the treatment of adult respiratory distress in low-resource settings. Int J Emerg Med 2019; 12:7. [PMID: 31179948 PMCID: PMC6399909 DOI: 10.1186/s12245-019-0224-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) is a mode of non-invasive ventilation used to treat a variety of respiratory conditions in the emergency department and intensive care unit. In low-resource settings where ventilators are not available, the ability to improvise a CPAP system from locally available equipment would provide a previously unavailable means of respiratory support for patients in respiratory distress. This manuscript details the design of such a system and its performance in healthy volunteers. METHODS An improvised CPAP system was assembled from standard emergency department equipment and tested in 10 healthy volunteers (6 male, 4 female; ages 29-33). The system utilizes a water seal and high-flow air to create airway pressure; it was set to provide a pressure of 5 cmH2O for the purposes of this pilot study. Subjects used the system in a monitored setting for 30 min. Airway pressure, heart rate, oxygen saturation, and end-tidal CO2 were monitored. Comfort with the device was assessed via questionnaire. RESULTS The system maintained positive airway pressure for the full trial period in all subjects, with a mean expiratory pressure (EP) of 5.1 cmH2O (SD 0.7) and mean inspiratory pressure (IP) of 3.2 cmH2O (SD 0.8). There was a small decrease in average EP (5.28 vs 4.88 cmH2O, p = 0.03) and a trend toward decreasing IP (3.26 vs 3.07 cmH2O, p = 0.22) during the trial. No significant change in heart rate, O2 saturation, respiratory rate, or end-tidal CO2 was observed. The system was well tolerated, ranked an average of 4.0 on a 1-5 scale for comfort (with 5 = very comfortable). CONCLUSIONS This improvised CPAP system maintained positive airway pressure for 30 min in healthy volunteers. Use did not cause tachycardia, hypoxia, or hypoventilation and was well tolerated. This system may be a useful adjunctive treatment for respiratory distress in low-resource settings. Further research should test this system in settings where other positive pressure modalities are not available.
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Affiliation(s)
- Brendan H Milliner
- Division of Emergency Medicine, University of Utah, 30 N 1900 E 1C026, Salt Lake City, UT, 84132, USA.
| | - Suzanne Bentley
- Simulation Center at Elmhurst and Department of Emergency Medicine, Elmhurst Hospital Center, Elmhurst, NY, USA.,Departments of Emergency Medicine and Medical Education, Icahn School of Medicine at Mount Sinai, 3 East 101st Street, Box 1620, New York, NY, 10029, USA
| | - James DuCanto
- Department of Anesthesiology, Aurora St. Luke's Medical Center, 2900 W Oklahoma Ave, Milwaukee, WI, 53215, USA
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21
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Nadir NA, Hart D, Cassara M, Noelker J, Moadel T, Kulkarni M, Sampson CS, Bentley S, Naik NK, Hernandez J, Krzyzaniak SM, Lai S, Podolej G, Strother C. Simulation-based Remediation in Emergency Medicine Residency Training: A Consensus Study. West J Emerg Med 2019; 20:145-156. [PMID: 30643618 PMCID: PMC6324703 DOI: 10.5811/westjem.2018.10.39781] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 07/13/2018] [Revised: 10/19/2018] [Accepted: 10/26/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Resident remediation is a pressing topic in emergency medicine (EM) training programs. Simulation has become a prominent educational tool in EM training and been recommended for identification of learning gaps and resident remediation. Despite the ubiquitous need for formalized remediation, there is a dearth of literature regarding best practices for simulation-based remediation (SBR). METHODS We conducted a literature search on SBR practices using the terms "simulation," "remediation," and "simulation based remediation." We identified relevant themes and used them to develop an open-ended questionnaire that was distributed to EM programs with experience in SBR. Thematic analysis was performed on all subsequent responses and used to develop survey instruments, which were then used in a modified two-round Delphi panel to derive a set of consensus statements on the use of SBR from an aggregate of 41 experts in simulation and remediation in EM. RESULTS Faculty representing 30 programs across North America composed the consensus group with 66% of participants identifying themselves as simulation faculty, 32% as program directors, and 2% as core faculty. The results from our study highlight a strong agreement across many areas of SBR in EM training. SBR is appropriate for a range of deficits, including procedural, medical knowledge application, clinical reasoning/decision-making, communication, teamwork, and crisis resource management. Simulation can be used both diagnostically and therapeutically in remediation, although SBR should be part of a larger remediation plan constructed by the residency leadership team or a faculty expert in remediation, and not the only component. Although summative assessment can have a role in SBR, it needs to be very clearly delineated and transparent to everyone involved. CONCLUSION Simulation may be used for remediation purposes for certain specific kinds of competencies as long as it is carried out in a transparent manner to all those involved.
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Affiliation(s)
- Nur-Ain Nadir
- Kaiser Permanente Central Valley, Department of Emergency Medicine, Modesto, California
- University of Illinois-Peoria, Jump Simulation, Peoria, Illinois
| | - Danielle Hart
- University of Minnesota, Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, Minnesota
| | - Michael Cassara
- Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Department of Emergency Medicine, Manhasset, New York
| | - Joan Noelker
- Washington University in St. Louis, Department of Medicine, Division of Emergency Medicine, St. Louis, Missouri
| | - Tiffany Moadel
- Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Department of Emergency Medicine, Manhasset, New York
| | - Miriam Kulkarni
- St. John’s Riverside Hospital, Department of Emergency Medicine, Yonkers, New York
| | | | - Suzanne Bentley
- Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Department of Emergency Medicine and Medical Education, Simulation Center, Elmhurst, New York
| | - Neel K. Naik
- New York Presbyterian, Weill Cornell Medicine, Department of Emergency Medicine, New York, New York
| | - Jessica Hernandez
- University of Texas Southwestern Medical Center, Department of Emergency Medicine, Dallas, Texas
| | - Sara M. Krzyzaniak
- Kaiser Permanente Central Valley, Department of Emergency Medicine, Modesto, California
- University of Illinois-Peoria, Jump Simulation, Peoria, Illinois
| | - Steven Lai
- Ronald Reagan UCLA Medical Center, Olive View-UCLA Medical Center, Department of Emergency Medicine, Los Angeles, California
| | - Gregory Podolej
- Kaiser Permanente Central Valley, Department of Emergency Medicine, Modesto, California
- University of Illinois-Peoria, Jump Simulation, Peoria, Illinois
| | - Christopher Strother
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, Pediatrics, and Medical Education, New York, New York
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Khan S, Meyers CM, Bentley S, Manini AF. Impact of Targeted Temperature Management on ED Patients with Drug Overdose-Related Cardiac Arrest. J Med Toxicol 2018; 15:22-29. [PMID: 30411236 DOI: 10.1007/s13181-018-0686-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Drug overdose is the leading cause of non-traumatic out-of-hospital cardiac arrest (OHCA) among young adults. This study investigates whether targeted temperature management (TTM) improves hospital survival from presumed overdose-related cardiac arrest. METHODS Retrospective chart review of consecutive cardiac arrests presenting to an urban tertiary care hospital ED from 2011 to 2015. ED patients with cardiac arrest were included if < 50 years old, and excluded if there was a non-overdose etiology (e.g., trauma, ST-elevation myocardial infarction, subarachnoid hemorrhage). The main intervention was TTM, carried out with a combination of the Arctic Sun device and refrigerated crystalloid/antipyretics (goal temperature 33-36 °C). The primary outcome was survival to hospital discharge; neurologically intact survival was the secondary outcome. RESULTS Of 923 patients with cardiac arrest, 802 (86.9%) met exclusion criteria, leaving 121 patients for final analysis. There were 29 patients in the TTM group (24.0%) vs 92 patients in the non-TTM group (76.0%). Eleven patients (9.1%) survived to hospital discharge. TTM was associated with increased odds of survival to hospital discharge (OR 11.3, 95% CI 2.8-46.3, p < 0.001), which increased substantially when palliative outcomes were excluded from the cohort (OR 117.3, 95% CI 17.0-808.4, p < 0.001). Despite achieving statistical significance (OR 1.1, 95% CI 1.0-1.3), TTM had no clinically significant effect on neurologically intact survival. CONCLUSIONS TTM was associated with improved survival in ED patients with presumed drug overdose-related cardiac arrest. The impact of TTM on neurologically intact survival among these patients requires further study.
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Affiliation(s)
- Sharaf Khan
- Department of Emergency Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Chad M Meyers
- Department of Emergency Medicine, The Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, New York, NY, USA
| | - Suzanne Bentley
- Department of Emergency Medicine, The Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, New York, NY, USA
| | - Alex F Manini
- Division of Medical Toxicology, The Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, New York, NY, USA
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Furyk C, Walsh ML, Kaliaperumal I, Bentley S, Hattingh C. Assessment of the reliability of intubation and ease of use of the Cook Staged Extubation Set-an observational study. Anaesth Intensive Care 2018; 45:695-699. [PMID: 29137579 DOI: 10.1177/0310057x1704500608] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The Staged Extubation Set has recently been introduced by Cook Medical for the management of difficult airway patients who potentially require reintubation; however, its reliability for intubation and ease of use is not reported in the literature. The set contains a wire and reintubation catheter with a central lumen for the wire and oxygenation if required. Reintubation is by a two-stage Seldinger-like technique. After induction of general anaesthesia, 23 low-risk elective surgical patients had the Staged Extubation Wire from the Cook set inserted into their trachea under direct laryngoscopy. The intubation was subsequently completed using the rest of the Staged Extubation Set as designed. Difficult intubation was simulated by intentionally decreasing the laryngeal view. Simulated reintubation failed in 8.3% and significant technical difficulty in simulated reintubation was noted in another 17.3% of intubation sequences. The latter represent probable failures in a clinical difficult reintubation setting. The mean time taken to intubate was 109 seconds. Using the Cook Staged Extubation Set may be inferior to using an airway exchange catheter for reintubation.
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Gottlieb M, Dehon E, Jordan J, Bentley S, Ranney ML, Lee S, Khandelwal S, Santen SA. Getting Published in Medical Education: Overcoming Barriers to Scholarly Production. West J Emerg Med 2017; 19:1-6. [PMID: 29383048 PMCID: PMC5785173 DOI: 10.5811/westjem.2017.11.35253] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 11/14/2017] [Accepted: 11/27/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Michael Gottlieb
- Rush University Medical Center, Department of Emergency Medicine, Chicago, Illinois
| | - Erin Dehon
- University of Mississippi Medical Center, Department of Emergency Medicine, Jackson, Mississippi
| | - Jaime Jordan
- Harbor-UCLA Medical Center, Department of Emergency Medicine, Torrance, California
| | - Suzanne Bentley
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York
| | - Megan L Ranney
- Alpert Medical School, Brown University, Department of Emergency Medicine, Providence, Rhode Island
| | - Sangil Lee
- University of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, Iowa
| | - Sorabh Khandelwal
- The Ohio State University, Department of Emergency Medicine, Columbus, Ohio
| | - Sally A Santen
- University of Michigan Medical School, Department of Emergency Medicine, Ann Arbor, Michigan
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Koelman D, Kremer P, Lees J, Brouwer M, Bentley S, van de Beek D. Bacterial hypervirulence in haemophilus influenzae meningitis identified by whole genome sequencing. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.523] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bentley S, Hu K, Messman A, Moadel T, Khandelwal S, Streich H, Noelker J. Are All Competencies Equal in the Eyes of Residents? A Multicenter Study of Emergency Medicine Residents' Interest in Feedback. West J Emerg Med 2016; 18:76-81. [PMID: 28116012 PMCID: PMC5226767 DOI: 10.5811/westjem.2016.11.32626] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 11/30/2016] [Indexed: 11/11/2022] Open
Abstract
Introduction Feedback, particularly real-time feedback, is critical to resident education. The emergency medicine (EM) milestones were developed in 2012 to enhance resident assessment, and many programs use them to provide focused resident feedback. The purpose of this study was to evaluate EM residents’ level of interest in receiving real-time feedback on each of the 23 competencies/sub-competencies. Methods This was a multicenter cross-sectional study of EM residents. We surveyed participants on their level of interest in receiving real-time on-shift feedback on each of the 23 competencies/sub-competencies. Anonymous paper or computerized surveys were distributed to residents at three four-year training programs and three three-year training programs with a total of 223 resident respondents. Residents rated their level of interest in each milestone on a six-point Likert-type response scale. We calculated average level of interest for each of the 23 sub-competencies, for all 223 respondents and separately by postgraduate year (PGY) levels of training. One-way analyses of variance were performed to determine if there were differences in ratings by level of training. Results The overall survey response rate across all institutions was 82%. Emergency stabilization had the highest mean rating (5.47/6), while technology had the lowest rating (3.24/6). However, we observed no differences between levels of training on any of the 23 competencies/sub-competencies. Conclusion Residents seem to ascribe much more value in receiving feedback on domains involving high-risk, challenging procedural skills as compared to low-risk technical and communication skills. Further studies are necessary to determine whether residents’ perceived importance of competencies/sub-competencies needs to be considered when developing an assessment or feedback program based on these 23 EM competencies/sub-competencies.
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Affiliation(s)
- Suzanne Bentley
- Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Department of Emergency Medicine, Department of Medical Education, New York, New York
| | - Kevin Hu
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York
| | - Anne Messman
- Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - Tiffany Moadel
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
| | - Sorabh Khandelwal
- The Ohio State University, Department of Emergency Medicine, Columbus, Ohio
| | - Heather Streich
- University of Virginia, Department of Emergency Medicine, Charlottesville, Virginia
| | - Joan Noelker
- Washington University in St. Louis, Department of Medicine, Division of Emergency Medicine, St. Louis, Missouri
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Nadir NA, Bentley S, Papanagnou D, Bajaj K, Rinnert S, Sinert R. Characteristics of Real-Time, Non-Critical Incident Debriefing Practices in the Emergency Department. West J Emerg Med 2016; 18:146-151. [PMID: 28116028 PMCID: PMC5226751 DOI: 10.5811/westjem.2016.10.31467] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 10/03/2016] [Accepted: 10/27/2016] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Benefits of post-simulation debriefings as an educational and feedback tool have been widely accepted for nearly a decade. Real-time, non-critical incident debriefing is similar to post-simulation debriefing; however, data on its practice in academic emergency departments (ED), is limited. Although tools such as TeamSTEPPS® (Team Strategies and Tools to Enhance Performance and Patient Safety) suggest debriefing after complicated medical situations, they do not teach debriefing skills suited to this purpose. Anecdotal evidence suggests that real-time debriefings (or non-critical incident debriefings) do in fact occur in academic EDs;, however, limited research has been performed on this subject. The objective of this study was to characterize real-time, non-critical incident debriefing practices in emergency medicine (EM). METHODS We conducted this multicenter cross-sectional study of EM attendings and residents at four large, high-volume, academic EM residency programs in New York City. Questionnaire design was based on a Delphi panel and pilot testing with expert panel. We sought a convenience sample from a potential pool of approximately 300 physicians across the four sites with the goal of obtaining >100 responses. The survey was sent electronically to the four residency list-serves with a total of six monthly completion reminder emails. We collected all data electronically and anonymously using SurveyMonkey.com; the data were then entered into and analyzed with Microsoft Excel. RESULTS The data elucidate various characteristics of current real-time debriefing trends in EM, including its definition, perceived benefits and barriers, as well as the variety of formats of debriefings currently being conducted. CONCLUSION This survey regarding the practice of real-time, non-critical incident debriefings in four major academic EM programs within New York City sheds light on three major, pertinent points: 1) real-time, non-critical incident debriefing definitely occurs in academic emergency practice; 2) in general, real-time debriefing is perceived to be of some value with respect to education, systems and performance improvement; 3) although it is practiced by clinicians, most report no formal training in actual debriefing techniques. Further study is needed to clarify actual benefits of real-time/non-critical incident debriefing as well as details on potential pitfalls of this practice and recommendations for best practices for use.
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Affiliation(s)
- Nur-Ain Nadir
- OSF St. Francis Medical Center, University of Illinois College of Medicine at Peoria, Department of Emergency Medicine, Peoria, Illinois; Kings County Hospital and SUNY Downstate Medical Center, Department of Emergency Medicine, New York, New York
| | - Suzanne Bentley
- Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine and Department of Medical Education, Elmhurst, New York
| | - Dimitrios Papanagnou
- Thomas Jefferson University Hospital, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Komal Bajaj
- Jacobi Medical Center, Department of Obstetrics and Gynecology, New York, New York
| | - Stephan Rinnert
- Kings County Hospital and SUNY Downstate Medical Center, Department of Emergency Medicine, New York, New York
| | - Richard Sinert
- Kings County Hospital and SUNY Downstate Medical Center, Department of Emergency Medicine, New York, New York
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Kairus R, Santos C, Kazzi Z, Bentley S, Olmedo R. Development of a medical Toxicology Curriculum in Spanish with content informed by a population survey for medical trainees in the Dominican Republic. Toxicol Lett 2016. [DOI: 10.1016/j.toxlet.2016.07.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Frallicciardi A, Vora S, Bentley S, Nadir NA, Cassara M, Hart D, Park C, Cheng A, Aghera A, Moadel T, Dobiesz V. Development of an Emergency Medicine Simulation Fellowship Consensus Curriculum: Initiative of the Society for Academic Emergency Medicine Simulation Academy. Acad Emerg Med 2016; 23:1054-60. [PMID: 27251553 DOI: 10.1111/acem.13019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/19/2016] [Accepted: 05/23/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES There is currently no consolidated list of existing simulation fellowship programs in emergency medicine (EM). In addition, there are no universally accepted or expected standards for core curricular content. The objective of this project is to develop consensus-based core content for EM simulation fellowships to help frame the critical components of such training programs. METHODS This paper delineates the process used to develop consensus curriculum content for EM simulation fellowships. EM simulation fellowship curricula were collected. Curricular content was reviewed and compiled by simulation experts and validated utilizing survey methodology, and consensus was obtained using a modified Delphi methodology. RESULTS Fifteen EM simulation fellowship curricula were obtained and analyzed. Two rounds of a modified Delphi survey were conducted. The final proposed core curriculum content contains 47 elements in nine domains with 14 optional elements. CONCLUSION The proposed consensus content will provide current and future fellowships a foundation on which to build their own specific and detailed fellowship curricula. Such standardization will ultimately increase the transparency of training programs for future trainees and potential employers.
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Affiliation(s)
- Alise Frallicciardi
- University of Connecticut School of Medicine and Hartford Hospital; Hartford CT
| | - Samreen Vora
- Stritch School of Medicine; Loyola University Chicago; Maywood IL
| | - Suzanne Bentley
- Elmhurst Hospital Center; Icahn School of Medicine at Mount Sinai; New York NY
| | - Nur-Ain Nadir
- University of Illinois; College of Medicine-Peoria/OSF St. Francis Medical Center Peoria and JUMP Trading Simulation and Education Center; Peoria IL
| | - Michael Cassara
- Hofstra Northwell School of Medicine; Hempstead NY
- Northwell Health Patient Safety Institute; Lake Success NY
| | | | - Chan Park
- Durham Veterans Affairs Medical Center and Duke University Medical Center; Durham NC
| | - Adam Cheng
- Alberta Children's Hospital; Calgary Alberta Canada
| | | | | | - Valerie Dobiesz
- University of Illinois College of Medicine at Chicago; Chicago IL
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Dandekar A, Gomez W, Rodriguez J, Bentley S. Preconception risk factors and attitudes about reproductive planning in
women of reproductive age in the Dominican Republic. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Arias MC, Lockwood A, Ali M, Veras K, Olivares J, Bentley S, Dandekar A. Effects of a hospital-based pilot education program on breastfeeding
knowledge in Santiago, Dominican Republic. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Lockwood A, Arias M, Ovalles M, Dandekar A, Bentley S. Factors associated with pediatric emergency room utilization in an Urban
community hospital in Santiago, Dominican Republic. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Bentley S, Mudan G, Strother C, Wong N. Are Live Ultrasound Models Replaceable? Traditional versus Simulated Education Module for FAST Exam. West J Emerg Med 2015; 16:818-22. [PMID: 26594272 PMCID: PMC4651576 DOI: 10.5811/westjem.2015.9.27276] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/31/2015] [Accepted: 09/26/2015] [Indexed: 11/28/2022] Open
Abstract
Introduction The focused assessment with sonography for trauma (FAST) is a commonly used and life-saving tool in the initial assessment of trauma patients. The recommended emergency medicine (EM) curriculum includes ultrasound and studies show the additional utility of ultrasound training for medical students. EM clerkships vary and often do not contain formal ultrasound instruction. Time constraints for facilitating lectures and hands-on learning of ultrasound are challenging. Limitations on didactics call for development and inclusion of novel educational strategies, such as simulation. The objective of this study was to compare the test, survey, and performance of ultrasound between medical students trained on an ultrasound simulator versus those trained via traditional, hands-on patient format. Methods This was a prospective, blinded, controlled educational study focused on EM clerkship medical students. After all received a standardized lecture with pictorial demonstration of image acquisition, students were randomized into two groups: control group receiving traditional training method via practice on a human model and intervention group training via practice on an ultrasound simulator. Participants were tested and surveyed on indications and interpretation of FAST and training and confidence with image interpretation and acquisition before and after this educational activity. Evaluation of FAST skills was performed on a human model to emulate patient care and practical skills were scored via objective structured clinical examination (OSCE) with critical action checklist. Results There was no significant difference between control group (N=54) and intervention group (N=39) on pretest scores, prior ultrasound training/education, or ultrasound comfort level in general or on FAST. All students (N=93) showed significant improvement from pre- to post-test scores and significant improvement in comfort level using ultrasound in general and on FAST (p<0.001). There was no significant difference between groups on OSCE scores of FAST on a live model. Overall, no differences were demonstrated between groups trained on human models versus simulator. Discussion There was no difference between groups in knowledge based ultrasound test scores, survey of comfort levels with ultrasound, and students’ abilities to perform and interpret FAST on human models. Conclusion These findings suggest that an ultrasound simulator is a suitable alternative method for ultrasound education. Additional uses of ultrasound simulation should be explored in the future.
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Affiliation(s)
- Suzanne Bentley
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York City, New York ; Elmhurst Hospital Center, Department of Emergency Medicine, Elmhurst, New York
| | - Gurpreet Mudan
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York City, New York
| | - Christopher Strother
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York City, New York
| | - Nelson Wong
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
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Leader A, Desai N, Torres S, Murphy R, Bentley S. 215 Implementation of a Pediatric Emergency Medicine Protocol and Curriculum in the Dominican Republic. Ann Emerg Med 2015. [DOI: 10.1016/j.annemergmed.2015.07.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bentley S, Hexom B, Nelson BP. Evaluation of an Obstetric Ultrasound Curriculum for Midwives in Liberia. J Ultrasound Med 2015; 34:1563-1568. [PMID: 26254155 DOI: 10.7863/ultra.15.14.08017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 11/29/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Point-of-care ultrasound is an effective tool for clinical decision making in low- and middle-income countries, but lack of trained providers is a barrier to its utility in these settings. In Liberia, given that midwives provide most prenatal care, it is hypothesized that training them in prenatal ultrasound through an intensive condensed training course is both feasible and practical. METHODS This quantitative prospective study of preobservational and postobservational assessment evaluated a 1-week ultrasound curriculum consisting of 4 modules, each comprising a didactic component, a practical session, and supervised patient encounters. A knowledge-based pretest and presurvey addressing prior use and comfort were administered. At the intervention conclusion, identical posttests and postsurveys were administered with an objective structured clinical examination (OSCE). The test, survey, and OSCE were repeated after 1 year. All scores and responses were tabulated, and qualitative analysis with paired t tests was performed. RESULTS Thirty-one midwives underwent intervention and written evaluation, with 14 followed up at 1 year. Seventeen underwent the OSCE, with 8 retained at 1 year. There was a significant increase between pretest and immediate and 1-year posttest scores (36.6% versus 90% and 66%; P < .001) but no difference between immediate and 1-year posttest scores (90% versus 66%; P > .05). Average overall comfort using ultrasound increased from presurvey to immediate postsurvey scores (from 1.8 to 3.8; P< .001) and remained higher at the 1-year postsurvey (1.8 to 3.4; P< .05). Overall OSCE scores remained high from immediately after the OSCE to 1 year after the OSCE (78% to 55%; P > .05). CONCLUSIONS Midwives in Liberia had very low baseline knowledge and comfort using ultrasound. A 1-week curriculum increased both short- and long-term knowledge and comfort and led to adequate overall OSCE scores that were retained at 1 year.
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Affiliation(s)
- Suzanne Bentley
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York USA
| | - Braden Hexom
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York USA.
| | - Bret P Nelson
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York USA
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Yvonne Chan YF, Nagurka R, Bentley S, Ordonez E, Sproule W. Medical utilization of kiosks in the delivery of patient education: a systematic review. Health Promot Perspect 2014; 4:1-8. [PMID: 25097831 DOI: 10.5681/hpp.2014.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 11/02/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The utilization of kiosks has previously been shown to be effective for collecting information, delivering educational modules, and providing access to health information. We discuss a review of current literature for the utilization of kiosks for the delivery of patient education. METHODS The criteria for inclusion in this literature review were: (1) study discusses the utilization of kiosks for patient health education; (2) study discusses the use of touch screens for patient health information; (3) published in English. Our review includes searches via MEDLINE databases and Google Scholar for the years 1996-2014. RESULTS Overall, 167 articles were screened for final eligibility, and after discarding duplicates and non-eligible studies with abstract. Full-text review of 28 articles was included in the final analysis. CONCLUSION The review of available literature demonstrates the effectiveness of touch screen kiosks to educate patients and to improve healthcare, both at a performance and cost advantage over other modes of patient education.
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Affiliation(s)
- Yu-Feng Yvonne Chan
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Roxanne Nagurka
- Department of Emergency Medicine, Rutgers, New Jersey Medical School, New Jersey, USA
| | - Suzanne Bentley
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Edgardo Ordonez
- Department of Medicine, Section of Emergency Medicine, Baylor College of Medicine, Texas, USA
| | - William Sproule
- Department of Emergency Medicine, Rutgers, New Jersey Medical School, New Jersey, USA
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Havryliuk T, Bentley S, Hahn S. Global health education in emergency medicine residency programs. J Emerg Med 2014; 46:847-52. [PMID: 24613226 DOI: 10.1016/j.jemermed.2013.11.101] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 09/21/2013] [Accepted: 11/17/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Interest in global health and international electives is growing among Emergency Medicine (EM) residents in the United States (US). The majority of EM residency programs offer opportunities for international electives. The degree of participation among residents and type of support provided by the residency program, however, remains unclear. STUDY OBJECTIVES To explore the current state of global health education among EM residents who participate in international electives. METHODS A 12-question survey was e-mailed to the program directors of the 192 EM residency programs in the US. The survey included questions about the number of residents participating in international electives and the types of preparation, project requirements, supervision, and feedback participating residents receive. RESULTS The response rate was 53% with 102 responses. Seventy-five of 102 (74%) programs reported that at least one resident participated in an international elective in the 2010-2011 academic year. Forty-three programs (42%) report no available funding to support any resident on an international elective. Residents receive no preparation for international work in 41 programs (40%). Only 25 programs (26%) required their residents to conduct a project while abroad. Forty-nine programs (48%) reported no formal debriefing session, and no formal feedback was collected from returning residents in 57 of 102 (59%) programs. CONCLUSION The majority of EM residencies have residents participating in international electives. However, the programs report variable preparation, requirements, and resident supervision. These results suggest a need for an expanded and more structured approach to international electives undertaken by EM residents.
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Affiliation(s)
| | - Suzanne Bentley
- Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sigrid Hahn
- Icahn School of Medicine at Mount Sinai, New York, New York
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Martin IB, Jacquet GA, Levine AC, Douglass K, Pousson A, Dunlop S, Khanna K, Bentley S, Tupesis JP. Global health and emergency care: a postgraduate medical education consensus-based research agenda. Acad Emerg Med 2013; 20:1233-40. [PMID: 24341578 DOI: 10.1111/acem.12258] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 08/20/2013] [Accepted: 08/21/2013] [Indexed: 11/29/2022]
Abstract
Global emergency medicine (EM) is a rapidly growing field within EM, as evidenced by the increasing number of trainees and clinicians pursuing additional experiences in global health and emergency care. In particular, many trainees now desire opportunities at the postgraduate level by way of global EM fellowship programs. Despite this growing popularity, little is known of the effects of postgraduate training in global health and emergency care on learners and patients in the United States and abroad. During the 2013 Academic Emergency Medicine consensus conference on global health and emergency care, a group of leading educators at the postgraduate medical education level convened to generate a research agenda of pressing questions to be answered in this area. The consensus-based research agenda is presented in this article.
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Affiliation(s)
- Ian B.K. Martin
- The Departments of Emergency Medicine and Internal Medicine; University of North Carolina at Chapel Hill; Chapel Hill NC
| | - Gabrielle A. Jacquet
- The Department of Emergency Medicine; Johns Hopkins University; Baltimore MD
- The Department of Emergency Medicine; Boston University; Boston MA
| | - Adam C. Levine
- The Department of Emergency Medicine; Brown University; Providence RI
| | - Kate Douglass
- The Department of Emergency Medicine; The George Washington University; Washington DC
| | | | - Stephen Dunlop
- The Department of Emergency Medicine; Hennepin County Medical Center and the University of Minnesota; Minneapolis MN
| | - Kajal Khanna
- The Division of Emergency Medicine; Department of Surgery; Stanford University; Palo Alto CA
| | - Suzanne Bentley
- The of Emergency Medicine; Mount Sinai Icahn School of Medicine; New York NY
| | - Janis P. Tupesis
- The Division of Emergency Medicine; Department of Medicine; University of Wisconsin; Madison WI
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Martin IBK, Devos E, Jordan J, Malya R, Tupesis JP, Bentley S, Flemister A, Kapur GB. Global health and emergency care: an undergraduate medical education consensus-based research agenda. Acad Emerg Med 2013; 20:1224-32. [PMID: 24341577 DOI: 10.1111/acem.12263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 08/15/2013] [Accepted: 08/16/2013] [Indexed: 01/05/2023]
Abstract
Global emergency medicine (EM) is a rapidly growing field within EM, as evidenced by the increasing number of medical students desiring global health and emergency care experiences. Despite this growing popularity, little is known of the effect of undergraduate medical education in global health on learners and patients in the United States and abroad. During the 2013 Academic Emergency Medicine consensus conference, a group of leading medical school educators convened to generate a research agenda on priority questions to be answered in this arena. This consensus-based research agenda is presented in this article.
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Affiliation(s)
- Ian B. K. Martin
- The Departments of Emergency Medicine and Internal Medicine; University of North Carolina at Chapel Hill; Chapel Hill NC
| | - Elizabeth Devos
- The Department of Emergency Medicine; University of Florida; Jacksonville FL
| | - Jaime Jordan
- The Department of Emergency Medicine; Harbor-UCLA Medical Center; Torrance CA
| | - Rohith Malya
- The Department of Emergency Medicine; University of Texas at Houston; Houston TX
| | - Janis P. Tupesis
- The Division of Emergency Medicine; Department of Medicine; University of Wisconsin; Madison WI
| | - Suzanne Bentley
- The Department of Emergency Medicine; Mount Sinai Icahn School of Medicine; New York NY
| | - Akeem Flemister
- The Department of Emergency Medicine; Central Michigan University; Saginaw MI
| | - G. Bobby Kapur
- The Section of Emergency Medicine; Baylor College of Medicine; Houston TX
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Bentley S. The “What If” Curriculum of Common Emergency Critical Care Procedures. Ann Emerg Med 2013. [DOI: 10.1016/j.annemergmed.2013.07.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bentley S, Gupta A, Balfour-Lynn I. Subtherapeutic itraconazole and voriconazole levels in children with cystic fibrosis. J Cyst Fibros 2013; 12:418-9. [DOI: 10.1016/j.jcf.2012.09.007] [Citation(s) in RCA: 7] [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: 06/20/2012] [Revised: 09/25/2012] [Accepted: 09/25/2012] [Indexed: 10/27/2022]
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Grad Y, Kirkcaldy R, Dordel J, Goldstein E, Trees D, Weinstock H, Parkhill J, Hanage WP, Bentley S, Lipsitch M. YI.4 Gonococcal Genomics Shows Impact of Recombination on Obscuring Phylogenetic Signal and Disseminating Resistance Loci. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Grad YH, Kirkcaldy R, Trees D, Dordel J, Goldstein E, Weinstock H, Parkhill J, Hanage WP, Bentley S, Lipsitch M. O03.4 Genomic Epidemiology of Neisseria Gonorrhoeae with Reduced Susceptibility to Cefixime in the United States. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lakoff D, Strayer R, Bentley S, Shah K. 37 A Blog-Format Asynchronous Learning Experience. Ann Emerg Med 2012. [DOI: 10.1016/j.annemergmed.2012.07.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Bentley S, Nelson B, Strother C. 319 Are Live Ultrasound Models Replaceable? Traditional versus Simulated Education Module for Ultrasound FAST. Ann Emerg Med 2011. [DOI: 10.1016/j.annemergmed.2011.06.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Liuzzo G, Manfredi A, Rossi R, Bentley S, Serraino A. TIMING OF INFORMATION FLOW IN THE RASFF AND EFFECTIVENESS ASSESSMENT OF RECALL/WITHDRAWAL. A CASE STUDY IN THE ASL OF MODENA. Ital J Food Saf 2011. [DOI: 10.4081/ijfs.2011.1.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Liuzzo G, Bonilauri P, Leonelli R, Serraino A, Bentley S. PRELIMINARY CONSIDERATIONS ON SUSHI AS POTENTIALLY HAZARDOUS FOOD. Ital J Food Saf 2011. [DOI: 10.4081/ijfs.2011.1s.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Chan YF, Alagappan K, Rella J, Bentley S, Soto-Greene M, Martin M. Interpreter services in emergency medicine. J Emerg Med 2008; 38:133-9. [PMID: 18571358 DOI: 10.1016/j.jemermed.2007.09.045] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2007] [Revised: 09/07/2007] [Accepted: 09/08/2007] [Indexed: 11/27/2022]
Abstract
Emergency physicians are routinely confronted with problems associated with language barriers. It is important for emergency health care providers and the health system to strive for cultural competency when communicating with members of an increasingly diverse society. Possible solutions that can be implemented include appropriate staffing, use of new technology, and efforts to develop new kinds of ties to the community served. Linguistically specific solutions include professional interpretation, telephone interpretation, the use of multilingual staff members, the use of ad hoc interpreters, and, more recently, the use of mobile computer technology at the bedside. Each of these methods carries a specific set of advantages and disadvantages. Although professionally trained medical interpreters offer improved communication, improved patient satisfaction, and overall cost savings, they are often underutilized due to their perceived inefficiency and the inconclusive results of their effect on patient care outcomes. Ultimately, the best solution for each emergency department will vary depending on the population served and available resources. Access to the multiple interpretation options outlined above and solid support and commitment from hospital institutions are necessary to provide proper and culturally competent care for patients. Appropriate communications inclusive of interpreter services are essential for culturally and linguistically competent provider/health systems and overall improved patient care and satisfaction.
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Affiliation(s)
- Yu-Feng Chan
- Department of Emergency Medicine, Mount Sinai School of Medicine, New York, New York 10029, USA
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Panerai RB, Sammons EL, Smith SM, Rathbone WE, Bentley S, Potter JF, Samani NJ. Continuous estimates of dynamic cerebral autoregulation: influence of non-invasive arterial blood pressure measurements. Physiol Meas 2008; 29:497-513. [PMID: 18401070 DOI: 10.1088/0967-3334/29/4/006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Temporal variability of parameters which describe dynamic cerebral autoregulation (CA), usually quantified by the short-term relationship between arterial blood pressure (BP) and cerebral blood flow velocity (CBFV), could result from continuous adjustments in physiological regulatory mechanisms or could be the result of artefacts in methods of measurement, such as the use of non-invasive measurements of BP in the finger. In 27 subjects (61+/-11 years old) undergoing coronary artery angioplasty, BP was continuously recorded at rest with the Finapres device and in the ascending aorta (Millar catheter, BP(AO)), together with bilateral transcranial Doppler ultrasound in the middle cerebral artery, surface ECG and transcutaneous CO(2). Dynamic CA was expressed by the autoregulation index (ARI), ranging from 0 (absence of CA) to 9 (best CA). Time-varying, continuous estimates of ARI (ARI(t)) were obtained with an autoregressive moving-average (ARMA) model applied to a 60 s sliding data window. No significant differences were observed in the accuracy and precision of ARI(t) between estimates derived from the Finapres and BP(AO). Highly significant correlations were obtained between ARI(t) estimates from the right and left middle cerebral artery (MCA) (Finapres r=0.60+/-0.20; BP(AO) r=0.56+/-0.22) and also between the ARI(t) estimates from the Finapres and BP(AO) (right MCA r=0.70+/-0.22; left MCA r=0.74+/-0.22). Surrogate data showed that ARI(t) was highly sensitive to the presence of noise in the CBFV signal, with both the bias and dispersion of estimates increasing for lower values of ARI(t). This effect could explain the sudden drops of ARI(t) to zero as reported previously. Simulated sudden changes in ARI(t) can be detected by the Finapres, but the bias and variability of estimates also increase for lower values of ARI. In summary, the Finapres does not distort time-varying estimates of dynamic CA obtained with a sliding window combined with an ARMA model, but further research is needed to confirm these findings in healthy subjects and to assess the influence of different physiological manoeuvres.
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Affiliation(s)
- R B Panerai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
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Galbally I, Meyer M, Bentley S, Weeks I, Leuning R, Kelly K, Phillips F, Barker-Reid F, Gates W, Baigent R, Eckard R, Grace P. A study of environmental and management drivers of non-CO2 greenhouse gas emissions in Australian agro-ecosystems. ACTA ACUST UNITED AC 2007. [DOI: 10.1080/15693430500395396] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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