Emergency Medical Service, Nursing, and Physician Providers’ Perspectives on Delirium Identification and Management

Purpose of the study The study objective was to understand providers’ perceptions regarding identifying and treating older adults with delirium, a common complication of acute illness in persons with dementia, in the pre-hospital and emergency department environments. Design and methods The authors conducted structured focus group interviews with separate groups of emergency medical services staff, emergency nurses, and emergency physicians. Recordings of each session were transcribed, coded, and analyzed for themes with representative supporting quotations identified. Results Providers shared that the busy emergency department environment was the largest challenge to delirium recognition and treatment. When describing delirium, participants frequently detailed hyperactive features of delirium, rather than hypoactive features. Participants shared that they employed no clear diagnostic strategy for identifying the condition and that they used heterogeneous approaches to treat the condition. To improve care for older adults with delirium, emergency nurses identified the need for more training around the management of the condition. Emergency medical services providers identified the need for more support in managing agitated patients when in transport to the hospital and more guidance from emergency physicians on what information to collect from the patient’s home environment. Emergency physicians felt that delirium care would be improved if they could have baseline mental status data on their patients and if they had access to a simple, accurate diagnostic tool for the condition. Implications Emergency medical services providers, emergency nurses, and emergency physicians frequently encounter delirious patients, but do not employ clear diagnostic strategies for identifying the condition and have varying levels of comfort in managing the condition. Clear steps should be taken to improve delirium care in the emergency department including the development of mechanisms to communicate patients’ baseline mental status, the adoption of a systematized approach to recognizing delirium, and the institution of a standardized method to treat the condition when identified

Logical equivalence of optical symbolic substitution and shadow-casting schemes

The logical equivalence between two powerful optical computing techniques, namely, optical symbolic substitution and optical shadow-casting is investigated. A common basis for both schemes is developed and their roots are traced back to fundamental principles of logic design. Both shadow-casting and symbolic substitution based optical computing operations are shown to be equivalent to logical sum of product operations.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29952/1/0000312.pd

The Vice Chair of Education in Emergency Medicine: A Workforce Study to Establish the Role, Clarify Responsibilities, and Plan for Success

ObjectivesDespite increasing prevalence in emergency medicine (EM), the vice chair of education (VCE) role remains ambiguous with regard to associated responsibilities and expectations. This study aimed to identify training experiences of current VCEs, clarify responsibilities, review career paths, and gather data to inform a unified job description.MethodsA 40‐item, anonymous survey was electronically sent to EM VCEs. VCEs were identified through EM chairs, residency program directors, and residency coordinators through solicitation e‐mails distributed through respective listservs. Quantitative data are reported as percentages with 95% confidence intervals and continuous variables as medians with interquartiles (IQRs). Open‐ and axial‐coding methods were used to organize qualitative data into thematic categories.ResultsForty‐seven of 59 VCEs completed the survey (79.6% response rate); 74.4% were male and 89.3% were white. Average time in the role was 3.56 years (median = 3.0 years, IQR = 4.0 years), with 74.5% serving as inaugural VCE. Many respondents held at least one additional administrative title. Most had no defined job description (68.9%) and reported no defined metrics of success (88.6%). Almost 78% received a reduction in clinical duties, with an average reduction of 27.7% protected time effort (median = 27.2%, IQR = 22.5%). Responsibilities thematically link to faculty affairs and promotion of the departmental educational mission and scholarship.ConclusionGiven the variability in expectations observed, the authors suggest the adoption of a unified VCE job description with detailed responsibilities and performance metrics to ensure success in the role. Efforts to improve the diversity of VCEs are encouraged to better match the diversity of learners.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154254/1/aet210407_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154254/2/aet210407.pd

Death notification: a digital communication platform for simulated patient-based training with medical students

This article is made available for unrestricted research re-use and secondary analysis in any form or be any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.Medical simulation experiences, focused on enhancing essential communication skills, provide high value to trainees. These communication-based simulations often require little equipment and instead use trained faculty facilitators who can impart clinical significance and expertise to trainees. Teaching communication skills and techniques remotely is theoretically possible but has been largely unexplored in medical education.1 The COVID-19 pandemic and the subsequent restrictions imposed by shelter-in-place orders and social distancing created a need to expand traditional training methods and experiment with remote simulation training for communication skills. In this brief report, we explore the experience, outcomes and barriers to implementing a simulated communication skill curriculum focused on death notification to a cohort of remote medical students

The 2016 Model of The Clinical Practice of Emergency Medicine

Emergency medicine (EM) has a scientifically derived and commonly accepted description of the domain of its clinical practice. That document, “The Model of the Clinical Practice of Emergency Medicine” (EM Model), was developed through the collaboration of six organizations: the American Board of Emergency Medicine (ABEM), the administrative organization for the project, the American College of Emergency Physicians (ACEP), the Council of Emergency Medicine Residency Directors (CORD), the Emergency Medicine Residents\u27 Association (EMRA), the Residency Review Committee for Emergency Medicine (RRC-EM), and the Society for Academic Emergency Medicine (SAEM). Development of the EM Model was based on an extensive practice analysis of the specialty. The practice analysis relied on both empiric data gathered from actual emergency department visits and several expert panels (1). The resulting product was first published in 2001, and has successfully served as the common source document for all EM organizations (2,3). One of its strengths is incorporating the reality that EM is a specialty driven by symptoms not diagnoses, requiring simultaneous therapeutic and diagnostic interventions

Acesso venoso central de longa duração: experiência com 79 cateteres em 66 pacientes

Procedures such as bone marrow transplantation, chemotherapy, total parenteral nutrition and hemodialysis increasingly require long-term central venous access (LTCVA). According to the indication, fully implantable catheters (with a reservoir) or partially catheters (Broviac- Hickman) are used. In the present study, we evaluated 79 catheres consecutively implanted into 66 patient treated at the University Hospital, Faculty of Medicine of Ribeirão Preto, USP, from January 1993 to June 1997. The following parameters were evaluated: indication of venous access, type of catheter implanted, technique used, early and late complications, and duration of the implant. Thirty four of the 66 patients (51,5%) were men. Mean patient age was 28.2 years. There was a predominance of catheter implantation for chemotherapy in 55 (69.5%) patients and for bone marrow transplantation in 12 (15.2%). Twenty eight catheters with a reservoir (35.5%) and 51 partially implantable catheters (64.5%) were implanted. As to the technique used, 71,4% of the catheters were implanted by percutaneous puncture and the remaining ones by open venous dissection and catheterization. Two types of complications related to the technique occured, 9 infections and 8 late occlusions. The mean duration of catheter was 371 days for the Broviac-Hickman catheters and 395 days for the totally implantable catheters. No death occured due to the implants. The rates of early and late complications observed in the present series are similar to those reported in the literature.Procedimentos, como o transplante de medula óssea, a quimioterapia, a nutrição parenteral total e a hemodiálise, exigem a necessidade cada vez maior do acesso venoso central de longa duração (AVCLD). Utilizam-se, de acordo com a indicação, cateteres totalmente implantáveis (com reservatório) e parcialmente implantáveis (Broviac-Hickman ). Foram avaliados setenta e nove (79) cateteres implantados, consecutivamente, em sessenta e seis (66) pacientes, tratados no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da USP, no período de janeiro de 1993 a junho de 1997. Avaliaram-se os seguintes parâmetros: indicação do acesso venoso, tipo de cateter implantado, técnica utilizada, complicações precoces e tardias e duração do implante. Dos sessenta e seis (66) pacientes, trinta e quatro (34) (51,5%) eram homens. A idade média foi de 28,2 anos. Houve predomínio de indicação de implante de cateter para realizar-se a quimioterapia em cinquenta e cinco (55) (69,5%) pacientes e transplante de medula óssea em doze (12) (15,2%). Foram implantados vinte e oito (28) (35,5%) cateteres com reservatório e cinqüenta e um (51) (64,5%) parcialmente implantáveis. Quanto à técnica utilizada, 71,4% foram implantados por punção percutânea e os demais por dissecção e cateterização venosa, a céu aberto. Ocorreram duas complicações relacionadas à técnica, nove (9) infecções e oito (8) oclusões tardias. A duração média da implantação dos cateteres foi trezentos e setenta e um (371) dias para os cateteres Broviac- Hickman e trezentos e noventa e cinco (395) para o totalmente implantável. Não houve óbito associado aos implantes. Os índices de complicações precoces e tardias, observadas nesta casuística, assemelham- se aos dados encontrados na literatura

Toward Innovative, Cost-Effective, and Systemic Solutions to Improve Outcomes and Well-Being of Military Families Affected by Autism Spectrum Disorder

The burdens faced by military families who have a child with autism are unique. The usual challenges of securing diagnostic, treatment, and educational services are compounded by life circumstances that include the anxieties of war, frequent relocation and separation, and a demand structure that emphasizes mission readiness and service. Recently established military autism-specific health care benefits set the stage for community-viable and cost-effective solutions that can achieve better outcomes for children and greater well-being for families. Here we argue for implementation of evidence-based solutions focused on reducing age of diagnosis and improving access to early intervention, as well as establishment of a tiered menu of services, individualized to the child and family, that fit with the military ethos and system of health care. Absence of this new model of care could compromise the utility and sustainability of the autism-specific benefit

The immune status of migrant populations in Europe and implications for vaccine-preventable disease control: a systematic review and meta-analysis.

BACKGROUND: Ensuring vaccination coverage reaches established herd immunity thresholds (HIT) is the cornerstone of any vaccination programme. Diverse migrant populations in European countries have been associated with cases of vaccine-preventable diseases (VPD) and outbreaks, yet it is not clear to what extent they are an under-immunised group. METHODS: We did a systematic review and meta-analysis to synthesise peer-reviewed published primary research reporting data on the immune status of migrants in EU/EEA countries, the UK and Switzerland, calculating their pooled immunity coverage for measles, mumps, rubella, and diphtheria using random-effects models. We searched on Web of Science, Embase, Global Health and MEDLINE (January 1st 2000 to June 10th 2022), with no language restrictions. The protocol is registered with PROSPERO (CRD42018103666). FINDINGS: Of 1103 abstracts screened, 62 met eligibility criteria, of which 39 were included in the meta-analysis. The meta-analysis included 75 089 migrants, predominantly from outside Europe. Pooled immunity coverage among migrant populations was well below the recommended HIT for diphtheria (n = 7, 57.4% [95% CI: 43.1-71.7%] I2 = 99% vs HIT 83-86%), measles (n = 21, 83.7% [95% CI: 79.2-88.2] I2 = 99% vs HIT 93-95%), and mumps (n = 8, 67.1% [95% CI: 50.6-83.6] I2 = 99% vs HIT 88-93%), and midway for rubella (n = 29, 85.6% [95% CI: 83.1-88.1%] I2 = 99% vs HIT 83-94%), with high heterogeneity across studies. INTERPRETATION: Migrants in Europe are an under-immunised group for a range of important VPDs, with this study reinforcing the importance of engaging children, adolescents, and adults in 'catch-up' vaccination initiatives on arrival for vaccines, doses, and boosters they may have missed in their home countries. Co-designing strategies to strengthen catch-up vaccination across the life-course in under-immunised groups is an important next step if we are to meet European and global targets for VPD elimination and control and ensure vaccine equity

Engaging men to support the resilience of Syrian refugee children and youth in Lebanon

Refugee men’s experiences as parents have been one of the least explored areas of psychosocial interventions with refugee families, yet there is a great need for engagement with men, including in their role as fathers. “Engaging Men” interventions seek to challenge the social norms, attitudes, and practices that increase the risk of gender-based violence against girls and women while also harnessing positive male power to prevent violence and promote safety. This chapter examines the impact of an “Engaging Men” intervention in Lebanon that involved 1028 Syrian refugee and 440 Lebanese men in a 12-week training course structure with the aims of promoting peaceful family and community relations, reducing violence and gender-based violence, and enhancing child protection and caregiving. The chapter focuses on the impact of the intervention on Syrian refugee children and adolescents through men’s reflections on the stressors in their own lives and how this impacted their role as fathers. The challenges of addressing child-specific protection risks of early marriage and child labor are discussed