The Chief Resident Role in Emergency Medicine Residency Programs

Study Objectives: Although other specialties have examined the role of the chief resident (CR), the role and training of the emergency medicine (EM) CR has largely been undefined.Methods: A survey was mailed to all EM CRs and their respective program directors (PD) in 124 EM residency programs. The survey consisted of questions defining demographics, duties of the typical CR, and opinions regarding the level of support and training received. Multiple choice, Likert scale (1 strong agreement, 5 strong disagreement) and short-answer responses were used. We analyzed associations between CR and PD responses using Chi-square, Student’s T and Mann-Whitney U tests.Results: Seventy-six percent of CRs and 65% of PDs responded and were similar except for age (31 vs. 42 years; p<0.001). CR respondents were most often male, in year 3 of training and held the position for 12 months. CRs and PDs agreed that the assigned level of responsibility is appropriate (2.63 vs. 2.73, p=0.15); but CRs underestimate their influence in the residency program (1.94 vs. 2.34, p=0.002) and the emergency department (2.61 vs. 3.03, p=0.002). The majority of CRs (70%) and PDs (77%) report participating in an extramural training program, and those CRs who participated in training felt more prepared for their job duties (2.26 vs. 2.73; p=0.03).Conclusion: EM CRs feel they have appropriate job responsibility but believe they are less influential in program and department administration than PD respondents. Extramural training programs for incoming CRs are widely used and felt to be helpful. [West J Emerg Med. 2010; 11(2):120-125.

Sexual Dimorphisms of Adrenal Steroids, Sex Hormones, and Immunological Biomarkers and Possible Risk Factors for Developing Rheumatoid Arthritis

Innate immunity and immunological biomarkers are believed to be interrelated with sex hormones and other neuroendocrine factors. Sexual dimorphism mechanisms may be operating in certain rheumatic and inflammatory diseases which occur more frequently in women than men, as rheumatoid arthritis (RA). Less data have been available on altered interrelations of the combined neuroendocrine and immune (NEI) systems as risk factors for development of certain diseases. In this study, serological interrelations of NEI biomarkers are analyzed before symptomatic onset of RA (pre-RA) versus control (CN) subjects, stratified by sex. Sexual dimorphism was found in serum levels of acute serum amyloid A (ASAA), soluble interleukin-2 receptor alpha (sIL-2Rα), and soluble tumor necrosis factor receptor 1 (sTNF-R1). Multiple steroidal and hormonal (neuroendocrine) factors also showed highly (p<0.001) significant sexual dimorphism in their assayed values, but less for cortisol (p=0.012), and not for 17-hydroxyprogesterone (p=0.176). After stratification by sex and risk of developing RA, differential NEI correlational patterns were observed in the interplay of the NEI systems between the pre-RA and CN groups, which deserve further investigation

Fibromyalgia in men: Comparison of psychological features with women

Fibromyalgia syndrome (FM) is a musculoskeletal pain disorder characterized by chronic widespread pain, hypersensitivity to pain upon palpation, and a range of functional disorders 1 . Although there is controversy regarding the frequency of psychological distress in FM, a majority of investigations suggest that patients with FM have significantly more psychological problems than healthy controls and patients with chronic pain diseases with structural pathology, such as rheumatoid arthritis (RA) 2-8 . The vast majority of patients in the FM literature have been female and in epidemiological studies, women have been shown to be more significantly depressed than men 9 . Psychological factors play an important role in FM 2,10 . However, the psychological status of male patients with FM compared with female patients has not been specifically studied. Our study addresses the issue of gender difference in common and important psychological factors in FM. Based on available literature on gender difference in chronic conditions similar to FM, e.g., headaches and irritable bowel syndrome, we hypothesized that there would be no gender difference in psychological status in FM. MATERIALS AND METHODS Forty men and 160 women with FM were included in the study. All patients fulfilled the 1990 American College of Rheumatology (ACR) criteria for the classification of FM 1 . Male study participants were consecutively seen in the outpatient rheumatology clinic of the University of Illinois College of Medicine at Peoria (UICOMP); female participants, seen in the same clinic during the same period of time (1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002), were randomly selected. Clinical and psychological variables of the patients were assessed by the same protocol in both groups. Duration of disease, education, and tender points (TP) were recorded as continuous variables. A visual analog scale (VAS) was used to evaluate global severity of disease, fatigue, and aches and pains. The items were scored on a 0-100 scale, with 100 denoting the worst possible condition. The severity of pain, sleep disturbance, morning fatigue, anxiety, stress, and depression in the previous month were scored on a 1-4 point scale (1 = none, 2 = mild, 3 = moderate, 4 = severe). These variables were dichotomized as none or mild (no) or moderate and severe (yes) as in our previous studies; the decision for this dichotomization was based on the observation that most symptoms among healthy controls were either none or mild, whereas most symptoms among the patients were either moderate or severe 11 . In addition to measuring psychological variables on ordinal scales 1-4 , they were also assessed by Spielberger State-Trait Anxiety Inventory Scale for anxiety (STAI) 12 , Hassles Scale (HS) for current mental stress 13 , and Zung Self-rating Depression Index (ZSDI) for depression 14 . Health status and physical function were assessed by self-administered Health Assessment Questionnaire (HAQ) STAI contains scales that measure state (SAI) and trait anxiety (TAI). SAI comprises 20 items that assess the intensity of current anxiety symptoms. TAI consists of 20 items and measures the level and symptoms of anxiety across situations over a long-standing period. Scale scores are obtained on a 4-point Likert-type scale and by summing the ratings for scale items. Scores range from 20 to 80 for both, with higher scores indicating higher levels of anxiety ZSDI includes 20 statements; one of the 4 responses is chosen for each statement (1 = none or a little of the time, 2 = some of the time, 3 = good part of the time, 4 = most or all of the time). This scale has been found to Personal, non-commercial use only. The Journal of Rheumatology

Epidemiology of community-onset Staphylococcus aureus infections in pediatric patients: an experience at a Children's Hospital in central Illinois

<p>Abstract</p> <p>Background</p> <p>The nation-wide concern over methicillin-resistant <it>Staphylococcus aureus </it>(MRSA) has prompted many clinicians to use vancomycin when approaching patients with suspected staphylococcal infections. We sought to characterize the epidemiology of community-onset <it>S. aureus </it>infections in hospitalized children to assist local clinicians in providing appropriate empiric antimicrobial therapy.</p> <p>Methods</p> <p>From January 2005–June 2008, children (0–18 years old) admitted to the Children's Hospital of Illinois with community-onset <it>S. aureus </it>infections were identified by a computer-assisted laboratory-based surveillance and medical record review.</p> <p>Results</p> <p>Of 199 patients, 67 (34%) had invasive infections, and 132 (66%) had skin and soft tissue infections (SSTIs). Among patients with invasive infections, <it>S. aureus </it>isolates were more likely to be susceptible to methicillin (MSSA 63% vs. MRSA 37%), whereas patients with SSTIs, <it>S. aureus </it>isolates were more likely to be resistant to methicillin (MRSA 64% vs. MSSA 36%). Bacteremia and musculoskeletal infections were the most common invasive infections in both groups of <it>S. aureus</it>. Pneumonia with empyema was more likely to be caused by MRSA (<it>P </it>= 0.02). The majority (~90%) of MRSA isolates were non-multidrug resistant, even in the presence of healthcare-associated risk factors.</p> <p>Conclusion</p> <p>Epidemiological data at the local level is important for antimicrobial decision-making. MSSA remains an important pathogen causing invasive community-onset <it>S. aureus </it>infections among hospitalized children. In our hospital, nafcillin in combination with vancomycin is recommended empiric therapy in critically ill patients with suspected invasive staphylococcal infections. Because up to 25% of MSSA circulating in our area are clindamycin-resistant, clindamycin should be used cautiously as empiric monotherapy in patients with suspected invasive staphylococcal infections.</p

The Chief Resident Role in Emergency Medicine Residency Programs

Study Objectives: Although other specialties have examined the role of the chief resident (CR), the role and training of the emergency medicine (EM) CR has largely been undefined.Methods: A survey was mailed to all EM CRs and their respective program directors (PD) in 124 EM residency programs. The survey consisted of questions defining demographics, duties of the typical CR, and opinions regarding the level of support and training received. Multiple choice, Likert scale (1 strong agreement, 5 strong disagreement) and short-answer responses were used. We analyzed associations between CR and PD responses using Chi-square, Student’s T and Mann-Whitney U tests.Results: Seventy-six percent of CRs and 65% of PDs responded and were similar except for age (31 vs. 42 years; p&lt;0.001). CR respondents were most often male, in year 3 of training and held the position for 12 months. CRs and PDs agreed that the assigned level of responsibility is appropriate (2.63 vs. 2.73, p=0.15); but CRs underestimate their influence in the residency program (1.94 vs. 2.34, p=0.002) and the emergency department (2.61 vs. 3.03, p=0.002). The majority of CRs (70%) and PDs (77%) report participating in an extramural training program, and those CRs who participated in training felt more prepared for their job duties (2.26 vs. 2.73; p=0.03).Conclusion: EM CRs feel they have appropriate job responsibility but believe they are less influential in program and department administration than PD respondents. Extramural training programs for incoming CRs are widely used and felt to be helpful. [West J Emerg Med. 2010; 11(2):120-125.

Do women with premenopausal-onset rheumatoid arthritis have relative insufficiency or imbalance of adrenocortical steroids?

Adrenocortical steroids may influence susceptibility to rheumatoid arthritis (RA). Serum levels of adrenocortical steroids in female RA patients not previously treated with glucocorticoids were reviewed in this paper, as were controlled cohort studies of predisease (pre-RA) and control (CN) women. Serum dehydroepiandrosterone sulfate (DHEAS) levels were lower in most reports of premenopausal-onset RA patients not treated with glucocorticoids and in the baseline levels in one cohort study of pre-RA females compared with CN subjects. The pre-RA versus CN cohort difference was confirmed in an independent laboratory. Basal DHEAS and cortisol levels correlated oppositely in pre-RA versus CN women, suggesting relative adrenocortical androgenic insufficiency in case subjects. Clinical observations of lower androstenedione levels in premenopausal RA patients were also reported in pre-RA versus CN subjects who had lower DHEAS and cortisol values. In summary, a minority of premenopausal-onset RA females had decreased adrenocortical androgenic steroid levels and exhibited an adrenal androgen-to-cortisol steroid imbalance

Evaluation of a Standardized All-Terrain Vehicle Safety Education Intervention for Youth in Rural Central Illinois

Background: Although research investigating all-terrain vehicle (ATV) riders and ATV injury patterns has led to support for legislative and educational efforts to decrease injuries in users younger than 16 years, there is little published data regarding the utility of ATV safety education programs. This study investigates the effectiveness of a standardized adolescent ATV safety program in changing the safety knowledge and safe ATV riding practices reported by rural Central Illinois youths. Methods: A convenience sample of 260 rural Central Illinois middle and high school students received an ATV safety presentation with both didactic and interactive features during the 2009-2010 school year. Preintervention and postintervention surveys were distributed and collected by teachers. Survey questions consisted of multiple-choice questions pertaining to demographics, ATV safety knowledge, and ATV riding practices. More than 200 surveys were collected prior to the intervention and 165 surveys were collected 12 to 24 weeks after the intervention. Percentages are reported, with differences in nominal variables tested by χ 2 test and interval variables by t test. Results: Following the intervention, there was a significant increase in the correct response rate for ATV safety knowledge questions (45.2% vs 56.2%, P < .001). For adolescents who reported riding ATVs, both safety gear use (11.8% to 21.2%, P = .05) and helmet use (25.4% to 29.0%, P = .56) increased; changes were not significant. Adolescent ATV riders reporting 2 or more accidents showed a slight nonsignificant decrease (25.2% vs 23.4%, P = .77) between the time of the pretest and posttest. Conclusion: This safety program was effective at increasing ATV safety knowledge but demonstrates limited effect on safe riding practices