Increase in Non-Contrast Computerized Tomography Scans of the Head Following Popular Media Stories About Head Injury

Introduction: On March 18, 2009, actress Natasha Richardson died after a head injury. It is possiblethat the rate of patients presenting with mild head injury and receiving computed tomographies (CTs)may have been influenced by the Richardson event. We hypothesized that there was a statisticallysignificant increase in the rate of census-adjusted head CTs performed for mild trauma after March16, 2009, compared to prior to this date.Methods: We included all with a non-contrast head CT performed from the emergency department(ED) between March 1and April 15, 2009, for minor trauma. The primary outcome was the censusadjustedrate of head CTs per time (# of head CTs/census). We compared the census adjusted ratefor the 2 weeks prior to 2 weeks after the accident. To document media dissemination we searchedLexis-Nexis for news stories mentioning “Richardson.”Results: In the 2 weeks prior to March 16, 2009, the census-adjusted rate was 0.81% (95% CI0.54–1.16) and there were no stories. The first media reports appeared on March 16, 2009, (n = 19)and quickly doubled (n = 40, n = 43) over the subsequent 2 days. The rate of CTs nearly doubledduring the 2 weeks post accident 1.46% (1.10–1.91%). This absolute increase in rate percentagewas statistically significant. (0.65%; 0.17 to 1.14%).Conclusion: The percentage of all ED patients seen with mild trauma tested with head CT almostdoubled when comparing the pre-Richardson accident vs. post time periods. There was an increasein media reports of the accident that occurred rapidly after the event and peaked on day 3. [West J Emerg Med. 2012;13(6):548-550

Emergency Physicians’ Familiarity with the Safe Handling of Firearms

Introduction: Emergency physicians (EP) experience high rates of workplace violence, the risks of which increase with the presence of weapons. Up to 25% of trauma patients brought to the emergency department (ED) have been found to carry weapons. Given these risks, we conducted an educational needs assessment to characterize EPs’ knowledge of firearms, frequency of encountering firearms in the ED, and level of confidence with safely removing firearms from patient care settings. Methods: This was a survey study of attending and resident EPs at two academic and four community hospitals in the Midwest and Northeast. A 26-item questionnaire was emailed to all EPs at the six institutions. Questions pertained to EPs’ knowledge of firearms, experience with handling firearms, and exposure to firearms while at work. We calculated response proportions and p-values. Results: Of 243 recipients who received the survey, 149 (61.3%) completed it. Thirty-three respondents (22.0%) reported encountering firearms in the workplace, 91 (60.7%) reported never handling firearms, and 25 (16.7%) reported handling firearms at least once per year. Thirty-six respondents (24.0%) reported formal firearms training, and 63 (42.3%) reported no firearms training. There were no significant regional differences regarding firearms training or exposure. Residents from the Northeast were more likely to be moderately confident that they could safely handle a firearm prior to law enforcement involvement (p=0.043), while residents from the Midwest were more likely to be not at all confident (p=0.018). Conclusion: The majority of surveyed attending and resident EPs reported little experience with handling firearms. Among resident EPs, there was a regional difference in confidence in handling firearms prior to law enforcement involvement. Given the realities of workplace violence and the frequency with which firearms are encountered in the ED, further investigation is needed to evaluate provider competence in safely handling them. EPs may benefit from training on this topic

Affective, cognitive, and behavioral outcomes from a resident personal finance curriculum pilot project

Background: The transition to residency marks a significant shift in the financial circumstances of medical trainees. Despite existing resources, residents still cite uncertainty in this domain. A personal finance curriculum is needed to close this educational gap and improve the financial well-being of trainees. Methods: The curriculum was developed using Kern\u27s framework. Two needs assessments informed the consensus development of goals and objectives, educational strategies, and assessments. Course material was hosted online for asynchronous review and complemented by two 1-hour webinars. The curriculum was piloted at one institution. Participants completed (1) knowledge assessments before and after the intervention, (2) a survey of reactions to the curriculum, and (3) an assessment of financial behavioral changes after the intervention. Results: Thirty-seven residents (37/49, 76%) enrolled in the curriculum. Among participants, 20 (20/37, 54%) completed the curriculum. Most participants agreed or strongly agreed that the content was relevant (20/20, 100%) and clearly presented (19/20, 95%) and that they would recommend the curriculum to other residents (20/20, 100%). Performance on the knowledge assessment improved 21% after the intervention (mean ± SD = pretest 57% ± 17%, posttest = 78% ± 12%; p \u3c 0.001). Most residents (17/20, 85%) also reported behavioral changes including setting new financial goals (12/20, 60%), taking new action toward financial planning (11/20, 55%), and changing financial habits (6/20, 30%). There were no direct financial costs incurred in the implementation of this pilot. Conclusions: This is a successful pilot of a virtual personal finance curriculum with positive outcomes data. Addressing this problem at scale will require buy-in from educators around the country to deliver this information to residents that may not otherwise seek it out. Future study should assess curricular outcomes in other settings and the durability of acquired knowledge and behavioral changes over time

Gaps in pediatric emergency medicine education of emergency medicine residents: A needs assessment of recent graduates

BACKGROUND: More than 90% of pediatric patients presenting to emergency departments (EDs) in the United States are evaluated and treated in community-based EDs. Recent evidence suggests that mortality outcomes may be worse for critically ill pediatric patients treated at community EDs. The disparate mortality outcomes may be due to inconsistency in pediatric-specific education provided to emergency medicine (EM) trainees during residency training. There are few studies surveying recently graduated EM physicians assessing perceived gaps in the pediatric emergency medicine (PEM) education they received during residency. METHODS: This was a prospective, survey-based, descriptive cohort study of EM residency graduates from 10 institutions across the United States who were \u3c5 years out from residency training. Deidentified surveys were distributed via email. RESULTS: A total of 222 responses were obtained from 570 eligible participants (39.1%). Non-ED pediatric rotations during residency training included pediatric intensive care (60%), pediatric anesthesia (32.4%), neonatal intensive care unit (26.1%), and pediatric wards (17.1%). A large percentage (42.8%) of respondents felt uncomfortable managing neonates and performing tube thoracostomy on pediatric patients (56.3%). The EM graduate\u27s satisfaction with pediatric simulation-based training during residency was positively associated with comfort caring for neonates and infants ( \u3c 0.0070 and  \u3c 0.0002) and performing endotracheal intubation ( \u3c 0.0027), lumbar puncture ( \u3c 0.0004), and Pediatric Advanced Life Support resuscitation ( \u3c 0.0001). CONCLUSIONS/DISCUSSION: This survey-based cohort study found considerable variation in pediatric-specific experiences during EM residency training and in perceived comfort managing pediatric patients. In general, participants were more comfortable managing older children. This study suggests that the greatest perceived knowledge gaps in PEM were neonatal medicine/resuscitation and pediatric cardiac arrest. Future research will continue to address larger cohorts, representative of the PEM education provided to EM physicians in the United States to promote future educational initiatives

Creation and Implementation of a Mastery Learning Curriculum for Emergency Department Thoracotomy

Introduction: Emergency department thoracotomy (EDT) is a lifesaving procedure within the scope of practice of emergency physicians. Because EDT is infrequently performed, emergency medicine (EM) residents lack opportunities to develop procedural competency.  There is no current mastery learning curriculum for residents to learn EDT. The purpose of this study was to develop and implement a simulation-based mastery learning curriculum to teach and assess EM residents’ performance of the EDT.  Methods: We developed an EDT curriculum using a mastery learning framework. The minimum passing standard (MPS) for a previously developed 22-item checklist was determined using the Mastery Angoff approach. EM residents at a four-year academic EM residency program underwent baseline testing in performing an EDT on a simulation trainer. Performance was scored by two raters using the checklist. Learners then participated in a novel mastery learning EDT curriculum that included an educational video, hands-on instruction, and deliberate practice. After a three-month period, residents then completed initial post testing. Residents who did not meet the minimum passing standard after post testing participated in additional deliberate practice until mastery was obtained. Baseline and post-test scores, and time to completion of the procedure were compared with paired t-tests.Results: Of 56 eligible EM residents, 54 completed baseline testing. Fifty-two residents completed post-testing until mastery was reached. The minimum passing standard was 91.1%, (21/22 items correct on the checklist). No participants met the MPS at the baseline assessment. After completion of the curriculum, all residents subsequently reached the MPS, with deliberate practice sessions not exceeding 40 minutes. Scores from baseline testing to post-testing significantly improved across all postgraduate years from a mean score of 10.2/22 to 21.4/22 (p <0.001). Mean time to complete the procedure improved from baseline testing (6 minutes [min] and 21 seconds [sec], interquartile range [IQR] = 4 min 54 sec - 7 min 51 sec) to post-testing (5 min 19 seconds, interquartile range 4 min 17sec - 6 min 15 sec; p = 0.001).Conclusion: This simulation-based mastery learning curriculum resulted in all residents performing an EDT at a level that met or exceeded the MPS with an overall decrease in time needed to perform the procedure

Creation and Implementation of a Mastery Learning Curriculum for Emergency Department Thoracotomy

Introduction: Emergency department thoracotomy (EDT) is a lifesaving procedure within the scope of practice of emergency physicians. Because EDT is infrequently performed, emergency medicine (EM) residents lack opportunities to develop procedural competency.  There is no current mastery learning curriculum for residents to learn EDT. The purpose of this study was to develop and implement a simulation-based mastery learning curriculum to teach and assess EM residents’ performance of the EDT.  Methods: We developed an EDT curriculum using a mastery learning framework. The minimum passing standard (MPS) for a previously developed 22-item checklist was determined using the Mastery Angoff approach. EM residents at a four-year academic EM residency program underwent baseline testing in performing an EDT on a simulation trainer. Performance was scored by two raters using the checklist. Learners then participated in a novel mastery learning EDT curriculum that included an educational video, hands-on instruction, and deliberate practice. After a three-month period, residents then completed initial post testing. Residents who did not meet the minimum passing standard after post testing participated in additional deliberate practice until mastery was obtained. Baseline and post-test scores, and time to completion of the procedure were compared with paired t-tests.Results: Of 56 eligible EM residents, 54 completed baseline testing. Fifty-two residents completed post-testing until mastery was reached. The minimum passing standard was 91.1%, (21/22 items correct on the checklist). No participants met the MPS at the baseline assessment. After completion of the curriculum, all residents subsequently reached the MPS, with deliberate practice sessions not exceeding 40 minutes. Scores from baseline testing to post-testing significantly improved across all postgraduate years from a mean score of 10.2/22 to 21.4/22 (p <0.001). Mean time to complete the procedure improved from baseline testing (6 minutes [min] and 21 seconds [sec], interquartile range [IQR] = 4 min 54 sec - 7 min 51 sec) to post-testing (5 min 19 seconds, interquartile range 4 min 17sec - 6 min 15 sec; p = 0.001).Conclusion: This simulation-based mastery learning curriculum resulted in all residents performing an EDT at a level that met or exceeded the MPS with an overall decrease in time needed to perform the procedure

Status of Radioactive Ion Beam Post-Acceleration at CERN-ISOLDE

The HIE-ISOLDE project* (High Intensity and Energy ISOLDE) reached an important milestone in September 2016 when the first physics run was carried out with radioactive beams at 6 MV/m. This is the first stage in the upgrade of the REX post-accelerator, whereby the energy of the radioactive ion beams was increased from 3 to 5.5 MeV per nucleon. The facility will ultimately be equipped with four high-beta cryomodule that will accelerate the beams up to 10 MeV per nucleon for the heaviest isotopes available at ISOLDE. The first 2 cryomodules of the new linac, hosting each five superconducting cavities and one solenoid, were commissioned in August 2016. Besides demonstrating the experimental capabilities of the facility, this successful first run validated the technical choices of the HIE ISOLDE team and provided a fitting reward for eight years of rigorous R&D; efforts. At the start of 2018, HIE-ISOLDE is expected to complete the energy upgrade, reaching 10 MeV/u and becoming an attractive facility for a wide variety of experiments. This contribution will focus on the results of the commissioning and on the main technical issues that were highlighted