Interosseous vs Intravenous Access is Associated with Survival in Out-of-Hospital Cardiac Arrest

Background:   Data have been unclear about the roles of interosseous (IO) vs IV access in out-of-hospital cardiac arrest (OHCA). One randomized controlled trial of prehospital providers showed increased rate of initial success and decreased time to access in IO vs IV. However, subsequent retrospective trials have shown decreased likelihoods of sustained return of spontaneous circulation (ROSC), survival, and favorable neurologic outcome. Our objective was to determine if there was a difference in survival for IO vs IV access in OHCA in our patient population. Methods:  This was a retrospective, observational study at an urban academic hospital. Three resuscitation bays were continuously videotaped to capture resuscitations of OHCA patients. Each resuscitation was analyzed by two independent observers for standardized metrics as well as type of access. If no time to IV access was recorded, only IO access by prehospital providers was assumed. Data was analyzed by contingency tables with Fisher\u27s exact test as well as Spearman rank correlation analysis. Results: A total of 47 cases were captured for analysis. 36 patients presented with prehospital IO access and 11 patients obtained IV access in the emergency department (ED). Overall, 91.7% of patients with prehospital IO access died, compared to 100% of patients with IV access. In addition, of the 47 cases, 35 patients received IV access in the ED and 12 did not. Patients who received IV access in the ED had higher overall survival (32/35 or 91% vs 12/12 or 100%). Conclusion: In this retrospective, observational study, there were trends towards survival for OHCA patients who had received prehospital IO access as well as those patients who received IV access in the ED. Future directions include analyzing data from a larger sample size, as well as analyzing specific data on what access patients have and anatomic site of IO access

Knowledge, Attitudes and Practices of East Tennessee Medical Providers towards Transgender Patients

Introduction: Transgender is an identity term used to describe people with diverse gender identities and expressions that differ from their sex assigned at birth. People who identify as transgender have worse health outcomes than the cisgender or non-transgender populations. Limited healthcare access and chronic stress from discrimination all contribute to worsening health outcomes for this population. However, research regarding this population is limited, particularly in the rural southern United States. The purpose of this study was to assess physicians’, nurse practitioners’, and physician assistants’ experience with, attitude towards, and knowledge of transgender healthcare in the Northeast Tennessee region. Methods: Medical providers, including NPs, PAs, DOs and MDs from Family Medicine, Emergency Medicine, Internal Medicine, Pediatrics, and Obstetrics and Gynecology in both academic and community settings were surveyed regarding their attitudes toward, knowledge of, and experiences with gender, sexual orientation, and sexuality as they relate to healthcare. All potential participants were informed that participation was voluntary. Limited demographics were gathered and surveys were collected in a confidential manner. Data were analyzed for statistical significance. Results: Initial analyses showed the majority of providers had not received training in transgender healthcare and perceived they had few to no trans-identified patients. Over half of all respondents felt competent in providing healthcare to trans people and the majority felt comfortable treating this population. Providers indicated it is important to know their patients’ sexual practices, gender identity and sexual orientation; however, the majority of providers do not ask patients their gender identity, sexuality, or desired pronouns. Respondents were unsure whether gender confirmation surgery is covered by insurance and widely accessible. In assessing clinical knowledge of providers, there were a wide variety of responses suggesting varying level of competence amongst providers. Responses were split regarding whether access to healthcare is the same for the transgender population as it is for the general population. Pediatric providers were asked about comfort in prescribing hormones, knowledge of mental health support in the area, referrals and discussing gender identity with patients. These responses fell along a normal distribution, indicating a variety of training, experiences, and opinion regarding trans healthcare for the adolescent population. Conclusions: Overall results from the preliminary data demonstrate a contradiction between ideology and practice. With most participants responding they felt comfortable and competent providing care to the transgender population, yet their responses indicated a lack of training and absence of inclusivity in their health care practices. This suggests that education is needed within the healthcare community on transgender healthcare

Transgender Medicine Integrated Grand Rounds: Are Medical Students Receiving Enough Education to Competently Care for our Patients?

Transgender individuals are defined as those whose gender does not match the sex they were assigned at birth. Healthcare providers receive inadequate training in transgender medicine, which could lead to provider stigma and lower health outcomes and higher health disparities. The purpose of our study was to assess the effect of an educational intervention on first and second year ETSU medical students’ knowledge and attitudes regarding transgender healthcare. A transgender healthcare-centered Integrated Grand Rounds (IGR) was used as a setting to conduct a 9-item survey regarding definitions, medical management, and attitudes/comfort levels with transgender care. First and second year medical students (n=140) who participated in the intervention had the option to complete pre and post surveys on paper before and after IGR. Of the 140 participants, 138 (98.6%) completed the pretest and posttest measures. The participants’ attitudes about transgender patients and their comfort in treating transgender patients significantly improved between pre and posttest surveys (

Knowledge, Attitudes and Practices of East Tennessee Medical Providers towards Transgender Patients

One-third of transgender individuals report having at least one negative health care experience related to being transgender and nearly a quarter report that they have delayed seeking health care due to fear of being mistreated. Objective: To assess medical providers’ experiences with, attitudes towards, and knowledge of transgender health care in the Northeast Tennessee region. Study Design: Cross-sectional survey. Setting: Academic and community health care clinics in Northeast Tennessee. Participants: Physicians, nurse practitioners, and physician assistants practicing emergency medicine, family medicine, internal medicine, obstetrics & gynecology, or pediatrics (n=154). Main and Secondary Outcome Measures: Descriptive statistics and multiple regression models were used to determine relationships between provider characteristics and three sets of dependent variables (practices, attitudes, and knowledge). Results: The majority of providers (65%) had not received training in transgender healthcare. Over 90% perceived they had treated fewer than five trans-identified patients in the last year. The majority of respondents (69.3%) felt comfortable providing health care to transgender patients, yet only 38% felt competent treating this population. Providers indicated it was important to know their patients’ sexual practices, gender identity and sexual orientation; however, the majority of providers never or rarely asked patients their gender identity (75.4%), sexuality (57.2%), or desired pronouns (84.4%). Having formal training in transgender health was the only significant predictor of knowledge, sexual orientation and gender history taking, and competence/comfort with transgender patient care. Conclusions: Results demonstrate a contradiction between ideology and practice. Most participants responded they felt comfortable providing care to the transgender population, yet their responses indicated a lack of training and absence of inclusivity in their health care practices. As formal training was the only significant predictor of outcomes, this suggests that additional medical education and training is needed on transgender health care

Transgender Health Education for Medical Students

Background Transgender individuals face numerous health disparities and report negative experiences with health care providers related to their gender identity. Significant gaps in medical education regarding transgender health persist despite calls for increased sexual and gender minority content. The purpose of this student‐led study was to assess the effectiveness of a half‐day educational intervention on first‐ and second‐year medical students’ attitudes and knowledge of transgender health. Methods Students and faculty members collaborated to develop an educational session on transgender health. This content was presented to first‐ and second‐year medical students at Integrated Grand Rounds, a pedagogical method in which basic science and clinical faculty members co‐present didactic content interspersed between live patient interviews and student‐led small group discussions. Student participants (n = 138) completed voluntary 9‐item pre‐ and post‐session surveys assessing comfort with and knowledge of transgender medicine. Results Students’ comfort with and perceived knowledge about transgender patients increased significantly between pre‐ and post‐test. Students’ knowledge of transgender medicine standards of care also improved, though not all items reached significance. Discussion A half‐day educational intervention improved many facets of medical students’ attitudes and knowledge about transgender patients. The significant disparities in physical health, mental health and access to care currently experienced by transgender persons in the United States warrants the continued testing and refinement of educational interventions for future and practising providers

Video case review for quality improvement during cardiac arrest resuscitation in the emergency department

Background: Out-of-hospital cardiac arrests are a leading global cause of mortality. The American Heart Association (AHA) promotes several important strategies associated with improved cardiac arrest (CA) outcomes, including decreasing pulse check time and maintaining a chest compression fraction (CCF) \u3e 0.80. Video review is a potential tool to improve skills and analyse deficiencies in various situations; however, its use in improving medical resuscitation remains poorly studied in the emergency department (ED). We implemented a quality improvement initiative, which utilised video review of CA resuscitations in an effort to improve compliance with such AHA quality metrics. Methods: A cardiopulmonary resuscitation video review team of emergency medicine residents were assembled to analyse CA resuscitations in our urban academic ED. Videos were reviewed by two residents, one of whom was a senior resident (Postgraduate Year 3 or 4), and analysed using Spearman\u27s rank correlation coefficient for numerous quality improvement metrics, including pulse check time, CCF, time to intravenous access and time to patient attached to monitor. Results: We collected data on 94 CA resuscitations between July 2017 and June 2020. Average pulse check time was 13.09 (SD ± 5.97) seconds, and 38% of pulse checks were \u3c10 seconds. After the implementation of the video review process, there was a significant decrease in average pulse check time (P =.01) and a significant increase in CCF (P =.01) throughout the study period. Conclusions: Our study suggests that the video review and feedback process was significantly associated with improvements in AHA quality metrics for resuscitation in CA amongst patients presented to the ED

Video case review for quality improvement during cardiac arrest resuscitation in the emergency department

Background: Out-of-hospital cardiac arrests are a leading global cause of mortality. The American Heart Association (AHA) promotes several important strategies associated with improved cardiac arrest (CA) outcomes, including decreasing pulse check time and maintaining a chest compression fraction (CCF) \u3e 0.80. Video review is a potential tool to improve skills and analyse deficiencies in various situations; however, its use in improving medical resuscitation remains poorly studied in the emergency department (ED). We implemented a quality improvement initiative, which utilised video review of CA resuscitations in an effort to improve compliance with such AHA quality metrics. Methods: A cardiopulmonary resuscitation video review team of emergency medicine residents were assembled to analyse CA resuscitations in our urban academic ED. Videos were reviewed by two residents, one of whom was a senior resident (Postgraduate Year 3 or 4), and analysed using Spearman\u27s rank correlation coefficient for numerous quality improvement metrics, including pulse check time, CCF, time to intravenous access and time to patient attached to monitor. Results: We collected data on 94 CA resuscitations between July 2017 and June 2020. Average pulse check time was 13.09 (SD ± 5.97) seconds, and 38% of pulse checks were \u3c10 seconds. After the implementation of the video review process, there was a significant decrease in average pulse check time (P =.01) and a significant increase in CCF (P =.01) throughout the study period. Conclusions: Our study suggests that the video review and feedback process was significantly associated with improvements in AHA quality metrics for resuscitation in CA amongst patients presented to the ED

Minimizing Pulse Check Duration Through Educational Video Review.

INTRODUCTION: The American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) recommend pulse checks of less than 10 seconds. We assessed the effect of video review-based educational feedback on pulse check duration with and without point-of-care ultrasound (POCUS). METHODS: Cameras recorded cases of CPR in the emergency department (ED). Investigators reviewed resuscitation videos for ultrasound use during pulse check, pulse check duration, and compression-fraction ratio. Investigators reviewed health records for patient outcomes. Providers received written feedback regarding pulse check duration and compression-fraction ratio. Researchers reviewed selected videos in multidisciplinary grand round presentations, with research team members facilitating discussion. These presentations highlighted strategies that include the following: limit on pulse check duration; emphasis on compressions; and use of record, then review method for pulse checks with POCUS. The primary endpoint was pulse check duration with and without POCUS. RESULTS: Over 19 months, investigators reviewed 70 resuscitations with a total of 325 pulse checks. The mean pulse check duration was 11.5 ± 8.8 seconds (n = 224) and 13.8 ± 8.6 seconds (n = 101) without and with POCUS, respectively. POCUS pulse checks were significantly longer than those without POCUS (P = 0.001). Mean pulse check duration per three-month block decreased statistically significantly from study onset to the final study period (from 17.2 to 10 seconds [P CONCLUSION: Consistent with previous studies, POCUS prolonged pulse checks. Educational interventions were associated with significantly decreased overall pulse-check duration, with an enhanced effect on pulse checks involving POCUS. Performance feedback and video review-based education can improve CPR by increasing chest compression-fraction ratio

Minimizing Pulse Check Duration Through Educational Video Review

Introduction: The American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) recommend pulse checks of less than 10 seconds. We assessed the effect of video review-based educational feedback on pulse check duration with and without point-of-care ultrasound (POCUS).Methods: Cameras recorded cases of CPR in the emergency department (ED). Investigators reviewed resuscitation videos for ultrasound use during pulse check, pulse check duration, and compression-fraction ratio. Investigators reviewed health records for patient outcomes. Providers received written feedback regarding pulse check duration and compression-fraction ratio. Researchers reviewed selected videos in multidisciplinary grand round presentations, with research team members facilitating discussion. These presentations highlighted strategies that include the following: limit on pulse check duration; emphasis on compressions; and use of “record, then review” method for pulse checks with POCUS. The primary endpoint was pulse check duration with and without POCUS.Results: Over 19 months, investigators reviewed 70 resuscitations with a total of 325 pulse checks. The mean pulse check duration was 11.5 ± 8.8 seconds (n = 224) and 13.8 ± 8.6 seconds (n = 101) without and with POCUS, respectively. POCUS pulse checks were significantly longer than those without POCUS (P = 0.001). Mean pulse check duration per three-month block decreased statistically significantly from study onset to the final study period (from 17.2 to 10 seconds [P<0.0001]) overall; decreased from 16.6 to 10.5 seconds (P<0.0001) without POCUS; and with POCUS from 19.8 to 9.88 seconds (P<0.0001) with POCUS. Pulse check times decreased significantly over the study period of educational interventions. The strongest effect size was found in POCUS pulse check duration (P = -0.3640, P = 0.002).Conclusion: Consistent with previous studies, POCUS prolonged pulse checks. Educational interventions were associated with significantly decreased overall pulse-check duration, with an enhanced effect on pulse checks involving POCUS. Performance feedback and video review-based education can improve CPR by increasing chest compression-fraction ratio

Minimizing Pulse Check Duration through Educational Video Review

© 2020 Yamane et al. Introduction: The American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) recommend pulse checks of less than 10 seconds. We assessed the effect of video review-based educational feedback on pulse check duration with and without point-of-care ultrasound (POCUS). Methods: Cameras recorded cases of CPR in the emergency department (ED). Investigators reviewed resuscitation videos for ultrasound use during pulse check, pulse check duration, and compression-fraction ratio. Investigators reviewed health records for patient outcomes. Providers received written feedback regarding pulse check duration and compression-fraction ratio. Researchers reviewed selected videos in multidisciplinary grand round presentations, with research team members facilitating discussion. These presentations highlighted strategies that include the following: limit on pulse check duration; emphasis on compressions; and use of “record, then review” method for pulse checks with POCUS. The primary endpoint was pulse check duration with and without POCUS. Results: Over 19 months, investigators reviewed 70 resuscitations with a total of 325 pulse checks. The mean pulse check duration was 11.5 ± 8.8 seconds (n = 224) and 13.8 ± 8.6 seconds (n = 101) without and with POCUS, respectively. POCUS pulse checks were significantly longer than those without POCUS (P = 0.001). Mean pulse check duration per three-month block decreased statistically significantly from study onset to the final study period (from 17.2 to 10 seconds [P\u3c0.0001]) overall; decreased from 16.6 to 10.5 seconds (P\u3c0.0001) without POCUS; and with POCUS from 19.8 to 9.88 seconds (P\u3c0.0001) with POCUS. Pulse check times decreased significantly over the study period of educational interventions. The strongest effect size was found in POCUS pulse check duration (P = -0.3640, P = 0.002). Conclusion: Consistent with previous studies, POCUS prolonged pulse checks. Educational interventions were associated with significantly decreased overall pulse-check duration, with an enhanced effect on pulse checks involving POCUS. Performance feedback and video review-based education can improve CPR by increasing chest compression-fraction ratio