Community service-learning as empowering pedagogy : implications for middle school reform.

EducationDoctor of Education (Ed.D.

Psychometric properties of a novel knowledge assessment tool of mechanical ventilation for emergency medicine residents in the northeastern United States.

PURPOSE: Prior descriptions of the psychometric properties of validated knowledge assessment tools designed to determine Emergency medicine (EM) residents understanding of physiologic and clinical concepts related to mechanical ventilation are lacking. In this setting, we have performed this study to describe the psychometric and performance properties of a novel knowledge assessment tool that measures EM residents\u27 knowledge of topics in mechanical ventilation. METHODS: Results from a multicenter, prospective, survey study involving 219 EM residents from 8 academic hospitals in northeastern United States were analyzed to quantify reliability, item difficulty, and item discrimination of each of the 9 questions included in the knowledge assessment tool for 3 weeks, beginning in January 2013. RESULTS: The response rate for residents completing the knowledge assessment tool was 68.6% (214 out of 312 EM residents). Reliability was assessed by both Cronbach\u27s alpha coefficient (0.6293) and the Spearman-Brown coefficient (0.6437). Item difficulty ranged from 0.39 to 0.96, with a mean item difficulty of 0.75 for all 9 questions. Uncorrected item discrimination values ranged from 0.111 to 0.556. Corrected item-total correlations were determined by removing the question being assessed from analysis, resulting in a range of item discrimination from 0.139 to 0.498. CONCLUSION: Reliability, item difficulty and item discrimination were within satisfactory ranges in this study, demonstrating acceptable psychometric properties of this knowledge assessment tool. This assessment indicates that this knowledge assessment tool is sufficiently rigorous for use in future research studies or for assessment of EM residents for evaluative purposes

The Nineties: Fin de Siecle or Vision of the Future? Faculty Symposium, 1990 | Panel I: Looking Ahead/Looking Back: Approaching the Year 2000

1:30 pm - 3:15 pm. The first panel deals with whether or not we are at a fin de l\u27epoque – the conceptual culmination of an era – and if so, what phenomena and consciousness might characterize it, Bright says. In Looking Ahead/Looking Back: Approaching the Year 2000 historian Scott Cook will explore the fin de sitcle concept as an historical phenomenon and discuss its usefulness to our times. English professor Susan Vander Closter will investigate what she calls the state of cultural trauma in contemporary literature and relate it to the recent controversy over obscene art. Art historian and critic Mary Anne Staniszewski will wrap up the first series of presentations by raising questions about the limitations of contemporary visual arts education at the university level and suggesting useful alternatives. A discussion led by Cathy Seigel of the English department will follow.https://digitalcommons.risd.edu/archives_thenineties_facultysymposium1990_videos/1000/thumbnail.jp

Duration of Mechanical Ventilation in the Emergency Department

Introduction: Due to hospital crowding, mechanically ventilated patients are increasinglyspending hours boarding in emergency departments (ED) before intensive care unit (ICU)admission. This study aims to evaluate the association between time ventilated in the ED and inhospitalmortality, duration of mechanical ventilation, ICU and hospital length of stay (LOS).Methods: This was a multi-center, prospective, observational study of patients ventilated in theED, conducted at three academic Level I Trauma Centers from July 2011 to March 2013. Allconsecutive adult patients on invasive mechanical ventilation were eligible for enrollment. Weperformed a Cox regression to assess for a mortality effect for mechanically ventilated patientswith each hour of increasing LOS in the ED and multivariable regression analyses to assessfor independently significant contributors to in-hospital mortal ity. Our primary outcome was inhospitalmortality, with secondary outcomes of ventilator days, ICU LOS and hospital LOS. Wefurther commented on use of lung protective ventilation and frequency of ventilator changesmade in this cohort.Results: We enrolled 535 patients, of whom 525 met all inclusion criteria. Altered mental statuswithout respiratory pathology was the most common reason for intubation, followed by traumaand respiratory failure. Using iterated Cox regression, a mortality effect occurred at ED time ofmechanical ventilation > 7 hours, and the longer ED stay was also associated with a longer totalduration of intubation. However, adjusted multivariable regression analysis demonstrated onlyolder age and admission to the neurosciences ICU as independently associated with increasedmortality. Of interest, only 23.8% of patients ventilated in the ED for over seven hours hadchanges made to their ventilator.Conclusion: In a prospective observational study of patients mechanically ventilated in the ED,there was a significant mortality benefit to expedited transfer o f patients into an appropriate ICUsetting. [West J Emerg Med. 2017;18(5)972-979.

Duration of Mechanical Ventilation in the Emergency Department

Introduction: Due to hospital crowding, mechanically ventilated patients are increasingly spending hours boarding in emergency departments (ED) before intensive care unit (ICU) admission. This study aims to evaluate the association between time ventilated in the ED and in-hospital mortality, duration of mechanical ventilation, ICU and hospital length of stay (LOS). Methods: This was a multi-center, prospective, observational study of patients ventilated in the ED, conducted at three academic Level I Trauma Centers from July 2011 to March 2013. All consecutive adult patients on invasive mechanical ventilation were eligible for enrollment. We performed a Cox regression to assess for a mortality effect for mechanically ventilated patients with each hour of increasing LOS in the ED and multivariable regression analyses to assess for independently significant contributors to in-hospital mortality. Our primary outcome was in-hospital mortality, with secondary outcomes of ventilator days, ICU LOS and hospital LOS. We further commented on use of lung protective ventilation and frequency of ventilator changes made in this cohort. Results: We enrolled 535 patients, of whom 525 met all inclusion criteria. Altered mental status without respiratory pathology was the most common reason for intubation, followed by trauma and respiratory failure. Using iterated Cox regression, a mortality effect occurred at ED time of mechanical ventilation > 7 hours, and the longer ED stay was also associated with a longer total duration of intubation. However, adjusted multivariable regression analysis demonstrated only older age and admission to the neurosciences ICU as independently associated with increased mortality. Of interest, only 23.8% of patients ventilated in the ED for over seven hours had changes made to their ventilator. Conclusion: In a prospective observational study of patients mechanically ventilated in the ED, there was a significant mortality benefit to expedited transfer of patients into an appropriate ICU setting

Academic emergency medicine physicians\u27 knowledge of mechanical ventilation.

INTRODUCTION: Although emergency physicians frequently intubate patients, management of mechanical ventilation has not been emphasized in emergency medicine (EM) education or clinical practice. The objective of this study was to quantify EM attendings\u27 education, experience, and knowledge regarding mechanical ventilation in the emergency department. METHODS: We developed a survey of academic EM attendings\u27 educational experiences with ventilators and a knowledge assessment tool with nine clinical questions. EM attendings at key teaching hospitals for seven EM residency training programs in the northeastern United States were invited to participate in this survey study. We performed correlation and regression analyses to evaluate the relationship between attendings\u27 scores on the assessment instrument and their training, education, and comfort with ventilation. RESULTS: Of 394 EM attendings surveyed, 211 responded (53.6%). Of respondents, 74.5% reported receiving three or fewer hours of ventilation-related education from EM sources over the past year and 98 (46%) reported receiving between 0-1 hour of education. The overall correct response rate for the assessment tool was 73.4%, with a standard deviation of 19.9. The factors associated with a higher score were completion of an EM residency, prior emphasis on mechanical ventilation during one\u27s own residency, working in a setting where an emergency physician bears primary responsibility for ventilator management, and level of comfort with managing ventilated patients. Physicians\u27 comfort was associated with the frequency of ventilator changes and EM management of ventilation, as well as hours of education. CONCLUSION: EM attendings report caring for mechanically ventilated patients frequently, but most receive fewer than three educational hours a year on mechanical ventilation, and nearly half receive 0-1 hour. Physicians\u27 performance on an assessment tool for mechanical ventilation is most strongly correlated with their self-reported comfort with mechanical ventilation

Academic Emergency Medicine Physicians’ Knowledge of Mechanical Ventilation

Introduction: Although emergency physicians frequently intubate patients, management of mechanical ventilation has not been emphasized in emergency medicine (EM) education or clinical practice. The objective of this study was to quantify EM attendings’ education, experience, and knowledge regarding mechanical ventilation in the emergency department.Methods: We developed a survey of academic EM attendings’ educational experiences with ventilators and a knowledge assessment tool with nine clinical questions. EM attendings at key teaching hospitals for seven EM residency training programs in the northeastern United States were invited to participate in this survey study. We performed correlation and regression analyses to evaluate the relationship between attendings’ scores on the assessment instrument and their training, education, and comfort with ventilation. Results: Of 394 EM attendings surveyed, 211 responded (53.6%). Of respondents, 74.5% reported receiving three or fewer hours of ventilation-related education from EM sources over the past year and 98 (46%) reported receiving between 0-1 hour of education. The overall correct response rate for the assessment tool was 73.4%, with a standard deviation of 19.9. The factors associated with a higher score were completion of an EM residency, prior emphasis on mechanical ventilation during one’s own residency, working in a setting where an emergency physician bears primary responsibility for ventilator management, and level of comfort with managing ventilated patients. Physicians’ comfort was associated with the frequency of ventilator changes and EM management of ventilation, as well as hours of education.Conclusion: EM attendings report caring for mechanically ventilated patients frequently, but most receive fewer than three educational hours a year on mechanical ventilation, and nearly half receive 0-1 hour. Physicians’ performance on an assessment tool for mechanical ventilation is most strongly correlated with their self-reported comfort with mechanical ventilation

Emergency medicine residents\u27 knowledge of mechanical ventilation.

BACKGROUND: Although Emergency physicians frequently intubate patients, management of mechanical ventilation has not been emphasized in emergency medicine (EM) residency curricula. OBJECTIVES: The objective of this study was to quantify EM residents\u27 education, experience, and knowledge regarding mechanical ventilation. METHODS: We developed a survey of residents\u27 educational experiences with ventilators and an assessment tool with nine clinical questions. Correlation and regression analyses were performed to evaluate the relationship between residents\u27 scores on the assessment instrument and their training, education, and comfort with ventilation. RESULTS: Of 312 EM residents, 218 responded (69.9%). The overall correct response rate for the assessment tool was 73.3%, standard deviation (SD) ± 22.3. Seventy-seven percent (n = 167) of respondents reported ≤ 3 h of mechanical ventilation education in their residency curricula over the past year. Residents reported frequently caring for ventilated patients in the ED, as 64% (n = 139) recalled caring for ≥ 4 ventilated patients per month. Fifty-three percent (n = 116) of residents endorsed feeling comfortable caring for mechanically ventilated ED patients. In multiregression analysis, the only significant predictor of total test score was residents\u27 comfort with caring for mechanically ventilated patients (F = 10.963, p = 0.001). CONCLUSIONS: EM residents report caring for mechanically ventilated patients frequently, but receive little education on mechanical ventilation. Furthermore, as residents\u27 performance on the assessment tool is only correlated with their self-reported comfort with caring for ventilated patients, these results demonstrate an opportunity for increased educational focus on mechanical ventilation management in EM residency training

Sabina das Laranjas: gênero, raça e nação na trajetória de um símbolo popular, 1889-1930<A NAME="top1"></A>

Este trabalho parte de uma passeata realizada em 1889 por estudantes de medicina em favor de uma quitandeira desalojada de seu posto de venda, passando a discutir as maneiras pelas quais o evento foi tematizado ao longo da Primeira República. Com isto, pretende-se lançar luz sobre os meandros das políticas cotidianas raciais e de gênero no período, bem como a relação deste processo com a negociação da identidade nacional.<br>This paper takes as its starting-point an 1889 march organized by medical students on behalf of a street-vendor displaced from her position. It goes on to explore the ways in which that event was taken up over the course of the First Republic, hoping to shed light on the twists and turns of the period's everyday racial and gender politics, and their relationship to the negotiation of national identity