32 research outputs found
Use of highâsensitivity cardiac troponin in the emergency department: A policy resource and education paper (PREP) from the American College of Emergency Physicians
Abstract This Policy Resource and Education Paper (PREP) from the American College of Emergency Physicians (ACEP) discusses the use of highâsensitivity cardiac troponin (hsâcTn) in the emergency department setting. This brief review discusses types of hsâcTn assays as well as the interpretation of hsâcTn in the setting of various clinical factors such as renal dysfunction, sex, and the important distinction between myocardial injury versus myocardial infarction. In addition, the PREP provides one possible example of an algorithm for the use of a hsâcTn assay in patients in whom the treating clinician is concerned about potential acute coronary syndrome
Direct Observation Assessment of Milestones: Problems with Reliability
Introduction: Emergency medicine (EM) milestones are used to assess residentsâ progress. While
some milestone validity evidence exists, there is a lack of standardized tools available to reliably
assess residents. Inherent to this is a concern that we may not be truly measuring what we intend
to assess. The purpose of this study was to design a direct observation milestone assessment
instrument supported by validity and reliability evidence. In addition, such a tool would further lend
validity evidence to the EM milestones by demonstrating their accurate measurement.
Methods: This was a multi-center, prospective, observational validity study conducted at eight
institutions. The Critical Care Direct Observation Tool (CDOT) was created to assess EM residents
during resuscitations. This tool was designed using a modified Delphi method focused on content,
response process, and internal structure validity. Paying special attention to content validity, the
CDOT was developed by an expert panel, maintaining the use of the EM milestone wording. We
built response process and internal consistency by piloting and revising the instrument. Raters
were faculty who routinely assess residents on the milestones. A brief training video on utilization
of the instrument was completed by all. Raters used the CDOT to assess simulated videos of three
residents at different stages of training in a critical care scenario. We measured reliability using
Fleissâ kappa and interclass correlations.
Results: Two versions of the CDOT were used: one used the milestone levels as global rating
scales with anchors, and the second reflected a current trend of a checklist response system.
Although the raters who used the CDOT routinely rate residents in their practice, they did not score
the residentsâ performances in the videos comparably, which led to poor reliability. The Fleissâ kappa
of each of the items measured on both versions of the CDOT was near zero.
Conclusion: The validity and reliability of the current EM milestone assessment tools have yet to
be determined. This study is a rigorous attempt to collect validity evidence in the development of
a direct observation assessment instrument. However, despite strict attention to validity evidence,
inter-rater reliability was low. The potential sources of reducible variance include rater- and
instrument-based error. Based on this study, there may be concerns for the reliability of other EM
milestone assessment tools that are currently in use
Direct Observation Assessment of Milestones: Problems with Reliability
Introduction: Emergency medicine (EM) milestones are used to assess residentsâ progress. While some milestone validity evidence exists, there is a lack of standardized tools available to reliably assess residents. Inherent to this is a concern that we may not be truly measuring what we intend to assess. The purpose of this study was to design a direct observation milestone assessment instrument supported by validity and reliability evidence. In addition, such a tool would further lend validity evidence to the EM milestones by demonstrating their accurate measurement.Methods: This was a multi-center, prospective, observational validity study conducted at eight institutions. The Critical Care Direct Observation Tool (CDOT) was created to assess EM residents during resuscitations. This tool was designed using a modified Delphi method focused on content, response process, and internal structure validity. Paying special attention to content validity, the CDOT was developed by an expert panel, maintaining the use of the EM milestone wording. We built response process and internal consistency by piloting and revising the instrument. Raters were faculty who routinely assess residents on the milestones. A brief training video on utilization of the instrument was completed by all. Raters used the CDOT to assess simulated videos of three residents at different stages of training in a critical care scenario. We measured reliability using Fleissâ kappa and interclass correlations.Results: Two versions of the CDOT were used: one used the milestone levels as global rating scales with anchors, and the second reflected a current trend of a checklist response system. Although the raters who used the CDOT routinely rate residents in their practice, they did not score the residentsâ performances in the videos comparably, which led to poor reliability. The Fleissâ kappa of each of the items measured on both versions of the CDOT was near zero.Conclusion: The validity and reliability of the current EM milestone assessment tools have yet to be determined. This study is a rigorous attempt to collect validity evidence in the development of a direct observation assessment instrument. However, despite strict attention to validity evidence, inter-rater reliability was low. The potential sources of reducible variance include rater- and instrument-based error. Based on this study, there may be concerns for the reliability of other EM milestone assessment tools that are currently in use
The 2013 Model of the Clinical Practice of Emergency Medicine
In 2001, âThe Model of the Clinical Practice of Emergency Medicineâ was first published. This document, the first of its kind, was the result of an extensive practice analysis of emergency department (ED) visits and several expert panels, overseen by representatives from six collaborating professional organizations (the American Board of Emergency Medicine, the American College of Emergency Physicians, the Society for Academic Emergency Medicine, the Residency Review Committee for Emergency Medicine, the Council of Emergency Medicine Residency Directors, and the Emergency Medicine Residents\u27 Association). Every 2 years, the document is reviewed by these organizations to identify practice changes, incorporate new evidence, and identify perceived deficiencies. For this revision, a seventh organization was included, the American Academy of Emergency Medicine
The 2013 Model of the Clinical Practice of Emergency Medicine
In 2001, âThe Model of the Clinical Practice of Emergency Medicineâ was first published. This document, the first of its kind, was the result of an extensive practice analysis of emergency department (ED) visits and several expert panels, overseen by representatives from six collaborating professional organizations (the American Board of Emergency Medicine, the American College of Emergency Physicians, the Society for Academic Emergency Medicine, the Residency Review Committee for Emergency Medicine, the Council of Emergency Medicine Residency Directors, and the Emergency Medicine Residents\u27 Association). Every 2 years, the document is reviewed by these organizations to identify practice changes, incorporate new evidence, and identify perceived deficiencies. For this revision, a seventh organization was included, the American Academy of Emergency Medicine
The salivary microbiota of patients with acute lower respiratory tract infection-A multicenter cohort study.
The human microbiome contributes to health and disease, but the oral microbiota is understudied relative to the gut microbiota. The salivary microbiota is easily accessible, underexplored, and may provide insight into response to infections. We sought to determine the composition, association with clinical features, and heterogeneity of the salivary microbiota in patients with acute lower respiratory tract infection (LRTI). We conducted a multicenter prospective cohort study of 147 adults with acute LRTI presenting to the emergency department of seven hospitals in three states (Pennsylvania, Michigan, and Ohio) between May 2017 and November 2018. Salivary samples were collected in the emergency department, at days 2-5 if hospitalized, and at day 30, as well as fecal samples if patients were willing. We compared salivary microbiota profiles from patients to those of healthy adult volunteers by sequencing and analyzing bacterial 16-rRNA. Compared to healthy volunteers, the salivary microbiota of patients with LRTI was highly distinct and strongly enriched with intestinal anaerobes such as Bacteroidaceae, Ruminococcaceae, and Lachnospiraceae (e.g., mean 10% relative abundance of Bacteroides vs < 1% in healthy volunteers). Within the LRTI population, COPD exacerbation was associated with altered salivary microbiota composition compared to other LRTI conditions. The largest determinant of microbiota variation within the LRTI population was geography (city in which the hospital was located)
Scatter plot of differentially abundant taxa between LRTI group and control group predicted by LOCOM method.
Taxonomic families appear along the and points are distributed along the X-axis according to effect size. Size of point indicates mean relative abundance of each family. (DOCX)</p