Strategies to promote language inclusion at 17 CTSA hubs.

The prioritization of English language in clinical research is a barrier to translational science. We explored promising practices to advance the inclusion of people who speak languages other than English in research conducted within and supported by NIH Clinical Translational Science Award (CTSA) hubs. Key informant interviews were conducted with representatives ( = 24) from CTSA hubs ( = 17).

Using Deep Learning to Detect the Presence and Location of Hemoperitoneum on the Focused Assessment with Sonography in Trauma (FAST) Examination in Adults.

Abdominal ultrasonography has become an integral component of the evaluation of trauma patients. Internal hemorrhage can be rapidly diagnosed by finding free fluid with point-of-care ultrasound (POCUS) and expedite decisions to perform lifesaving interventions. However, the widespread clinical application of ultrasound is limited by the expertise required for image interpretation.

Automated detection and localization of pericardial effusion from point-of-care cardiac ultrasound examination.

Focused Assessment with Sonography in Trauma (FAST) exam is the standard of care for pericardial and abdominal free fluid detection in emergency medicine. Despite its life saving potential, FAST is underutilized due to requiring clinicians with appropriate training and practice. To aid ultrasound interpretation, the role of artificial intelligence has been studied, while leaving room for improvement in localization information and computation time.

Informed Consent for Placebo-Controlled Trials: Do Ethics and Science Conflict?

The use of a placebo has been considered the best method for controlling bias in a prospective randomized clinical trial and provides the most rigorous test of treatment efficacy for evaluating a medical therapy. Placebos commonly produce clinically important effects particularly in studies where the primary outcomes are subjective. Yet the potential beneficial or harmful effects of placebos are often not addressed in designing a clinical trial, calculating the sample size, seeking consent, or interpreting clinical trial results.

Adaptation of a Simulation Model and Checklist to Assess Pediatric Emergency Care Performance by Prehospital Teams.

Introduction: Simulation tools to assess prehospital team performance and identify patient safety events are lacking. We adapted a simulation model and checklist tool of individual paramedic performance to assess prehospital team performance and tested interrater reliability.

Methods: We used a modified Delphi process to adapt 3 simulation cases (cardiopulmonary arrest, seizure, asthma) and checklist to add remote physician direction, target infants, and evaluate teams of 2 paramedics and 1 physician.

False negative point-of-care urine pregnancy tests in an urban academic emergency department: a retrospective cohort study.

Study Objective: To determine the prevalence of false negative point-of-care (POC) urine pregnancy tests among emergency department (ED) patients and among those with abdominal pain or vaginal bleeding.

Methods: We identified all female patients, ages 14-50 years without prior hysterectomy who had a negative POC urine pregnancy test (beta subunit of human chorionic gonadotropin [β-hCG]) performed by trained clinical staff in the ED between September 1, 2017 and December 31, 2018, as well as a subgroup we defined a priori as "high risk" for early pregnancy complications based on a triage chief complaint (text) of abdominal pain or vaginal bleeding. We identified those with a positive urine β-hCG, serum β-hCG >5 mIU/mL, or a diagnosis of pregnancy within 3 months of the initial ED visit (index visit).

Pilot Paramedic Survey of Benefits, Risks, and Strategies for Pediatric Prehospital Telemedicine.

Objective: A national survey found prehospital telemedicine had potential clinical applications but lacked provider opinion on its use for pediatric emergency care. We aimed to (1) estimate prehospital telemedicine use, (2) describe perceived benefits and risks of pediatric applications, and (3) identify preferred utilization strategies by paramedics.

Methods: We administered a 14-question survey to a convenience sample of 25 Massachusetts paramedics attending a regional course in 2018.

Variability in Institutional Board Review for a Multisite Assessment of Resident Professionalism.

Residents serve as both trainees and employees and can be considered potentially vulnerable research participants. This can lead to variation in the institutional review board (IRB) review. We studied sites participating in the Assessment of Professional Behaviors Study sponsored by the National Board of Medical Examiners (2009-2011).

Is hallway care dangerous? An observational study.

Objectives: In response to crowding the use of hallway beds has become an increasingly prevalent practice in Emergency Departments (EDs). There is limited research on whether caring for patients in hallways (HP) is associated with adverse outcomes. The goal of this study was to examine the effects of HP triage on 30 day outcomes for ED return, readmission, and mortality.

Are Geriatric Patients Placed in an Emergency Department Observation Unit on a Chest Pain Pathway More Likely Than Non-Geriatric Patients to Re-Present to the Hospital within 30 Days?

Background: Emergency department observation units (EDOUs) are used frequently for low-risk chest pain evaluations.

Objective: The purpose of this study was to determine whether geriatric compared to non-geriatric patients evaluated in an EDOU for chest pain have differences in unscheduled 30-day re-presentation, length of stay (LOS), and use of stress testing.

Methods: We conducted an exploratory, retrospective, cohort study at a single academic, urban ED of all adult patients placed in an EDOU chest pain protocol from June 1, 2014 to May 31, 2015.

Is the Pelvic Examination Still Crucial in Patients Presenting to the Emergency Department With Vaginal Bleeding or Abdominal Pain When an Intrauterine Pregnancy Is Identified on Ultrasonography? A Randomized Controlled Trial.

Study Objective: We determine whether omitting the pelvic examination in emergency department (ED) evaluation of vaginal bleeding or lower abdominal pain in ultrasonographically confirmed early intrauterine pregnancy is equivalent to performing the examination.

Methods: We conducted a prospective, open-label, randomized, equivalence trial in pregnant patients presenting to the ED from February 2011 to November 2015. Patients were randomized to no pelvic examination versus pelvic examination.

Identifying Patients for Overdose Prevention With ICD-9 Classification in the Emergency Department, Massachusetts, 2013-2014.

The national rise in opioid overdose deaths signifies a need to integrate overdose prevention within healthcare delivery settings. The emergency department (ED) is an opportune location for such interventions. To effectively integrate prevention services, the target population must be clearly defined.

Why is it so hard to implement change? A qualitative examination of barriers and facilitators to distribution of naloxone for overdose prevention in a safety net environment.

Background: The increase in opioid overdose deaths has become a national public health crisis. Naloxone is an important tool in opioid overdose prevention. Distribution of nasal naloxone has been found to be a feasible, and effective intervention in community settings and may have potential high applicability in the emergency department, which is often the initial point of care for persons at high risk of overdose.

A critical analysis of unplanned ICU transfer within 48 hours from ED admission as a quality measure.

Hypothesis: Unplanned intensive care unit (ICU) transfer (UIT) within 48 hours of emergency department (ED) admission increases morbidity and mortality. We hypothesized that a majority of UITs do not have critical interventions (CrIs) and that CrI is associated with worse outcomes.

Objective: The objective of the study is to characterize all UITs (including patients who died before ICU transfer), the proportion with CrI, and the effect of having CrI on mortality.

Is It Exertional Heatstroke or Something More? A Case Report.

Background: Heat stroke, heat-related illness, and malignant hyperthermia all present with hyperthermia. The former two are common presentations in the emergency department (ED). On the other hand, malignant hyperthermia (MH) is an uncommon but equally dangerous condition that requires prompt recognition and specific treatment with dantrolene sodium and avoidance of certain medications to reduce morbidity and mortality.

Prescription drug monitoring programs: examining limitations and future approaches.

Prescription drug abuse is a leading cause of accidental death in the United States. Prescription drug monitoring programs (PDMPs) are a popular initiative among policy makers and a key tool to combat the prescription drug epidemic. This editorial discusses the limitations of PDMPs, future approaches needed to improve the effectiveness of PDMPs, and other approaches essential to curbing the rise of drug abuse and overdose.

Characteristics of emergency department "doctor shoppers".

Background: There is a need to accurately identify patients at risk for drug abuse before giving a prescription for a scheduled medication.

Objective: Our aim was to describe a subset of emergency department (ED) patients that had eight or more schedule II-V prescriptions filled from eight or more providers in 1 year, known as "doctor-shopping" (DS) behavior, to compare demographic features of DS and non-DS patients, and to determine clinical factors associated with DS.

Methods: We conducted a prospective, observational study of emergency providers' (EPs) assessment of patients with back pain, dental pain, or headache.

Gender differences in acute and chronic pain in the emergency department: results of the 2014 Academic Emergency Medicine consensus conference pain section.

Pain is a leading public health problem in the United States, with an annual economic burden of more than $630 billion, and is one of the most common reasons that individuals seek emergency department (ED) care. There is a paucity of data regarding sex differences in the assessment and treatment of acute and chronic pain conditions in the ED. The Academic Emergency Medicine consensus conference convened in Dallas, Texas, in May 2014 to develop a research agenda to address this issue among others related to sex differences in the ED.

Salivary inflammatory mediator profiling and correlation to clinical disease markers in asthma.

Rationale: There is a need for a readily available, non-invasive source of biomarkers that predict poor asthma control.

Objectives: We sought to determine if there is an association between the salivary inflammatory profile and disease control in children and adults with asthma.

Methods: In this cross-sectional study, we collected demographic and clinical information from two independent populations at different sites, resulting in convenience samples of 58 pediatric and 122 adult urban asthmatics.

Clinician impression versus prescription drug monitoring program criteria in the assessment of drug-seeking behavior in the emergency department.

Study Objective: We compare emergency provider impression of drug-seeking behavior with objective criteria from a state prescription drug monitoring program, assess change in opioid pain reliever prescribing after prescription drug monitoring program review, and examine clinical factors associated with suspected drug-seeking behavior.

Methods: This was a prospective observational study of emergency providers assessing a convenience sample of patients aged 18 to 64 years who presented to either of 2 academic medical centers with chief complaint of back pain, dental pain, or headache. Drug-seeking behavior was objectively defined as present when a patient had greater than or equal to 4 opioid prescriptions by greater than or equal to 4 providers in the 12 months before emergency department evaluation.

Are patients aware of angiotensin-converting enzyme inhibitor-associated adverse effects?

It is important for patients to understand the potential adverse effects (AEs) of their daily medications. Because associated adverse effects (ACEIs) may result in life-threatening angioedema, we sought to assess patients' level of awareness of ACEI AEs, determine if patients have an appropriate action plan in the event of an ACEI AE, determine if a brief educational intervention in the emergency department (ED) could improve knowledge about ACEI AEs. This was a prospective in-person survey conducted between August and December 2008 in a large urban academic ED.

Effects of cardiology review of the electrocardiogram in patients with suspected acute coronary syndromes.

Background: Misclassification of the electrocardiogram (ECG) contributes to treatment errors in patients with acute coronary syndrome. We hypothesized that cardiology ECG review could reduce these errors.

Objective: The purpose of this study is to examine the effects of real-time cardiology ECG review in patients evaluated for acute coronary syndrome.