Medical Student Attitudes toward USMLE Step 1 and Health Systems Science - A Multi-Institutional Survey.

Because of its importance in residency selection, the United States Medical Licensing Examination Step 1 occupies a critical position in medical education, stimulating national debate about appropriate score use, equitable selection criteria, and the goals of undergraduate medical education. Yet, student perspectives on these issues and their implications for engagement with health systems science-related curricular content are relatively underexplored. We conducted an online survey of medical students at 19 American allopathic medical schools from March-July, 2019.

Effect of Initial Bedside Ultrasonography on Emergency Department Skin and Soft Tissue Infection Management.

Study Objective: We examine the utility of emergency department (ED) ultrasonography in treatment of skin and soft tissue infections.

Methods: We enrolled ED patients with skin and soft tissue infections and surveyed clinicians in regard to their pre-ultrasonography certainty about the presence or absence of an abscess, their planned management, post-ultrasonography findings, and actual management. We determined sensitivity and specificity of ultrasonography and clinical evaluation, and assessed appropriateness of management changes based on initial clinical assessment and outcomes through 1-week follow-up.

Subgroup Analysis of Antibiotic Treatment for Skin Abscesses.

Study Objective: Two large randomized trials recently demonstrated efficacy of methicillin-resistant Staphylococcus aureus (MRSA)-active antibiotics for drained skin abscesses. We determine whether outcome advantages observed in one trial exist across lesion sizes and among subgroups with and without guideline-recommended antibiotic indications.

Methods: We conducted a planned subgroup analysis of a double-blind, randomized trial at 5 US emergency departments, demonstrating superiority of trimethoprim-sulfamethoxazole (320/1,600 mg twice daily for 7 days) compared with placebo for patients older than 12 years with a drained skin abscess.

Effect of Cephalexin Plus Trimethoprim-Sulfamethoxazole vs Cephalexin Alone on Clinical Cure of Uncomplicated Cellulitis: A Randomized Clinical Trial.

Importance: Emergency department visits for skin infections in the United States have increased with the emergence of methicillin-resistant Staphylococcus aureus (MRSA). For cellulitis without purulent drainage, β-hemolytic streptococci are presumed to be the predominant pathogens. It is unknown if antimicrobial regimens possessing in vitro MRSA activity provide improved outcomes compared with treatments lacking MRSA activity.

A Randomized Trial of Clindamycin Versus Trimethoprim-sulfamethoxazole for Uncomplicated Wound Infection.

Background: With the emergence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) in the United States, visits for skin infections greatly increased. Staphylococci and streptococci are considered predominant causes of wound infections. Clindamycin and trimethoprim-sulfamethoxazole (TMP-SMX) are commonly prescribed, but the efficacy of TMP-SMX has been questioned.

Trimethoprim-Sulfamethoxazole versus Placebo for Uncomplicated Skin Abscess.

Background: U.S. emergency department visits for cutaneous abscess have increased with the emergence of methicillin-resistant Staphylococcus aureus (MRSA).

Utility of routine testing for patients with asymptomatic severe blood pressure elevation in the emergency department.

Study Objective: Recommendations for the treatment of emergency department (ED) patients with asymptomatic severely elevated blood pressure advise assessment for occult, acute hypertensive target-organ damage. This study determines the prevalence of unanticipated, clinically meaningful test abnormalities in ED patients with asymptomatic severely elevated blood pressure.

Methods: This was a prospective observational study at 3 urban academic EDs.

Antibiotic use for emergency department patients with upper respiratory infections: prescribing practices, patient expectations, and patient satisfaction.

Study Objective: Physicians often prescribe antibiotics to patients even when there is no clear indication for their use. Previous studies examining antibiotic use in acute bronchitis and upper respiratory infections have been conducted in primary care settings. We evaluate the factors that physicians in the emergency department (ED) consider when prescribing antibiotics (eg, patient expectations) and the factors associated with patient satisfaction.

Emergency medicine and the public's health: emerging infectious diseases.

In recent years, multiple global forces have contributed to the emergence and widespread distribution of previously unknown disease entities. This article discusses Ebola virus, West Nile virus, and Hantavirus as representative emerging infectious diseases. Smallpox is discussed along with concerns about the safety of the smallpox vaccine, given the uncertain risk of bioterrorism and smallpox exposure.

Emergency medicine research directors and research programs: characteristics and factors associated with productivity.

Background: Periodic surveys of research directors (RDs) in emergency medicine (EM) are useful to assess the specialty's development and evolution of the RD role.

Objectives: To assess associations between characteristics and research productivity of RDs and EM programs.

Methods: A survey of EM RDs was developed using the nominal group technique and pilot tested.

Evaluation and treatment of patients with severely elevated blood pressure in academic emergency departments: a multicenter study.

Study Objective: Current guidelines advise that emergency department (ED) patients with severely elevated blood pressure be evaluated for acute target organ damage, have their medical regimen adjusted, and be instructed to follow up promptly for reassessment. We examine factors associated with performance of recommended treatment of patients with severely elevated blood pressure.

Methods: Observational study performed during 1 week at 4 urban, academic EDs.

Aspiration of gastric contents: association with prehospital intubation.

We prospectively compared the incidence of pulmonary aspiration of gastric contents between patients endotracheally intubated in the prehospital (PH) setting and those intubated in the emergency department (ED). Tracheal aspirates were collected using a standard Leukens trap from all patients as soon as possible after endotracheal intubation. Tracheal aspirates were then tested for the presence of pepsin, a sensitive and specific marker of gastric contents, using a fibrinogen digestion technique.

A new pepsin assay to detect pulmonary aspiration of gastric contents among newly intubated patients.

Aspiration of gastric contents by endotracheally intubated patients is associated with significant morbidity and mortality. Previous studies suggest that pepsin in tracheal aspirates may be a valuable marker of occult aspiration. We sought to show the sensitivity and specificity of a new, pepsin-specific assay in humans.