Rate of Successful Shoulder Reduction on First Confirmatory Imaging in the Emergency Department.

Background: Management of acute shoulder dislocation in the emergency department (ED) is common.

Objective: This study describes the rate, risk factors, and length of stay (LOS) associated with shoulder dislocation reduction failure in the ED.

Methods: The study was a retrospective case-control study of patients 18 years and older presenting to the ED with acute shoulder dislocation who underwent attempted reduction.

Impact of the COVID-19 Pandemic on Emergency Department Encounters in a Major Metropolitan Area.

Background: The end of 2019 marked the emergence of the COVID-19 pandemic. Public avoidance of health care facilities, including the emergency department (ED), has been noted during prior pandemics.

Objective: This study described pandemic-related changes in adult and pediatric ED presentations, acuity, and hospitalization rates during the pandemic in a major metropolitan area.

Impact of COVID-19 Pandemic on Emergency Department Visits: A Regional Case Study of Informatics Challenges and Opportunities.

In this paper, we examined informatics challenges and opportunities related to emergency department visit data during public health emergencies. We investigated the impact of COVID-19 pandemic on the volume and acuity of adult patients visiting the emergency department (ED) of a medical center in Arizona during the pandemic compared to the pre-pandemic period. We performed a negative binomial regression analysis to understand how different public health-related mandates and statewide business opening/closing orders in Arizona affected the daily emergency department visits.

A Multicenter, Prospective Study Comparing Subxiphoid and Parasternal Views During Brief Echocardiography: Effect on Image Quality, Acquisition Time, and Visualized Anatomy.

Background: Recent literature has suggested echocardiography (echo) may prolong pauses in chest compressions during cardiac arrest.

Objectves: We sought to determine the impact of the sonographic approach (subxiphoid [SX] vs. parasternal long [PSL]) on time to image completion, image quality, and visualization of cardiac anatomy during echo, as performed during Advanced Cardiac Life Support.

Evaluation of Gender Differences in Ultrasound Milestone Evaluations During Emergency Medicine Residency Training: A Multicenter Study.

Objectives: Prior literature has demonstrated incongruities among faculty evaluation of male and female residents' procedural competency during residency training. There are no known studies investigating gender differences in the assessment of procedural skills among emergency medicine (EM) residents, such as those required by ultrasound. The objective of this study was to determine if there are significant gender differences in ultrasound milestone evaluations during EM residency training.

Risk of contrast extravasation with vascular access in computed tomography.

Purpose: Diagnostic computed tomography (CT) imaging, utilizing intravenous (IV) contrast administration, has become increasingly common. Potential IV contrast-associated complications include local skin and soft tissue reactions due to extravasation. The goal of this study is to describe the risk of contrast extravasation based on IV catheter anatomic location in patients receiving contrast-enhanced CT imaging.

Evaluation of a novel curriculum on point-of-care ultrasound competency and confidence.

Introduction: Point-of-care ultrasound (POCUS) education is a requirement of graduate medical education in EM. Milestones have been established to assess resident US competency. However, the delivery of POCUS education has not been standardized.

Impact of Emergency Department Phlebotomists on Left-Before-Treatment-Completion Rates.

Introduction: The emergency department (ED) serves as the primary access point to the healthcare system. ED throughput efficiency is critical. The percentage of patients who leave before treatment completion (LBTC) is an important marker of department efficiency.

Concordance between blood and cerebrospinal fluid cultures in meningitis.

Objective: To examine the association between cerebrospinal fluid (CSF) cultures and blood cultures in patients with suspected bacterial or fungal meningitis.

Methods: A 5-year retrospective chart review, conducted from April 2012 to January 2017 of consecutive patient encounters with bacterial or fungal organism growth in CSF culture, when a blood culture was also obtained. Patients were excluded if they received antibiotics prior to either lumbar puncture (LP) or blood culture acquisition, or if CSF cultures were positive for common bacterial skin contaminants.

Successful Point-Of-Care Ultrasound-Guided Treatment of Submassive Pulmonary Embolism.

Pulmonary embolism is associated with significant mortality and impaired long-term functional outcomes. Timely identification and treatment is crucial for successful management. Unfortunately, prompt diagnosis can be challenging in patients without overt signs of cardiovascular compromise.

Implications of language barrier on the diagnostic yield of computed tomography in pulmonary embolism.

Objectives: To determine if a physician-patient language barrier impacts the diagnostic accuracy of pulmonary embolism (PE) evaluation.

Methods: A retrospective chart review, conducted between June 2015 and December 2016, of a consecutive sample of diagnostic computed tomography pulmonary angiogram (CTPA) studies performed on adult patients. Positive and negative CTPA scans were further categorized by patient language and the positive diagnostic yield was determined for each language group.

Critical care ultrasound: A national survey across specialties.

Purpose: Management of the critically ill patient requires rapid assessment and differentiation. Point-of-care ultrasound (POCUS) improves diagnostic accuracy and guides resuscitation. This study sought to describe the use of critical care related POCUS amongst different specialties.

Perception of point-of-care ultrasound performed by emergency medicine physicians.

Purpose: Point-of-care ultrasound (POCUS) is integral to the practice of emergency medicine (EM). Furthermore, EM-performed POCUS (EM-POCUS) offers consultants the opportunity to avoid delays in care due to wait times for confirmatory imaging studies. This study is the first to describe the perception of POCUS to consulting services at a single institution where EM-POCUS is routinely performed.

Evaluation of an innovative hands-on anatomy-centered ultrasound curriculum to supplement graduate gross anatomy education.

Ultrasound (US) can enhance anatomy education, yet is incorporated into few non-medical anatomy programs. This study is the first to evaluate the impact of US training in gross anatomy for non-medical students in the United States. All 32 master's students enrolled in gross anatomy with the anatomy-centered ultrasound (ACUS) curriculum were recruited.

Effect of Interventional Program on the Utilization of PACS in Point-of-Care Ultrasound.

While the implementation of Picture Archiving and Communication Systems (PACS) has revolutionized the field of radiology, there has been considerably less utilization of PACS by emergency physicians with point-of-care ultrasound. Benefits of PACS archival of images include improved quality assurance, preservation of image quality, and accessibility of images. Our objective was to determine if a simple interventional program would influence the utilization of PACS in point-of-care ultrasound.

Ultrasound-Guided Cannulation: Time to Bring Subclavian Central Lines Back.

Despite multiple advantages, subclavian vein (SCV) cannulation via the traditional landmark approach has become less used in comparison to ultrasound (US) guided internal jugular catheterization due to a higher rate of mechanical complications. A growing body of evidence indicates that SCV catheterization with real-time US guidance can be accomplished safely and efficiently. While several cannulation approaches with real-time US guidance have been described, available literature suggests that the infraclavicular, longitudinal "in-plane" technique may be preferred.

Emergency medicine resident clinical hours: a national survey.

Background: Emergency medicine (EM) residency programs have significant scheduling flexibility. As a result, there is potentially significant variation in scheduling practices. Few studies have previously sought to describe this variation.

Attachment anxiety is linked to alterations in cortisol production and cellular immunity.

Although evidence suggests that attachment anxiety may increase risk for health problems, the mechanisms underlying these effects are not well understood. In the current study, married couples (N = 85) provided saliva samples over 3 days and blood samples on two occasions. Participants with higher attachment anxiety produced more cortisol and had fewer numbers of CD3(+) T cells, CD45(+) T cells, CD3(+)CD4(+) helper T cells, and CD3(+)CD8(+) cytotoxic T cells than participants with lower attachment anxiety.

Cognitive word use during marital conflict and increases in proinflammatory cytokines.

Objective: To examine whether greater cognitive engagement during a marital conflict discussion, as evidenced by use of words that suggest thinking and meaning-making, results in attenuated proinflammatory cytokine increases to stress and wounding.

Design: Husbands and wives (N = 84 individuals) were observed during two separate 24-hr visits: each visit included a wounding procedure, which was followed by a nonconflictive marital discussion (first visit) and a conflictive marital discussion (second visit).

Main Outcome Measures: Serum proinflammatory cytokines interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha).

Validation of the Symptoms of Illness Checklist (SIC) as a tool for health psychology research.

We developed the Symptoms of Illness Checklist (SIC) to study psychological influences on physical symptoms of illness. A total of 520 participants completed the SIC and, in some samples, the Salient Stressor Impact Questionnaire, Perceived Stress Scale, Daily Hassles and Uplifts Scale, Derogatis Stress Profile, Life Experiences Survey, and the Symptoms CheckList-90-R. The SIC's test-retest, internal reliability, and validity verified by physician ratings, were very good.

Hostile marital interactions, proinflammatory cytokine production, and wound healing.

Context: A growing epidemiological literature has suggested that marital discord is a risk factor for morbidity and mortality. In addition, depression and stress are associated with enhanced production of proinflammatory cytokines that influence a spectrum of conditions associated with aging.

Objective: To assess how hostile marital behaviors modulate wound healing, as well as local and systemic proinflammatory cytokine production.

Use and abuse of academic examinations in stress research.

Previous research suggests that certain types of academic examinations can have a significant impact on psychological and physical health. However, there has not been adequate discussion about the methodological and statistical issues associated with using academic examinations as a model for short-term stress in the context of psychoneuroimmunology research. Limitations of the model are presented with recommendations for appropriate use.