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1.
Viruses ; 13(12)2021 12 07.
Article in English | MEDLINE | ID: covidwho-1554805

ABSTRACT

BACKGROUND: We evaluated how plasma proteomic signatures in patients with suspected COVID-19 can unravel the pathophysiology, and determine kinetics and clinical outcome of the infection. METHODS: Plasma samples from patients presenting to the emergency department (ED) with symptoms of COVID-19 were stratified into: (1) patients with suspected COVID-19 that was not confirmed (n = 44); (2) non-hospitalized patients with confirmed COVID-19 (n = 44); (3) hospitalized patients with confirmed COVID-19 (n = 53) with variable outcome; and (4) patients presenting to the ED with minor diseases unrelated to SARS-CoV-2 infection (n = 20). Besides standard of care diagnostics, 177 circulating proteins related to inflammation and cardiovascular disease were analyzed using proximity extension assay (PEA, Olink) technology. RESULTS: Comparative proteome analysis revealed 14 distinct proteins as highly associated with SARS-CoV-2 infection and 12 proteins with subsequent hospitalization (p < 0.001). ADM, IL-6, MCP-3, TRAIL-R2, and PD-L1 were each predictive for death (AUROC curve 0.80-0.87). The consistent increase of these markers, from hospital admission to intensive care and fatality, supported the concept that these proteins are of major clinical relevance. CONCLUSIONS: We identified distinct plasma proteins linked to the presence and course of COVID-19. These plasma proteomic findings may translate to a protein fingerprint, helping to assist clinical management decisions.


Subject(s)
Biomarkers/blood , COVID-19/blood , Plasma/metabolism , Proteome , Berlin , Blood Proteins , COVID-19/drug therapy , Emergency Medicine , Emergency Service, Hospital , Hospitalization , Humans , Proteomics , SARS-CoV-2
2.
Glob Health Sci Pract ; 9(3): 690-697, 2021 09 30.
Article in English | MEDLINE | ID: covidwho-1542965

ABSTRACT

Emergency medicine (EM) is rapidly being recognized as a specialty around the globe. This has particular promise for low- and middle-income countries (LMICs) that experience the largest burden of disease for emergency conditions. Specialty education and training in EM remain essentially an apprenticeship model. Finding the required expertise to educate graduate learners can be challenging in regions where there are low densities of specialty providers.We describe an initiative to implement a sustainable, bidirectional partnership between the Emergency Medicine Departments of Weill Cornell Medicine (WCM) in New York, NY, USA, and Bugando Medical Center (BMC) in Mwanza, Tanzania. We used synchronous and asynchronous telecommunication technology to enhance an ongoing emergency medicine education collaboration.The Internet infrastructure for this collaboration was created by bolstering 4G services available in Mwanza, Tanzania. By maximizing the 4G signal, sufficient bandwidth could be created to allow for live 2-way audio/video communication. Using synchronous and asynchronous applications such as Zoom and WhatsApp, providers at WCM and BMC can attend real-time didactic lectures, participate in discussion forums on clinical topics, and collaborate on the development of clinical protocols. Proof of concept exercises demonstrated that this system can be used for real-time mentoring in EKG interpretation and ultrasound technique, for example. This system was also used to share information and develop operations flows during the COVID-19 pandemic. The use of telecommunication technology and e-learning in a format that promotes long-term, sustainable interaction is practical and innovative, provides benefit to all partners, and should be considered as a mechanism by which global partnerships can assist with training in emergency medicine in LMICs.


Subject(s)
Curriculum , Education, Distance/methods , Education, Medical, Graduate/methods , Emergency Medicine/education , Emergency Medicine/methods , Academic Medical Centers , Emergency Service, Hospital , Humans , Mobile Applications , New York City , Social Media , Tanzania
3.
Emerg Med Australas ; 33(6): 1106-1109, 2021 12.
Article in English | MEDLINE | ID: covidwho-1528344
6.
Ann Med ; 53(1): 1520-1530, 2021 12.
Article in English | MEDLINE | ID: covidwho-1455001

ABSTRACT

OBJECTIVE: During the COVID-19 pandemic, emergency medicine (EM) teachers had to employ innovative methods to ensure the continuity of the education process. The purpose of this study was to explore the adequacy of the 360-degree video (video 360) technology in EM education in the context of: (a) students' attitudes towards the video 360; (b) students' academic performance in their required examination at the end of the EM course compared to the assessment results of students from the previous academic year. METHODS: A mixed-method research project enrolled the fourth-year medical students who attended the required EM course during the first semester of the academic year 2020-2021 when all activities with undergraduate students went online and teaching scenarios recorded in the video 360 format were employed. Data collection was two-fold: (a) anonymous questionnaires, complemented with basic YouTube analytics; (b) multiple-choice questionnaires (MCQ) and oral examination, contrasting the results with those in 2019-2020. Data analysis used descriptive statistics and non-parametric methods. RESULTS: Seventy-nine students (53 females and 26 males) participated in the project and all completed the EM course. Students' interest in and their acceptance of the video 360 technology were high (total scoring in the upper 20% of the respective scales), with consistently good performance in two parallel, independent, interview-based oral/practical evaluations (Spearman correlation coefficient R = 0.665, p < .001). The majority scored over 90% in the summative MCQ, with higher values compared to their colleagues' during the previous academic year (with on-site teaching): scoring percentages with mean ± standard deviation of 92.52 ± 4.57 and 76.67 ± 18.77, respectively. CONCLUSION: Our project showed that the video 360 scenarios were effective in teaching EM. In the long term, employing this accessible and inexpensive educational approach would add value to on-site training by enriching the exposure to a specific ED environment.KEY MESSAGESMedical students valued the 360-degree video scenarios as contributing substantially to their EM knowledge and preparedness.Examination results confirmed the 360-degree video scenarios as viable in EM teaching.The 360-degree video technology would be a sustainable solution for hybrid medical teaching in the long term.


Subject(s)
COVID-19/epidemiology , Education, Medical, Undergraduate/methods , Emergency Medicine/education , Students, Medical/statistics & numerical data , Virtual Reality , Educational Measurement , Female , Humans , Male
8.
Ann Emerg Med ; 78(5): 587-592, 2021 11.
Article in English | MEDLINE | ID: covidwho-1439183

ABSTRACT

We, emergency physicians of color, are not okay. We are living and working through a pandemic that has disproportionately affected our communities and a year in which we cannot escape our lived experiences of police brutality. We see you, dear White people in emergency medicine, and are glad you want to support us. However, let us guide you in supporting our cause.


Subject(s)
African Americans/psychology , Emergency Medicine , Organizational Culture , Physicians/psychology , Racism , COVID-19/epidemiology , Humans , Pandemics , SARS-CoV-2 , United States/epidemiology , Violence
9.
Emerg Med Australas ; 33(5): 938-940, 2021 10.
Article in English | MEDLINE | ID: covidwho-1434614

ABSTRACT

Since 2018, the Australasian College for Emergency Medicine has collaborated with the Swinburne University of Technology on a research project to understand and enhance the leadership capacity of emergency physicians, beginning with Australasian Directors of Emergency Medicine (DEMs). Over the last 3 years, this research programme has revealed the complexity of leadership in emergency medicine, illuminating the strengths and limitations of extant research and suggesting promising new directions for emergency medicine leadership and leadership development research. This programme has also shed new light on the knowledge, skills and abilities that DEMs need to develop to catalyse change in the systems where DEMs practice both medicine and leadership. We propose that an approach to leadership development that reflects the diversity of DEMs' leadership challenges and the complexity of leadership in emergency medicine would go a long way to enhancing the sophistication, effectiveness and impact of the leadership in emergency medicine.


Subject(s)
Emergency Medicine , Leadership , Humans
10.
Med Klin Intensivmed Notfmed ; 115(6): 495-497, 2020 Sep.
Article in German | MEDLINE | ID: covidwho-1384337

ABSTRACT

The year 2020 is the year of care on the occasion of the 200th birthday of Florence Nightingale. However, due to current events, the "Year of Corona" will be remembered more. A positive aspect is the attention and appreciation of the nursing profession in the population. Nevertheless, politicians and various professional groups in the hospital limit nursing care almost exclusively to practical activities that are directly necessary for the patients. A clearly noticeable improvement in working conditions for nurses as a result of the political efforts of this legislative period has so far failed to materialise to the same extent as the active involvement of nurses in political decisions and resolutions that directly affect the professional group. The rapid build-up of bed capacities has made it possible to provide the patients concerned with the necessary intensive medical care. In many places, however, this has been at the expense of the nurses and physicians, some of whom have had to work without the necessary training, with insufficient protective equipment and in unfamiliar areas. These problems continue to exist even after months of the covid-19 crisis.The Nursing Section of the DGIIN expressly declares its willingness to actively and constructively participate in any processes in the future and, with the following 5 points, offers initial practical assistance to improve the situation in German intensive care units.


Subject(s)
Coronavirus Infections/epidemiology , Critical Care , Emergency Medicine , Nursing , Pneumonia, Viral/epidemiology , Betacoronavirus , COVID-19 , Germany , Humans , Pandemics , SARS-CoV-2 , Societies, Medical
11.
CJEM ; 23(6): 842-846, 2021 11.
Article in English | MEDLINE | ID: covidwho-1372842

ABSTRACT

OBJECTIVE: The COVID-19 pandemic has created numerous unique challenges for the recruitment of prospective trainees. Cancellation of visiting electives and in-person interviews created challenges for programs to showcase elements that have been shown to influence applicants' program selection, including geographical considerations and program collegiality. Novel strategies have been recommended and employed to facilitate candidate recruitment, but it is unclear how influential such strategies are on candidates' program ranking. It is also unclear what factors influence program selection among CCFP(EM) candidates. We sought to evaluate the impact of novel recruitment strategies on applicants' ranking of the University of Ottawa CCFP(EM) program and determine factors which were most influential in applicants' first-choice program selection. METHODS: An online survey was distributed to all candidates (n = 127) who applied to the University of Ottawa CCFP(EM) program. The survey instrument included 33 items. Respondents were asked to rate on a 3-point scale how influential specific recruitment strategies were on their ranking of our program and the influence of different training factors on their selection of first-choice program. RESULTS: The survey response rate was 27% (34/127). Recruitment strategies rated as most positively influential included virtual one-on-one meetings with program directors (100%), virtual Q&A sessions (77.8%), virtual communication with chief residents (73.3%), and a mailed personalized recruitment package (72.2%). The top factors influencing applicants' first-choice program selection included: collegiality between faculty and residents (96.4%); level of responsibility given to residents (96.4%); support within the program (96.4%); and procedural opportunities within the program (96.3%). CONCLUSION: Facilitating virtual personal interaction with program leadership is highly influential in how CCFP(EM) candidates rank programs. CCFP(EM) candidates value characteristics of a training program over the geographical location and available amenities. Program leaders should consider these findings when recruiting prospective candidates.


Subject(s)
COVID-19 , Emergency Medicine , Internship and Residency , Emergency Medicine/education , Family Practice , Humans , Pandemics , Prospective Studies , SARS-CoV-2
12.
13.
14.
JAMA ; 326(6): 481-482, 2021 Aug 10.
Article in English | MEDLINE | ID: covidwho-1363619
15.
BMJ Open ; 11(7): e047349, 2021 07 15.
Article in English | MEDLINE | ID: covidwho-1341323

ABSTRACT

PURPOSE: Research in acute care faces many challenges, including enrolment challenges, legal limitations in data sharing, limited funding and lack of singular ownership of the domain of acute care. To overcome these challenges, the Center of Acute Care of the University Medical Center Groningen in the Netherlands, has established a de novo data, image and biobank named 'Acutelines'. PARTICIPANTS: Clinical data, imaging data and biomaterials (ie, blood, urine, faeces, hair) are collected from patients presenting to the emergency department (ED) with a broad range of acute disease presentations. A deferred consent procedure (by proxy) is in place to allow collecting data and biomaterials prior to obtaining written consent. The digital infrastructure used ensures automated capturing of all bed-side monitoring data (ie, vital parameters, electrophysiological waveforms) and securely importing data from other sources, such as the electronic health records of the hospital, ambulance and general practitioner, municipal registration and pharmacy. Data are collected from all included participants during the first 72 hours of their hospitalisation, while follow-up data are collected at 3 months, 1 year, 2 years and 5 years after their ED visit. FINDINGS TO DATE: Enrolment of the first participant occurred on 1 September 2020. During the first month, 653 participants were screened for eligibility, of which 180 were approached as potential participants. In total, 151 (84%) provided consent for participation of which 89 participants fulfilled criteria for collection of biomaterials. FUTURE PLANS: The main aim of Acutelines is to facilitate research in acute medicine by providing the framework for novel studies and issuing data, images and biomaterials for future research. The protocol will be extended by connecting with central registries to obtain long-term follow-up data, for which we already request permission from the participant. TRIAL REGISTRATION NUMBER: NCT04615065.


Subject(s)
COVID-19 , Emergency Medicine , Biological Specimen Banks , Humans , Netherlands , SARS-CoV-2 , Treatment Outcome
16.
Acad Emerg Med ; 28(11): 1328-1340, 2021 11.
Article in English | MEDLINE | ID: covidwho-1324961

ABSTRACT

OBJECTIVE: The objective was to identify, screen, highlight, review, and summarize some of the most rigorously conducted and impactful original research (OR) and review articles (RE) in global emergency medicine (EM) published in 2020 in the peer-reviewed and gray literature. METHODS: A broad systematic search of peer-reviewed publications related to global EM indexed on PubMed and in the gray literature was conducted. The titles and abstracts of the articles on this list were screened by members of the Global Emergency Medicine Literature Review (GEMLR) Group to identify those that met our criteria of OR or RE in the domains of disaster and humanitarian response (DHR), emergency care in resource-limited settings (ECRLS), and EM development. Those articles that met these screening criteria were then scored using one of three scoring templates appropriate to the article type. Those articles that scored in the top 5% then underwent in-depth narrative summarization. RESULTS: The 2020 GEMLR search initially identified 35,970 articles, more than 50% more than last year's search. From these, 364 were scored based on their full text. Nearly three-fourths of the scored articles constituted OR, of which nearly three-fourths employed quantitative research methods. Nearly 10% of the articles identified this year were directly related to COVID-19. Research involving ECRLS again constituted most of the articles in this year's review, accounting for more than 60% of the literature scored. A total of 20 articles underwent in-depth narrative critiques. CONCLUSIONS: The number of studies relevant to global EM identified by our search was very similar to that of last year. Revisions to our methodology to identify a broader range of research were successful in identifying more qualitative research and studies related to DHR. The number of COVID-19-related articles is likely to continue to increase in subsequent years.


Subject(s)
COVID-19 , Emergency Medical Services , Emergency Medicine , Global Health , Humans , SARS-CoV-2
18.
J Med Internet Res ; 23(7): e28615, 2021 07 14.
Article in English | MEDLINE | ID: covidwho-1311344

ABSTRACT

BACKGROUND: The early conversations on social media by emergency physicians offer a window into the ongoing response to the COVID-19 pandemic. OBJECTIVE: This retrospective observational study of emergency physician Twitter use details how the health care crisis has influenced emergency physician discourse online and how this discourse may have use as a harbinger of ensuing surge. METHODS: Followers of the three main emergency physician professional organizations were identified using Twitter's application programming interface. They and their followers were included in the study if they identified explicitly as US-based emergency physicians. Statuses, or tweets, were obtained between January 4, 2020, when the new disease was first reported, and December 14, 2020, when vaccination first began. Original tweets underwent sentiment analysis using the previously validated Valence Aware Dictionary and Sentiment Reasoner (VADER) tool as well as topic modeling using latent Dirichlet allocation unsupervised machine learning. Sentiment and topic trends were then correlated with daily change in new COVID-19 cases and inpatient bed utilization. RESULTS: A total of 3463 emergency physicians produced 334,747 unique English-language tweets during the study period. Out of 3463 participants, 910 (26.3%) stated that they were in training, and 466 of 902 (51.7%) participants who provided their gender identified as men. Overall tweet volume went from a pre-March 2020 mean of 481.9 (SD 72.7) daily tweets to a mean of 1065.5 (SD 257.3) daily tweets thereafter. Parameter and topic number tuning led to 20 tweet topics, with a topic coherence of 0.49. Except for a week in June and 4 days in November, discourse was dominated by the health care system (45,570/334,747, 13.6%). Discussion of pandemic response, epidemiology, and clinical care were jointly found to moderately correlate with COVID-19 hospital bed utilization (Pearson r=0.41), as was the occurrence of "covid," "coronavirus," or "pandemic" in tweet texts (r=0.47). Momentum in COVID-19 tweets, as demonstrated by a sustained crossing of 7- and 28-day moving averages, was found to have occurred on an average of 45.0 (SD 12.7) days before peak COVID-19 hospital bed utilization across the country and in the four most contributory states. CONCLUSIONS: COVID-19 Twitter discussion among emergency physicians correlates with and may precede the rising of hospital burden. This study, therefore, begins to depict the extent to which the ongoing pandemic has affected the field of emergency medicine discourse online and suggests a potential avenue for understanding predictors of surge.


Subject(s)
COVID-19/epidemiology , Communication , Emergency Medicine , Forecasting/methods , Hospitalization/statistics & numerical data , Hospitalization/trends , Physicians , Social Media/statistics & numerical data , COVID-19/diagnosis , COVID-19 Vaccines/administration & dosage , Humans , Latent Class Analysis , Longitudinal Studies , Pandemics , Retrospective Studies , SARS-CoV-2 , Vaccination/statistics & numerical data
19.
CJEM ; 23(5): 696-699, 2021 09.
Article in English | MEDLINE | ID: covidwho-1310620

ABSTRACT

Limited professional development training exists for chief residents. The available training uses in-person lectures and workshops at annual national conferences. The COVID-19 pandemic prevented most in-person gatherings in 2020, including pivotal onboarding and training events for new chief residents. However, for the last five years, Academic Life in Emergency Medicine's Chief Resident Incubator conducted year-long remote training programs, creating virtual communities of practice for chief residents in emergency medicine (EM). As prior leaders and alumni from the Incubator, we sought to respond to the limitations presented by the pandemic and create an onboarding event to provide foundational knowledge for incoming chief residents. We developed a half-day virtual conference, whereupon 219 EM chief residents enrolled. An effective professional development experience is feasible and scalable using online videoconferencing technologies, especially if constructed with content expertise, psychological safety, and production design in mind.


Subject(s)
COVID-19 , Emergency Medicine , Internship and Residency , Emergency Medicine/education , Humans , Pandemics , SARS-CoV-2
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