Point-of-Care Ultrasound in the Emergency Department: Training, Perceptions, Applications, and Barriers from Different Healthcare Professionals.

Background: Point-of-care ultrasound (POCUS) is a valuable tool that assists in diagnosis and management of patients in the emergency department (ED) while being cost-efficient and without the use of ionizing radiation. To discern the opinions and perceptions of ED staff about POCUS applications and barriers, we conducted a cross-sectional survey of employees of 12 EDs in North Texas. Methods: Participants completed a 20-item online survey about POCUS with questions pertaining to four domains: (1) employee and training information, (2) perceived benefits, (3) common applications, and (4) barriers to use. Out of 805 eligible ED employees, 103 completed the survey (16.1% response rate). Results: The results indicated a generally positive perception of POCUS among all employee types. Physician had significant exposure and training of POCUS than non-physician group ( p < 0.001). Physicians tend to find cardiac assessments more useful for clinical management than non-physicians (47% vs. 23%, p = 0.01), while non-physicians find soft tissue/abscess assessments more useful (27% vs. 9%, p = 0.01). Conclusion: The most significant barriers to POCUS use were time constraints for physicians and a lack of training for non-physician employees. Our study provides valuable insights into the perceptions of multiple ED professionals, serving as a foundation for promoting POCUS use in the ED.

The impact of the COVID-19 pandemic on ocular trauma in American infants and toddlers.

PURPOSE: To assess the impact of the COVID-19 pandemic on infant and toddler ocular trauma in the United States. METHODS: This retrospective analysis of ocular injury data for children ≤3 years of age focused on epidemiologic trends in pediatric ocular injuries in the United States caused by consumer products from 2017 to 2021 and compared differences between pre-pandemic (2017-2019) and pandemic (2020-2021) time periods. Data were collected from the US Consumer Product Safety Commission National Electronic Injury Surveillance System, which includes emergency department visits caused by consumer product-related injuries from a nationally representative sample of hospitals. RESULTS: The national-level estimate of ocular injuries in infants and toddlers was 51,250 (95% CI, 30471-72030). Most injuries occurred at home. We found a significant decline in the proportion of projectile ocular injuries from 0.89% (95% CI, 0.35-2.25) to 0.12% (95% CI, 0.03-0.45) (P = 0.037). The proportion of patients diagnosed with chemical-burn-related injuries increased significantly, from 23.34% (95% CI, 19.73-27.38) in the pre-pandemic period to 31.63% (95% CI, 26.98-36.69) in the pandemic period (P = 0.048), with 71.75% (95% CI, 65.25-77.46) due to cleaning products. After adjusting for confounding variables, the odds of sustaining a chemical-burn-related injury in the post-pandemic period were 1.51 times higher than in the pre-pandemic period (95% CI, 1.10-2.08). CONCLUSIONS: The proportion of children diagnosed with chemical-burn-related injuries increased significantly in the post-pandemic period, with a large portion due to cleaning products.

Healthcare lobbying and campaign finance activities of vision-related professional societies, 2015 to 2022.

Purpose: To compare the lobbying expenditures and political action committee (PAC) campaign finance activities of the American Academy of Ophthalmology (AAO), American Society of Cataract and Refractive Surgery (ASCRS), and American Optometric Association (AOA) from 2015 to 2022. Methods: Financial data were collected from the Federal Election Commission and OpenSecrets database. Analysis was performed to characterize and compare financial activity among the organizations. P < 0.05 was considered significant and all analyses were two-sided. Results: From 2015 to 2022, the AAO, ASCRS, and AOA spent $6,745,000, $5,354,406, and $13,335,000 on lobbying, respectively. The AOA's annual lobbying expenditure (median, $1,725,000) was significantly greater than AAO's ($842,500, P = 0.03) and ASCRS's ($694,289, P < 0.001). In PAC donations, OPHTHPAC, affiliated with AAO, received $3,221,737 from 2079 donors (median, $900); eyePAC, affiliated with ASCRS, received $506,255 from 349 donors ($500); and AOA-PAC received $6,642,588 from 3641 donors ($825). Compared to eyePAC, median donations to OPHTHPAC (P = 0.01) and AOA-PAC (P = 0.04) were significantly higher. In campaign spending, OPHTHPAC contributed $2,728,500 to 326 campaigns (median, $5000), eyePAC contributed $293,500 to 58 campaigns ($3000), and AOA-PAC contributed $5,128,673 to 617 campaigns ($5500). eyePAC's median campaign contribution was significantly lower than the AOA's (P < 0.001) and AAO's (P = 0.007). Every PAC directed most of its contributions toward Republican campaigns; eyePAC donated the highest proportion (64.9%). Conclusions: AOA was more assertive in shaping policy by increasing lobbying expenditures, fundraising, and donating to a greater number of election campaigns.

Forecasting Retirement in Pediatric Ophthalmology.

This cross-sectional study uses a forecasting model to assess the potential loss of pediatric ophthalmology care in the US due to potential ophthalmologist retirement.

Rapid lymphatic malformation expansion: Imaging, association with asymptomatic Streptococcus infection, multidisciplinary management, and therapeutic approach.

Lymphatic malformations are congenital anomalies of the lymphatic system that can occur anywhere in the body and typically present in early childhood. They are often painless, slow-growing, and asymptomatic, but may lead to a wide range of symptoms depending on their size and location. Rarely, congenital malformations may not be diagnosed until later in childhood or adolescence, despite being present from birth. In some individuals, lymphatic malformations can expand quickly, especially in the setting of an inflammatory process. We present the case of an 8-year-old boy who had a rapidly enlarging, nonpainful mass on his right neck and a positive streptococcus throat swab. After evaluation by multiple specialists and imaging studies, he was diagnosed with a multilocular, multicystic lymphatic malformation. He was treated with fluoroscopy-guided doxycycline sclerotherapy, and has had near total resolution of neck swelling. This case report is significant because it highlights the potential benefits of a multidisciplinary approach to the diagnosis and management of lymphatic malformations. Additionally, it emphasizes the importance of considering congenital malformations in the differential diagnosis of neck masses, even in older children. Finally, it also adds to the growing body of evidence that hypothesizes that strep throat infections may trigger the sudden expansion of previously asymptomatic congenital lymphatic malformations.

Point-of-Care Ultrasound in Airway Evaluation and Management: A Comprehensive Review.

Airway management is a common and critical procedure in acute settings, such as the Emergency Department (ED) or Intensive Care Unit (ICU) of hospitals. Many of the traditional physical examination methods have limitations in airway assessment. Point-of-care ultrasound (POCUS) has emerged as a promising tool for airway management due to its familiarity, accessibility, safety, and non-invasive nature. It can assist physicians in identifying relevant anatomy of the upper airway with objective measurements of airway parameters, and it can guide airway interventions with dynamic real-time images. To date, ultrasound has been considered highly accurate for assessment of the difficult airway, confirmation of proper endotracheal intubation, prediction of post-extubation laryngeal edema, and preparation for cricothyrotomy by identifying the cricothyroid membrane. This review aims to provide a comprehensive overview of the key evidence on the use of ultrasound in airway management. Databases including PubMed and Embase were systematically searched. A search strategy using a combination of the term "ultrasound" combined with several search terms, i.e., "probe", "anatomy", "difficult airway", "endotracheal intubation", "laryngeal edema", and "cricothyrotomy" was performed. In conclusion, POCUS is a valuable tool with multiple applications ranging from pre- and post-intubation management. Clinicians should consider using POCUS in conjunction with traditional exam techniques to manage the airway more efficiently in the acute setting.

Asset mapping score analysis: a novel public health research methodology applied to maternal and child health resources in New Orleans.

BACKGROUND: Asset mapping is a commonly used method in public health to identify and describe the resources within a community. However, there is currently a lack of standardization in the methods used for asset mapping, which can make it difficult for users to apply the method and compare results between different studies. In this article, we present a new approach called Asset Mapping Score Analysis (AMSA), which is a framework for collecting and organizing data on community assets. We provide an example of the AMSA method through its application in the evaluation of maternal and child health resources in New Orleans, Louisiana. RESULTS: The AMSA approach consists of five steps and results in a data collection tool that uses a scoring system to quantify the functional and content areas defined by the users. This method is flexible, reproducible, quantitative, inexpensive, and can be adapted to fit the needs of different geographic areas and fields of study. It can also be repeated over time to monitor changes in systems. We conducted a pilot study to examine the participation of local maternal and child health organizations in four functional areas (education, direct services, policy/advocacy, and research) and 22 content areas. CONCLUSIONS: In addition to describing the AMSA method and providing an example of its application, we also discuss the methodological issues involved in using the AMSA approach. These include considerations related to study design, data analysis, and interpreting results. We assess the strengths, limitations, and potential future directions of the AMSA method. Finally, we present the results of our AMSA study on maternal and child health organizations in New Orleans to illustrate the utility of this approach. Our findings suggest that the AMSA method is a valuable tool for understanding and characterizing the assets and resources within a community.

Clinical Characteristics of Patients Returning to Emergency Department With Initial False-Negative Reverse Transcriptase Polymerase Chain Reaction (RT-PCR)-Based COVID-19 Test.

Background: The coronavirus disease 2019 (COVID-19) outbreak is an international public health emergency. Early identification of COVID-19 patients with false-negative RT-PCR tests is paramount in the ED to prevent both nosocomial and community transmission. This study aimed to compare clinical characteristics of repeat emergency department (ED) visits among coronavirus disease 2019 (COVID-19) patients with initial false-negative reverse transcriptase-polymerase chain reaction (RT-PCR)-based COVID-19 test. Methods: This is a retrospective, multi-center, cohort study conducted at 12 hospitals affiliated with Baylor Scott & White Health system. Patients visiting the EDs of these hospitals between June and August 2020 were screened. Patients tested negative for viral RNA by quantitative RT-PCR in the first ED visit and positive in the second ED visit were included. The primary outcome was the comparison of clinical characteristics between two consecutive ED visits including the clinical symptoms, triage vital signs, laboratory, and chest X-ray (CXR) results. Results: A total of 88 confirmed COVID-19 patients with initial false-negative RT-PCR COVID-19 test in the ED were included in the final analyses. The mean duration of symptoms in the second ED visit was significantly higher (3.6 ± 0.4 vs. 2.6 ± 0.3 days, p = 0.020). In the first ED visit, lymphocytopenia (35.2%), fever (32.6%), nausea (29.5%), and dyspnea (27.9%) are the most common signs of COVID-19 infection during the window period. There were significant increases in the rate of hypoxia (13.6% vs. 4.6%, p = 0.005), abnormal infiltrate on CXR (59.7% vs. 25.9%, p < 0.001), and aspartate aminotransferase (AST) elevation (26.1% vs. 9.1%, p < 0.001) in the second ED visit. Conclusions: Early COVID-19 testing (less than 3 days of symptom duration) could be associated with a false-negative result. In this window period, lymphocytopenia, fever, nausea, and dyspnea are the most common early signs that can potentially be clinical hints for COVID-19 diagnosis.

A systematic review on methodological variation in acute:chronic workload research in elite male football players.

Objectives: To investigate and evaluate the methodological variation in research on acute:chronic workload ratio (ACWR) and injury in elite male football players.Methods: Relevant literature was electronically searched on PubMed, Web of Science, ScienceDirect, and Embase. Additional literature was obtained from studies' bibliographies and authors. Cohort studies investigating the effects of ACWR on male elite footballer injuries were included. Information regarding study population, time frame, protocol, injury classification, and statistical analysis were elucidated.Results: Database searches led to 2,689 articles. After full text screening, twelve articles remained. All studies were of poor quality. Five studies had GPS-derived workload measures with consideration of running intensity zones, though little consensus over zone thresholds were found. Nine studies incorporated rated perceived exertion data; heterogeneity in exposure type and data collection timing was observed. All studies applied rolling average ACWRs, exploring 1:2, 1:3, and 1:4-week load ratio windows. Differences in data grouping, inference or regression analysis, and other statistical methods were noted.Conclusion: Existing literature displayed methodological heterogeneity. Future studies should consider consulting guidelines for developing prognostic studies and further examine causal links between workload and injury. From that basis, decisions around ACWR definitions, workload measures, and statistical methods may be more appropriately made.

Heroin Use Is Associated with AA-Type Kidney Amyloidosis in the Pacific Northwest.

BACKGROUND AND OBJECTIVES: AA-type kidney amyloidosis is classically associated with chronic autoimmune or inflammatory disorders. However, some urban centers have reported a high prevalence of injection drug use among patients with kidney AA amyloidosis. Previous reports lack control groups to quantify associations and most predate the opioid epidemic in the United States. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a case-control study of 38 patients with biopsy-confirmed kidney AA amyloidosis and 72 matched control individuals without this condition from two large hospital systems in Seattle, Washington. We ascertained the pattern and duration of heroin use by medical chart review and determined associations using logistic regression. RESULTS: Among case patients, 95% had a prior history of heroin use, 87% had skin abscesses, and 76% and 27% had evidence of muscling and skin popping, respectively. After adjustment for age, race, sex, site, and year of biopsy, any heroin use (past or current) was associated with an estimated 170-times higher risk of kidney AA amyloidosis compared with no heroin use (95% confidence interval, 28 to 1018 times higher; P<0.001). Chronic autoimmune disorders were uncommon among case patients in this study. The median time to ESKD among patients with AA amyloidosis was 2.4 years (interquartile range, 0.5-7.5 years). CONCLUSIONS: Injection heroin use is strongly associated with kidney AA amyloidosis in the Pacific Northwest. Unique aspects of heroin use, in particular geographic regions or frequent associated soft-tissue infections, may be an important cause of this progressive kidney disease.