Feasibility of a Video Otoscope for Diagnosis of Otologic Pathology in the Pediatric Emergency Department.

OBJECTIVES: Performing pediatric otoscopy can be difficult secondary to patient compliance, which potentiates misdiagnosis and inaccurate treatment of acute otitis media. This study used a convenience sample to assess the feasibility of using a video otoscope for the examination of tympanic membranes in children presenting to a pediatric emergency department. METHODS: We obtained otoscopic videos using the JEDMED Horus + HD Video Otoscope. Participants were randomized to video or standard otoscopy, and a physician completed their bilateral ear examinations. In the video group, physicians reviewed otoscope videos with the patient's caregiver. The caregiver and physician completed separate surveys using a 5-point Likert Scale regarding perceptions of the otoscopic examination. A second physician reviewed each otoscopic video. RESULTS: We enrolled 213 participants in 2 groups (standard otoscopy, n = 94; video otoscopy, n = 119). We used Wilcoxon rank sum, Fisher exact test, and descriptive statistics to compare results across groups. For physicians, there were no statistically significant differences between groups with ease of device use, quality of otoscopic view, or diagnosis. There was moderate agreement between physician video otoscopic view satisfaction and slight agreement between physician video otologic diagnosis. Estimates of length of time to complete the ear examinations were longer more often for the video otoscope compared with standard for both caregivers (OR, 2.00; 95% confidence interval, 1.10-3.70; P = 0.02) and physicians (OR, 3.08; 95% confidence interval, 1.67-5.78; P < 0.01). There were no statistically significant differences between video and standard otoscopy with regard to caregiver perception of comfort, cooperation, satisfaction, or diagnosis understanding. CONCLUSIONS: Caregivers perceive that video otoscopy and standard otoscopy are comparable in comfort, cooperation, examination satisfaction, and diagnosis understanding. Physicians made a wider range of more subtle diagnoses with the video otoscope. However, examination length of time may limit the JEDMED Horus + HD Video Otoscope's feasibility in a busy pediatric emergency department.

Pediatric Emergency Medicine Fellow Training for Bedside Teaching: A National Survey of Pediatric Emergency Medicine Fellows and Program Directors.

Background The pediatric emergency department (PED) is a unique fast-paced learning environment. Most pediatric emergency medicine (PEM) physicians work in academic centers and therefore require specific bedside teaching skills to improve and enhance learners' experiences, yet there is no standardized training in bedside teaching for PEM fellows. We aimed to (1) evaluate whether PEM fellowship programs train their fellows to become bedside teachers through a dedicated curriculum and (2) determine how these programs measure curricular effectiveness. Methods In 2022, we developed and disseminated two separate electronic surveys to PEM fellows and PEM fellowship program directors (PDs) and associate program directors (APDs) through the American Academy of Pediatrics' Section of Emergency Medicine PEM PD Survey Committee. Results One-third of PEM fellows (32.7%, n=69/211) and PEM PDs/APDs (32.5%, n=26/80) completed the surveys. The majority of fellows (59.4%, n=41/69) and PDs/APDs (76.9%, n=20/26) reported that their programs did not have a formal bedside teaching curriculum. Of the respondents, 81.2% (n=56/69) of fellows and 100% of PDs/APDs believed that their programs prepared fellows to be bedside teachers (p-value=0.04). Most fellows (75.4%, n=52/69) expressed interest in working at an academic medical center, with 19.2% (n=10/52) feeling unprepared to be bedside teachers upon completion of the fellowship. Additionally, 19.2% (n=5/26) PDs/APDs, evaluated their bedside teaching curriculum effectiveness. In addition, the majority of fellows (60.9%, n=42/69) and PDs/APDs (61.5%, n=16/26) described clinical expectations and competing fellowship priorities, respectively, as major barriers to learning bedside teaching. Most PDs/APDs (53.8%, n=14/26) stated that they were uncertain on how to create a bedside teaching curriculum. Conclusions While the majority of PEM fellows plan to be academicians, where they will be expected to teach a variety of learners at the bedside, most PEM fellowship programs do not have dedicated bedside teaching curricula. There is a compelling need to investigate how to encourage and implement bedside teaching education into PEM fellowship curricula.

Pre-Learning Stress That Is Temporally Removed from Acquisition Impairs Fear Learning.

Few studies have examined the time-dependent effects of stress on fear learning. Previously, we found that stress immediately before fear conditioning enhanced fear learning. Here, we aimed to extend these findings by assessing the effects of stress 30 min prior to fear conditioning on fear learning and fear generalization. Two hundred and twenty-one healthy adults underwent stress (socially evaluated cold pressor test) or a control manipulation 30 min before completing differential fear conditioning in a fear-potentiated startle paradigm. One visual stimulus (CS+), but not another (CS-), was associated with an aversive airblast to the throat (US) during acquisition. The next day, participants were tested for their fear responses to the CS+, CS-, and several generalization stimuli. Stress impaired the acquisition of fear on Day 1 but had no significant impact on fear generalization. The stress-induced impairment of fear learning was particularly evident in participants who exhibited a robust cortisol response to the stressor. These findings are consistent with the notion that stress administered 30 min before learning impairs memory formation via corticosteroid-related mechanisms and may help us understand how fear memories are altered in stress-related psychological disorders.

Childhood Maltreatment in Females Is Associated with Enhanced Fear Acquisition and an Overgeneralization of Fear.

Childhood maltreatment may alter fear neurocircuitry, which results in pathological anxiety and depression. One alteration of fear-related behaviors that has been observed in several psychiatric populations is an overgeneralization of fear. Thus, we examined the association between childhood maltreatment and fear generalization in a non-clinical sample of young adults. Two hundred and ninety-one participants underwent differential fear conditioning in a fear-potentiated startle paradigm. One visual stimulus (CS+), but not another (CS-), was associated with an aversive airblast to the throat (US) during acquisition. The next day, participants were tested for their fear responses to the CS+, CS-, and several generalization stimuli (GS) without the presence of the US. Participants also completed questionnaires that assessed symptoms of childhood maltreatment, anxiety, depression, and post-traumatic stress disorder (PTSD). Participants reporting high childhood maltreatment (n = 71; 23 males, 48 females) exhibited significantly greater anxiety, depression, and symptoms of PTSD than participants reporting low childhood maltreatment (n = 220; 133 males, 87 females). Females reporting high childhood maltreatment demonstrated significantly enhanced fear learning and greater fear generalization, based on their fear-potentiated startle responses. Our findings suggest that childhood maltreatment may sex-dependently influence the development of fear neurocircuitry and result in greater fear generalization in maltreated females.