Voluntary wheel running promotes resilience to the behavioral effects of unpredictable chronic mild stress in male and female mice.

Besides significant benefits to physical health, exercise promotes mental health, reduces symptoms of mental illness, and enhances psychological development. Exercise can offset the impact of chronic stress, which is a major precursor to the development of mental disorders. The effects of exercise on chronic stress-induced behaviors are contradictory in preclinical studies, primarily due to the lack of data and sex-specific investigations. We sought to evaluate the effects of exercise on chronic stress-induced behavioral changes in both male and female mice. Mice were subjected to an Unpredictable Chronic Mild Stress (UCMS) paradigm with accessibility to running wheels for 2 h daily. Physiological and behavioral evaluations were conducted throughout the stress paradigm to determine if exercise blunts the effects of UCMS. Chronic stress induced voluntary wheel running (VWR) and weight loss in male and female mice. Compared to males, increased VWR was reported in females who also regained their weight lost by the end of the UCMS protocol. Exercise promoted resilience to stress-induced hyponeophagia in the novelty-suppressed feeding test and increased sucrose consumption. Exercise induced a sex-specific reduction in immobility and avoidance behavior in the tail suspension and open field tests and increased exploratory behavior in the light-dark test. These results indicate that exercise can promote resilience to the behavioral effects of chronic stress in males and females, and can affect behavior independent of chronic stress.

eFAST exam errors at a level 1 trauma center: A retrospective cohort study.

OBJECTIVES: Extended Focused Assessment with Sonography for Trauma (eFAST) ultrasound exams are central to the care of the unstable trauma patient. We examined six years of eFAST quality assurance data to identify the most common reasons for false positive and false negative eFAST exams. METHODS: This was an observational, retrospective cohort study of trauma activation patients evaluated in an urban, academic Level 1 trauma center. All eFAST exams that were identified as false positive or false negative exams compared with computed tomography (CT) imaging were included. RESULTS: 4860 eFAST exams were performed on trauma patients. 1450 (29.8%) were undocumented, technically limited, or incomplete (missing images). Of the 3410 remaining exams, 180 (5.27%) were true positive and 3128 (91.7%) were true negative. 27 (0.79%) exams were identified as false positive and 75 (2.19%) were identified as false negative. Of the false positive scans, 7 had no CT scan and 8 had correct real-time trauma paper documentation of eFAST exam results when compared to CT and were excluded, leaving 12 false positive scans. Of the false negative scans, 11 were excluded for concordant documentation in real-time trauma room paper documentation, 20 were excluded for no CT scan, and 2 were excluded as incomplete, leaving 42 false negative scans. Pelvic fluid, double-line sign, pericardial fat pad, and the thoracic portion of the eFAST exam were the most common source of errors. CONCLUSION: The eFAST exams in trauma activation patients are highly accurate. Unfortunately poor documentation and technically limited/incomplete studies represent 29.8% of our eFAST exams. Pelvic fluid, double-line sign, pericardial fat pad, and the thoracic portion of the eFAST exam are the most common source of errors.

Point of care ultrasound and ocular injuries: A case of lens dislocation and a comprehensive review of the literature.

Point-of-care ultrasound (POCUS) can help the clinician diagnose different ocular pathologies including retinal detachment, vitreous detachment, lens dislocation, and intraocular foreign bodies. Ocular pathologies such as blurry vision, double vision, loss of vision, and eye trauma are common chief complaints and require a comprehensive evaluation in order to determine the etiology and choose the correct treatment. Specifically ultrasound can help the clinician decide whether an urgent ophthalmology consult is appropriate. We present a case in which a lens dislocation was diagnosed using POCUS and review the available literature.

Learner-centered Survey of Point-of-care Ultrasound Training, Competence, and Implementation Barriers in Emergency Medicine Training Programs in India.

BACKGROUND: Point-of-care ultrasound (POCUS) is important to the practice of emergency medicine (EM), but requires training to achieve competence. The purpose of this study was to describe the current state of POCUS practice and perceived barriers to the implementation in EM training programs in India. METHODS: A cross-sectional survey consisting of 28 questions was administered to 378 faculty and residents in postgraduate EM training programs across India. RESULTS: Data were collected from 159 physicians from 16 institutions; 76% of them were EM residents, with a response rate of 42%. Respondents overwhelmingly reported high interest (91%) in learning POCUS topics. Respondents identified highest levels of comfort with the performance and interpretation of trauma ultrasound (US) and echocardiography. Conversely, there was a scarce interest and low levels of competence in performing obstetric US, which may be a result of the practice of triaging these complaints to obstetricians and gynecologists. Lack of US equipment and dedicated training were the highest rated barriers by a significant margin, which 56% of respondents ranked as "very important." CONCLUSIONS: While significant interest in POCUS exists among the Indian EM physicians, comfort and competence were limited to trauma and echocardiography applications. Expansion of and comfort with POCUS use in these settings may be sought through improvement of access to US equipment and a dedicated US curriculum.

Optic Nerve Sheath Diameter Measured by Point-of-Care Ultrasound and MRI.

BACKGROUND AND PURPOSE: Ultrasound (US) measurement of the optic nerve sheath diameter (ONSD) and optic nerve diameter (OND) is a method frequently used to screen for an increased intracranial pressure. The aim of this study was to assess the accuracy of US measurements of ONSD and OND, when compared to magnetic resonance imaging (MRI) measurements as the criterion standard. METHODS: In this prospective, single-institution study, orbital US was performed for those patients requiring an emergent brain MRI. ONSD and OND of both eyes were measured in the axial and coronal planes in straight gaze by US. ONSD and OND from brain and orbital MRI were measured by two neuroradiologists. Correlation and agreement between readings were assessed using Pearson's correlations. RESULTS: Eighty-two patients met inclusion criteria. The mean axial and coronal ONSD in the MRI examinations was 5.6 and 5.7 mm at 3-5.9 mm behind the globe, respectively. The mean ONSD from the US measurements was 6.22 and 5.52 mm in the axial and coronal planes, respectively. The mean OND in US examinations was 4.31 mm (axial) and 3.68 mm (coronal). Axial versus coronal measurements of ONSD had a modest correlation in US assessment with an r2 of .385 (P < .001) but there were no correlations between any of the US and MRI measurements. CONCLUSIONS: In measuring ONSD and OND, US measurements showed a modest correlation between axial and coronal measurements, but no concordance was found between US and MRI in our setting.

Utility of point-of-care ultrasound in patients with suspected diverticulitis in the emergency department.

In emergency department (ED) cases with clinically suspected diverticulitis, diagnostic imaging is often needed for diagnostic confirmation, to exclude complications, and to direct patient management. Patients typically undergo a CT scan in the ED; however, in a subset of cases with suspected diverticulitis, point-of-care ultrasound (POCUS) may provide sufficient data to confirm the diagnosis and ascertain a safe plan for outpatient management.We review the main sonographic features of diverticulitis and discuss the diagnostic accuracy and potential benefits of a POCUS First model.

Point-of-Care Ultrasound for the Detection of Hip Effusion and Septic Arthritis in Adult Patients With Hip Pain and Negative Initial Imaging.

BACKGROUND: Acute or recurrent hip pain in adults can be a challenging presentation in the emergency department. While ultrasound is routinely used in the evaluation of pediatric patients with hip pain and a new limp, it is not commonly used for this purpose in adult emergency medicine. This case series demonstrates the clinical utility of point-of-care ultrasound (POCUS) in adult patients with acute or recurrent hip pain because performance of POCUS was the critical action that led to the identification of pathologic hip effusions in this series of adults. CASE SERIES: This case series includes 5 patients in whom clinical suspicion existed for the presence of a hip effusion and possible septic arthritis, despite nondiagnostic radiographic findings. Ultrasound was used to detect the effusion and guide subsequent arthrocentesis, imaging, or surgical intervention. In all patients, computed tomography scans or magnetic resonance imaging scans were later used to confirm the presence of effusion. In all 5 patients (2 women and 3 men, with a mean age of 47.4 years), POCUS accurately detected the presence of hip effusion. Two of 5 synovial collections were caused by septic arthritis as confirmed by synovial fluid microbiologic examination. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case series emphasizes the clinical utility of POCUS in adult patients with acute and recurrent hip pain to detect a hip effusion, particularly in patients with significant risk factors for septic arthritis. POCUS can also be used to guide further imaging, arthrocentesis, surgical consultation, and intervention.

Point-of-care Transperineal Ultrasound to Diagnose Abscess in the Emergency Department.

Perineal and rectal pain are common presentations in the emergency department (ED). In the majority of cases, clinical examination is sufficient to detect local anorectal pathologies. However, perianal and rectal abscesses and fistulas are often the primary concerns prompting diagnostic imaging in the ED. Currently, computed tomography is the preferred imaging modality. Recently, transperineal ultrasound has emerged as an optimal imaging modality for the diagnosis of perineal and perianal abscesses. We present a case in which point-of-care ultrasound accurately detected an intersphincteric abscess, and review the appropriate ultrasound technique to evaluate patients with suspected perianal and rectal abscesses.

The utility of point-of-care ultrasound in the assessment of volume status in acute and critically ill patients.

BACKGROUND: Volume resuscitation has only been demonstrated to be effective in approximately fifty percent of patients. The remaining patients do not respond to volume resuscitation and may even develop adverse outcomes (such as acute pulmonary edema necessitating endotracheal intubation). We believe that point-of-care ultrasound is an excellent modality by which to adequately predict which patients may benefit from volume resuscitation. DATA RESOURCES: We performed a search using PubMed, Scopus, and MEDLINE. The following search terms were used: fluid responsiveness, ultrasound, non-invasive, hemodynamic, fluid challenge, and passive leg raise. Preference was given to clinical trials and review articles that were most relevant to the topic of assessing a patient's cardiovascular ability to respond to intravenous fluid administration using ultrasound. RESULTS: Point-of-care ultrasound can be easily employed to measure the diameter and collapsibility of various large vessels including the inferior vena cava, common carotid artery, subclavian vein, internal jugular vein, and femoral vein. Such parameters are closely related to dynamic measures of fluid responsiveness and can be used by providers to help guide fluid resuscitation in critically ill patients. CONCLUSION: Ultrasound in combination with passive leg raise is a non-invasive, cost- and time-effective modality that can be employed to assess volume status and response to fluid resuscitation. Traditionally sonographic studies have focused on the evaluation of large veins such as the inferior vena cava, and internal jugular vein. A number of recently published studies also demonstrate the usefulness of evaluating large arteries to predict volume status.

Using an alumni survey to target improvements in an emergency medicine training programme.

INTRODUCTION: The Accreditation Council for Graduate Medical Education (ACGME) is the governing body responsible for accrediting graduate medical training programme in the USA. The Emergency Medicine Milestones (EM-Milestones) were developed by the ACGME and American Board of Emergency Medicine as a guide and monitoring tool for the knowledge, skills, abilities and experiences to be acquired during training. Alumni surveys have been reported as a valuable resource for training programme to identify areas for improvement; however, there are few studies regarding programme improvement in emergency medicine. We aimed to use the EM-Milestones, adapted as an alumni self-assessment survey, to identify areas for training programme improvement. METHODS: This study was conducted at an urban, academic affiliated, community hospital in New York city with an emergency medicine training programme consisting of 30 residents over 3 years. Alumni of our emergency medicine training programme were sent an EM-Milestones-based self-assessment survey. Participants evaluated their ability in each EM-Milestones subcompetency on a Likert scale. Data were analysed using descriptive statistics. RESULTS: Response rate was 74% (69/93). Alumni reported achieving the target performance in 5/6 general competencies, with Systems-Based Practice falling below the target performance. The survey further identified 6/23 subcompetencies (Pharmacotherapy, Ultrasound, Wound Management, Patient Safety, Systems-Based Management and Technology) falling below the target performance level. DISCUSSION: Alumni self-evaluation of competence using the EM-Milestones provides valuable information concerning confidence to practice independently; these data, coupled with regular milestone evaluation of existing trainees, can identify problem areas and provide a blueprint for targeted programme improvement.

Focused Board Intervention (FBI): A Remediation Program for Written Board Preparation and the Medical Knowledge Core Competency.

BACKGROUND: Residents deemed at risk for low performance on standardized examinations require focused attention and remediation. OBJECTIVE: To determine whether a remediation program for residents identified as at risk for failure on the Emergency Medicine (EM) Written Board Examination is associated with improved outcomes. INTERVENTION: All residents in 8 classes of an EM 1-3 program were assessed using the In-Training Examination. Residents enrolled in the Focused Board Intervention (FBI) remediation program based on an absolute score on the EM 3 examination of <70% or a score more than 1 SD below the national mean on the EM 1 or 2 examination. Individualized education plans (IEPs) were created for residents in the FBI program, combining self-study audio review lectures with short-answer examinations. The association between first-time pass rate for the American Board of Emergency Medicine (ABEM) Written Qualifying Examination (WQE) and completion of all IEPs was examined using the χ(2) test. RESULTS: Of the 64 residents graduating and sitting for the ABEM examination between 2000 and 2008, 26 (41%) were eligible for the program. Of these, 10 (38%) residents were compliant and had a first-time pass rate of 100%. The control group (12 residents who matched criteria but graduated before the FBI program was in place and 4 who were enrolled but failed to complete the program) had a 44% pass rate (7 of 16), which was significantly lower (χ(2)  =  8.6, P  =  .003). CONCLUSIONS: The probability of passing the ABEM WQE on the first attempt was improved through the completion of a structured IEP.