A novel emergency medicine cultural competency curriculum addressing health care disparities.

Background: Effective cultural competency (CC) training for future health professionals is an important first step towards improving healthcare disparities (HCD). The Accreditation Council for Graduate Medical Education (ACGME) now requires that institutions train residents and faculty members in CC relevant to the patient population they serve. Methods: Using Kern's Model, we created and implemented a novel CC curriculum tailored to specific program needs in an emergency medicine residency program. Results: At the end of the curriculum, respondents reported having a better understanding of the importance of CC for their practice (p = 0.004) and of how a patient's personal and historical context affects treatment (p = 0.002). They also reported an increase in the frequency of practicing strategies to reduce bias in themselves (p < 0.001) and others (p < 0.001), as well as comfort interacting with and treating patients from different backgrounds (p < 0.001). Lastly, they reported improved preparedness to collaborate with communities to address HCD (p = 0.004) and to identify community leaders to do so (p < 0.001). Conclusions: The challenges of CC training demonstrate the need for a standard yet adaptable framework. We have designed, implemented, and evaluated a novel curriculum tailored to the specific needs of our EM residency program. The curriculum improved participants' attitudes, preparedness, and self-reported behaviors regarding CC and HCD. This framework represents an example of a successful model to meet ACGME requirements.

Implementation of a standardized pregnancy screening process to address gender disparities in radiology turn-around-time and ED length of stay.

OBJECTIVE: The objective of this initiative was to quantify and intervene upon suspected gender disparities in CT turn-around-time and emergency department (ED) length of stay. METHODS: This was a single-site before-after quality improvement initiative including patients aged 12-50 who underwent CT chest and/or abdomen/pelvis. The intervention included protocolization of the pregnancy screening process in triage. Primary outcomes included the difference between women of childbearing age and similarly aged men in regards to CT turn-around-time and ED length of stay. Pre- and post-intervention data were analyzed, including an "intensive intervention period" subanalysis. RESULTS: CT turn-around-time for women of childbearing age was 19 min longer than for similarly aged men at baseline and did not change significantly post-intervention. ED length of stay was 27 min longer for women of childbearing age compared to similarly aged men at baseline and 7 min longer post-intervention, although this was still a significant difference. During the intensive intervention period, CT turn-around-time for women of childbearing age was 15 min longer than similarly aged men but the difference in ED length of stay of 10 min was no longer significant. CONCLUSIONS: There is gender disparity in CT turn-around-time and ED length of stay in our ED, highlighting an important area for improvement to promote equitable care. A quality improvement initiative that aimed to protocolize pregnancy testing in triage did not show sustainable improvement in these outcomes but did result in increased pregnancy testing.

RéSUMé: OBJECTIF: L'objectif de cette initiative était de quantifier et d'intervenir sur les disparités présumées entre les sexes dans le délai d'exécution du scanner et la durée du séjour au service des urgences. MéTHODES: Il s'agissait d'une initiative d'amélioration de la qualité à un seul site avant-après, incluant les patients âgés de 12 à 50 ans qui ont subi une TDM thoracique et/ou abdominale/bassin. L'intervention comprenait la protocolisation du processus de dépistage de la grossesse lors du triage. Les résultats primaires comprenaient la différence entre les femmes en âge de procréer et les hommes du même âge en ce qui concerne le délai d'exécution du scanner et la durée du séjour aux urgences. Les données avant et après l'intervention ont été analysées, y compris une sous-analyse de la "période d'intervention intensive". RéSULTATS: Le temps d'exécution de la TDM chez les femmes en âge de procréer était 19 minutes de plus que chez les hommes de même âge au départ et n'a pas changé de façon significative après l'intervention. La durée de séjour aux urgences était de 27 minutes de plus pour les femmes en âge de procréer par rapport aux hommes du même âge au départ et de 7 minutes de plus après l'intervention, bien que cette différence reste significative. Au cours de la période d'intervention intensive, le temps de passage au scanner des femmes en âge de procréer était de 15 minutes plus long que celui des hommes du même âge, mais la différence de 10 minutes dans la durée de séjour aux urgences n'était plus significative. CONCLUSIONS: Il existe une disparité entre les sexes en ce qui concerne le délai d'exécution du scanner et la durée de séjour dans nos urgences, ce qui met en évidence un domaine important à améliorer pour promouvoir des soins équitables. Une initiative d'amélioration de la qualité visant à protocoliser le test de grossesse au triage n'a pas montré d'amélioration durable de ces résultats mais a entraîné une augmentation des tests de grossesse.

A User's Guide to the ALiEM Emergency Medicine Match Advice Web Series.

ALiEM EM Match Advice is a web series hosted on the Academic Life in Emergency Medicine website. The intended audience includes senior medical students seeking a residency in emergency medicine (EM) and the faculty members who advise them. Each episode features a panel of three EM program directors who discuss a critical step in the residency application process. This article serves as a user's guide to the series, including a timeline for viewing each episode, brief summaries of the panel discussions, and reflection questions for discussion between students and their faculty advisors.

IL28B genotype does not correlate with HIV control in African Americans.

BACKGROUND: HIV-1 natural viral suppressors (NVS) are individuals that control HIV replication without antiretrovirals (also know as HIV elite controllers). We have recently shown that these individuals have an elevated rate of hepatitis C virus (HCV) clearance. Given the association of IL28B genotype, specifically the rs12979860 single nucleotide polymorphism (SNP) based CC genotype, with HCV clearance, we studied its association with HIV control in 172 African American HIV subjects and 173 race-matched controls. FINDINGS: The frequency of the CC genotype was 12.5% in the NVS, 14.7% in the LVL ("low viral load" cohort with 400-20,000 HIV-1 RNA copies/mL), 17.8% in the MHVL ("medium/high viral load" cohort with >20,000 HIV-1 RNA copies/mL), and 11.6% in an HIV-negative cohort. There was no statistical significance in the CC genotype distribution between these cohorts (p= 0.48 between the NVS and non-NVS HIV positive controls, p= 0.85 between NVS and HIV-negatives). We also did not observe any association between CC genotype distribution and HIV RNA viral load, as a continuous measure. CONCLUSIONS: The IL28B CC genotype does not account for the noted HIV control in our specific NVS cohort. Further studies will be needed to determine if a common genetic factor can primarily account for any joint clearance of HCV and control of HIV.

Hepatitis C infection in HIV-1 natural viral suppressors.

OBJECTIVE: HIV-1 natural viral suppressors (NVSs) demonstrate an intrinsic ability to control HIV-1 replication in the absence of antiretroviral therapy. The objective of this study was to investigate whether HIV-infected NVSs also demonstrate enhanced ability to control hepatitis C virus (HCV) infection, and whether HCV infection in the NVSs affects the degree of HIV control. DESIGN AND METHODS: A cross-sectional study was undertaken to compare HCV-related parameters in the NVS to the two race-matched cohorts (HIV/HCV-coinfected or HCV-monoinfected patients). Within the NVS, HIV-related parameters were compared based on the presence or absence of chronic HCV. RESULTS: NVS patients had a significantly higher clearance rate of HCV at 23.3% (seven of 30), compared to the 6.5% (23 of 350) of HIV/HCV-coinfected and 9.1% (32 of 350) of HCV-monoinfected patients (P = 0.005 and P = 0.024, respectively). Apart from the HCV clearance rate, there was no significant difference in HCV-related parameters such as HCV viral load or liver histology in the NVS with chronic HCV compared to HCV/HIV-coinfected patients or HCV-monoinfected patients. However, NVS patients with chronic HCV infection had statistically significant lower CD4 cell count and CD4%, and lower CD4/CD8 ratio compared to those NVSs without chronic HCV infection (P = 0.029, P = 0.046, and P = 0.062, respectively). CONCLUSION: It appears that some NVS patients have the ability to effectively control multiple agents that can cause chronic viral infections. In addition, it appears that the presence of chronic HCV infection within the NVS adversely affects immunological parameters.