The COVID-19 impact on STEMI disparities.

ST-segment elevation myocardial infarction (STEMI) is a significant source of morbidity and mortality. Despite guideline-driven management and increased awareness of social determinants of health, there are persistent disparities in diagnosis, management, and outcomes. The coronavirus disease 2019 (COVID-19) pandemic has greatly affected emergency department visitation, conditions and throughput. The aim of this study was to find any potential health disparities in patients who presented with STEMI during the COVID-19 pandemic by reviewing STEMI care data from April to September 2019 (pre-pandemic) and April to September 2020 (during the pandemic) for our hospital system. Patients with STEMI within 12 h of presentation were included in this study, and subdivided by age, gender, and race/ethnicity. We compared the turnaround times between emergency department arrival to intervention (electrocardiogram or catheterization) within the patient subgroups to find any notable differences. No statistically significant changes in turnaround times during either study period were found based on age, gender, or race/ethnicity for the STEMI interventions despite shifts in emergency department resources during the pandemic. This study helped assess the status quo in STEMI intervention for our health system and serves as a baseline for us to monitor gaps in care or areas of improvement. As healthcare systems institute new measures to promote equitable care, such as improving the accuracy of demographic data capture, establishing a baseline is an essential first step in evaluating the impact of these measures.

The Prevalence and Distribution of Osteopathic Chief Residents in Emergency Medicine.

Background The chief resident position fulfills important administrative and educational functions for emergency medicine (EM) residency programs and has been associated with advanced academic and career opportunities. This study seeks to determine the prevalence and distribution of Doctor of Osteopathic Medicine (D.O.) and allopathic Doctor of Medicine (M.D.) degrees among chief residents within EM residencies. Methodology EM residency program websites, affiliated social media accounts on X (formerly Twitter) and Instagram, and program coordinator surveys were used to collect data, including the number of current residents, chief residents, and the listed medical degrees for residents and program directors during the 2021-2022 and 2022-2023 academic years. A Pearson's chi-square test was used to compare the number of residents, chief residents, and program directors by medical degree. Results A total of 188/229 (82.1%) and 201/229 (87.8%) eligible EM residencies identified their current chief residents and the medical degrees of their residents for the academic year 2021-2022 and 2022-2023, respectively. Of 14,487 EM residents included during the study period, 3,676 (25.4%) were D.O.s, and of the 1,230 chief residents identified, 362 (29.4%) were D.O.s. Conclusions The proportion of D.O. chief residents was higher than the proportion of D.O. residents within EM residencies. However, osteopathic residents were asymmetrically distributed across programs and were most likely to serve as chief residents at programs with a higher proportion of D.O. trainees and at programs with osteopathic program directors.

RESIDENTS AS INTERVIEWERS: A COMPARISON OF RESIDENT AND FACULTY EVALUATIONS OF EMERGENCY MEDICINE RESIDENCY APPLICANTS.

BACKGROUND: Interviews are an integral component of the residency selection process. Many programs use current residents as interviewers in addition to faculty. Although the reliability of interview scores between faculty members has been examined, little is known about the reliability between resident and faculty interviewers. OBJECTIVE: This study evaluates the reliability of residents as interviewers compared with faculty. METHODS: A retrospective analysis of interview scores from the 2020-2021 application cycle was performed at an emergency medicine (EM) residency program. Each applicant participated in five separate one-on-one interviews led by four faculty members and one senior resident. Interviewers assigned applicants a score from 0 to 10. Consistency between interviewers was measured using the intraclass correlation coefficient (ICC). Generalizability theory was used to measure variance components including applicant, interviewer, and rater type (resident vs. faculty) and their impact on scoring. RESULTS: There were 250 applicants interviewed by 16 faculty members and 7 senior residents during the application cycle. The mean (SD) interview score given by resident interviewers was 7.10 (1.53) and the mean (SD) score given by faculty was 7.07 (1.69). There was no statistically significant difference between the pooled scores (p = 0.97). Reliability between interviewers was good to excellent (ICC = 0.90; 95% CI 0.88-0.92). The generalizability study showed most score variance was attributable to applicant characteristics and only 0.6% was attributable to interviewer or rater type (resident vs. faculty). CONCLUSIONS: There was strong concordance between faculty and resident interview scores indicating reliability of EM resident scoring compared to faculty.

A primer on proning in the emergency department.

Historically, the prone position was used almost exclusively in the ICU for patients suffering from refractory hypoxemia due to acute respiratory distress syndrome (ARDS). Amidst the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, however, this technique has been increasingly utilized in settings outside of the ICU, particularly in the emergency department. With emerging evidence that patients diagnosed with COVID-19 who are not intubated and mechanically ventilated may benefit from the prone position, this strategy should not be isolated to only those with critical illness. This is a review of the pertinent physiology and evidence supporting prone positioning along with a step-by-step guide meant to familiarize those who are not already comfortable with the maneuver. Placing a patient in the prone position helps to improve ventilation-perfusion matching, dorsal lung recruitment, and ultimately gas exchange. Evidence also suggests there is improved oxygenation in both mechanically ventilated patients and those who are awake and spontaneously breathing, further reinforcing the utility of the prone position in non-ICU settings. Given present concerns about resource limitations because of the pandemic, prone positioning has especially demonstrable value as a technique to delay or even prevent intubation. Patients who are able to self-prone should be directed into the ''swimmer's position'' and then placed in reverse Trendelenburg position if further oxygenation is needed. If a mechanically ventilated patient is to be placed in the prone position, specific precautions should be taken to ensure the patient's safety and to prevent any unwanted sequelae of prone positioning.

Effect of positive urine fentanyl screen on attitudes toward heroin use.

BACKGROUND: It is unknown if targeted risk reduction counseling in the health care setting, after documented exposure to fentanyl, can affect behavior change to reduce risks and increase utilization of evidence-based overdose prevention strategies. METHODS: We conducted a retrospective analysis of results (7/2018-6/2019) from questionnaire-facilitated counseling by recovery coaches in the emergency department (ED) and primary care settings following disclosure of a urine toxicology positive for fentanyl. RESULTS: Seventy-five percent of N = 101 respondents were neither aware of nor expecting fentanyl in their substances of use. Fifty-three (70 %) of those initially unaware answered that learning about exposure to and the risks from fentanyl changed their thoughts about reducing or abstaining from use. A greater proportion of patients seen in the ED expressed desire to stop or reduce opioid use as compared to ambulatory clinic patients (91 % vs. 46 %, p < 0.001). Of those not already engaged in treatment, 18 % and 15 % were interested in medication and behavioural health treatment, respectively, and each of them indicated a change in thought based on the counseling. Forty-five percent of individuals not yet receiving naloxone endorsed interest in receiving it, and 22 % of all respondents were somewhat or very interested in access to safe consumption sites. CONCLUSION: This study suggests a novel clinical utility in toxicology screens to inform behavior in the setting of illicit fentanyl exposure. In addition to linkages to evidence-based treatment, linkages to harm-mitigating strategies associated with ongoing substance use may be critical to a comprehensive overdose prevention strategy in the clinical setting.