Developing capacity for the American Indian health professional workforce: an academic-community partnership in Spirit Lake, North Dakota.

BACKGROUND: American Indians/Alaskan Native (AIAN) populations experience significant disparities in health when compared to the average US population who are under-represented in the health care professional workforce. Current research suggests that racial concordance between patients and providers has a positive effect on patient care. OBJECTIVE: We describe a successful academic-community partnership between a tribal college, a local state academic center, an urban public health institution, and an urban academic center all aligned with the goal to increase AIAN health care professional capacity. METHODS: A tribal college course and youth education program were developed with the intent to expose AIAN youth to the health care professions and encourage entry into health professional career tracks. Evaluation using a pre- and post-survey design is underway to assess the impact of the intervention on participating AIAN attitudes and career intentions. CONCLUSION: We believe this model is one way of addressing the need for an increased AIAN health care professional career force.

Atrial fibrillation: management strategies in the emergency department.

Atrial fibrillation and atrial flutter are the most common dysrhythmias seen in the emergency department. As the aging population continues to grow, atrial fibrillation and atrial flutter are expected to affect 6 million people by 2050. This will lead to an increase in emergency department visits for symptoms from the disease itself or its complications, such as heart failure or thromboembolic disease. This review examines the recent literature on the diagnosis and management of atrial fibrillation. Evidence-based recommendations are provided, including cost-effective strategies to evaluate new-onset arrhythmias and unstable patients with atrial fibrillation, rate control strategies, the use of medical and direct current cardioversion for new-onset atrial fibrillation/atrial flutter, whom and when to anticoagulate, and the use of the novel anticoagulation agents.

Evidence-based guidelines for evaluation and antimicrobial therapy for common emergency department infections.

Infections are among the most common diagnoses in the emergency department (ED), and antibiotics are among the most frequently prescribed drugs. Community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP) are frequently encountered in the ED, and pneumonia is the seventh leading cause of death in the United States. Cystitis, pyelonephritis, and complicated urinary tract infection (UTI) are often treated in the ED, with UTI being one of the most common reasons for healthy young women to require antimicrobial treatment. Intra-abdominal infections have an incidence of 3.5 million cases per year in the United States, and emergency clinicians must make complex decisions regarding appropriate evaluation and management. Skin and soft-tissue infections (SSTIs) are common, their incidence in the ED has been rising, and the emergence of methicillin-resistant Staphylococcus aureus (MRSA) infection has altered their management. Timely diagnosis and management of infectious disease, including proper antimicrobial treatment, is an important goal of emergency care. This issue of Emergency Medicine Practice reviews the available evidence and consensus guidelines for the management of common infectious diseases presenting to the ED and presents recommendations for treatment.