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Applied Longitudinal Data Analysis Modeling Change And Event Occurrence

BIOMEDICAL RESEARCH POLICY COMMITTEE REPORT WAS PUBLISHED AS A SUPPLEMENT TO THE AUGUSTJOURNAL OF MEDICAL EDUCATION. A REPRINT IS ENCLOSED. REQUESTS FOR ADDITIONAL COPIES SHOULD BE ADDRESSED TO THISOFFICE. -COPIES ARE BEING SENT TO MEMBERS OF CONGRESS AND THE KEY MEMBERS OF THE ADMINISTRATION. CALLING UPON-YOUR SENATORSAND CONGRESSMEN TO TELL THE STORY OF THE ROLE. OF MEDICAL SCHOOLS IN BIOMEDICAL RESEARCH AND HEALTH CARE IS IMPORTANT.I STRONGLY URGE THAT YOU MAKE AN 411 APPOINTMENT TO SEE YOUR CONGRESSIONAL REPRESENTATIVES WHILE YOU ARE IN WASHINGTON FOR THE COUNCIL MEETINGON OCTOBER 29. UPON REQUEST WE CAN SUPPLY THE NAMES OF APPOINTMENT SECRETARIES AND PHONE NUMBERS OF YOUR SENATORS AND CONGRESSMEN. APPROPRIATIONS COMMITTEE ACTED WITH EXTRAORDINARY ALACRITY THIS YEAR. THE-NIH APPROPRIATION WAS INCREASED BY 242 MILLION DOLLARSOVER 1971, REPRESENTING A 142 MILLION DOLLAR INCREASE OVER. THE ADMINISTRATION BUDGET, THE BLUE SHEET ASCRIBES APPROPRIATIONS OUTCOME TO THE EFFECTIVENESS OF THE COALITION FOR HEALTH FUNDING UNDER THE LEADERSHIP OF JOHN A. D. COOPER.

The Association of American Medical Colleges

Background— Quality cardiopulmonary resuscitation contributes to cardiac arrest survival. The proportion of time in which chest compressions are performed in each minute of cardiopulmonary resuscit...

/pdf/chest-compression-fraction-determines-survival-in-patients-6l6jk9zdpu.pdf

Chest Compression Fraction Determines Survival in Patients With Out-of-Hospital Ventricular Fibrillation

McKenney, S. (2012, 4-5 September). What is educational design research? Invited lecture for the Crossfield Graduate School at the University of St. Gallen, St. Gallen, Switzerland.

What is educational design research

Background—Functionally favorable survival remains low after out-of-hospital cardiac arrest. When initial interventions fail to achieve the return of spontaneous circulation, they are repeated with little incremental benefit. Patients without rapid return of spontaneous circulation do not typically survive with good functional outcome. Novel approaches to out-of-hospital cardiac arrest have yielded functionally favorable survival in patients for whom traditional measures had failed, but the optimal transition point from traditional measures to novel therapies is ill defined. Our objective was to estimate the dynamic probability of survival and functional recovery as a function of resuscitation effort duration to identify this transition point. Methods and Results—Retrospective cohort study of a cardiac arrest database at a single site. We included 1014 adult (≥18 years) patients experiencing nontraumatic out-of-hospital cardiac arrest between 2005 and 2011, defined as receiving cardiopulmonary resuscitati...

Duration of Resuscitation Efforts and Functional Outcome After Out-of-Hospital Cardiac Arrest When Should We Change to Novel Therapies?

The science of surveillance is rapidly evolving due to changes in public health information and preparedness as national security issues, new information technologies and health reform. As the Emergency Department has become a much more utilized venue for acute care, it has also become a more attractive data source for disease surveillance. In recent years, influenza surveillance from the Emergency Department has increased in scope and breadth and has resulted in innovative and increasingly accepted methods of surveillance for influenza and influenza-like-illness (ILI). We undertook a systematic review of published Emergency Department-based influenza and ILI syndromic surveillance systems. A PubMed search using the keywords “syndromic”, “surveillance”, “influenza” and “emergency” was performed. Manuscripts were included in the analysis if they described (1) data from an Emergency Department (2) surveillance of influenza or ILI and (3) syndromic or clinical data. Meeting abstracts were excluded. The references of included manuscripts were examined for additional studies. A total of 38 manuscripts met the inclusion criteria, describing 24 discrete syndromic surveillance systems. Emergency Department-based influenza syndromic surveillance has been described worldwide. A wide variety of clinical data was used for surveillance, including chief complaint/presentation, preliminary or discharge diagnosis, free text analysis of the entire medical record, Google flu trends, calls to teletriage and help lines, ambulance dispatch calls, case reports of H1N1 in the media, markers of ED crowding, admission and Left Without Being Seen rates. Syndromes used to capture influenza rates were nearly always related to ILI (i.e. fever +/− a respiratory or constitutional complaint), however, other syndromes used for surveillance included fever alone, “respiratory complaint” and seizure. Two very large surveillance networks, the North American DiSTRIBuTE network and the European Triple S system have collected large-scale Emergency Department-based influenza and ILI syndromic surveillance data. Syndromic surveillance for influenza and ILI from the Emergency Department is becoming more prevalent as a measure of yearly influenza outbreaks.

/pdf/syndromic-surveillance-for-influenza-in-the-emergency-2fy9g1ublv.pdf

Syndromic surveillance for influenza in the emergency department-A systematic review.

http://degreesofclarity.com/emsbasics/library/wang%20-%20Differential%20effects%20of%20out-of-hospital%20interventions%20on%20short-%20and%20long-term%20survival%20after%20cardiopulmonary%20arrest.pdf

Differential effects of out-of-hospital interventions on short- and long-term survival after cardiopulmonary arrest

Background The Standardized Letter of Recommendation (SLOR) was developed in an attempt to standardize the evaluation of applicants to an emergency medicine (EM) residency. Objective Our aim was to determine whether the Global Assessment Score (GAS) and Likelihood of Matching Assessment (LOMA) of the SLOR for applicants applying to an EM residency are affected by the experience of the letter writer. We describe the distribution of GAS and LOMA grades and compare the GAS and LOMA scores to length of time an applicant knew the letter writer and number of EM rotations. Methods We conducted a retrospective review of all SLORs written for all applicants applying to three EM residency programs for the 2012 match. Median number of letters written the previous year were compared across the four GAS and LOMA scores using an equality of medians test and test for trend to see if higher scores on the GAS and LOMA were associated with less experienced letter writers. Distributions of the scores were determined and length of time a letter writer knew an applicant and number of EM rotations were compared with GAS and LOMA scores. Results There were 917 applicants representing 27.6% of the total applicant pool for the 2012 United States EM residency match and 1253 SLORs for GAS and 1246 for LOMA were analyzed. The highest scores on the GAS and LOMA were associated with the lowest median number of letters written the previous year (equality of medians test across groups, p p p = 0.002; p = 0.005). Number of EM rotations was not associated with GAS and LOMA scores. Conclusions SLORs written by less experienced letter writers were more likely to have a GAS of “Outstanding” ( p p

Does the experience of the writer affect the evaluative components on the standardized letter of recommendation in emergency medicine

Background : Medical residency can be a time of increased psychological stress and sleep disturbance. We examine the prospective associations between self-reported sleep quality and resident wellness across a single training year. Methods : Sixty-nine ( N =69) resident physicians completed the Brief Resident Wellness Profile ( M =17.66, standard deviation [SD]=3.45, range: 0–17) and the Pittsburgh Sleep Quality Index ( M =6.22, SD=2.86, range: 12–25) at multiple occasions in a single training year. We examined the 1-month lagged effect of sleep disturbances on residents’ self-reported wellness. Results : Accounting for residents’ overall level of sleep disturbance across the entire study period, both the concurrent (within-person) within-occasion effect of sleep disturbance ( B =−0.20, standard error [SE]=0.06, p= 0.003, 95% confidence interval [CI]: −0.33, −0.07) and the lagged within-person effect of resident sleep disturbance ( B= −0.15, SE=0.07, p= 0.037, 95% CI: −0.29, −0.009) were significant predictors of decreased resident wellness. Increases in sleep disturbances are a leading indicator of resident wellness, predicting decreased well-being 1 month later. Conclusions : Sleep quality exerts a significant effect on self-reported resident wellness. Periodic evaluation of sleep quality may alert program leadership and the residents themselves to impending decreases in psychological well-being. Keywords: wellness; sleep quality; residency training (Published: 21 June 2015) Citation: Med Educ Online 2015, 20: 28530 - http://dx.doi.org/10.3402/meo.v20.28530

Sleep disturbances predict prospective declines in resident physicians’ psychological well-being

Background The transition from medical student to first-year intern can be challenging. The stress of increased responsibilities, the gap between performance expectations and varying levels of clinical skills, and the need to adapt to a new institutional space and culture can make this transition overwhelming. Orientation programs intend to help new residents prepare for their new training environment. Objective To ease our interns' transition, we piloted a novel clinical primer course. We believe this course will provide an introduction to basic clinical knowledge and procedures, without affecting time allotted for mandatory orientation activities, and will help the interns feel better prepared for their clinical duties. Methods First-year Emergency Medicine residents were invited to participate in this primer course, called the Introductory Clinician Development Series (or "intern boot camp"), providing optional lecture and procedural skills instruction prior to their participation in the mandatory orientation curriculum and assumption of clinical responsibilities. Participating residents completed postcourse surveys asking for feedback on the experience. Results Survey responses indicated that the intern boot camp helped first-year residents feel more prepared for their clinical shifts in the Emergency Department. Conclusion An optional clinical introductory series can allow for maintenance of mandatory orientation activities and clinical shifts while easing the transition from medical student to clinician.

https://www.dovepress.com/getfile.php?fileID=21323

Alice A Min

Papers

Syndromic surveillance for influenza in the emergency department-A systematic review.

Differential effects of out-of-hospital interventions on short- and long-term survival after cardiopulmonary arrest

Does the experience of the writer affect the evaluative components on the standardized letter of recommendation in emergency medicine

Sleep disturbances predict prospective declines in resident physicians’ psychological well-being

Implementation of the Introductory Clinician Development Series: an optional boot camp for Emergency Medicine interns.