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Objective To identify, screen, highlight, review, and summarize some of the most rigorously conducted and impactful original research and review articles in global emergency medicine (EM) published in 2020 in the peer-reviewed and gray literature. Methods A broad systematic search of peer-reviewed publications related to global EM indexed on PubMed and in the gray literature was conducted. The titles and abstracts of the articles on this list were screened by members of the Global Emergency Medicine Literature Review team to identify those that met our criteria of original research or review articles in the domains of Disaster and Humanitarian Response, Emergency Care in Resource-Limited Settings, and Emergency Medicine Development. Those articles that met these screening criteria were then scored using one of three scoring templates appropriate to the article type. Those articles that scored in the top 5% then underwent in-depth narrative summarization. Results The 2020 GEMLR search initially identified 35,970 articles, more than 50% more than last year's search. From these, 364 were scored based on their full text. Nearly three-fourths of the scored articles constituted original research, of which nearly three-fourths employed quantitative research methods. Nearly 10% of the articles identified this year were directly related to COVID-19. Research involving Emergency Care in Resource-Limited Settings again constituted most of the articles in this year's review, accounting for more than 60% of the literature scored. A total of 20 articles underwent in-depth narrative critiques. Conclusions The number of studies relevant to global EM identified by our search was very similar to last year. Revisions to our methodology to identify a broader range of research were successful in identifying more qualitative research and studies related to Disaster and Humanitarian Response. The number of COVID-19-related articles is likely to continue to increase in subsequent years.

The objective was to identify the most important and impactful peer-reviewed global emergency medicine (GEM) articles published in 2021. The top articles are summarized in brief narratives and accompanied by a comprehensive list of all identified articles that address the topic during the year to serve as a reference for clinicians, researchers, and policy makers.A systematic PubMed search was carried out to identify all GEM articles published in 2021. Title and abstract screening was performed by trained reviewers and editors to identify articles in one of three categories based on predefined criteria: disaster and humanitarian response (DHR), emergency care in resource-limited settings (ECRLS), and emergency medicine development (EMD). Included articles were each scored by two reviewers using established rubrics for original (OR) and review (RE) articles. The top 5% of articles overall and the top 5% of articles from each category (DHR, ECRLS, EMD, OR, and RE) were included for narrative summary.The 2021 search identified 44,839 articles, of which 444 articles screened in for scoring, 25% and 22% increases from 2020, respectively. After removal of duplicates, 23 articles were included for narrative summary. ECRLS constituted the largest category (n = 16, 70%), followed by EMD (n = 4, 17%) and DHR (n = 3, 13%). The majority of top articles were OR (n = 14, 61%) compared to RE (n = 9, 39%).The GEM peer-reviewed literature continued to grow at a fast rate in 2021, reflecting the continued expansion and maturation of this subspecialty of emergency medicine. Few high-quality articles focused on DHR and EMD, suggesting a need for further efforts in those fields. Future efforts should focus on improving the diversity of GEM research and equitable representation.

Objective The annual systematic search of the peer-reviewed and gray literature relevant to global emergency medicine (EM) was conducted by the Global Emergency Medicine Literature Review (GEMLR) to screen, evaluate, and review the most rigorously conducted and relevant research in global EM published in 2019. Methods After a broad search of PubMed and websites of organizations publishing relevant gray literature, all articles that were deemed relevant to the fields of disaster and humanitarian response, emergency care in resource-limited settings, and EM development by at least one reviewer, an editor, and the managing editors were then scored by two different reviewers using a 20-point scoring template relevant to either original research (OR) or review (RE) articles. This scoring system rates articles on their clarity, research design, ethics, importance to global EM, and breadth of impact. Articles that then scored in the top 5% were then critiqued in depth. Results A total of 23,321 article titles and abstracts were screened by 22 reviewers with a wide swath of clinical and research experience in global EM. From these, a total of 356 articles underwent full-text review and scoring on the 20-point scale; 26% were categorized as disaster and humanitarian response, 58% as emergency care in resource-limited settings, and 15% as EM development. Of these 356 articles, 276 (77.5%) were OR articles and 80 (22.5%) were RE articles. The 16 articles that scored in the top 5% (>17.5 of 20 points) received full in-depth narrative summaries. Conclusions In 2019, the overall number of studies relevant to global EM that were identified by our search decreased from the prior year, but more high-scoring articles related to the development of EM clinical practice and as a specialty in resource-constrained settings were identified.

BACKGROUND: Pakistan has an underdeveloped and overburdened emergency care system, with most emergency departments (EDs) staffed by physicians not formally trained in emergency medicine (EM). As of January 2020, only nine Pakistani institutions were providing formal EM specialty training; therefore, a training program of shorter duration is needed in the interim. METHODS: The Certification Program in Emergency Medicine (CPEM) is a 1‐year training program in EM consisting of two arms: CPEM‐Clinical (CPEM‐C), which includes physicians from The Indus Hospital (TIH) ED, and CPEM‐Didactic (CPEM‐D), including physicians from EDs across Karachi. Both groups participate in weekly conferences, including didactics, small‐group discussions, workshops, and journal clubs. CPEM‐C learners also receive clinical mentorship from visiting international and TIH EM faculty. Both groups were assessed with preprogram, midterm, and final examinations as well as on clinical skills. Additionally, both groups provided regular feedback on program content and administration. RESULTS: Twenty‐five of the 32 initially enrolled learners completed the program in June 2019. Scores on a matched set of 50 questions administered in the pretest and final examination improved by an average of 15.1% (p

To date, the practice of global emergency medicine (GEM) has involved being "on the ground" supporting in-country training of local learners, conducting research, and providing clinical care. This face-to-face interaction has been understood as critically important for developing partnerships and building trust. The COVID-19 pandemic has brought significant uncertainty worldwide, including international travel restrictions of indeterminate permanence. Following the 2020 Society for Academic Emergency Medicine meeting, the Global Emergency Medicine Academy (GEMA) sought to enhance collective understanding of best practices in GEM training with a focus on multidirectional education and remote collaboration in the setting of COVID-19. GEMA members led an initiative to outline thematic areas deemed most pertinent to the continued implementation of impactful GEM programming within the physical and technologic confines of a pandemic. Eighteen GEM practitioners were divided into four workgroups to focus on the following themes: advances in technology, valuation, climate impacts, skill translation, research/scholastic projects, and future challenges. Several opportunities were identified: broadened availability of technology such as video conferencing, Internet, and smartphones; online learning; reduced costs of cloud storage and printing; reduced carbon footprint; and strengthened local leadership. Skills and knowledge bases of GEM practitioners, including practicing in resource-poor settings and allocation of scarce resources, are translatable domestically. The COVID-19 pandemic has accelerated a paradigm shift in the practice of GEM, identifying a previously underrecognized potential to both strengthen partnerships and increase accessibility. This time of change has provided an opportunity to enhance multidirectional education and remote collaboration to improve global health equity.

Background: Despite the growing interest in the development of emergency care systems and emergency medicine (EM) as a specialty globally, there still exists a significant gap between the need for and the provision of emergency care by specialty trained providers. Many efforts to date to expand the practice of EM have focused on programs developed through partnerships between higher- and lower-resource settings. Objective: To systematically review the literature to evaluate the composition of EM training programs in low- and middle-income countries (LMICs) developed through partnerships. Methods: An electronic search was conducted using four databases for manuscripts on EM training programs – defined as structured education and/or training in the methods, procedures, and techniques of acute or emergency care – developed through partnerships. The search produced 7702 results. Using a priori inclusion and exclusion criteria, 94 manuscripts were included. After scoring these manuscripts, a more in-depth examination of 26 of the high-scoring manuscripts was conducted. Findings: Fifteen highlight programs with a focus on specific EM content (i.e. ultrasound) and 11 cover EM programs with broader scopes. All outline programs with diverse curricula and varied educational and evaluative methods spanning from short courses to full residency programs, and they target learners from medical students and nurses to mid-level providers and physicians. Challenges of EM program development through partnerships include local adaptation of international materials; addressing the local culture(s) of learning, assessment, and practice; evaluation of impact; sustainability; and funding. Conclusions: Overall, this review describes a diverse group of programs that have been or are currently being implemented through partnerships. Additionally, it highlights several areas for program development, including addressing other topic areas within EM beyond trauma and ultrasound and evaluating outcomes beyond the level of the learner. These steps to develop effective programs will further the advancement of EM as a specialty and enhance the development of effective emergency care systems globally.

doi: https://doi.org/10.12669/pjms.36.ICON-Suppl.1726

Objectives Formal education in global health (GH) and short-term experiences in GH (STEGH) are offered by many emergency medicine (EM) residency programs in the United States. In an increasingly connected world, training in GH and STEGH can provide essential knowledge and practical skills to trainees, particularly at the graduate medical education level. The current core programmatic components and the essential competencies and curricula that support ethical and effective STEGH, however, still vary widely. The authors conducted a survey of the 228 EM residency programs in the United States to describe the current state of GH training and STEGH. Methods An online survey was developed in REDCap by a team of GH faculty. In July 2018, programs were invited to participate via individual invitation of program directors from a directory. The programs received two reminders to participate until January 2019. Results Of the 84 programs that responded, 75% offer STEGH and 39% have longitudinal GH curricula. Within these programs, only 55% have dedicated GH faculty and only 70% have dedicated sites. Both faculty and residents encounter funding and insurance barriers; most notably, only 20% of programs that offer STEGH provide evacuation insurance for their residents. Most residents (95%) engage in clinical work along with teaching and other activities, but 24% of programs do not allow these activities to fulfill any residency requirements. Finally, only 80 and 85% of programs offer preparatory and debriefing activities for residents, respectively. Conclusions While the results of this survey show progress relative to prior surveys, there are still barriers to implementing GH curricula and supporting safe, ethical, and effective STEGH, particularly in the form of continued financial and logistic support for faculty and for residents, in U.S. EM training programs.

According to the World Health Organization (WHO), burns result in more than 250,000 deaths and the loss of approximately 18 million disability adjusted life years (DALYs), more than 90% of which occur in low- and middle-income countries (LMICs), annually. This type of serious injury - one that is particularly devastating in LMICs - is preventable. To further explore the effectiveness of burn prevention strategies in LMICs, we performed a systematic review of the literature indexed in PubMed, EMBASE, Web of Science, Global Health, and the Cochrane Library databases as of October 2015. Our search resulted in 12,568 potential abstracts. Through multiple rounds of screening using criteria determined a priori, 11 manuscripts were identified for inclusion. The majority of these studies demonstrate reductions in hazardous behaviors, incidence of burns, morbidity, and mortality using educational programs, but also highlight other initiatives, such as media campaigns, as effective strategies. Given that only 11 manuscripts are highlighted in this review, it is evident that original research is lacking. Further studies of preventative efforts tailored to populations in LMICs are needed. It is also essential that these studies be founded in population-based epidemiology and use meaningful end points, such as reductions in incidence, morbidity, and mortality.

Author(s): Saleem, Syed G.; Haider, Kaniz F.; Salman, Saima; Samad, Lubna; Yasin, Zayed; Rybarczyk, Megan

The relationship between gender, violence, and substance use in the emergency department (ED) is complex. This article examines the role of gender in the intersection of substance use and three types of violence: peer violence, intimate partner violence, and firearm violence. Current approaches to treatment of substance abuse and violence are similar across both genders; however, as patterns of violence and substance abuse differ by gender, interventions may be more effective if they are designed with a specific gender focus.

The fundamental concepts set forth in the formal Post-Conflict Needs Assessment (PCNA) initiative created by the United Nations Development Group have the potential to be adapted to assist local groups in documenting the needs of and the provision of health care to survivors of sex- and gender-based violence (SGBV) in Eastern Democratic Republic of Congo (DRC). In partnership with Congolese health care providers, we took the first step in advocating for a locally-adapted and focused needs assessment through the development and administration of surveys to providers in the South Kivu Province, DRC. The content of the surveys was largely based on lists of medical supplies deemed essential for reproductive health and for the care of survivors by the Reproductive Health Response in Crises Consortium. The providers in both urban and rural settings considered many of the supplies identified on the surveys necessary for the care of survivors (84%; p0.05) but considered few accessible (26%; p0.05) in their particular clinical settings. Providers also felt that the existing list of supplies was inadequate to meet the needs of survivors, and also that providers needed ongoing training to improve supply procurement and management, more knowledge of the needs of male survivors of SGBV, and more educational opportunities to improve the quality of care to survivors. Given the deficiencies expressed by providers in the surveys, this study demonstrated a critical need for a locally-adapted and focused needs assessment to improve health services to survivors.

Introduction Rho GTPases are overexpressed and hyperactivated in human breast cancers. Deficiency of p190B RhoGAP, a major inhibitor of the Rho GTPases, inhibits mouse mammary tumor virus long terminal repeat (MMTV)-Neu/ErbB2 mammary tumor formation and progression in part through effects within the stromal environment, suggesting that p190B function is pro-tumorigenic. To further investigate the potential pro-tumorigenic actions of p190B, we examined the effects of exogenous p190B expression within the mammary epithelium on MMTV-Neu tumor formation and progression. Methods Tetracycline (tet)-regulatable p190B transgenic mice were bred to MMTV-Neu mice, and the effects of exogenous p190B expression on tumor latency, multiplicity, growth rates, angiogenesis, and metastasis were examined. The effects of exogenous p190B expression on cell-matrix adhesion and invasion were tested using non-transformed primary mammary epithelial cells (MECs). Rho GTPase activity, oxidative stress as an indicator of reactive oxygen species (ROS) production, and downstream signaling pathways were analyzed. Results Altered p190B expression resulted in a two-fold increase in tumor multiplicity and a three-fold increase in metastases compared to control mice indicating that exogenous p190B expression in the mammary epithelium promotes MMTV-Neu mammary tumor formation and progression. Interestingly, non-transformed primary MECs expressing exogenous p190B displayed increased adhesion to laminin and type IV collagen and formed invasive structures in a three-dimensional culture assay. Ras related C3 botulinum toxin 1 (Rac1)-GTP levels were elevated in p190B transgenic tumors whereas Ras homologous A (RhoA) and cell division cycle 42 (Cdc42)-GTP levels were not significantly altered. Rac1 activity affects production of ROS, which regulate transformation, metastasis, and oxidative stress. Protein carbonylation, which is indicative of oxidative stress, was elevated 1.75-fold in p190B transgenic tumors as compared to control tumors suggesting that exogenous p190B expression may affect Rac1-dependent ROS production. Conclusions These studies indicate that paradoxically, p190B RhoGAP, a major inhibitor of the Rho GTPases in vitro, has pro-tumorigenic functions that enhance MMTV-Neu induced mammary tumor formation and metastasis. Furthermore, exogenous p190B expression enhances cell adhesion and invasion, which may facilitate metastasis. Rac1 activity and oxidative stress are elevated in tumors expressing exogenous p190B suggesting that p190B may promote tumorigenesis through a Rac1/ROS dependent mechanism.