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1. The impact and efficiency of medical screening exams in forward treatment areas at New York City public hospitals during the initial COVID‐19 surge

Author

Joshua B. Moskovitz, Timothy Tan, Monisha Dilip, Kaushal Khambhati, Colleen Smith, Joshua Sapadin, Morgan Dauer, Robert Chin, Regina Hammock, Richard Leno, Stuart Kessler, Eric Wei, David Silvestri, and Shaw Natsui

Subjects
COVID‐19 surge, emergency, medical screening evaluations, NYC, pandemic, public health preparedness, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background New York City (NYC) emergency departments (EDs) experienced a surge of patients because of coronavirus disease 2019 (COVID‐19) in March 2020. NYC Health and Hospitals established rapid medical screening exams (MSE) and each hospital designated areas to perform their MSE. Five of the 11 hospitals created a forward treatment area (FTA) external to the ED to disposition patients before entering who presented with COVID‐like symptoms. Three hospitals used paper‐based, and 2 used an electronic medical record (EMR)‐based MSE. This study evaluated the effectiveness of safely discharging patients home from the FTA while also evaluating the efficiency of using paper‐based versus EMR‐based MSEs. Methods Charts were reviewed using standardized data extraction templates. Patients discharged from the FTA were contacted by phone, and a structured interview captured additional data regarding subsequent clinical courses. Chi‐square tests were used to compare proportions of patients hospitalized, as well as proportions of patients with vital signs recorded. Mortality rates were compared with Fisher exact test. A logistic regression model with fixed effects to account for clustering at hospitals was used to compare the odds of being sent to the ED for further evaluation based on vital signs and adjusted for age and sex Results Across 5 EDs, 3335 patients were evaluated in their FTAs from March 17, 2020, to April 27, 2020. A total of 970 (29.1%) patients were referred for further evaluation into the ED, of which 203 (20.9%) were hospitalized and 19 (2.0%) died. Of 2302 patients discharged from the FTA, 182 (7.9%) returned to the ED within 7 days, resulting in 42 (1.8%) hospitalizations and 7 (0.3%) deaths. Facilities using EMR‐MSE discharged more patients from their FTA (81.9% vs 65.3%, P

Published
2021
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2. 2080 Implementing and evaluating an evidence-based intervention from the intensive care unit (ICU) setting into primary care using promotoras to reduce CA-MRSA recurrence and household transmission

Author

Brianna M. D’Orazio, Jonathan N. Tobin, Rhonda G. Kost, Chamanara Khalida, Jessica Ramachandran, Mina Pastagia, Teresa H. Evering, Maria P. de la Gandara, Cameron Coffran, Joel Correa da Rosa, Kimberly Vasquez, Getaw W. Hassen, Franco Barsanti, Satoko Kanahara, Regina Hammock, Rosalee Nguyen, Mark Trezia, Trang Gisler, Herminia de Lencastre, Alexander Tomasz, and Barry S. Coller

Subjects
Medicine
Abstract

OBJECTIVES/SPECIFIC AIMS: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs) recurrence ranges from 16% to 43% and presents significant challenges to clinicians, patients, and families. This comparative effectiveness research study aims to disseminate, implement and evaluate whether an existing intervention, consisting of decolonization and decontamination procedures, which has been determined to be effective in hospital intensive care unit settings, can be implemented by Community Health Workers (CHWs) or “promotoras” conducting home visits prevent recurrence of CA-MRSA and transmission within their households for patients presenting to primary care with SSTIs. METHODS/STUDY POPULATION: In partnership with 3 Community Health Centers and 4 community hospitals in NYC, this study will recruit patients (n=278) with confirmed MRSA SSTIs and their household members. Participants are randomized to receive either a CHW/Promotora-delivered decolonization-decontamination intervention or usual care, which includes hygiene education. The highly engaged stakeholder team meets monthly to review interim results, identify areas for refinement and new research questions, and develop and implement strategies to improve participant engagement and retention. RESULTS/ANTICIPATED RESULTS: MRSA and MSSA were found in 19% and 21.1% of wound cultures, respectively. 59.5% with MRSA+ wound culture had one or more MRSA+ surveillance culture; 67.8% with MSSA+ wound culture had one or more MSSA+ surveillance culture. The “warm handoff” approach, developed and implemented by the stakeholder team to engage patients from their initial consent to return of lab results and scheduling of the home visits, helped improve completion of baseline home visits by 14%, from 45% to 59% of eligible participants. Home visits have demonstrated that 60% of households had at least one surface contaminated with S. aureus. Of the surfaces that tested positive in the households, nearly 20% were MRSA and 81% were MSSA; 32.5% of household members had at least one surveillance culture positive for S. aureus (MRSA: 7.7%, MSSA: 92.3%). DISCUSSION/SIGNIFICANCE OF IMPACT: This study aims to understand the systems-level, patient-level, and environmental-level factors associated with SSTI recurrence and household transmission, and to examine the interactions between bacterial genotypic and clinical/phenotypic factors on decontamination, decolonization, SSTI recurrence and household transmission. This study will evaluate the barriers and facilitators of implementation of home visits by CHWs in underserved populations, and aims to strengthen the weak evidence base for implementation of strategies to reduce SSTI recurrence and household transmission.

Published
2018
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3. Stakeholder Engagement In a Comparative Effectiveness/Implementation Study to Prevent Staphylococcus Aureus Infection Recurrence: CA-MRSA Project (CAMP2)

Author

Brianna D’Orazio, Jessica Ramachandran, Chamanara Khalida, Johana Gonzalez, Rhonda G. Kost, Kimberly S. Vasquez, Teresa H. Evering, Tameir Holder, Getaw Worku Hassen, Regina Hammock, Rosalee Nguyen, Ronette Davis, Keenan Millan, Van Johnson, Claude Parola, Barry S. Coller, and Jonathan N. Tobin

Subjects
Health (social science), Sociology and Political Science, General Medicine, Education
Published
2022

4. The impact and efficiency of medical screening exams in forward treatment areas at New York City public hospitals during the initial COVID‐19 surge

Author

Richard Leno, David Silvestri, Timothy Tan, Monisha Dilip, Robert Chin, Morgan Dauer, Colleen Smith, Regina Hammock, Joshua B. Moskovitz, Stuart Kessler, Eric K. Wei, Kaushal Khambhati, Joshua Sapadin, and Shaw Natsui

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Vital signs, NYC, Logistic regression, Disaster Medicine, Odds, symbols.namesake, Medicine, medical screening evaluations, Fisher's exact test, Original Research, General Environmental Science, RC86-88.9, emergency, business.industry, pandemic, Mortality rate, Medical emergencies. Critical care. Intensive care. First aid, Data extraction, public health preparedness, Structured interview, Emergency medicine, COVID‐19 surge, symbols, General Earth and Planetary Sciences, business
Abstract

Background New York City (NYC) emergency departments (EDs) experienced a surge of patients because of coronavirus disease 2019 (COVID‐19) in March 2020. NYC Health and Hospitals established rapid medical screening exams (MSE) and each hospital designated areas to perform their MSE. Five of the 11 hospitals created a forward treatment area (FTA) external to the ED to disposition patients before entering who presented with COVID‐like symptoms. Three hospitals used paper‐based, and 2 used an electronic medical record (EMR)‐based MSE. This study evaluated the effectiveness of safely discharging patients home from the FTA while also evaluating the efficiency of using paper‐based versus EMR‐based MSEs. Methods Charts were reviewed using standardized data extraction templates. Patients discharged from the FTA were contacted by phone, and a structured interview captured additional data regarding subsequent clinical courses. Chi‐square tests were used to compare proportions of patients hospitalized, as well as proportions of patients with vital signs recorded. Mortality rates were compared with Fisher exact test. A logistic regression model with fixed effects to account for clustering at hospitals was used to compare the odds of being sent to the ED for further evaluation based on vital signs and adjusted for age and sex Results Across 5 EDs, 3335 patients were evaluated in their FTAs from March 17, 2020, to April 27, 2020. A total of 970 (29.1%) patients were referred for further evaluation into the ED, of which 203 (20.9%) were hospitalized and 19 (2.0%) died. Of 2302 patients discharged from the FTA, 182 (7.9%) returned to the ED within 7 days, resulting in 42 (1.8%) hospitalizations and 7 (0.3%) deaths. Facilities using EMR‐MSE discharged more patients from their FTA (81.9% vs 65.3%, P

Published
2021

5. The revised Approved Instructional Resources score: An improved quality evaluation tool for online educational resources

Author

Nadim Lalani, Shelaina Anderson, Jonas Wilmer, Marina Roure, Kristen Weersink, Katherine A. Stuart, Brent Benavides, Wisarut Bunchit, Colleen Sweeney, Robert R. Ehrman, Richard Tang, Kelvin Tran, Gregory Wanner, Drew Kalnow, Christine Roh, Kinjal Patel, Bill Fraser, Therese Mead, Stephen Carroll, Paul Schofield, Caley Flynn, Lindy Buzikievich, Lucy Chen, Tara Stratton, Jan Hansel, Hector C. Singson, Tanner Gronowski, Ali Jamal, Adeeb Saleh, Todd Taylor, Rayan Delbani, Phil Griffith, Michael J. Ward, Miranda Wan, Ashley Kilp, Anna Whalen-Browne, Logan Mills, Ali S. Raja, Perry Menzies, Christine Patterson, Sandra Viggers, Brendan Devine, Vanessa Rogers, Braeden Beaumont, Jennifer Baird, Paula Sneath, Natasha Chatham-Zvelebil, Brandon Herb, Harry Liu, Marie Decock, Sarah Mott, Elise Lovell, Mohammad Ali Jamil, Ken Edwards, Victor Jansen, Maia Dorsett, Jaasmit Khurana, Salim R. Rezaie, Alexander Hart, Fareen Zaver, Manpreet Singh, Ching-Hsing Lee, Suzanne Rannazzisi, Mike McDonnell, Loice Swisher, Rob Carey, Joe Walter, Andrew D. D’Alessandro, Bob Stuntz, James Stempien, Preston Fedor, Kelly Lien, Parisa Shahrabadi, Shauna Regan, Alan Taylor, Nilantha Lenora, Scott Anderson, Calvin H. Yeh, Jason Trickovic, David Calcara, Werner Oberholzer, Catherine Patocka, James Fukakusa, T. Oyedokun, Ivy Liu, Regina Hammock, Steve Liu, Kevin Cullison, Chris Belcher, Teresa Dunphy, Alexis Pelletier-Bui, Zander Laurie, Ashley Lubberdink, James Pearlman, James Huffman, Nikhil Tambe, Carolyn McQuarrie, Gerhard Tiwald, Gregor Prosen, David Lowe, Henry Swoboda, Jennifer Weekes, Kimberly Connors, Aaron Tyagi, Anali Maneshi, Patrick M. Lank, Emina Hajdinjak, Levi Johnston, Eric Chen, Abdulaziz S. Almehlisi, Zach Jarou, Noorin Walji, Alvin Chin, Tanis Quaife, Nikytha Antony, Lawrence Yau, Alexander Zozula, Gregory Costello, Louise Rang, John Mayo, Evan S. Schwarz, Victoria Brazil, P. Mukherj, Taylor Duda, Jaime Jordan, Susan McLellan, Alim Pardhan, Jared Baylis, Allan Mix, Cathy Grossman, Sean Dyer, Emily House, Eric Shappell, Colin Andrews, Mark Woodcroft, William D.T. Kent, Anthony Bryson, Nelson Wong, Pawan Gupta, Diptesh Aryal, Owen Scheirer, Morgan Oakland, Patrick Vallance, Brendan Moore, Mary R C Haas, Kenn Ghaffarian, Steve Montag, Elyse Berger Pelletier, Julianna Deutscher, Nina House, Keith Rosenberg, Sushant Chhabra, Viktor Gawlik, Michael Benham, Andrew Baker, Brent Thoma, Ernest Leber, Larissa Hattin, Casey Lyons, Timothy Chaplin, Kamini Premkumar, Shahbaz Syed, Ivanna Kruhlak, Stephanie Louka, Haakon Lenes, Rene Verbeek, SueLin Hilbert, Joshua Rudner, Julia Nood, Kelly van Diepen, Brian Whiteside, Karthryn T. Eastley, Julia Sheffield, Damjan Gaco, Sam Smith, Quinten S. Paterson, Teresa M. Chan, Jeremy Christensen, Jocelyn Andruko, Youness Elkhalidy, Cory Meeuwisse, Sheena Nandalal, Cara Weessies, Scott Knapp, Sheng Hsiang Ma, Meagan Fu, Veronica Coppersmith, William Denq, Vivian Jia, Kristina Lea, Hugh MacLeod, Simon Huang, Yingchun Lin, Wyatt Warawa, Will Sanderson, Brian Ficiur, Jessica G.Y. Luc, Taylor Nikel, Jessica Yee, Tina Choudhri, Patricia Van den Berg, Andrew Grock, Samantha Lam, Andrew Guy, Keeth Krishnan, Taku Taira, Eric Funk, Rachel Taylor, Ali Mulla, Sebastian Kohler, Kyle Kelson, Nicholas Bouchard, Stanislaw Haciski, Jesse Leontowicz, Paul Trinquero, Charlie Inboriboon, Justin Dueweke, Julian Botta, Emily Brumfield, Kat Butler, Patrick Meloy, Laleh Gharahbaghian, Andrew K. Hall, Maria Rosa Carrillo, Aubrey Powell, Louise Cassidy, Jesse May, Isabelle N. Colmers-Gray, Evelyn Tran, Sarah Batty, Vishal Puri, Randi Ramunno, Luis Vargas, Stephen Miazga, Justin Morgenstern, Michelle Lin, Andrew Griffith, Michael Susalla, Charlotte Alexander, Alex Ireland, Kerstin de Wit, Marcia L. Edmonds, Robert Sobehart, Rob Woods, Kirsty Challen, Dave Slessor, Abby Cosgrove, Eric Chochi, Onyeka Otugo, Amy F. Ho, Alexandra Gustafson, Zlata Vlodaver, Kerry Spearing, Ryan Raffel, Milan L Ridderikhof, Barbra Backus, Saeed Alqahtani, Paul Schunk, Anne Messman, Seth Kelly, Puneet Kapur, Andrew Little, Kathryn Chan, Sean Nugent, Rishi Khakhkhar, Mohammed Alkhalifah, Rachel Wang, Jesse Hill, Marc Phan, Jaroslaw Gucwa, Nick Mancuso, Paxton Ting, Matthew Wagner, Zafrina Poonja, Elisha Targonsky, Britni Sternard, Katherine Yurkiw, Manrique Umana, Jeff Hill, Matthew Willis, and Sherri L. Rudinsky

Subjects
Medical education, education.field_of_study, Intraclass correlation, business.industry, Best practice, Population, MEDLINE, Context (language use), Usability, Original Contribution, Emergency Nursing, Education, Emergency Medicine, Thematic analysis, education, business, Psychology, Quality assurance
Abstract

Background Free Open-Access Medical education (FOAM) use among residents continues to rise. However, it often lacks quality assurance processes and residents receive little guidance on quality assessment. The Academic Life in Emergency Medicine Approved Instructional Resources tool (AAT) was created for FOAM appraisal by and for expert educators and has demonstrated validity in this context. It has yet to be evaluated in other populations. Objectives We assessed the AAT's usability in a diverse population of practicing emergency medicine (EM) physicians, residents, and medical students; solicited feedback; and developed a revised tool. Methods As part of the Medical Education Translational Resources: Impact and Quality (METRIQ) study, we recruited medical students, EM residents, and EM attendings to evaluate five FOAM posts with the AAT and provide quantitative and qualitative feedback via an online survey. Two independent analysts performed a qualitative thematic analysis with discrepancies resolved through discussion and negotiated consensus. This analysis informed development of an initial revised AAT, which was then further refined after pilot testing among the author group. The final tool was reassessed for reliability. Results Of 330 recruited international participants, 309 completed all ratings. The Best Evidence in Emergency Medicine (BEEM) score was the component most frequently reported as difficult to use. Several themes emerged from the qualitative analysis: for ease of use-understandable, logically structured, concise, and aligned with educational value. Limitations include deviation from questionnaire best practices, validity concerns, and challenges assessing evidence-based medicine. Themes supporting its use include evaluative utility and usability. The author group pilot tested the initial revised AAT, revealing a total score average measure intraclass correlation coefficient (ICC) of moderate reliability (ICC = 0.68, 95% confidence interval [CI] = 0 to 0.962). The final AAT's average measure ICC was 0.88 (95% CI = 0.77 to 0.95). Conclusions We developed the final revised AAT from usability feedback. The new score has significantly increased usability, but will need to be reassessed for reliability in a broad population.

Published
2021

6. STAKEHOLDER ENGAGEMENT IN A COMPARATIVE EFFECTIVENESS/IMPLEMENTATION STUDY TO PREVENT CA-MRSA INFECTION RECURRENCE: CA-MRSA Project (CAMP2)

Author

Kimberly S. Vasquez, Johana Gonzalez, Barry S. Coller, Ronette Davis, Getaw Worku Hassen, Teresa H. Evering, Claude Parola, Brianna D’Orazio, Keenan Millan, Jonathan N. Tobin, Rhonda G. Kost, Rosalee Nguyen, Jessica Ramachandran, Regina Hammock, and Chamanara Khalida

Subjects
medicine.medical_specialty, Home visits, business.industry, Public health, Advisory committee, Family medicine, medicine, Stakeholder, Infection control, Stakeholder engagement, MRSA infection, business, Community hospital
Abstract

BackgroundMethicillin-Resistant (MRSA) or Methicillin-Sensitive (MSSA) Staphylococcus aureus skin and soft tissue infections (SSTIs) pose serious clinical and public health challenges. Few protocols exist for outpatient education, decolonization and decontamination.ObjectivesThis trial implemented infection prevention protocols in homes via Community Health Workers/promotoras.MethodsWe engaged clinicians, patients, clinical and laboratory researchers, New-York-based Federally Qualified Health Centers and community hospital Emergency Departments. The Clinician and Patient Stakeholder Advisory Committee (CPSAC) convened in-person and remotely for shared decision-making and trial oversight.ResultsThe trial consented 186 and randomized 119 participants with SSTIs with MRSA (n=59) or MSSA (n=59), completed home visits, obtained surveillance cultures from index patients and household members and sampled household environmental surfaces at baseline and three months.Lessons LearnedThe retention of the CPSAC during the trial demonstrated high levels of engagement.ConclusionsCPSAC was highly effective throughout design and execution by troubleshooting recruitment and home visit challenges.

Published
2020
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7. The Social Media Index as an Indicator of Quality for Emergency Medicine Blogs: A METRIQ Study

Author

Brent Thoma, Teresa M. Chan, Puneet Kapur, Derek Sifford, Marshall Siemens, Michael Paddock, Felix Ankel, Andy Grock, Michelle Lin, Charlotte Alexander, Mohammed Alkhalifah, Abdulaziz S. Almehlisi, Saeed Alqahtani, Scott Anderson, Shelaina Anderson, Colin Andrews, Jocelyn Andruko, Nikytha Antony, Diptesh Aryal, Barbra Backus, Jennifer Baird, Andrew Baker, Sarah Batty, Jared Baylis, Braeden Beaumont, Chris Belcher, Brent Benavides, Michael Benham, Julian Botta, Nicholas Bouchard, Victoria Brazil, Emily Brumfield, Anthony Bryson, Wisarut Bunchit, Kat Butler, Lindy Buzikievich, David Calcara, Rob Carey, Stephen Carroll, Louise Cassidy, Kirsty Challen, Kathryn Chan, Tim Chaplin, Natasha Chatham-Zvelebil, Eric Chen, Lucy Chen, Sushant Chhabra, Alvin Chin, Eric Chochi, Tina Choudhri, Jeremy Christensen, Isabelle Colmers-Gray, Kimberly Connors, Veronica Coppersmith, Abby Cosgrove, Gregory Costello, Kevin Cullison, Andrew D'Alessandro, Kerstin de Wit, Marie Decock, Rayan Delbani, William Denq, Julianna Deutscher, Brendan Devine, Maia Dorsett, Taylor Duda, Justin Dueweke, Teresa Dunphy, Sean Dyer, Karthryn T Eastley, Marcia Edmonds, Ken Edwards, Robert Ehrman, Youness Elkhalidy, Preston Fedor, Brian Ficiur, Caley Flynn, Bill Fraser, Meagan Fu, James Fukakusa, Eric Funk, Damjan Gaco, Viktor Gawlik, Kenn Ghaffarian, Laleh Gharahbaghian, Phil Griffith, Andrew Griffith, Andrew Grock, Tanner Gronowski, Cathy Grossman, Jaroslaw Gucwa, Pawan Gupta, Alexandra Gustafson, Andrew Guy, Mary Haas, Stanislaw Haciski, Emina Hajdinjak, Andrew K. Hall, Regina Hammock, Jan Hansel, Alexander Hart, Larissa Hattin, Brandon Herb, SueLin Hilbert, Jesse Hill, Jeff Hill, Amy Ho, Emily House, Nina House, James Huffman, Charlie Inboriboon, Alex Ireland, Ali Jamal, Mohammad Ali Jamil, Victor Jansen, Zach Jarou, Vivian Jia, Levi Johnston, Drew Kalnow, Seth Kelly, Kyle Kelson, William Kent, Rishi Khakhkhar, Jaasmit Khurana, Ashley Kilp, Scott Knapp, Sebastian Kohler, Ivanna Kruhlak, Nadim Lalani, Samantha Lam, Patrick Lank, Zander Laurie, Kristina Lea, Ernest Leber, Ching-Hsing Lee, Haakon Lenes, Nilantha Lenora, Jesse Leontowicz, Kelly Lien, Yingchun Lin, Andrew Little, Ivy Liu, Harry Liu, Steve Liu, Stephanie Louka, Elise Lovell, David Lowe, Ashley Lubberdink, Jessica Luc, Casey Lyons, Sheng-Hsiang Ma, Hugh MacLeod, Nick Mancuso, Anali Maneshi, Jesse May, John Mayo, Mike McDonnell, Susan McLellan, Carolyn McQuarrie, Julia Nood, Therese Mead, Cory Meeuwisse, Patrick Meloy, Perry Menzies, Anne Messman, Stephen Miazga, Logan Mills, Ken Milne, Allan Mix, Steve Montag, Brendan Moore, Justin Morgenstern, Sarah Mott, P. Mukherj, Ali Mulla, Sheena Nandalal, Taylor Nikel, Sean Nugent, Morgan Oakland, Werner Oberholzer, Onyeka Otugo, Taofiq Segun Oyedokun, Mike Paddock, Alim Pardhan, Kinjal Patel, Quinten Paterson, Catherine Patocka, Christine Patterson, James Pearlman, Elyse Berger Pelletier, Alexis Pelletier-Bui, Marc Phan, Zafrina Poonja, Aubrey Powell, Kamini Premkumar, Gregor Prosen, Vishal Puri, Tanis Quaife, Ryan Raffel, Ali Raja, Randi Ramunno, Louise Rang, Suzanne Rannazzisi, Shauna Regan, Salim R. Rezaie, Milan Ridderikhof, Vanessa Rogers, Christine Roh, Dra. Maria Rosa Carrillo, Keith Rosenberg, Marina Roure, Sherri Rudinsky, Joshua Rudner, Adeeb Saleh, Will Sanderson, Owen Scheirer, Paul Schofield, Paul Schunk, Evan Schwarz, Parisa Shahrabadi, Eric Shappell, Julia Sheffield, Jonathan Sherbino, Manpreet Singh, Hector C Singson, Dave Slessor, Sam Smith, Paula Sneath, Robert Sobehart, Kerry Spearing, James Stempien, Britni Sternard, Tara Stratton, Katherine Stuart, Bob Stuntz, Michael Susalla, Colleen Sweeney, Loice Swisher, Henry Swoboda, Shahbaz Syed, Taku Taira, Nikhil Tambe, Richard Tang, Elisha Targonsky, Rachel Taylor, Alan Taylor, Todd Taylor, Paxton Ting, Gerhard Tiwald, Kelvin Tran, Evelyn Tran, Jason Trickovic, Paul Trinquero, Seth Trueger, Aaron Tyagi, Manrique Umana, Patrick Vallance, Patricia Van den Berg, Luis Vargas, Rene Verbeek, Sandra Viggers, Zlata Vlodaver, Matthew Wagner, Noorin Walji, Joe Walter, Miranda Wan, Rachel Wang, Gregory Wanner, Wyatt Warawa, Mike Ward, Jennifer Weekes, Kristen Weersink, Cara Weessies, Anna Whalen-Browne, Brian Whiteside, Matthew Willis, Jonas Wilmer, Nelson Wong, Mark Woodcroft, Rob Woods, Lawrence Yau, Jessica Yee, Calvin Yeh, Simon York Ming Huang, Katherine Yurkiw, Fareen Zaver, Alexander Zozula, Emergency Department, Graduate School, ACS - Heart failure & arrhythmias, and ACS - Diabetes & metabolism

Subjects
Adult, Male, medicine.medical_specialty, Index (economics), Blogging, Cross-sectional study, media_common.quotation_subject, education, MEDLINE, 03 medical and health sciences, 0302 clinical medicine, Medicine, Humans, Social media, Quality (business), 030212 general & internal medicine, media_common, Web site, business.industry, 030208 emergency & critical care medicine, Critical appraisal, Cross-Sectional Studies, Emergency medicine, Emergency Medicine, Gestalt psychology, Female, business, Social Media
Abstract

Study objective Online educational resources such as blogs are increasingly used for education by emergency medicine clinicians. The Social Media Index was developed to quantify their relative impact. The Medical Education Translational Resources: Indicators of Quality (METRIQ) study was conducted in part to determine the association between the Social Media Index score and quality as measured by gestalt and previously derived quality instruments. Methods Ten blogs were randomly selected from a list of emergency medicine and critical care Web sites. The 2 most recent clinically oriented blog posts published on these blogs were evaluated with gestalt, the Academic Life in Emergency Medicine Approved Instructional Resources (ALiEM AIR) score, and the METRIQ-8 score. Volunteer raters (including medical students, emergency medicine residents, and emergency medicine attending physicians) were identified with a multimodal recruitment methodology. The Social Media Index was calculated in February 2016, November 2016, April 2017, and December 2017. Pearson's correlations were calculated between the Social Media Index and the average rater gestalt, ALiEM AIR score, and METRIQ-8 score. Results A total of 309 of 330 raters completed all ratings (93.6%). The Social Media Index correlated moderately to strongly with the mean rater gestalt ratings (range 0.69 to 0.76) and moderately with the mean rater ALiEM AIR score (range 0.55 to 0.61) and METRIQ-8 score (range 0.53 to 0.57) during the month of the blog post's selection and for 2 years after. Conclusion The Social Media Index's correlation with multiple quality evaluation instruments over time supports the hypothesis that it is associated with overall Web site quality. It can play a role in guiding individuals to high-quality resources that can be reviewed with critical appraisal techniques.

Published
2018

8. 2080 Implementing and evaluating an evidence-based intervention from the intensive care unit (ICU) setting into primary care using promotoras to reduce CA-MRSA recurrence and household transmission

Author

Mark Trezia, Trang Gisler, Brianna D’Orazio, Franco Barsanti, Jonathan N. Tobin, Satoko Kanahara, Kimberly S. Vasquez, Jessica Ramachandran, Getaw Worku Hassen, Maria Pardos de la Gandara, Rhonda G. Kost, Hermínia de Lencastre, Barry S. Coller, Alexander Tomasz, Teresa H. Evering, Mina Pastagia, Chamanara Khalida, Rosalee Nguyen, Regina Hammock, Cameron Coffran, and Joel Correa da Rosa

Subjects
medicine.medical_specialty, Evidence-based practice, business.industry, media_common.quotation_subject, Comparative effectiveness research, General Medicine, Intensive care unit, Health Equity & Community Engagement, law.invention, Underserved Population, Hygiene, law, Intervention (counseling), Interim, Family medicine, Community health, Medicine, business, media_common
Abstract

OBJECTIVES/SPECIFIC AIMS: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs) recurrence ranges from 16% to 43% and presents significant challenges to clinicians, patients, and families. This comparative effectiveness research study aims to disseminate, implement and evaluate whether an existing intervention, consisting of decolonization and decontamination procedures, which has been determined to be effective in hospital intensive care unit settings, can be implemented by Community Health Workers (CHWs) or “promotoras” conducting home visits prevent recurrence of CA-MRSA and transmission within their households for patients presenting to primary care with SSTIs. METHODS/STUDY POPULATION: In partnership with 3 Community Health Centers and 4 community hospitals in NYC, this study will recruit patients (n=278) with confirmed MRSA SSTIs and their household members. Participants are randomized to receive either a CHW/Promotora-delivered decolonization-decontamination intervention or usual care, which includes hygiene education. The highly engaged stakeholder team meets monthly to review interim results, identify areas for refinement and new research questions, and develop and implement strategies to improve participant engagement and retention. RESULTS/ANTICIPATED RESULTS: MRSA and MSSA were found in 19% and 21.1% of wound cultures, respectively. 59.5% with MRSA+ wound culture had one or more MRSA+ surveillance culture; 67.8% with MSSA+ wound culture had one or more MSSA+ surveillance culture. The “warm handoff” approach, developed and implemented by the stakeholder team to engage patients from their initial consent to return of lab results and scheduling of the home visits, helped improve completion of baseline home visits by 14%, from 45% to 59% of eligible participants. Home visits have demonstrated that 60% of households had at least one surface contaminated with S. aureus. Of the surfaces that tested positive in the households, nearly 20% were MRSA and 81% were MSSA; 32.5% of household members had at least one surveillance culture positive for S. aureus (MRSA: 7.7%, MSSA: 92.3%). DISCUSSION/SIGNIFICANCE OF IMPACT: This study aims to understand the systems-level, patient-level, and environmental-level factors associated with SSTI recurrence and household transmission, and to examine the interactions between bacterial genotypic and clinical/phenotypic factors on decontamination, decolonization, SSTI recurrence and household transmission. This study will evaluate the barriers and facilitators of implementation of home visits by CHWs in underserved populations, and aims to strengthen the weak evidence base for implementation of strategies to reduce SSTI recurrence and household transmission.

Published
2018

9. Individual Gestalt Is Unreliable for the Evaluation of Quality in Medical Education Blogs: A METRIQ Study

Author

Brent Thoma, Stefanie S. Sebok-Syer, Keeth Krishnan, Marshall Siemens, N. Seth Trueger, Isabelle Colmers-Gray, Rob Woods, Emil Petrusa, Teresa Chan, Charlotte Alexander, Mohammed Alkhalifah, Saeed Alqahtani, Scott Anderson, Shelaina Anderson, Colin Andrews, Jocelyn Andruko, Felix Ankel, Nikytha Antony, Diptesh Aryal, Barbra Backus, Jennifer Baird, Andrew Baker, Sarah Batty, Jared Baylis, Braeden Beaumont, Chris Belcher, Brent Benavides, Michael Benham, Elyse Berger Pelletier, Julian Botta, Nicholas Bouchard, Victoria Brazil, Emily Brumfield, Anthony Bryson, Wisarut Bunchit, Kat Butler, Lindy Buzikievich, David Calcara, Rob Carey, Stephen Carroll, Casey Lyons, Louise Cassidy, Kirsty Challen, Tim Chaplin, Natasha Chatham-Zvelebil, Eric Chen, Lucy Chen, Sushant Chhabra, Alvin Chin, Eric Chochi, Tina Choudhri, Jeremy Christensen, Kimberly Connors, Veronica Coppersmith, Abby Cosgrove, Gregory Costello, Kevin Cullison, Andrew D'Alessandro, Kerstin de Wit, Marie Decock, Rayan Delbani, William Denq, Julianna Deutscher, Brendan Devine, Maia Dorsett, Taylor Duda, Justin Dueweke, Teresa Dunphy, Sean Dyer, Kathryn T. Eastley, Marcia Edmonds, Ken Edwards, Robert Ehrman, Youness Elkhalidy, Preston Fedor, Brian Ficiur, Caley Flynn, Bill Fraser, Meagan Fu, James Fukakusa, Eric Funk, Damjan Gaco, Viktor Gawlik, Kenn Ghaffarian, Laleh Gharahbaghian, Phil Griffith, Andrew Griffith, Andrew Grock, Tanner Gronowski, Cathy Grossman, Jaroslaw Gucwa, Pawan Gupta, Alexandra Gustafson, Andrew Guy, Mary Haas, Stanislaw Haciski, Emina Hajdinjak, Andrew K. Hall, Regina Hammock, Jan Hansel, Alexander Hart, Larissa Hattin, Brandon Herb, SueLin Hilbert, Jesse Hill, Jeff Hill, Amy Ho, Emily House, Nina House, James Huffman, Charlie Inboriboon, Alex Ireland, Mohammed Ali Jamal, Victor Jansen, Zach Jarou, Vivian Jia, Levi Johnston, Drew Kalnow, Puneet Kapur, Seth Kelly, Kyle Kelson, William Kent, Rishi Khakhkhar, Jaasmit Khurana, Ashley Kilp, Scott Knapp, Sebastian Kohler, Ivanna Kruhlak, Nadim Lalani, Samantha Lam, Patrick Lank, Zander Laurie, Kristina Lea, Ernest Leber, Ching-Hsing Lee, Haakon Lenes, Nilantha Lenora, Jesse Leontowicz, Kelly Lien, Yingchun Lin, Michelle Lin, Andrew Little, Ivy Liu, Harry Liu, Steve Liu, Stephanie Louka, Elise Lovell, David Lowe, Ashley Lubberdink, Jessica Luc, Sheng-Hsiang Ma, Hugh MacLeod, Nick Mancuso, Anali Maneshi, Dra. Maria Rosa Carrillo, Jesse May, John Mayo, Mike McDonnell, Susan McLellan, Carolyn McQuarrie, Julia Nood, Therese Mead, Cory Meeuwisse, Patrick Meloy, Perry Menzies, Anne Messman, Stephen Miazga, Logan Mills, Ken Milne, Allan Mix, Steve Montag, Brendon Moore, Justin Morgenstern, Sarah Mott, P. Mukherj, Ali Mulla, Sheena Nandalal, Taylor Nikel, Sean Nugent, Morgan Oakland, Werner Oberholzer, Onyeka Otugo, Taofiq Segun Oyedokun, Mike Paddock, Alim Pardhan, Kinjal Patel, Quinten Paterson, Catherine Patocka, Christine Patterson, James Pearlman, Alexis Pelletier-Bui, Marc Phan, Zafrina Poonja, Aubrey Powell, Kamini Premkumar, Gregor Prosen, Vishal Puri, Tanis Quaife, Ryan Raffel, Ali Raja, Randi Ramunno, Louise Rang, Suzanne Rannazzisi, Shauna Regan, Milan Ridderikhof, Vanessa Rogers, Christine Roh, Keith Rosenberg, Marina Roure, Sherri Rudinsky, Joshua Rudner, Adeeb Saleh, Will Sanderson, Owen Scheirer, Paul Schofield, Paul Schunk, Evan Schwarz, Parisa Shahrabadi, Eric Shappell, Julia Sheffield, Jonathan Sherbino, Manpreet Singh, Hector C. Singson, Dave Slessor, Sam Smith, Paula Sneath, Robert Sobehart, Kerry Spearing, James Stempien, Britni Sternard, Tara Stratton, Katherine Stuart, Bob Stuntz, Michael Susalla, Colleen Sweeney, Loice Swisher, Henry Swoboda, Shahbaz Syed, Taku Taira, Nikhil Tambe, Richard Tang, Elisha Targonsky, Rachel Taylor, Alan Taylor, Todd Taylor, Paxton Ting, Gerhard Tiwald, Kelvin Tran, Evelyn Tran, Jason Trickovic, Paul Trinquero, Seth Trueger, Aaron Tyagi, Manrique Umana, Patrick Vallance, Patricia Van den Berg, Luis Vargas, Rene Verbeek, Sandra Viggers, Zlata Vlodaver, Matthew Wagner, Noorin Walji, Joe Walter, Miranda Wan, Rachel Wang, Gregory Wanner, Wyatt Warawa, Mike Ward, Jennifer Weekes, Kristen Weersink, Cara Weessies, Anna Whalen-Browne, Brian Whiteside, Matthew Willis, Jonas Wilmer, Nelson Wong, Mark Woodcroft, Lawrence Yau, Jessica Yee, Calvin Yeh, Simon York Ming Huang, Katherine Yurkiw, Fareen Zaver, Alexander Zozula, Graduate School, Emergency Department, ACS - Heart failure & arrhythmias, and ACS - Diabetes & metabolism

Subjects
Adult, Male, Students, Medical, Blogging, Intraclass correlation, media_common.quotation_subject, education, MEDLINE, Likert scale, 03 medical and health sciences, 0302 clinical medicine, Evaluation methods, Medicine, Humans, Quality (business), Generalizability theory, 030212 general & internal medicine, Reliability (statistics), media_common, Medical education, Education, Medical, business.industry, Internship and Residency, Reproducibility of Results, 030208 emergency & critical care medicine, Gestalt Theory, Emergency Medicine, Gestalt psychology, Female, Clinical Competence, Educational Measurement, business, Social Media
Abstract

Study objective Open educational resources such as blogs are increasingly used for medical education. Gestalt is generally the evaluation method used for these resources; however, little information has been published on it. We aim to evaluate the reliability of gestalt in the assessment of emergency medicine blogs. Methods We identified 60 English-language emergency medicine Web sites that posted clinically oriented blogs between January 1, 2016, and February 24, 2016. Ten Web sites were selected with a random-number generator. Medical students, emergency medicine residents, and emergency medicine attending physicians evaluated the 2 most recent clinical blog posts from each site for quality, using a 7-point Likert scale. The mean gestalt scores of each blog post were compared between groups with Pearson's correlations. Single and average measure intraclass correlation coefficients were calculated within groups. A generalizability study evaluated variance within gestalt and a decision study calculated the number of raters required to reliably (>0.8) estimate quality. Results One hundred twenty-one medical students, 88 residents, and 100 attending physicians (93.6% of enrolled participants) evaluated all 20 blog posts. Single-measure intraclass correlation coefficients within groups were fair to poor (0.36 to 0.40). Average-measure intraclass correlation coefficients were more reliable (0.811 to 0.840). Mean gestalt ratings by attending physicians correlated strongly with those by medical students (r=0.92) and residents (r=0.99). The generalizability coefficient was 0.91 for the complete data set. The decision study found that 42 gestalt ratings were required to reliably evaluate quality (>0.8). Conclusion The mean gestalt quality ratings of blog posts between medical students, residents, and attending physicians correlate strongly, but individual ratings are unreliable. With sufficient raters, mean gestalt ratings provide a community standard for assessment.

Published
2016

10. Association between Substance Abuse and Acute Exacerbation of Bronchial Asthma

Author

Howard Brown, Karen Rhoden, Theodore A. Spevack, Theodore J. Gaeta, and Regina Hammock

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, Exacerbation, Substance-Related Disorders, Bronchospasm, Heroin, Internal medicine, medicine, Humans, Prospective Studies, Asthma, biology, business.industry, Smoking, General Medicine, Middle Aged, medicine.disease, biology.organism_classification, Substance abuse, Case-Control Studies, Acute Disease, Emergency Medicine, Female, Cannabis, medicine.symptom, business, medicine.drug
Published
1996

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