Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Multicenter Study Observational Study
Emergency Medicine Residents' Self-assessments Play a Critical Role When Receiving Feedback.
Emergency medicine (EM) faculty often aim to improve resident performance by enhancing the quality and delivery of feedback. The acceptance and integration of external feedback is influenced by multiple factors. However, it is interpreted through the "lens" of the learner's own self-assessment. Ideally, following an educational activity with feedback, a learner should be able to generate and act upon specific learning goals to improve performance. Examining the source of generated learning goals, whether from one's self-assessment or from external feedback, might shed light on the factors that lead to improvement and guide educational initiatives. Using a standard oral board scenario, the objective of this study was to determine the effects that residents' self-assessment and specific feedback from faculty have on not only the generation of learning goals but also the execution of these goals for performance improvement. ⋯ Following feedback on an oral board scenario, residents generated the majority of their learning goals from their own self-assessments. Conversely, at the follow-up period, they recalled an increased number of learning goals stemming from feedback, while the largest proportion of learning goals acted upon stemmed from both feedback and self-assessments in agreement. This suggests that educators need to incorporate residents' self-assessments into any delivered feedback to have the greatest influence on future learning goals and actions taken to improve performance.
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Expanding insurance coverage is designed to improve access to primary care and reduce use of emergency department (ED) services. Whether expanding coverage achieves this is of paramount importance as the United States prepares for the Affordable Care Act. ⋯ Since CHIP, adolescent non-ED outpatient visits have increased, while ED visits have remained unchanged. In comparison to young adults, expanding insurance coverage to adolescents improved use of health care services and suggests a shift to non-ED settings. Expanding insurance through the Affordable Care Act of 2010 will likely increase use of outpatient services, but may not decrease ED volumes.
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Observational Study
Intranasal Ketamine for Analgesia in the Emergency Department: A Prospective Observational Series.
The objective was to examine the feasibility, effectiveness, and adverse effect profile of intranasal ketamine for analgesia in emergency department (ED) patients. ⋯ Intranasal ketamine reduced VAS pain scores to a clinically significant degree in 88% of ED patients in this series. Adverse effects were minor and transient. Intranasal ketamine may have a role in the provision of effective, expeditious analgesia to ED patients.
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Observational Study
Parental Anxiety at Initial Acute Presentation Is Not Associated With Prolonged Symptoms Following Pediatric Concussion.
Anxiety modulates symptom perception in adults following concussion, prolonging the time to full recovery. The authors sought to determine whether parental anxiety was associated with persistent postconcussive symptoms (PCS) in their children following concussion. ⋯ Parental anxiety at time of acute presentation does not appear to be associated with prolongation of postconcussive symptoms in their children. However, parents of persistently symptomatic children remain significantly more anxious than those whose children's symptoms have resolved. Future research should attempt to reduce the familial burden of concussion through expectation management strategies.
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Low back pain (LBP) is a common reason for emergency department (ED) visits in the United States. Pain and functional outcomes after ED visits for LBP tend to be poor. ED-based clinical LBP research is hampered by complexity of available outcome instruments, which can be time-consuming to administer. The purpose of this investigation was to determine if a shorter version of the well-validated and commonly used Roland Morris Disability Questionnaire (RMDQ) would retain the original 24-item instrument's ability to assess functional outcomes accurately in ED patients with LBP. ⋯ An abbreviated five-item version of the RMDQ was developed. Pending independent validation, this shortened instrument should streamline ED-based low back pain research.