Malford Pillow - Academia.edu (original) (raw)

Papers by Malford Pillow

BackgroundThe transition of the Accreditation Council for Graduate Medical Education (ACGME) to m... more BackgroundThe transition of the Accreditation Council for Graduate Medical Education (ACGME) to milestone assessment creates opportunities for collaboration and shared assessments across graduate medical programs. Breaking bad news is an essential communication skill that is a common milestone across almost every medical specialty. The purpose of this study was to develop and pilot an integrated milestone assessment (IMA) tool for breaking bad news using ACGME milestone criteria and to compare the IMA tool with the existing SPIKES protocol. MethodsThe IMA tool was created using sub-anchors in professionalism and interpersonal communication skills that are applicable to every specialty and to the ability to break bad news. Two cases of breaking bad news, designed to be “easy” and “intermediate” in difficulty, were used to assess basic skills in breaking bad news in first-year medical residents from six residency specialties. Eight standardized patients were trained to portray the cas...

Western Journal of Emergency Medicine, 2013

The Journal of emergency medicine, Jan 2, 2015

Acute pancreatitis (AP) is a common presentation in the emergency department (ED). Severity of pa... more Acute pancreatitis (AP) is a common presentation in the emergency department (ED). Severity of pancreatitis is an important consideration for ED clinicians making admission judgments. Validated scoring systems can be a helpful tool in this process. The aim of this review is to give a general outline on the subject of AP and compare different criteria used to predict severity of disease for use in the ED. This review updates the classifications and scoring systems for AP and the relevant parameters of each. This article assesses past and current scoring systems for AP, including Ranson criteria, Glasgow criteria, Acute Physiology and Chronic Health Evaluation II (APACHE II), computed tomography imaging scoring systems, Bedside Index of Severity in Acute Pancreatitis (BISAP) score, Panc 3, Harmless Acute Pancreatitis Score (HAPS), and the Japanese Severity Score. This article also describes the potential use of single variable predictors. Finally, this article discusses risk factors f...

The western journal of emergency medicine, 2013

The western journal of emergency medicine, 2012

Prehospital and disaster medicine

Terrorist bombings continue to remain a risk for local jurisdictions, and retrospective data from... more Terrorist bombings continue to remain a risk for local jurisdictions, and retrospective data from the United States show that bombings occur in residential and business areas due to interpersonal violence without political motives. In the event of a mass-casualty bombing incident, prehospital care providers will have the responsibility for identifying and managing blast injuries unique to bombing victims. In a large-scale event, emergency medical services personnel should be required to provide prolonged medical care in the prehospital setting, and they will be able to deliver improved care with a better understanding of blast injuries and a concise algorithm for managing them. Blast injuries are categorized as primary, secondary, tertiary, and quaternary, and these injuries are related to the mechanism of injury from the blast event. After an initial evaluation, the emergency healthcare provider should consider following a universal algorithm to identify and treat blast injuries wi...

The western journal of emergency medicine, 2010

Emergency Medicine Clinics of North America, 2014

Acid-base disorders should be considered a process with the goal being to treat the patient and t... more Acid-base disorders should be considered a process with the goal being to treat the patient and the underlying condition, not the numbers. A good understanding of the normal acid-base regulation in the body, as well as the most common derangements can prepare the emergency physician for this very common disorder that presents on every shift.

Emergency Medicine Clinics of North America, 2005

Endocrinology and metabolism often have been viewed as just biochemistry topics, more theoretical... more Endocrinology and metabolism often have been viewed as just biochemistry topics, more theoretical than practical, that were to be memorized in medical school. In fact, mastery of this field is essential for the effective practice of emergency medicine. This issue is designed to make the knowledge of this field become more pertinent and accessible to emergency physicians. While including the pathophysiology that is necessary for understanding basic details, each article emphasizes the emergency department presentation, diagnostic evaluation, and immediate therapeutic approach to the patient who presents with a metabolic problem.

Social media has become a staple of everyday life among over one billion people worldwide. A soci... more Social media has become a staple of everyday life among over one billion people worldwide. A social networking presence has become a hallmark of vibrant and transparent communications. It has quickly become the preferred method of communication and information sharing. It offers the ability for various entities, especially residency programs, to create an attractive internet presence and "brand" the program. Social media, while having significant potential for communication and knowledge transfer, carries with it legal, ethical, personal, and professional risks. Implementation of a social networking presence must be deliberate, transparent, and optimize potential benefits while minimizing risks. This is especially true with residency programs. The power of social media as a communication, education, and recruiting tool is undeniable. Yet the pitfalls of misuse can be disastrous, including violations in patient confidentiality, violations of privacy, and recruiting misconduct. These guidelines were developed to provide emergency medicine residency programs leadership with guidance and best practices in the appropriate use and regulation of social media, but are applicable to all residency programs that wish to establish a social media presence. [West J Emerg Med. 2014;15(1):26-30.]

Western Journal of Emergency Medicine, 2011

We present the case of a 32-year-old woman who presented to the emergency department with a witne... more We present the case of a 32-year-old woman who presented to the emergency department with a witnessed cardiac arrest. She was otherwise healthy with no cardiac risk factors and had undergone an uneventful repeated cesarean section 3 days priorly. The patient underwent defibrillation, out of ventricular fibrillation to a perfusing sinus rhythm, and was taken to the catheterization laboratory where coronary angiography findings showed spontaneous dissection of the left anterior descending artery. The patient received a total of 6 stents during her hospital stay and was eventually discharged in good condition. Spontaneous coronary artery dissection is a rare entity with a predilection for pregnant or postpartum women. Early diagnosis and treatment are key for survival, and when identified early, mortality rate is reduced. [West J Emerg Med. 2011;12(4):567-570.] IABP to manage the cardiogenic shock. Over the next several days, the patient slowly improved and was weaned off

The Journal of Emergency Medicine, 2012

The Journal of Emergency Medicine, 2013

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is an uncommon but serious hyp... more Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is an uncommon but serious hypersensitivity drug reaction most frequently associated with antiepileptics. Clinical manifestations include rash, fever, and visceral organ involvement, most commonly hepatitis. The mortality rate associated with DRESS syndrome is approximately 10%, the majority due to fulminant liver failure. We report one case of phenytoin-induced DRESS syndrome in a patient who presented to the Emergency Department (ED). Our objectives for this case report include: 1) to learn the importance of DRESS syndrome; 2) to recognize the signs and symptoms of DRESS syndrome; 3) to know what diagnostic studies are indicated; and 4) to learn the appropriate treatment. We report one case of phenytoin-induced DRESS syndrome in a 34-year-old man, previously on phenytoin for seizure prophylaxis, who presented to the ED with 5 days of worsening symptoms including generalized rash, fever, tongue swelling, and dysphagia. Laboratory results revealed an eosinophilia and elevated liver enzymes. With initiation of steroids, the transaminitis improved despite increasing eosinophilia and development of an atypical lymphocytosis. Fever and angioedema resolved with improvement of the rash, and the patient was discharged on hospital day 3. Given the significant mortality related to DRESS syndrome, ED staff should have a low threshold for suspecting the condition in patients who present with unusual complaints and skin findings after starting any antiepileptic drug. Early diagnosis and prompt treatment with corticosteroids is imperative.

The Journal of Emergency Medicine, 2014

Background: Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), and Pediatric Advance... more Background: Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), and Pediatric Advanced Life Support (PALS) are integral parts of emergency resuscitative care. Although this training is usually reserved for residents, introducing the training in the medical student curriculum may enhance acquisition and retention of these skills. Objectives: We developed a survey to characterize the perceptions and needs of graduating medical students regarding BLS, ACLS, and PALS training. Methods: This was a study of graduating 4 th -year medical students at a U.S. medical school. The students were surveyed prior to participating in an ACLS course in March of their final year. Results: Of 152 students, 109 (71.7%) completed the survey; 48.6% of students entered medical school without any prior training and 47.7% started clinics without training; 83.4% of students reported witnessing an average of 3.0 in-hospital cardiac arrests during training (range of 0-20). Overall, students rated their preparedness 2.0 (SD 1.0) for adult resuscitations and 1.7 (SD 0.9) for pediatric resuscitations on a 1-5 Likert scale, with 1 being unprepared. A total of 36.8% of students avoided participating in resuscitations due to lack of training; 98.2%, 91.7%, and 64.2% of students believe that BLS, ACLS, and PALS, respectively, should be included in the medical student curriculum. Conclusions: As per previous studies that have examined this topic, students feel unprepared to respond to cardiac arrests and resuscitations. They feel that training is needed in their curriculum and would possibly enhance perceived comfort levels and willingness to participate in resuscitations. Ó 2014 Elsevier Inc.

The Journal of Emergency Medicine, 2012

A 53-year-old man with history of hypertension, coronary artery disease, and chronic left leg dee... more A 53-year-old man with history of hypertension, coronary artery disease, and chronic left leg deep vein thrombosis on Coumadin (Bristol-Myers Squibb Company, Princeton, NJ) presented complaining of chest pain. The pain was dull, midsternal, gradual in onset, and rated 5/10. There was no radiation of the pain, and the patient initially said that this pain was similar to his previous cardiac pain. Review of systems was positive for mild exertional chest pain and occasional shortness of breath. Vital signs were stable and the examination was remarkable for a 2/6 systolic ejection murmur. Electrocardiogram showed right bundle branch block without ischemia. Cardiac enzymes were normal. Chest X-ray study ( ) showed widened mediastinum. A computed tomography scan with angiography of the chest ( ) revealed a pulmonary aneurysm with the main pulmonary artery dilatated to 71 mm and enlargement of both pulmonary arteries. An echocardiogram showed a severely dilatated right ventricle, moderate tricuspid regurgitation, and a pulmonary artery pressure of approximately 66 mm Hg, consistent with pulmonary hypertension. The patient's pulmonary aneurysm was thought to most likely be secondary to chronic undiagnosed pulmonary embolisms causing pulmonary hypertension. His symptoms resolved, so he was medically optimized and discharged. The aneurysm has remained stable since his first visit.

The Journal of Emergency Medicine, 2013

Background: Many patients present to the Emergency Department (ED) for multiple visits. Whatever ... more Background: Many patients present to the Emergency Department (ED) for multiple visits. Whatever the cause, assuring the highest quality of care is difficult in the ED. Objectives: We sought to implement a web-based, ED-initiated, multidisciplinary program to improve patient care and reduce frequent visits to the ED. Methods: The top 50 ED frequent visitors were identified and care plans were constructed. Care plans consist primarily of a summary of the patient's pertinent history and any psychosocial issues that can contribute to frequent use of the ED, and recommend treatment plans for these patients. Results: During the study period, ED visits by the top 50 chronic frequent visitors ranged from 88 to 98 visits/month and 28 to 31 admissions/month. As of January 2007, the top 50 frequent visitors had 94 ED visits/month (1,129 visits/year) for 2.2% of the total census, and 31 admissions/month (372 admissions per year) for approximately 3.3% of the total admissions. Each frequent visitor has approximately 22.6 visits/year (range from 11 to 41) and 7.3 admissions/year (range from 0 to 20). By May 2008, the top 50 frequent visitors had a decrease to 88 visits/month (1,059 visits/year) and 28 admissions/month (340 admissions/year), with each frequent visitor having 21.2 visits/year and 6.8 admissions/ year. Social determinants included psychiatric disease (36%), substance abuse (22%), malingering (20%), medication noncompliance (16%), and unstable housing (10%). Conclusions: There was a trend toward a decrease of monthly ED visits by the top 50 ED frequent visitors, but no effect on the rate of admissions. Based on these preliminary data and the relative ease of integration into the system, this project shows the potential to begin to address the problem of chronic ED use with patient care plans. Ó 2013 Elsevier Inc.

Annals of Emergency Medicine, 2011

Objective: Various HIV testing models have been described, but widespread implementation has lagg... more Objective: Various HIV testing models have been described, but widespread implementation has lagged. We describe a clinical HIV testing program notable for its use of conventional (nonrapid) assays, native hospital personnel, and an electronic system to aid targeted patient selection.

American Journal of Critical Care, 2010

BackgroundThe transition of the Accreditation Council for Graduate Medical Education (ACGME) to m... more BackgroundThe transition of the Accreditation Council for Graduate Medical Education (ACGME) to milestone assessment creates opportunities for collaboration and shared assessments across graduate medical programs. Breaking bad news is an essential communication skill that is a common milestone across almost every medical specialty. The purpose of this study was to develop and pilot an integrated milestone assessment (IMA) tool for breaking bad news using ACGME milestone criteria and to compare the IMA tool with the existing SPIKES protocol. MethodsThe IMA tool was created using sub-anchors in professionalism and interpersonal communication skills that are applicable to every specialty and to the ability to break bad news. Two cases of breaking bad news, designed to be “easy” and “intermediate” in difficulty, were used to assess basic skills in breaking bad news in first-year medical residents from six residency specialties. Eight standardized patients were trained to portray the cas...

Western Journal of Emergency Medicine, 2013

The Journal of emergency medicine, Jan 2, 2015

Acute pancreatitis (AP) is a common presentation in the emergency department (ED). Severity of pa... more Acute pancreatitis (AP) is a common presentation in the emergency department (ED). Severity of pancreatitis is an important consideration for ED clinicians making admission judgments. Validated scoring systems can be a helpful tool in this process. The aim of this review is to give a general outline on the subject of AP and compare different criteria used to predict severity of disease for use in the ED. This review updates the classifications and scoring systems for AP and the relevant parameters of each. This article assesses past and current scoring systems for AP, including Ranson criteria, Glasgow criteria, Acute Physiology and Chronic Health Evaluation II (APACHE II), computed tomography imaging scoring systems, Bedside Index of Severity in Acute Pancreatitis (BISAP) score, Panc 3, Harmless Acute Pancreatitis Score (HAPS), and the Japanese Severity Score. This article also describes the potential use of single variable predictors. Finally, this article discusses risk factors f...

The western journal of emergency medicine, 2013

The western journal of emergency medicine, 2012

Prehospital and disaster medicine

Terrorist bombings continue to remain a risk for local jurisdictions, and retrospective data from... more Terrorist bombings continue to remain a risk for local jurisdictions, and retrospective data from the United States show that bombings occur in residential and business areas due to interpersonal violence without political motives. In the event of a mass-casualty bombing incident, prehospital care providers will have the responsibility for identifying and managing blast injuries unique to bombing victims. In a large-scale event, emergency medical services personnel should be required to provide prolonged medical care in the prehospital setting, and they will be able to deliver improved care with a better understanding of blast injuries and a concise algorithm for managing them. Blast injuries are categorized as primary, secondary, tertiary, and quaternary, and these injuries are related to the mechanism of injury from the blast event. After an initial evaluation, the emergency healthcare provider should consider following a universal algorithm to identify and treat blast injuries wi...

The western journal of emergency medicine, 2010

Emergency Medicine Clinics of North America, 2014

Acid-base disorders should be considered a process with the goal being to treat the patient and t... more Acid-base disorders should be considered a process with the goal being to treat the patient and the underlying condition, not the numbers. A good understanding of the normal acid-base regulation in the body, as well as the most common derangements can prepare the emergency physician for this very common disorder that presents on every shift.

Emergency Medicine Clinics of North America, 2005

Endocrinology and metabolism often have been viewed as just biochemistry topics, more theoretical... more Endocrinology and metabolism often have been viewed as just biochemistry topics, more theoretical than practical, that were to be memorized in medical school. In fact, mastery of this field is essential for the effective practice of emergency medicine. This issue is designed to make the knowledge of this field become more pertinent and accessible to emergency physicians. While including the pathophysiology that is necessary for understanding basic details, each article emphasizes the emergency department presentation, diagnostic evaluation, and immediate therapeutic approach to the patient who presents with a metabolic problem.

Social media has become a staple of everyday life among over one billion people worldwide. A soci... more Social media has become a staple of everyday life among over one billion people worldwide. A social networking presence has become a hallmark of vibrant and transparent communications. It has quickly become the preferred method of communication and information sharing. It offers the ability for various entities, especially residency programs, to create an attractive internet presence and "brand" the program. Social media, while having significant potential for communication and knowledge transfer, carries with it legal, ethical, personal, and professional risks. Implementation of a social networking presence must be deliberate, transparent, and optimize potential benefits while minimizing risks. This is especially true with residency programs. The power of social media as a communication, education, and recruiting tool is undeniable. Yet the pitfalls of misuse can be disastrous, including violations in patient confidentiality, violations of privacy, and recruiting misconduct. These guidelines were developed to provide emergency medicine residency programs leadership with guidance and best practices in the appropriate use and regulation of social media, but are applicable to all residency programs that wish to establish a social media presence. [West J Emerg Med. 2014;15(1):26-30.]

Western Journal of Emergency Medicine, 2011

We present the case of a 32-year-old woman who presented to the emergency department with a witne... more We present the case of a 32-year-old woman who presented to the emergency department with a witnessed cardiac arrest. She was otherwise healthy with no cardiac risk factors and had undergone an uneventful repeated cesarean section 3 days priorly. The patient underwent defibrillation, out of ventricular fibrillation to a perfusing sinus rhythm, and was taken to the catheterization laboratory where coronary angiography findings showed spontaneous dissection of the left anterior descending artery. The patient received a total of 6 stents during her hospital stay and was eventually discharged in good condition. Spontaneous coronary artery dissection is a rare entity with a predilection for pregnant or postpartum women. Early diagnosis and treatment are key for survival, and when identified early, mortality rate is reduced. [West J Emerg Med. 2011;12(4):567-570.] IABP to manage the cardiogenic shock. Over the next several days, the patient slowly improved and was weaned off

The Journal of Emergency Medicine, 2012

The Journal of Emergency Medicine, 2013

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is an uncommon but serious hyp... more Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is an uncommon but serious hypersensitivity drug reaction most frequently associated with antiepileptics. Clinical manifestations include rash, fever, and visceral organ involvement, most commonly hepatitis. The mortality rate associated with DRESS syndrome is approximately 10%, the majority due to fulminant liver failure. We report one case of phenytoin-induced DRESS syndrome in a patient who presented to the Emergency Department (ED). Our objectives for this case report include: 1) to learn the importance of DRESS syndrome; 2) to recognize the signs and symptoms of DRESS syndrome; 3) to know what diagnostic studies are indicated; and 4) to learn the appropriate treatment. We report one case of phenytoin-induced DRESS syndrome in a 34-year-old man, previously on phenytoin for seizure prophylaxis, who presented to the ED with 5 days of worsening symptoms including generalized rash, fever, tongue swelling, and dysphagia. Laboratory results revealed an eosinophilia and elevated liver enzymes. With initiation of steroids, the transaminitis improved despite increasing eosinophilia and development of an atypical lymphocytosis. Fever and angioedema resolved with improvement of the rash, and the patient was discharged on hospital day 3. Given the significant mortality related to DRESS syndrome, ED staff should have a low threshold for suspecting the condition in patients who present with unusual complaints and skin findings after starting any antiepileptic drug. Early diagnosis and prompt treatment with corticosteroids is imperative.

The Journal of Emergency Medicine, 2014

Background: Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), and Pediatric Advance... more Background: Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), and Pediatric Advanced Life Support (PALS) are integral parts of emergency resuscitative care. Although this training is usually reserved for residents, introducing the training in the medical student curriculum may enhance acquisition and retention of these skills. Objectives: We developed a survey to characterize the perceptions and needs of graduating medical students regarding BLS, ACLS, and PALS training. Methods: This was a study of graduating 4 th -year medical students at a U.S. medical school. The students were surveyed prior to participating in an ACLS course in March of their final year. Results: Of 152 students, 109 (71.7%) completed the survey; 48.6% of students entered medical school without any prior training and 47.7% started clinics without training; 83.4% of students reported witnessing an average of 3.0 in-hospital cardiac arrests during training (range of 0-20). Overall, students rated their preparedness 2.0 (SD 1.0) for adult resuscitations and 1.7 (SD 0.9) for pediatric resuscitations on a 1-5 Likert scale, with 1 being unprepared. A total of 36.8% of students avoided participating in resuscitations due to lack of training; 98.2%, 91.7%, and 64.2% of students believe that BLS, ACLS, and PALS, respectively, should be included in the medical student curriculum. Conclusions: As per previous studies that have examined this topic, students feel unprepared to respond to cardiac arrests and resuscitations. They feel that training is needed in their curriculum and would possibly enhance perceived comfort levels and willingness to participate in resuscitations. Ó 2014 Elsevier Inc.

The Journal of Emergency Medicine, 2012

A 53-year-old man with history of hypertension, coronary artery disease, and chronic left leg dee... more A 53-year-old man with history of hypertension, coronary artery disease, and chronic left leg deep vein thrombosis on Coumadin (Bristol-Myers Squibb Company, Princeton, NJ) presented complaining of chest pain. The pain was dull, midsternal, gradual in onset, and rated 5/10. There was no radiation of the pain, and the patient initially said that this pain was similar to his previous cardiac pain. Review of systems was positive for mild exertional chest pain and occasional shortness of breath. Vital signs were stable and the examination was remarkable for a 2/6 systolic ejection murmur. Electrocardiogram showed right bundle branch block without ischemia. Cardiac enzymes were normal. Chest X-ray study ( ) showed widened mediastinum. A computed tomography scan with angiography of the chest ( ) revealed a pulmonary aneurysm with the main pulmonary artery dilatated to 71 mm and enlargement of both pulmonary arteries. An echocardiogram showed a severely dilatated right ventricle, moderate tricuspid regurgitation, and a pulmonary artery pressure of approximately 66 mm Hg, consistent with pulmonary hypertension. The patient's pulmonary aneurysm was thought to most likely be secondary to chronic undiagnosed pulmonary embolisms causing pulmonary hypertension. His symptoms resolved, so he was medically optimized and discharged. The aneurysm has remained stable since his first visit.

The Journal of Emergency Medicine, 2013

Background: Many patients present to the Emergency Department (ED) for multiple visits. Whatever ... more Background: Many patients present to the Emergency Department (ED) for multiple visits. Whatever the cause, assuring the highest quality of care is difficult in the ED. Objectives: We sought to implement a web-based, ED-initiated, multidisciplinary program to improve patient care and reduce frequent visits to the ED. Methods: The top 50 ED frequent visitors were identified and care plans were constructed. Care plans consist primarily of a summary of the patient's pertinent history and any psychosocial issues that can contribute to frequent use of the ED, and recommend treatment plans for these patients. Results: During the study period, ED visits by the top 50 chronic frequent visitors ranged from 88 to 98 visits/month and 28 to 31 admissions/month. As of January 2007, the top 50 frequent visitors had 94 ED visits/month (1,129 visits/year) for 2.2% of the total census, and 31 admissions/month (372 admissions per year) for approximately 3.3% of the total admissions. Each frequent visitor has approximately 22.6 visits/year (range from 11 to 41) and 7.3 admissions/year (range from 0 to 20). By May 2008, the top 50 frequent visitors had a decrease to 88 visits/month (1,059 visits/year) and 28 admissions/month (340 admissions/year), with each frequent visitor having 21.2 visits/year and 6.8 admissions/ year. Social determinants included psychiatric disease (36%), substance abuse (22%), malingering (20%), medication noncompliance (16%), and unstable housing (10%). Conclusions: There was a trend toward a decrease of monthly ED visits by the top 50 ED frequent visitors, but no effect on the rate of admissions. Based on these preliminary data and the relative ease of integration into the system, this project shows the potential to begin to address the problem of chronic ED use with patient care plans. Ó 2013 Elsevier Inc.

Annals of Emergency Medicine, 2011

Objective: Various HIV testing models have been described, but widespread implementation has lagg... more Objective: Various HIV testing models have been described, but widespread implementation has lagged. We describe a clinical HIV testing program notable for its use of conventional (nonrapid) assays, native hospital personnel, and an electronic system to aid targeted patient selection.

American Journal of Critical Care, 2010