cherri hobgood | Indiana University (original) (raw)

Papers by cherri hobgood

Diversity and Inclusion in Quality Patient Care, 2018

A 60-year-old male presents to the emergency department with a chief complaint of chest pain and ... more A 60-year-old male presents to the emergency department with a chief complaint of chest pain and shortness of breath (SOB) for 2 h. Review of Symptoms The 2 h of SOB is associated with diaphoresis and central chest pain that radiates to the back. The patient states the pain is dull and unrelenting. He reports nausea − one attempt to vomit which was unsuccessful. The patient has experienced pain like this before while working, but it has always resolved with rest.

AEM Education and Training, 2019

This is the author manuscript accepted for publication and has undergone full peer review but has... more This is the author manuscript accepted for publication and has undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as

Journal of Interprofessional Education & Practice, 2018

Background: Physician assistants continue to play an increasingly important role in our healthcar... more Background: Physician assistants continue to play an increasingly important role in our healthcare system, including a growing role in the emergency department. Introducing physician assistant students into an existing emergency department learning environment makes efficient use of resources and provides an opportunity for interprofessional education, but the success of such a strategy and the resultant impact on medical student education have not been previously described. The goals of our study were to determine the impact of the introduction of physician assistant students into a learning environment that already serves medical students and residents, and to assess the readiness of physician assistant students to participate in an established medical student emergency medicine clerkship. Methods: A survey was completed by emergency medicine faculty and residents shortly after the introduction of physician assistant students into an emergency department learning environment. The survey contained 18 questions in two sections: 11 questions asking about the effect of physician assistant students on the emergency department learning environment and 7 questions comparing the skills of physician assistant students with medical students. Data from medical student evaluations of the clerkship were also collected. Results and Discussion: Forty-six physician preceptors (43%) responded to the survey. The majority of preceptors felt that the presence of physician assistant students offered valuable interprofessional education and overall was a positive experience, though some expressed concerns about the effect on the education of other learners. Most preceptors felt that physician assistant students had comparable skills with medical students, though some concerns were expressed regarding knowledge base and variability of skill level. Medical student evaluations of the clerkship were similar before and after the introduction of physician assistant students. These results, however, must be viewed with caution as we were able replace a medical student with a physician assistant student, keeping the total number of students at the study sites constant, which some institutions may not be able to do. Conclusions: The impact of introducing physician assistant students to a medical student emergency medicine clerkship is viewed as being positive overall, though more research is needed to understand and optimize the learning involvement for all learners.

The western journal of emergency medicine, 2018

Effective communication between clinicians and patients has been shown to improve patient outcome... more Effective communication between clinicians and patients has been shown to improve patient outcomes, reduce malpractice liability, and is now being tied to reimbursement. Use of a communication strategy known as "scripting" has been suggested to improve patient satisfaction in multiple hospital settings, but the frequency with which medical students use this strategy and whether this affects patient perception of medical student care is unknown. Our objective was to measure the use of targeted communication skills after an educational intervention as well as to further clarify the relationship between communication element usage and patient satisfaction. Medical students were block randomized into the control or intervention group. Those in the intervention group received refresher training in scripted communication. Those in the control group received no instruction or other intervention related to communication. Use of six explicit communication behaviors were recorded by...

The Journal of emergency medicine, Jun 25, 2017

In 2001, "The Model of the Clinical Practice of Emergency Medicine" was first published. This doc... more In 2001, "The Model of the Clinical Practice of Emergency Medicine" was first published. This document, the first of its kind, was the result of an extensive practice analysis of emergency department (ED) visits and several expert panels, overseen by representatives from six collaborating professional organizations

AEM Education and Training, 2017

Implicit bias in clinical decision making has been shown to contribute to healthcare disparities ... more Implicit bias in clinical decision making has been shown to contribute to healthcare disparities and results in negative patient outcomes. Our objective was to develop a high-fidelity simulation model for assessing the effect of socioeconomic status (SES) on medical student (MS) patient care. METHODS Teams of medical students were randomly assigned to participate in a high-fidelity simulation of acute coronary syndrome. Cases were identical with the exception of patient SES, which alternated between a low SES homeless man and a high SES executive. Students were blinded to study objectives. Cases were recorded and scored by blinded independent raters using 24 dichotomous items in the following domains: 13 communication, 6 information gathering, 5 clinical care. In addition, quantitative data were obtained on the number of times students performed the following patient actions: acknowledged patient by name, asked about pain, generally conversed, and touching the patient. Fisher's exact test was used to test for differences between dichotomous items. For continuous measures, group differences were tested using a mixed-effects model with a random effect for case to account for multiple observations per case. RESULTS Fifty-eight teams participated in an equal number of high and low SES cases. MS asked about pain control more often (P=0.04) in patients of high SES. MS touched the low SES patient more frequently (P=0.01). There were no statistically significant differences in clinical care or information gathering measures. CONCLUSIONS This study demonstrates more attention to pain control in patients with higher SES as well as a trend toward better communication. Despite the differences in interpersonal behavior, quantifiable differences in clinical care were not seen. These results may be limited by sample size and larger cohorts will be required to identify the factors that contribute to SES bias.

Dementia (London, England), Jan 25, 2015

The study objective was to understand providers' perceptions regarding identifying and treati... more The study objective was to understand providers' perceptions regarding identifying and treating older adults with delirium, a common complication of acute illness in persons with dementia, in the pre-hospital and emergency department environments. The authors conducted structured focus group interviews with separate groups of emergency medical services staff, emergency nurses, and emergency physicians. Recordings of each session were transcribed, coded, and analyzed for themes with representative supporting quotations identified. Providers shared that the busy emergency department environment was the largest challenge to delirium recognition and treatment. When describing delirium, participants frequently detailed hyperactive features of delirium, rather than hypoactive features. Participants shared that they employed no clear diagnostic strategy for identifying the condition and that they used heterogeneous approaches to treat the condition. To improve care for older adults wit...

MedEdPORTAL Publications, 2010

Percentage of Views Leading to Downloads: 15% MedEdPORTAL® is the journal of teaching and learnin... more Percentage of Views Leading to Downloads: 15% MedEdPORTAL® is the journal of teaching and learning resources published by the Association of American Medical Colleges (AAMC) in partnership with the American Dental Education Association (ADEA).

BMJ Quality & Safety, 2010

Objectives The authors conducted a randomised controlled trial of four pedagogical methods common... more Objectives The authors conducted a randomised controlled trial of four pedagogical methods commonly used to deliver teamwork training and measured the effects of each method on the acquisition of student teamwork knowledge, skills, and attitudes. Methods The authors recruited 203 senior nursing students and 235 fourth-year medical students (total N¼438) from two major universities for a 1-day interdisciplinary teamwork training course. All participants received a didactic lecture and then were randomly assigned to one of four educational methods: didactic (control), audience response didactic, role play and human patient simulation. Student performance was assessed for teamwork attitudes, knowledge and skills using: (a) a 36-item teamwork attitudes instrument (CHIRP), (b) a 12-item teamwork knowledge test, (c) a 10-item standardised patient (SP) evaluation of student teamwork skills performance and (d) a 20-item modification of items from the Mayo High Performance Teamwork Scale (MHPTS). Results All four cohorts demonstrated an improvement in attitudes (F 1,370 ¼48.7, p¼0.001) and knowledge (F 1,353 ¼87.3, p¼0.001) pre-to post-test. No educational modality appeared superior for attitude (F 3,370 ¼0.325, p¼0.808) or knowledge (F 3,353 ¼0.382, p¼0.766) acquisition. No modality demonstrated a significant change in teamwork skills (F 3,18 ¼2.12, p¼0.134). Conclusions Each of the four modalities demonstrated significantly improved teamwork knowledge and attitudes, but no modality was demonstrated to be superior. Institutions should feel free to utilise educational modalities, which are best supported by their resources to deliver interdisciplinary teamwork training.

Annals of Emergency Medicine, 2014

Older adults who visit emergency departments (EDs) often experience delirium, but it is infrequen... more Older adults who visit emergency departments (EDs) often experience delirium, but it is infrequently recognized. A systematic review was therefore conducted to identify what delirium screening tools have been used in ED-based epidemiologic studies of delirium, whether there is a validated set of screening instruments to identify delirium among older adults in the ED or prehospital environments, and an ideal schedule during an older adult's visit to perform a delirium evaluation. MEDLINE/EMBASE, Cochrane, PsycINFO, and CINAHL databases were searched from inception through February 2013 for original, English-language research articles reporting on the assessment of older adults' mental status for delirium. Twenty-two articles met all study inclusion criteria. Overall, 7 screening instruments were identified, though only 1 has undergone initial validation for use in the ED environment and a second instrument is currently undergoing such validation. Minimal information was identified to suggest the ideal scheduling of a delirium assessment process to maximize the recognition of this condition in the ED. Study results indicate that several delirium screening tools have been used in investigations in the ED, though validation of these instruments for this particular environment has been minimal to date. The ideal interval(s) during which a delirium screening process should take place has yet to be determined. Research will be needed both to validate delirium screening instruments to be used for investigation and clinical care in the ED and to define the ideal timing and form of the delirium assessment process for older adults.

Social Science & Medicine, 2008

Teaching and Learning in Medicine, 2009

Our study examined whether GRIEV_ING improved death notification skills of medical students, whet... more Our study examined whether GRIEV_ING improved death notification skills of medical students, whether pretesting with simulated survivors primed learners and improved results of the intervention, and whether feedback on the simulated encounter improved student performance. GRIEV_ING training was given to 138 fourth-year medical students divided into three groups: exposure to simulated survivor (SS) with written feedback, exposure to SS but no feedback, and no exposure to SS before the training. Students were tested on self-confidence before and after the intervention and were rated by SSs on interpersonal communication and death notification skills. ANCOVA was performed, with gender and race covariates. All groups improved on death notification competence and confidence at about the same rate. Competence significantly (p =.037) improved for the feedback group. Interpersonal communication scores declined for all groups. GRIEV_ING provides an effective model medical educators can use to train medical students to provide competent death notifications. Senior medical students are primed to learn death notification and do not require a preexposure.

Journal of graduate medical education, 2011

The chief resident's role encompasses administrative, academic, educational, and social resp... more The chief resident's role encompasses administrative, academic, educational, and social responsibilities and is traditionally filled by a small number of residents who are charged with various administrative and educational duties. These duties lay the groundwork that prepares chief residents to assume future leadership positions.

Journal of Vascular Surgery, 1986

of bacterial adhesion by surface pretreatment of vascular Polytetrafluoroethylene grafts were pre... more of bacterial adhesion by surface pretreatment of vascular Polytetrafluoroethylene grafts were pretreated with oxacillin, with the cationic detergent benzalkonium, or with both substances, either at room temperature or at 90 ° C. Inhibition zones ranging from 6.4 to 15.2 mm formed around all grafts incubated on Staphylococcus aureus-streaked agar plates except control disks and those treated with oxacillin. Treated grafts were exposed in vitro to S. aureus in high concentration, followed by distilled water lavage. The graft surface was then stained with ruthenium red to stain polysaccharides and studied by scanning and transmission electron microscopy. Colonization of the graft surface by adhesive bacteria was demonstrated in all cases, although it was less prevalent on grafts pretreated with benzalkonium bound at 90 ° C. (J VASC SURG 1986; 4:16-21.) The incidence of infected lower limb vascular prostheses ranges from 2% to 6%/With few exceptions, an infection involving a prosthetic implant is resistant to treatment and requires removal of the implant. The resistance of implant-related infection to antibiotic therapy has been ascribed to a number of factors, including the adhesive mode of bacterial growth on the surface of a bioimplant. 2-7 Bacteria in natural systems, as well as in industrial oil and aquatic systems, have a specific response to ambient surfaces, that is, adhesion to those surfaces, sIx With ruthenium red staining, it has been shown that the adhesion is effected by an exopolysaccharide bacterial coating, and it is known that the surrounding adhesive coating affords a degree of protection from biocides 12 and antiseptics. ~' Therefore, Gristina et al. ~4,~s hypothesized that the resistance of biomaterial-related infections to treatment might be explained by adhesion; using techniques developed from industrial biology, they demonstrated exopolysaccharide biofilm-surrounded microcolonies of adhesive bacteria on orthopedic prosthetic devices and adjacent tissues in biomaterial-related, resistant infections. The first clinical demonstration of that ad-From the

Emergency Medicine Australasia, 2011

Terrence Mulligan, Cherri Hobgood and Peter A Cameron Department of Emergency Medicine, Universit... more Terrence Mulligan, Cherri Hobgood and Peter A Cameron Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA; Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa; and Emergency and Trauma Centre, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia

Emergency Medicine Australasia, 2009

med-ed.virginia.edu

The disparities in health care and health outcomes between the majority population and cultural a... more The disparities in health care and health outcomes between the majority population and cultural and racial minorities in the US are a problem likely influenced by the lack of culturally competent care. Emergency medicine and other primary care specialties remain on the front lines of this struggle due to the nature of their open door practice. In order to provide culturally appropriate care, health care providers must recognize the factors impeding cultural awareness, seek to understand the biases and traditions in medical education potentially fueling this phenomenon, and create a health care community open to individuals' "otherness," thus leading to better communication of ideas and information between patients and their health care providers. This article highlights the rationale for and current problems in teaching cultural competency and examines several different models implemented to teach and promote cultural competency. However, the literature addressing the true efficacy of such programs in leading to longlasting change and improvement in minority outcomes remains insufficient.

Annals of Emergency Medicine, 2008

Annals of Emergency Medicine, 2010

ELEMENTS OF A STANDARDIZED ED SIGN-OUT TJC's recommendations act as a starting point by including... more ELEMENTS OF A STANDARDIZED ED SIGN-OUT TJC's recommendations act as a starting point by including elements that can be applied to a sign-out process that focus on (1) content of sign-out, (2) communication techniques, (3) Volume , .  : December 

Diversity and Inclusion in Quality Patient Care, 2018

A 60-year-old male presents to the emergency department with a chief complaint of chest pain and ... more A 60-year-old male presents to the emergency department with a chief complaint of chest pain and shortness of breath (SOB) for 2 h. Review of Symptoms The 2 h of SOB is associated with diaphoresis and central chest pain that radiates to the back. The patient states the pain is dull and unrelenting. He reports nausea − one attempt to vomit which was unsuccessful. The patient has experienced pain like this before while working, but it has always resolved with rest.

AEM Education and Training, 2019

This is the author manuscript accepted for publication and has undergone full peer review but has... more This is the author manuscript accepted for publication and has undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as

Journal of Interprofessional Education & Practice, 2018

Background: Physician assistants continue to play an increasingly important role in our healthcar... more Background: Physician assistants continue to play an increasingly important role in our healthcare system, including a growing role in the emergency department. Introducing physician assistant students into an existing emergency department learning environment makes efficient use of resources and provides an opportunity for interprofessional education, but the success of such a strategy and the resultant impact on medical student education have not been previously described. The goals of our study were to determine the impact of the introduction of physician assistant students into a learning environment that already serves medical students and residents, and to assess the readiness of physician assistant students to participate in an established medical student emergency medicine clerkship. Methods: A survey was completed by emergency medicine faculty and residents shortly after the introduction of physician assistant students into an emergency department learning environment. The survey contained 18 questions in two sections: 11 questions asking about the effect of physician assistant students on the emergency department learning environment and 7 questions comparing the skills of physician assistant students with medical students. Data from medical student evaluations of the clerkship were also collected. Results and Discussion: Forty-six physician preceptors (43%) responded to the survey. The majority of preceptors felt that the presence of physician assistant students offered valuable interprofessional education and overall was a positive experience, though some expressed concerns about the effect on the education of other learners. Most preceptors felt that physician assistant students had comparable skills with medical students, though some concerns were expressed regarding knowledge base and variability of skill level. Medical student evaluations of the clerkship were similar before and after the introduction of physician assistant students. These results, however, must be viewed with caution as we were able replace a medical student with a physician assistant student, keeping the total number of students at the study sites constant, which some institutions may not be able to do. Conclusions: The impact of introducing physician assistant students to a medical student emergency medicine clerkship is viewed as being positive overall, though more research is needed to understand and optimize the learning involvement for all learners.

The western journal of emergency medicine, 2018

Effective communication between clinicians and patients has been shown to improve patient outcome... more Effective communication between clinicians and patients has been shown to improve patient outcomes, reduce malpractice liability, and is now being tied to reimbursement. Use of a communication strategy known as "scripting" has been suggested to improve patient satisfaction in multiple hospital settings, but the frequency with which medical students use this strategy and whether this affects patient perception of medical student care is unknown. Our objective was to measure the use of targeted communication skills after an educational intervention as well as to further clarify the relationship between communication element usage and patient satisfaction. Medical students were block randomized into the control or intervention group. Those in the intervention group received refresher training in scripted communication. Those in the control group received no instruction or other intervention related to communication. Use of six explicit communication behaviors were recorded by...

The Journal of emergency medicine, Jun 25, 2017

In 2001, "The Model of the Clinical Practice of Emergency Medicine" was first published. This doc... more In 2001, "The Model of the Clinical Practice of Emergency Medicine" was first published. This document, the first of its kind, was the result of an extensive practice analysis of emergency department (ED) visits and several expert panels, overseen by representatives from six collaborating professional organizations

AEM Education and Training, 2017

Implicit bias in clinical decision making has been shown to contribute to healthcare disparities ... more Implicit bias in clinical decision making has been shown to contribute to healthcare disparities and results in negative patient outcomes. Our objective was to develop a high-fidelity simulation model for assessing the effect of socioeconomic status (SES) on medical student (MS) patient care. METHODS Teams of medical students were randomly assigned to participate in a high-fidelity simulation of acute coronary syndrome. Cases were identical with the exception of patient SES, which alternated between a low SES homeless man and a high SES executive. Students were blinded to study objectives. Cases were recorded and scored by blinded independent raters using 24 dichotomous items in the following domains: 13 communication, 6 information gathering, 5 clinical care. In addition, quantitative data were obtained on the number of times students performed the following patient actions: acknowledged patient by name, asked about pain, generally conversed, and touching the patient. Fisher's exact test was used to test for differences between dichotomous items. For continuous measures, group differences were tested using a mixed-effects model with a random effect for case to account for multiple observations per case. RESULTS Fifty-eight teams participated in an equal number of high and low SES cases. MS asked about pain control more often (P=0.04) in patients of high SES. MS touched the low SES patient more frequently (P=0.01). There were no statistically significant differences in clinical care or information gathering measures. CONCLUSIONS This study demonstrates more attention to pain control in patients with higher SES as well as a trend toward better communication. Despite the differences in interpersonal behavior, quantifiable differences in clinical care were not seen. These results may be limited by sample size and larger cohorts will be required to identify the factors that contribute to SES bias.

Dementia (London, England), Jan 25, 2015

The study objective was to understand providers' perceptions regarding identifying and treati... more The study objective was to understand providers' perceptions regarding identifying and treating older adults with delirium, a common complication of acute illness in persons with dementia, in the pre-hospital and emergency department environments. The authors conducted structured focus group interviews with separate groups of emergency medical services staff, emergency nurses, and emergency physicians. Recordings of each session were transcribed, coded, and analyzed for themes with representative supporting quotations identified. Providers shared that the busy emergency department environment was the largest challenge to delirium recognition and treatment. When describing delirium, participants frequently detailed hyperactive features of delirium, rather than hypoactive features. Participants shared that they employed no clear diagnostic strategy for identifying the condition and that they used heterogeneous approaches to treat the condition. To improve care for older adults wit...

MedEdPORTAL Publications, 2010

Percentage of Views Leading to Downloads: 15% MedEdPORTAL® is the journal of teaching and learnin... more Percentage of Views Leading to Downloads: 15% MedEdPORTAL® is the journal of teaching and learning resources published by the Association of American Medical Colleges (AAMC) in partnership with the American Dental Education Association (ADEA).

BMJ Quality & Safety, 2010

Objectives The authors conducted a randomised controlled trial of four pedagogical methods common... more Objectives The authors conducted a randomised controlled trial of four pedagogical methods commonly used to deliver teamwork training and measured the effects of each method on the acquisition of student teamwork knowledge, skills, and attitudes. Methods The authors recruited 203 senior nursing students and 235 fourth-year medical students (total N¼438) from two major universities for a 1-day interdisciplinary teamwork training course. All participants received a didactic lecture and then were randomly assigned to one of four educational methods: didactic (control), audience response didactic, role play and human patient simulation. Student performance was assessed for teamwork attitudes, knowledge and skills using: (a) a 36-item teamwork attitudes instrument (CHIRP), (b) a 12-item teamwork knowledge test, (c) a 10-item standardised patient (SP) evaluation of student teamwork skills performance and (d) a 20-item modification of items from the Mayo High Performance Teamwork Scale (MHPTS). Results All four cohorts demonstrated an improvement in attitudes (F 1,370 ¼48.7, p¼0.001) and knowledge (F 1,353 ¼87.3, p¼0.001) pre-to post-test. No educational modality appeared superior for attitude (F 3,370 ¼0.325, p¼0.808) or knowledge (F 3,353 ¼0.382, p¼0.766) acquisition. No modality demonstrated a significant change in teamwork skills (F 3,18 ¼2.12, p¼0.134). Conclusions Each of the four modalities demonstrated significantly improved teamwork knowledge and attitudes, but no modality was demonstrated to be superior. Institutions should feel free to utilise educational modalities, which are best supported by their resources to deliver interdisciplinary teamwork training.

Annals of Emergency Medicine, 2014

Older adults who visit emergency departments (EDs) often experience delirium, but it is infrequen... more Older adults who visit emergency departments (EDs) often experience delirium, but it is infrequently recognized. A systematic review was therefore conducted to identify what delirium screening tools have been used in ED-based epidemiologic studies of delirium, whether there is a validated set of screening instruments to identify delirium among older adults in the ED or prehospital environments, and an ideal schedule during an older adult's visit to perform a delirium evaluation. MEDLINE/EMBASE, Cochrane, PsycINFO, and CINAHL databases were searched from inception through February 2013 for original, English-language research articles reporting on the assessment of older adults' mental status for delirium. Twenty-two articles met all study inclusion criteria. Overall, 7 screening instruments were identified, though only 1 has undergone initial validation for use in the ED environment and a second instrument is currently undergoing such validation. Minimal information was identified to suggest the ideal scheduling of a delirium assessment process to maximize the recognition of this condition in the ED. Study results indicate that several delirium screening tools have been used in investigations in the ED, though validation of these instruments for this particular environment has been minimal to date. The ideal interval(s) during which a delirium screening process should take place has yet to be determined. Research will be needed both to validate delirium screening instruments to be used for investigation and clinical care in the ED and to define the ideal timing and form of the delirium assessment process for older adults.

Social Science & Medicine, 2008

Teaching and Learning in Medicine, 2009

Our study examined whether GRIEV_ING improved death notification skills of medical students, whet... more Our study examined whether GRIEV_ING improved death notification skills of medical students, whether pretesting with simulated survivors primed learners and improved results of the intervention, and whether feedback on the simulated encounter improved student performance. GRIEV_ING training was given to 138 fourth-year medical students divided into three groups: exposure to simulated survivor (SS) with written feedback, exposure to SS but no feedback, and no exposure to SS before the training. Students were tested on self-confidence before and after the intervention and were rated by SSs on interpersonal communication and death notification skills. ANCOVA was performed, with gender and race covariates. All groups improved on death notification competence and confidence at about the same rate. Competence significantly (p =.037) improved for the feedback group. Interpersonal communication scores declined for all groups. GRIEV_ING provides an effective model medical educators can use to train medical students to provide competent death notifications. Senior medical students are primed to learn death notification and do not require a preexposure.

Journal of graduate medical education, 2011

The chief resident's role encompasses administrative, academic, educational, and social resp... more The chief resident's role encompasses administrative, academic, educational, and social responsibilities and is traditionally filled by a small number of residents who are charged with various administrative and educational duties. These duties lay the groundwork that prepares chief residents to assume future leadership positions.

Journal of Vascular Surgery, 1986

of bacterial adhesion by surface pretreatment of vascular Polytetrafluoroethylene grafts were pre... more of bacterial adhesion by surface pretreatment of vascular Polytetrafluoroethylene grafts were pretreated with oxacillin, with the cationic detergent benzalkonium, or with both substances, either at room temperature or at 90 ° C. Inhibition zones ranging from 6.4 to 15.2 mm formed around all grafts incubated on Staphylococcus aureus-streaked agar plates except control disks and those treated with oxacillin. Treated grafts were exposed in vitro to S. aureus in high concentration, followed by distilled water lavage. The graft surface was then stained with ruthenium red to stain polysaccharides and studied by scanning and transmission electron microscopy. Colonization of the graft surface by adhesive bacteria was demonstrated in all cases, although it was less prevalent on grafts pretreated with benzalkonium bound at 90 ° C. (J VASC SURG 1986; 4:16-21.) The incidence of infected lower limb vascular prostheses ranges from 2% to 6%/With few exceptions, an infection involving a prosthetic implant is resistant to treatment and requires removal of the implant. The resistance of implant-related infection to antibiotic therapy has been ascribed to a number of factors, including the adhesive mode of bacterial growth on the surface of a bioimplant. 2-7 Bacteria in natural systems, as well as in industrial oil and aquatic systems, have a specific response to ambient surfaces, that is, adhesion to those surfaces, sIx With ruthenium red staining, it has been shown that the adhesion is effected by an exopolysaccharide bacterial coating, and it is known that the surrounding adhesive coating affords a degree of protection from biocides 12 and antiseptics. ~' Therefore, Gristina et al. ~4,~s hypothesized that the resistance of biomaterial-related infections to treatment might be explained by adhesion; using techniques developed from industrial biology, they demonstrated exopolysaccharide biofilm-surrounded microcolonies of adhesive bacteria on orthopedic prosthetic devices and adjacent tissues in biomaterial-related, resistant infections. The first clinical demonstration of that ad-From the

Emergency Medicine Australasia, 2011

Terrence Mulligan, Cherri Hobgood and Peter A Cameron Department of Emergency Medicine, Universit... more Terrence Mulligan, Cherri Hobgood and Peter A Cameron Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA; Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa; and Emergency and Trauma Centre, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia

Emergency Medicine Australasia, 2009

med-ed.virginia.edu

The disparities in health care and health outcomes between the majority population and cultural a... more The disparities in health care and health outcomes between the majority population and cultural and racial minorities in the US are a problem likely influenced by the lack of culturally competent care. Emergency medicine and other primary care specialties remain on the front lines of this struggle due to the nature of their open door practice. In order to provide culturally appropriate care, health care providers must recognize the factors impeding cultural awareness, seek to understand the biases and traditions in medical education potentially fueling this phenomenon, and create a health care community open to individuals' "otherness," thus leading to better communication of ideas and information between patients and their health care providers. This article highlights the rationale for and current problems in teaching cultural competency and examines several different models implemented to teach and promote cultural competency. However, the literature addressing the true efficacy of such programs in leading to longlasting change and improvement in minority outcomes remains insufficient.

Annals of Emergency Medicine, 2008

Annals of Emergency Medicine, 2010

ELEMENTS OF A STANDARDIZED ED SIGN-OUT TJC's recommendations act as a starting point by including... more ELEMENTS OF A STANDARDIZED ED SIGN-OUT TJC's recommendations act as a starting point by including elements that can be applied to a sign-out process that focus on (1) content of sign-out, (2) communication techniques, (3) Volume , .  : December 