Javier Amador-Castañeda, BHS, RRT, FCCM’s Post

An important message from NAEMSP President José G Cabañas MD, MPH, FAEMS regarding the NFPA Urban Chiefs Forum and inappropriate assertion of standard of care. https://lnkd.in/eNWECYme A Message from the NAEMSP President October 2, 2023 Dear NAEMSP Members, Fellow EMS Physicians and EMS Clinicians: I am taking a moment to share my thoughts and concerns regarding the recently published Urban Chiefs Forum and NFPA document regarding the elevation of head and torso during CPR. I am troubled by the recommendations concerning this practice as the “standard of care.” It is concerning that a non-clinical forum is asserting a stance on EMS medicine standards, especially with regards to the utilization of specific devices or techniques for the care of victims of cardiac arrest. This raises questions about the appropriateness of their involvement in ongoing scientific dialogues that directly impact patient care. It is crucial that EMS physicians maintain a strong voice in determining the best practices and standards for our field. Furthermore, the involvement of non-clinical forum in making statements about our practice sets a potentially dangerous precedent that could create pressure from non-clinical leaders and elected officials to adopt clinical practices that are not based on strong scientific evidence. As dedicated EMS clinicians, we understand the importance of evidence-based medicine and the need for rigorous evaluation before endorsing widespread adoption of clinical practices based on preliminary observational evidence that almost always has major limitations due to bias. Any publication that calls for a recognized and accepted widely applicable standard of care should include authorship as well as disclosure of conflicts of interest. Without such information, it becomes challenging to fully evaluate the objectivity of the position statement. Developing new and innovative methods to improve patient care and outcomes is exceedingly important - but it must be done through a scientific method that is valid and unbiased before advocating for widespread adoption in clinical practice. The concept of elevating the head and torso during CPR is certainly provocative and represents disruptive thinking that may potentially be important as we seek to improve outcomes from cardiac arrest. EMS physician oversight is crucial in interpreting and effectively implementing new interventions within our communities. Thank you for all you do, José G Cabañas MD, MPH, FAEMS NAEMSP President

Medical professionals and community members are invited to join us at the 4th Annual Improving Diagnostic Accuracy in Medicine Conference 4-8 p.m. on May 9-10 at Providence Alaska Medical Center. The conference is also available via livestream. Learn from local, national, and international experts as they share information, tools, and techniques to recognize and mitigate risk factors that contribute to diagnostic error or delay. Efforts to improve patient outcomes will be shared from both the perspective of medical professionals and patient advocates. Featured presenters include: — Jack Penner, M.D. Clinical Problem Solving Exercise — Andrew M. Freeman M.D., FACC, FACP, Improving Diagnostic Accuracy in Cardiology — Laura Zwaan, Ph.D., Managing Uncertainty in the Diagnostic Process — Edward Hoffer M.D., FACP, FACC, FACMI, Diagnostic Error and Failure to Rescue — Helene Epstein, national advocate for patients and families and author of the blog "Patient No More" — Sue Sheridan, MIM, MBA, DHL, founding member of Patients for Patient Safety US and the director of Patient Engagement emeritus at the Society to Improve Diagnosis in Medicine Please contact [email protected] if you are interested in attending. Caregivers interested in attending can register on the CME Tracker at https://bit.ly/CMETracker. Call (907) 212-4571 for more information.

It is great to share another publication from our recent HDR Grandaunt, Dr Emma Bourke-Matas and her team Tan Doan, Kelly-Ann Bowles and Emma Bosley (PhD). As Emma's thesis worked to increase awareness and evidence in the area of pre-hospital clinical deterioration, this work has recently been published online in Academic Emergency Medicine. A prediction model for prehospital clinical deterioration: The use of early warning scores (https://lnkd.in/g8dZR9_p) This retrospective cohort study investigated adult patients of all etiologies attended by Queensland Ambulance Service paramedics between January 1, 2018, and December 31, 2020. With logistic regression, several models were developed to predict adverse event outcomes. The National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), Queensland Adult Deterioration Detection System (Q-ADDS), and shock index were calculated from vital signs taken by paramedics. This study found NEWS, MEWS, and Q-ADDS all performed well in the prehospital setting. Although a simple shock index is easier for paramedics to use in the prehospital environment, it did not perform comparably to established EWSs. Further research is required to develop suitably performing parsimonious solutions until established EWSs are integrated into technological solutions to be used by prehospital clinicians in real time.

“As described in this article, the management of the patient with CS is complex and frequently requires multidisciplinary collaboration. Care heterogeneity exists within and across health care institutions and systems. Such heterogeneity threatens to stymie collaborative scientific endeavors and potentially undermine patient outcomes. Challenges in CS care include but are not limited to (1) the ability to identify patients early; (2) the institution of timely, life‐saving interventions; (3) the transfer of patients to centers with advanced resources; (4) an understanding of the utility of temporary MCS devices; (5) the vetting of indications for escalation or deescalation of support; and (6) the capacity to define optimal methods to facilitate transition from temporary to more durable heart‐replacement strategies. Few would argue that CS care is easy, and complicated problems often require coordinated decision‐making. We believe that the employment of a CS team can lead to better outcomes and more thoughtful resource use. Although there exist several high‐quality CS registries and collaboratives that have been pivotal toward our understanding of the contemporary landscape, none have specifically focused on the shock team, multidisciplinary involvement, or process improvement.”

In this new #CME publication, UPMC's Joseph Shivers, MD, Jesse Champi, MD, and Michael Glicksman, MD, describe the skills needed in evaluating low back pain so that providers are better prepared to rule out serious pathologies while simultaneously minimizing unnecessary diagnostic tests and treatment strategies. They also discuss the importance of the awareness and management of psychosocial factors that are relevant to the overall treatment of low back pain, as well as increasing patient autonomy for those with axial low back pain by emphasizing patient-controlled treatments. Earn your CME credit: https://lnkd.in/exnJ7_39

Johns Hopkins Hospital doctors, and others, have reported that 40%-80% of chronic patients are misdiagnosed. The attached article describes an approach to evaluating these patients, which produces 89% reduction in narcotic usage, 45% reduction in doctor visits, and cost savings ranging from $20,000 to $175,000 for long term, high-cost cases. Paradoxically, this often requires appropriate interventional testing in 95% of the cases, and surgical intervention for 50%-65% of the cases mistakenly called "cervical sprain or whiplash." These patients typically received an inadequate history, usually only 11 minutes, and incorrect testing, usually merely anatomical tests such as MRI and CT, the two leading causes of medical misdiagnosis (Landro-The Biggest Mistake Doctors Make, Wall Street Journal- Nov. 17, 2013). The program at www.PainValidityTest.com provides a complete narrative summary, diagnoses with a 96% correlation with diagnoses of Johns Hopkins Hospital doctors, and recommendations for the correct medical tests based on the diagnoses. Request a one month free trial by registration on the website, or emailing [email protected]. See -How Johns Hopkins Hospital Doctors Evaluate Chronic Pain.

The 19th Annual McMaster Hematology and Thromboembolism Update is now #accredited! Earn up to 6.5 Mainpro+ and 6.5 MOC Section 1 by attending this #MacCPD hybrid conference on September 29, 2023. #ThromboCPD View the agenda, speakers, and register now as in-person space at the #DBHSC is limited! 💻 thrombosishamilton.ca 📌 Target Audience Subspecialists, General Internists, Hospitalists, Community Physicians, Primary Care Practitioners, Residents, Physician Assistants, Nurse Practitioners and Laboratory Technologists involved in the care of patients with thromboembolic disease. Learning Objectives By attending this activity, participants will be able to: 📌 Identify and discuss current trends in hematology and thromboembolism. 📌Recognize which hematologic/thrombotic issues can be managed in primary care and which should be referred to a specialist. 📌Provide practical guidance on the diagnosis and management of common hematological conditions, with a focus on recent innovations.

Best Hospitals 2024-2025: This year's U.S. News & World Report Best Hospitals list introduces Duke University Hospital to the Honor Roll, alongside established names like Johns Hopkins and Massachusetts General. The rankings now place a heavier emphasis on patient outcomes, accounting for 45% of a hospital’s score, and include Medicare Advantage data for the first time. Read more to see how these changes impact primary care and specialty hospitals. https://bit.ly/3zGRJM7 Duke University Hospital Johns Hopkins Medicine Mass General Hospital

Amy Yu MD, from the University of Colorado Division of Hospital Medicine received the prestigious Society of General Internal Medicine (SGIM) 2024 Founders’ Grant for her research on improving inter-hospital transfers. Dr. Yu's work aims to address the lack of standardized guidelines and the troubling outcomes often associated with these transfers. In her research, Dr. Yu plans to gather insights from patients, their care partners, and healthcare providers to develop better systems for safer and more effective inter-hospital transfers. Her ultimate goal is to create a patient-centered approach that reduces stress and improves outcomes for all involved. This grant recognizes Dr. Yu's significant potential and supports her innovative project to fill an important gap in patient care. Congratulations, Dr. Yu! 🌟 Read the rest of the story below! https://lnkd.in/gmc6r9XN #HealthcareInnovation #PatientSafety #ResearchExcellence #HospitalMedicine #SGIM #Medicine #Colorado

🌟 **Spotlight Achievement: Dr. Deborah Cook and the REVISE Trial** 🌟 I am thrilled to share the groundbreaking work of Dr. Deborah Cook, a leading intensivist and researcher at St. Joseph's Healthcare Hamilton and McMaster University, who is at the forefront of revolutionizing intensive care medicine. As the Director of Academic Affairs in the Department of Critical Care, holder of the prestigious St. Joseph's s-McMaster Critical Care Research Chair, and a Canada Research Chair in Intensive Care Medicine, Dr. Cook's contributions are nothing short of inspiring. 🔍 **About the REVISE Trial:** The REVISE Trial is re-evaluating pantoprazole use to prevent upper gastrointestinal (GI) bleeding in ICU patients requiring mechanical ventilation. This study is pivotal, challenging the status quo and re-assessing the efficacy and safety of universal acid suppression in today's ICU settings. By aligning with the principles of the Declaration of Helsinki, the REVISE Trial ensures that even the most trusted interventions undergo rigorous scrutiny to maximize patient care quality, efficiency, and accessibility. 🤝 **A Collaborative Effort:** Its collaborative nature sets the REVISE Trial apart, involving over 4,800 patients across 68 centers in 8 countries. This trial is a testament to Dr. Cook's leadership in fostering multi-disciplinary, multi-center ICU research, emphasizing the importance of patient and family involvement in developing meaningful outcomes. 🌍 **Impact on Global ICU Practices:** The findings from the REVISE Trial have the potential to significantly influence public health, professional guidelines, and policy-making for ICUs worldwide. This research doubles the evidence on the topic and addresses the public's concerns and expectations regarding ICU care. #CriticalCare #ICUResearch #MedicalInnovation #REVISETrial #HealthcareHeroes