Medication non-adherence is a very prevalent problem among older adults who are self-neglecting, and higher non-adherence levels were associated with the number of medications being consumed as well as lower physical function. Physicians who find high rates of medication non-adherence in their patients should consider barriers to adherence, including a large number of medications, lower physical function and the possibility of elder self-neglect. Future efforts should focus on studying the underlying reasons for medication non-adherence in larger samples of older adults who are self-neglecting. This would facilitate the development of interventions to reduce medication non-adherence in this population.
Background
Despite having well‐described benefits, diversifying the physician workforce has been an ongoing challenge. Within emergency medicine (EM), multiple professional organizations have identified expanding diversity and inclusion as top priorities. The following is a description of an interactive session held at the SAEM annual meeting addressing recruitment strategies for underrepresented in medicine (URiM) and sexual and gender minority (SGM) students into EM.
Methods
During the session, the authors provided an overview of the current state of diversity in EM. In the small‐group portion of the session, a facilitator helped characterize the challenges programs face in recruiting URiM and SGM students. These challenges were described during three distinct phases of the recruitment process: (1) preinterview, (2) interview day, and (3) postinterview.
Results
Our facilitated small‐group session allowed for discussing the challenges faced by various programs in recruiting a diverse group of trainees. Common challenges in the preinterview and interview day included messaging and visibility as well as funding and support. Postinterview challenges included communication and the ranking process. Through this exercise, we were able to collaboratively share ideas on tangible solutions that programs may use to overcome their specific challenges.
Conclusions
Given the importance of intentionality in diversifying the physician workforce, the authors describe successful strategies implemented within one residency program and those shared by session participants to overcome recruitment challenges.
Objective: We developed a curriculum to improve resident knowledge and comfort in charting and coding during emergency medicine (EM) encounters. Our tool kit includes simulated charts and assessments in a team-based learning (TBL) format. Settings: The curriculum was delivered at one an academic institution’s emergency medicine program. Participants: Thirty-one residents and 18 faculty and APP learners attended the TBL reimbursement workshop. Primary and secondary measures: Learners perceived knowledge and comfort in charting and coding
Results: The response to the TBL exercise was overwhelmingly positive, with an increase in learner’s comfort with understanding and placing the 6 different evaluation and management Current Procedural Terminology codes commonly used in EM significantly increasing. The learners also had a significant increase in distinguishing between new (e.g., alternative payment systems) and older (e.g., fee-for-service) payment systems had a significant 30-point increase (p<0.001).
Conclusions: This study demonstrates that TBL can successfully be used as part of EM residency curriculum to teach charting and coding skills. Our TBL exercise demonstrated significant gains in self-rated knowledge for the three learning objectives pertaining to EM reimbursement.
including 17,000 pediatric patients) and busy tertiary care pediatric hospital (80, 000 ED visits annually) from January 2015 to December 2020. Patients were included if they had an age less than or equal to 18 years, had an ultrasound done as part of their initial ED work up, and had appendicitis confirmed on surgical pathology. Patients were excluded if an alternate diagnosis was found on pathology or if their appendix was not removed during the same hospitalization. A multivariate analysis was used to compare the rates of inconclusive ultrasounds, computed tomography, magnetic resonance imaging, and ruptured appendicitis. All tests were two-sided and performed using SAS EG 7.13 (Cary, NC). P values of less than 0.05 were considered statistically significant.Results: There were 256 patients at the community hospital and 2,925 patients at the pediatric hospital that met all criteria. Both hospitals had similar baseline demographics (age, sex, body mass index, weight, and weight-for-age percentile). The community ED had a higher inconclusive rate of ultrasound (41% vs. 34.7%, p ¼0.04) and a higher rate of subsequent computed tomography imaging (43% vs 20.8%, p<0.0001) than the pediatric ED. The pediatric hospital has a higher rate of ruptured appendicitis compared to the community hospital (33.3% vs 12.9%, p<0.0001).Conclusion: Pediatric emergency departments more accurately diagnosed appendicitis using ultrasound. Pediatric patients with appendicitis presenting to a community hospital are more likely to have an inconclusive ultrasound leading to subsequent utilization of computed tomography.
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