The science of surveillance is rapidly evolving due to changes in public health information and preparedness as national security issues, new information technologies and health reform. As the Emergency Department has become a much more utilized venue for acute care, it has also become a more attractive data source for disease surveillance. In recent years, influenza surveillance from the Emergency Department has increased in scope and breadth and has resulted in innovative and increasingly accepted methods of surveillance for influenza and influenza-like-illness (ILI). We undertook a systematic review of published Emergency Department-based influenza and ILI syndromic surveillance systems. A PubMed search using the keywords “syndromic”, “surveillance”, “influenza” and “emergency” was performed. Manuscripts were included in the analysis if they described (1) data from an Emergency Department (2) surveillance of influenza or ILI and (3) syndromic or clinical data. Meeting abstracts were excluded. The references of included manuscripts were examined for additional studies. A total of 38 manuscripts met the inclusion criteria, describing 24 discrete syndromic surveillance systems. Emergency Department-based influenza syndromic surveillance has been described worldwide. A wide variety of clinical data was used for surveillance, including chief complaint/presentation, preliminary or discharge diagnosis, free text analysis of the entire medical record, Google flu trends, calls to teletriage and help lines, ambulance dispatch calls, case reports of H1N1 in the media, markers of ED crowding, admission and Left Without Being Seen rates. Syndromes used to capture influenza rates were nearly always related to ILI (i.e. fever +/− a respiratory or constitutional complaint), however, other syndromes used for surveillance included fever alone, “respiratory complaint” and seizure. Two very large surveillance networks, the North American DiSTRIBuTE network and the European Triple S system have collected large-scale Emergency Department-based influenza and ILI syndromic surveillance data. Syndromic surveillance for influenza and ILI from the Emergency Department is becoming more prevalent as a measure of yearly influenza outbreaks.

ObjectivesThis study aimed to assess residents’ and fellows’ knowledge of finance principles that may affect their personal financial health. MethodsA cross-sectional, anonymous, web-based survey was administered to a convenience sample of residents and fellows at two academic medical centers.  Respondents answered 20 questions on personal finance and 28 questions about their own financial planning, attitudes, and debt. Questions regarding satisfaction with one’s financial condition and investment-risk tolerance used a 10-point Likert scale (1=lowest, 10=highest).  Of 2,010 trainees, 422 (21%) responded (median age 30 years; interquartile range, 28-33).   ResultsThe mean quiz score was 52.0% (SD = 19.1). Of 299 (71%) respondents with student loan debt, 144 (48%) owed over $200,000.  Many respondents had other debt, including 86 (21%) with credit card debt. Of 262 respondents with retirement savings, 142 (52%) had saved less than $25,000. Respondents’ mean satisfaction with their current personal financial condition was 4.8 (SD = 2.5) and investment-risk tolerance was 5.3 (SD = 2.3). Indebted trainees reported lower satisfaction than trainees without debt (4.4 vs. 6.2, F (1,419) = 41.57, p < .001).   Knowledge was moderately correlated with investment-risk tolerance (r=0.41, p < .001), and weakly correlated with satisfaction with financial status (r=0.23, p < .001). ConclusionsResidents and fellows had low financial literacy and investment-risk tolerance, high debt, and deficits in their financial preparedness.  Adding personal financial education to the medical education curriculum would benefit trainees.  Providing education in areas such as budgeting, estate planning, investment strategies, and retirement planning early in training can offer significant long-term benefits.

Context Hypothermia improves neurological outcome for comatose survivors of out-of-hospital cardiac arrest. Use of computer controlled high surface area devices for cooling may lead to faster cooling rates and potentially improve patient outcome. Objective To compare the effectiveness of surface cooling with the standard blankets and ice packs to the Arctic Sun, a mechanical device used for temperature management. Design, Setting, and Patients Multi-center randomized trial of hemodynamically stable comatose survivors of out-of-hospital cardiac arrest. Intervention Standard post-resuscitative care inducing hypothermia using cooling blankets and ice (n=30) or the Arctic Sun (n=34). Main Outcome Measures The primary end point was the proportion of subjects who reached a target temperature within 4 hours of beginning cooling. The secondary end points were time interval to achieve target temperature (34°) and survival to 3 months. Results The proportion of subjects cooled below the 34°C target at 4 hours was 71% for the Arctic Sun group and 50% for the standard cooling group (p=0.12). The median time to target was 54 minutes faster for cooled patients in the Arctic Sun group than the standard cooling group (p<0.01). Survival rates with good neurological outcome were similar; 46% of Arctic Sun patients and 38% of standard patients had a cerebral performance category of 1 or 2 at 30 days (P=0.6). Conclusions While the proportion of subjects reaching target temperature within 4 hours was not significantly different, the Arctic Sun cooled patients to a temperature of 34° C more rapidly than standard cooling blankets. Trial Registration ClinicalTrials.gov NCT00282373, registered January 24, 2006.

IntroductionThe standard letter of recommendation in emergency medicine (SLOR) was developed to standardize the evaluation of applicants, improve inter-rater reliability, and discourage grade inflation. The primary objective of this study was to describe the distribution of categorical variables on the SLOR in order to characterize scoring tendencies of writers.MethodsWe performed a retrospective review of all SLORs written on behalf of applicants to the three Emergency Medicine residency programs in the University of Arizona Health Network (i.e. the University Campus program, the South Campus program and the Emergency Medicine/Pediatrics combined program) in 2012. All “Qualifications for Emergency Medicine” and “Global Assessment” variables were analyzed.Results1457 SLORs were reviewed, representing 26.7% of the total number of Electronic Residency Application Service applicants for the academic year. Letter writers were most likely to use the highest/most desirable category on “Qualifications for EM” variables (50.7%) and to use the second highest category on “Global Assessments” (43.8%). For 4-point scale variables, 91% of all responses were in one of the top two ratings. For 3-point scale variables, 94.6% were in one of the top two ratings. Overall, the lowest/least desirable ratings were used less than 2% of the time.ConclusionsSLOR letter writers do not use the full spectrum of categories for each variable proportionately. Despite the attempt to discourage grade inflation, nearly all variable responses on the SLOR are in the top two categories. Writers use the lowest categories less than 2% of the time. Program Directors should consider tendencies of SLOR writers when reviewing SLORs of potential applicants to their programs.

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