Objectives The emergency department (ED) is characterized by stressors (e.g. fatigue, stress, time-pressure, and complex decision-making) that can pose challenges to delivering high quality, equitable care. Although it has been suggested that characteristics of the ED may exacerbate reliance on cognitive heuristics, no research has directly investigated whether stressors in the ED impact physician racial bias, a common heuristic. We seek to determine if physicians have different levels of implicit racial bias post-ED shift versus pre-shift, and to examine associations between demographics and cognitive stressors with bias. Methods This repeated measures study of resident physicians in a pediatric ED used electronic pre- and post-shift assessments of implicit racial bias, demographics, and cognitive stressors. Implicit bias was measured using the Race Implicit Association Test (IAT). Linear regression models compared differences in IAT scores pre- to post-shift, and determined associations between participant demographics and cognitive stressors with post-shift IAT and pre- to post-shift difference scores. Results Participants (n=91) displayed moderate pro-white/anti-black bias on pre-shift (M=0.50, SD=0.34, d=1.48) and post-shift (M=0.55, SD=0.39, d=1.40) IAT scores. Overall, IAT scores did not differ pre-shift to post-shift (mean increase=0.05, 95% CI −0.02,0.14, d=0.13). Sub-analyses revealed increased pre- to post-shift bias among participants working when the ED was more overcrowded (mean increase=0.09, 95% CI 0.01,0.17, d=0.24) and among those caring for >10 patients (mean increase=0.17, 95% CI 0.05,0.27, d=0.47). Residents’ demographics (including specialty), fatigue, busyness, stressfulness, and number of shifts were not associated with post-shift IAT or difference scores. In multivariable models, ED overcrowding was associated with greater post-shift bias (coefficient=0.11 per 1 unit of NEDOCS score, SE=0.05, 95% CI 0.00,0.21). Conclusions While resident implicit bias remained stable overall pre-shift to post-shift, cognitive stressors (overcrowding and patient load) were associated with increased implicit bias. Physicians in the ED should be aware of how cognitive stressors may exacerbate implicit racial bias.

Background and Objectives The general population and most physicians have implicit racial bias against black adults. Pediatricians also have implicit bias against black adults, albeit less than other specialties. There is no published research on the implicit racial attitudes of pediatricians or other physicians towards children. Our objectives were to compare implicit racial bias towards adults versus children among resident physicians working in a pediatric emergency department (ED), and to assess whether bias varied by specialty (pediatrics, emergency medicine, or other), gender, race, age, and year of training. Methods We measured implicit racial bias of residents before a pediatric ED shift using the Adult and Child Race Implicit Association Tests (IATs). Generalized linear models compared Adult and Child IAT scores and determined the association of participant demographics with Adult and Child IAT scores. Results Among 91 residents, we found moderate pro-white/anti-black bias on both the Adult (M=0.49, SD=0.34) and Child Race IAT (M=0.55, SD=0.37). There was no significant difference between Adult and Child Race IAT scores (difference=0.06, p=0.15). Implicit bias was not associated with resident demographic characteristics, including specialty. Conclusions This is the first study demonstrating that resident physicians have implicit racial bias against black children, similar to levels of bias against black adults. Bias in our study did not vary by resident demographic characteristics, including specialty, suggesting that pediatric residents are as susceptible as other physicians to implicit bias. Future studies are needed to explore how physicians’ implicit attitudes towards parents and children may impact inequities in pediatric healthcare.

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BackgroundTargeted advertising using social networking sites (SNS) as a recruitment strategy in health research is in its infancy.ObjectiveThe aim of this study was to determine the feasibility of targeted Facebook advertisements to increase recruitment of unvaccinated women into a human papillomavirus (HPV) vaccine effectiveness study.MethodsBetween September 2011 and November 2013, females aged 18 to 25 years, residing in Victoria, Australia, were recruited through Facebook advertisements relating to general women’s health. From November 2013 to June 2015, targeted advertising campaigns were implemented to specifically recruit women who had not received the HPV vaccine. Consenting participants were invited to complete an online questionnaire and those who had ever had sexual intercourse were asked to provide a self-collected vaginal swab. The HPV vaccination status of participants was confirmed from the National HPV Vaccination Program Register (NHVPR).ResultsThe campaign comprised 10 advertisements shown between September 2011 and June 2015 which generated 55,381,637 impressions, yielding 23,714 clicks, at an overall cost of AUD $22,078.85. A total of 919 participants were recruited. A greater proportion of unvaccinated women (50.4%, 131/260) were recruited into the study following targeted advertising, compared with those recruited (19.3%, 127/659) prior to showing the modified advertisement (P<.001). A greater proportion of the total sample completed tertiary education and resided in inner regional Victoria, compared with National population census data (P<.001), but was otherwise representative of the general population.ConclusionsTargeted Facebook advertising is a rapid and cost-effective way of recruiting young unvaccinated women into a HPV vaccine effectiveness study.

Context Medication drug exposures among young children continue to rise despite current poison prevention efforts. These exposures result in increased healthcare utilization and medical costs. New tactics are needed to reduce injuries related to pediatric drug exposures. Objective We aimed to identify cluster patterns in 1) calls for pediatric medication drug exposures and 2) a subset of calls that resulted in medical evaluation referrals. We identified and evaluated population characteristics associated with cluster patterns. Methods We analyzed 26,685 pharmaceutical drug exposures involving children less than 5 years of age based on calls reported to the Pittsburgh Poison Center from January 1, 2006 to December 31, 2010. We performed spatial statistics to assess for clustering. We used logistic regression was used to estimate population characteristics associated with clustering. Results Spatial analysis identified 22 exposure clusters and 5 referral clusters. 65% of 89 ZIP codes in the clusters of drug exposure with HCF referral were not identified in the exposure clusters. ZIP codes in the HCF referral clusters were characterized as rural, impoverished, and with high rates of unemployment and school dropouts. Discussion Our principal findings demonstrate pediatric drug exposures do exist in discrete geographic clusters and with distinct socioeconomic characteristics. Conclusion This study offers a starting point for subsequent investigations into the geographic and social context of pediatric medication drug exposures. This is an important step in revising pediatric poison prevention strategies.

We present a case of an 11-year-old girl with eye swelling and hip pain and the use of point-of-care hip ultrasound (US) to facilitate diagnosis of a septic hip. We review the US technique, sonographic findings, and relevant literature regarding point-of-care hip US.

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