The Central Line 2014-11-24 15:20:45

Annals November podcast is posted for all to hear! Keep the feedback coming, and THANK YOU.

This month look out for:
-LEAN process for reducing ED LOS
-Case law on EMTALA and psych emergencies
-Press Gainey scores and ED analgesics: not what they thought
-Randomized trial of anti-emetics: no better than placebo???

and much much more!

Email any time, annalsaudio@acep.org,

D&A

Social Media in Medicine – Useless!

Or, might it be how you use it that matters?

This is a brief report from the journal Circulation, regarding a self-assessment of their social media strategy.  The editors of the journal performed a prospective, block-randomization of published articles to either social media promotion on Facebook and Twitter, or no promotion, and compared 30-day website page views for each article.  121 articles were randomized to social media and 122 to control, and were generally evenly balanced between article types.

And, the answer – unfortunately, for their 3-person associate editor team – is: no difference.  Articles posted to social media received an average of 409 pageviews within 30-days, compared with 392 to those with no promotion.  Thus, the journal of Circulation declares social media dead – and ultimately generalizes their failures to all cardiovascular journals via their Conclusions section.

So, we should all stop blogging and tweeting?  Or, is journal self-promotion futile?  And, are page views the best measure of the effectiveness of knowledge translation?  Or, is there more nuance and heterogeneity between online strategies, rendering this Circulation data of only passing curiosity?  I tend to believe the latter – but, certainly, it’s an interesting publication I hope inspires other journals to perform their own, similarly rigorous studies.

[Note: if my blog entries receive as many (or more!) pageviews as Circulation articles, does this mean my impact factor is higher than Circulation’s 14.98?]

“A Randomized Trial of Social Media from Circulation”
http://circ.ahajournals.org/content/early/2014/11/17/CIRCULATIONAHA.114.013509.abstract

A Response to the “How a SHPOS is Born” article in The National Post

You may have read the article “How a SHPOS is born: What doctors call their very worst patients”, which was written by Anne Skomorowsky and published in The National Post (originally appearing on the Slate Magazine website) on November 10, 2014. Many people in the social media universe had very strong emotional responses to the article. If you haven’t read it, I encourage you to do so. I collaborated with several other individuals (Eve Purdy @eve_purdy, Teresa Chan @tchanMD, Swapnil Hiremath @hswapnil, Heather Murray @heatherm211, Ross Morton @signindoc) to produce a letter to the editor, which was submitted but was not published by The National Post. Thus, we decided to publish our letter on three FOAM websites (TheChartReview.org, manuetcorde.org, BoringEM.org) to share our response with the medical community online. Read below. Feel free to share your thoughts on the comments or on Twitter.

Dear Editor,

We read with horror the recent article “How a SHPOS is born: What doctors call their very worst patients” by Anne Skomorowsky dated November 10, 2014.

We were appalled that the author conveyed the impression that this offensive term, SHPOS, is common and used by the general medical community. The opening line “A medical acronym, SHPOS, helps a doctor summarize a patient’s history in just five letters” implies that the term “a doctor” would include a large number of practicing physicians.

This is false.

This article has sparked discussions over several social media platforms and in the hallways of our hospitals. The consensus from our investigation is that the majority have never used, nor heard of this disgraceful and offensive term. Physicians and learners spanning many generations (medical students to experienced physicians of greater than 20 years) and specialties (emergency medicine, internist, surgeons) agree that that the SHPOS term is completely foreign. The term is as uncomfortable to us as it is the intended readership. On digging a bit deeper (as a result of this article), it seems this term may have been used in the past, in the early 80s or before but given the unfamiliarity of currently practicing physicians, it is unlikely that it is used with any frequency today (1,2). Thus, to taint all current doctors with this archaic and unused term is a reckless overreach at best and slanderous at worst. In fact, the journalistic ethics of reintroducing such a horrible term back into the current lexicon is both irresponsible and dangerous. Language evolves over time, and most of the time with good cause, because terms like SHPOS are eliminated because of their inherent problems.

As a community we do recognize that the language physicians choose is important and appreciate that in many instances we might do better. We have explored issues around language in medicine through an international and open-access case study that can be accessed at one of the world’s pre-eminent medical education blogs (3). We would encourage readers interested in the use of slang by medical professionals to read this much more up to date, balanced and thoughtful exploration of the important topic. This document incorporated patient, allied health, and physician voices all together to generate a very robust discussion and handout for young physicians to read and better understand the importance of words in clinical practice.

Sadly, the information in this article was likely not verified among the health care professionals to whom it refers. Unfortunately, the message conveyed to the readership of the National Post and general public is that terms like “SHPOS” are commonplace and accepted among the medical community, and this supposition is largely unverified in Canada too – especially since it is merely a repurposing of a previously featured article from an American magazine. Acknowledging that slang and language are contextual, and cultural, the National Post might have been better served to do their own, contextually relevant, investigation into this issue, rather than simply feature the article of an American author.

We do not use the term SHPOS. The thesis of the article is simply untrue. This article potentially biases and inflicts pre-arrival damage to future doctor-patient encounters, creating barriers and potentially interferes with the relationship developed by current health care staff and the people they wish to help.

We urge your newspaper to consider the ramifications of posting such inaccurate and potentially damaging materials in the future.

Elisha Targonsky, MD CCFP-EM
Eve Purdy BHSc MD Candidate
Teresa Chan MD FRCPC
Swapnil Hiremath, MD MPH
Heather Murray MD MSc FRCPC
Ross Morton MD FRCP FRCPC FACP

 

The post A Response to the “How a SHPOS is Born” article in The National Post appeared first on The Chart Review.

Counterpoint: SHPOS…we haven’t heard of it

This Counterpoint is an open letter from a group of Canadian learners and physicians that was written in response to a recent National Post Article (How a SHPOS is born: What doctors call their very worst patients) which described a phrase  the author suggested is “commonly” used in medicine.  Our work was submitted as a letter to the editor in response to the article but we have not received any correspondence from the National Post. We are publishing this on a number of Canadian medical blogs because we feel that sharing our perspective is necessary with the hopes of continuing a more thoughtful, balanced dialogue of language in medicine. 

Dear Editor,

We read with horror the recent article “How a SHPOS is born: What doctors call their very worst patients” by Anne Skomorowsky dated November 10, 2014.

We were appalled that the author conveyed the impression that this offensive term, SHPOS, is common and used by the general medical community. The opening line “A medical acronym, SHPOS, helps a doctor summarize a patient’s history in just five letters” implies that the term “a doctor” would include a large number of practicing physicians.

This is false.

This article has sparked discussions over several social media platforms and in the hallways of our hospitals. The consensus from our investigation is that the majority have never used, nor heard of this disgraceful and offensive term. Physicians and learners spanning many generations (medical students to experienced physicians of greater than 20 years) and specialties (emergency medicine, internist, surgeons) agree that that the SHPOS term is completely foreign. The term is as uncomfortable to us as it is the intended readership. On digging a bit deeper (as a result of this article), it seems this term may have been used in the past, in the early 80s or before but given the unfamiliarity of currently practicing physicians, it is unlikely that it is used with any frequency today (1,2). Thus, to taint all current doctors with this archaic and unused term is a reckless overreach at best and slanderous at worst. In fact, the journalistic ethics of reintroducing such a horrible term back into the current lexicon is both irresponsible and dangerous. Language evolves over time, and most of the time with good cause, because terms like SHPOS are eliminated because of their inherent problems.

As a community we do recognize that the language physicians choose is important and appreciate that in many instances we might do better. We have explored issues around language in medicine through an international and open-access case study that can be accessed at one of the world’s pre-eminent medical education blogs (3). We would encourage readers interested in the use of slang by medical professionals to read this much more up to date, balanced and thoughtful exploration of the important topic. This document incorporated patient, allied health, and physician voices all together to generate a very robust discussion and handout for young physicians to read and better understand the importance of words in clinical practice.

Sadly, the information in this article was likely not verified among the health care professionals to whom it refers. Unfortunately, the message conveyed to the readership of the National Post and general public is that terms like “SHPOS” are commonplace and accepted among the medical community, and this supposition is largely unverified in Canada too – especially since it is merely a repurposing of a previously featured article from an American magazine. Acknowledging that slang and language are contextual, and cultural, the National Post might have been better served to do their own, contextually relevant, investigation into this issue, rather than simply feature the article of an American author.

We do not use the term SHPOS. The thesis of the article is simply untrue. This article potentially biases and inflicts pre-arrival damage to future doctor-patient encounters, creating barriers and potentially interferes with the relationship developed by current health care staff and the people they wish to help.

We urge your newspaper to consider the ramifications of posting such inaccurate and potentially damaging materials in the future.

Elisha Targonsky, MD, CCFP-EM

Eve Purdy, BHSc, MD Candidate

Teresa Chan, HBSc, BEd, MD, FRCPC, MHPE Candidate

Swapnil Hiremath, MD, MPH

Heather Murray, MD, MSc, FRCPC

Ross Morton MD, FRCP, FRCPC, FACP

 

References

  1. Strauss A. (1983). Shpos. South Med J; 76 (8): 981-4.PMID: 6879294
  2. Schwartz H. (1980). A person is a person an shpos is not. Man and Medicine; 5(3): 226-8.  PMID: 7242156
  3. Murray H .(2014). Academic Life in Emergency Medicine, MedICs Cases “Case of the Backroom Blunder”

 

Author information

Eve Purdy
Medical Student Editor at BoringEM
Fourth year medical student at Queen's University-happily consuming, sharing, creating and researching #FOAMed

The post Counterpoint: SHPOS…we haven’t heard of it appeared first on BoringEM and was written by Eve Purdy.

Chandler Assessment of the Sick Child

My first registrar post in Australia was in a mixed ED with children. The most common question I statement I encountered was ‘I’m not sure if this child needs to come into Hospital’.

I use the CHANDLER assessment tool to highlight potential red flags for paediatric admission. If 2 of the major groups are seen, the child should be strongly considered for admission and Paediatric specialist involvement.

CHANDLER

C – Colour

  • Pale- perhaps dehydrated
  • Blue- cyanosed, hypoxic, hypothermic
  • Red- Rash, Burn, infection
  • Pink- healthy

H – Hydration status

  • Moderate dehydration (4-6% loss)
  • Capillary refill time >2 secs
  • Mild decreased skin turgor
  • Severe dehydration(>7% loss)
  • Capillary refill time >3secs
  • Deep acidotic breathing
  • Signs of shock (Tachycardia, Hypotension, altered mental state)
  • Decreased skin turgor
  • Sunken eyes

A – Alert

  • GCS status
  • Is the patient awake, smiling and interacting.
  • With neonates are they looking around, interested in their surroundings- reaching out for things put in front of them or are they floppy and disinterested.
  • For older children are they tired and miserable looking or hard to rouse.
  • Is the child inconsolable

N – Nutritional Status

  • Fat reserves
  • Does the child have good nutritional reserve and appear to be on normal weight limits?
  • Are they very underweight? Consider serious medical/surgical illness; anorexia or even neglect in the home?
  • Is the child overweight? Consider weight related issues such as Diabetes.

D – Dysmorphia

  • *Important to remember associations of certain conditions with particular syndromes
  • Example – Congenital Heart Disease in children with Down’s Syndrome.
  • These children can get sick very quickly.
  • Children with syndromes also have an increased incidence of renal abnormalities and swallowing issues and at risk for aspiration

L – Limbs

  • Are all the limb moving – particularly important in neonates or young toddlers with obvious communication issues.
  • Take note of children not moving arms or legs, examining thoroughly for tenderness.
  • Caution in those also with a limp.
  • Problems may not be obviously in the knees or lower aspect of the leg but in the hip, or even in genitalia in boys.
  • Consider Non-accidental injury also in children <2yrs

E – External Supports

  • This can be noted on your first interaction with the child as parents or Ambulance bring them in.
  • Does the child require external supports such as:
    • Wheelchair or splint. Does the parent carry them (when they can easily walk)
    • Oxygen, nebulisers or IV fluids
    • Sedation or significant analgesia prior to arrival
    • Cooling aids (wet towels/ ice packs etc)

R- Respiratory Distress

  • Is the child’s breathing becoming compromised.
    • Increased Respiratory rate for age
    • Accessory Muscle use
    • Stridor
    • Posturing- tripod position
    • Sternal and Sub/intercostal recession
    • Tracheal Tug
    • Nasal Flaring and head bobbing

Reviewed by Dr Michael Baker Paediatric Emergency Physician

Additional Resources:

 

The post Chandler Assessment of the Sick Child appeared first on LITFL.