Inter-rater reliability of optic nerve sheath diameter measurement using real-time ultrasonography

Objectives Ultrasound measurement of the optic nerve sheath diameter (ONSD) is a rapid, non-invasive means to indirectly assess intracranial pressure. Previous research has demonstrated the ability of emergency physicians to measure ONSD accurately with bedside ultrasound when compared to CT scan or MRI, however the reliability of this measurement between two or more operators has been called into question (Hassen et al. in J Emerg Med 48:450–457, 2015; Shirodkar et al. in Ind J Crit Care Med 19:466–470, 2015). Given the need for accurate and precise measurement to use this as a screening exam, we sought to determine the inter-rater reliability between ONSD measurements obtained in real time by fellowship-trained emergency ultrasound physicians. Methods Three ultrasound fellowship-trained emergency physicians measured bilateral ONSD of 10 healthy volunteers using a high-frequency linear transducer. The physicians were blinded to the other scanners’ measurements, and no instructions were given other than to obtain the ONSD. Each sonographer measured the ONSD in real time and it was recorded by a research coordinator. All measurements were recorded in millimeters. Intraclass correlation coefficients (ICCs) were calculated to estimate the inter-rater reliability. Results A total of 60 measurements of ONSD were obtained. The average measurement was 4.3 mm (3.83–4.77). Very little variation was found between the three physicians, with a calculated ICC of 0.82 (95% confidence interval 0.63–0.92). Conclusions ONSD measurement obtained by ultrasound fellowship-trained emergency medicine physicians is a reliable measurement with a high degree of correlation between scanners.

Pneumomediastinum following a dental procedure

Background: Subcutaneous emphysema is a common presentation to the emergency department. The presence of emphysema in the head and neck region due to dental procedure is not common, and the presence of pneumomediastinum is exceedingly rare. Case Report: A young lady, presented to the emergency department with chest pain, found to have pneumomediastinum following a dental procedure including a wisdom tooth extraction. Conclusion: Complications following dental procedures are not uncommon, hence there should be a high index of suspicion for the emergency physicians for such patients, especially those where air turbine dental tools have been used.

Education and Information Need for Emergency Physicians About Rare Diseases in China

Background: Rare diseases are serious and chronic disease that affect no more than 1 person in 2000. The patients suffering from RD may come to emergency department for life-threatening symptoms, such as acute aortic dissection, intracranial hemorrhage, and severe respiratory distress. Diagnostic delay of rare disease patients is common and often caused by low rare disease awareness among physicians. The main aim of this study was to investigate the Chinese emergency physicians’ basic knowledge, information access and educational needs regarding rare diseases. An online questionnaire was completed by Chinese emergency physicians during January and March 2021. Methods and Results: A total of 539 emergency physicians responded to the questionnaire-based study, including 200 females and 339 males. More than half of respondents were from Tertiary A hospital and had engaged in medical clinical work more than 10 years. Only 4.27% of respondents correctly estimated the prevalence of rare diseases. A few respondents knew the exact number of RD in the first official list of rare diseases in 2018. 98.5% of respondents rated their knowledge about rare diseases as rare or insufficient. Most of emergency physicians preferred to getting information by search engine instead of specialized websites of rare diseases. Lack of practice guidelines or consensus and were considered as the most important reason for diagnostic delay of RD. Practice guidelines or consensus and professional websites on rare diseases were urgently needed for emergency physicians.Conclusion: The investigation shows poor knowledge of emergency physicians regarding rare diseases. Practice guidelines and professional websites on rare diseases were the prominently urgent needs for emergency physicians. Specialized RD courses should also be added in medical education.

SMART: Stress Management and Resilience Training for emergency physicians. Protocol for a pilot study with intervention. (Preprint)

UNSTRUCTURED Background In recent years, the factors of stress, anxiety and work-life balance received more attention. More specifically, the determinants of professional well-being, impact of occupational risks and traumatic events, stress and type D personality, and work stress related problems in physicians in COVID-19 Times were addressed in physicians and more specifically in emergency physicians. The primary aim of this study is to evaluate the effectiveness of a Stress Management and Resiliency Training (SMART) program on stress, anxiety and resilience as well as the professional quality of life of hospital physicians and in particular emergency physicians. Methods This is a pre-post intervention study, pilot study with intervention. Setup / Participants: The participants (hospital physicians/emergency physicians) are recruited through internal and external networks such as the specialist medicine trainees and social media of the own professional group of physicians and physician specialists in training. A combination of several validated interventional and coping strategies will be used to achieve an improvement of personal factors such as stress reduction, anxiety reduction, resilience, quality of professional life of the hospital physicians/emergency physicians. This study also measures additional data such as heart rate variability and physical activity based on the number of daily steps. Discussion Some aspects of this intervention study have already been initiated in previous studies, whereby we aim to achieve even more efficient and structural improvement with a combination of various validated methodologies and coping strategies to address these factors (stress reduction, anxiety reduction, resilience increase, quality of life increase) of hospital/emergency physicians. The abovementioned study will also include process measures such as heart rate variability and physical activity based on the number of daily steps. With this she responds to new trends in chronic stress research. Further studies should be undertaken to confirm the results of this study to identify determinants that can be the object of adequate interventions to improve professional well-being in these physicians.