Academic Life in Emergency Medicine

ACEP E-QUAL 50: tPA for Stroke and Litigation

This episode is a rapid fire review of litigation issues surrounding the provision of (or lack of provision of) tPA for stroke.

Guests:
Latha Ganti, MD, MS, MBA
Professor of Emergency Medicine & Neurology ,University of Central Florida College of Medicine

Joshua N. Goldstein MD, PhD
Professor of Emergency Medicine, Harvard Medical School

Host: Jason Woods MD

References:

1. Chernyshev OY, Martin-Schild S, Albright KC, Barreto A, Misra V, Acosta I, Grotta JC, Savitz SI. Safety of tPA in stroke mimics and neuroimaging-negative cerebral ischemia. Neurology. 2010 Apr 27;74(17):1340-5. doi: 10.1212/WNL.0b013e3181dad5a6. Epub 2010 Mar 24. PMID: 20335564; PMCID: PMC2875935.
2. Gebel JM, Sila CA, Sloan MA, Granger CB, Mahaffey KW, Weisenberger J, Green CL, White HD, Gore JM, Weaver WD, Califf RM, Topol EJ. Thrombolysis-related intracranial hemorrhage: a radiographic analysis of 244 cases from the GUSTO-1 trial with clinical correlation. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries. Stroke. 1998 Mar;29(3):563-9. doi: 10.1161/01.str.29.3.563. PMID: 9506593.
3. Kass J et al. CONTINUUM (MINNEAP MINN) 2020;26(2, CEREBROvascular disease): 499-505

 

ACEP E-QUAL 49: Code Stroke | Optimizing ED Stroke Response

Guest: Adam Oostema, MD MS FACEP (Associate Professor of EM, Michigan State University College of Human Medicine)

Host: Jason Woods MD

 

Select References:

• National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995 Dec 14;333(24):1581-7. doi: 10.1056/NEJM199512143332401. PMID: 7477192.
• Saver JL, Gornbein J, Starkman S. Graphic reanalysis of the two NINDS-tPA trials confirms substantial treatment benefit. Stroke. 2010 Oct;41(10):2381-90. doi: 10.1161/STROKEAHA.110.583807. Epub 2010 Sep 9. PMID: 20829518; PMCID: PMC2949055.
• Kwiatkowski TG et al. Effects of tissue plasminogen activator for acute ischemic stroke at one year. National Institute of Neurological Disorders and Stroke Recombinant Tissue Plasminogen Activator Stroke Study Group. N Engl J Med. 1999 Jun 10;340(23):1781-7. doi: 10.1056/NEJM199906103402302. PMID: 10362821.
• Ingall TJ et al. Findings from the reanalysis of the NINDS tissue plasminogen activator for acute ischemic stroke treatment trial. Stroke. 2004 Oct;35(10):2418-24. doi: 10.1161/01.STR.0000140891.70547.56. Epub 2004 Sep 2. PMID: 15345796.
• Emberson J et al. Stroke Thrombolysis Trialists' Collaborative Group. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014 Nov 29;384(9958):1929-35. doi: 10.1016/S0140-6736(14)60584-5. Epub 2014 Aug 5. PMID: 25106063; PMCID: PMC4441266.
• Hacke W et al. ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008 Sep 25;359(13):1317-29. doi: 10.1056/NEJMoa0804656. PMID: 18815396.
• Alper BS et al. Thrombolysis with alteplase 3-4.5 hours after acute ischaemic stroke: trial reanalysis adjusted for baseline imbalances. BMJ Evid Based Med. 2020 Oct;25(5):168-171. doi: 10.1136/bmjebm-2020-111386. Epub 2020 May 19. PMID: 32430395; PMCID: PMC7548536.
• Powers WJ et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019 Dec;50(12):e344-e418. doi: 10.1161/STR.0000000000000211. Epub 2019 Oct 30. Erratum in: Stroke. 2019 Dec;50(12):e440-e441. PMID: 31662037.

EM Match Advice 37: Program Directors Reflect on the 2022 Residency Match

In this episode of EM Match Advice, our panel tackles the hot topic of making your rank list for residency match, which includes the shocking news of so many SOAP positions this year (over 200!) as well as the upcoming preference signaling being employed in the 2022-23 Match season. In this podcast, Dr. Mike Gisondi and Dr. Michelle Lin host an all-star panel of 3 program directors, Dr. Sara Krzyzaniak (Stanford University), Dr. Abra Fant (Northwestern University), and Dr. Bonnie Kaplan (Denver Health). Sound Engineer: Kellen Vu

Go to the EM Match Advice blog posts on ALiEM.

The Leader’s Library 6: New Rules of Work

Join us in the sixth installment of ALiEM's The Leader's Library, which is a professional development book club for health professionals. Led by Dr. Dina Wallin and a team of renowned educators, the featured book is New Rules of Work: The Muse Playbook for Navigating the Modern Workplace by Alexandra Cavoulacos and Kathryn Minshew. Come sign up! https://www.aliem.com/leaders-library-new-rules-of-work-sign-up-book-club/

ACEP E-QUAL 48: Supporting New Buprenorphine Providers

In this episode from ACEP E-QUAL, we feature Dr. Jeanmarie Perrone (@JMPerroneMD), Professor of Emergency Medicine and the Director of the Center for Addiction Medicine and Policy at the University of Pennsylvania. 

Host: Jason Woods, MD
Sound Engineer: Kellen Vu

ACEP E-QUAL 47: Harm Reduction in the Emergency Department

In this episode from ACEP E-QUAL, Dr. Bill Soares is an Associate Professor of EM and Director of Harm Reduction Services in the Deptartment of Emergency Medicine at Bay State Medical Center. He also serves as a Fellow at the Institute of Health Care Delivery and Population Science at the University of Massachusetts Chan School of Medicine. 

Host: Jason Woods, MD
Sound Engineer: Kellen Vu

EM Match Advice 36: It is Time to Make Your Rank List

In this episode of EM Match Advice, our panel tackles the hot topic of making your rank list for residency match, which includes "love letters" to programs and second look visits. In this podcast, Dr. Mike Gisondi and Dr. Michelle Lin host an esteemed panel of 3 program directors, Dr. Emily Fisher (University of Oklahoma), Dr. William Paolo (SUNY Upstate), and Dr. Michael Van Meter (University of Texas Health Science Center at Houston).

ACEP E-QUAL 46: Opioids and Social Emergency Medicine

In this episode from ACEP E-QUAL, Dr. Elizabeth Samuels discusses a social emergency medicine approach to opioid use disorder.

• Guest: Elizabeth A. Samuels, MD MPH MHS, Brown Emergency Medicine
• Host: Jason Woods MD

 

Select references:

1. Weiner SG, Baker O, Bernson D, Schuur JD. One-Year Mortality of Patients After Emergency Department Treatment for Nonfatal Opioid Overdose. Ann Emerg Med. 2020 Jan;75(1):13-17. doi: 10.1016/j.annemergmed.2019.04.020. Epub 2019 Jun 20. PMID: 31229387; PMCID: PMC6920606.
2. Wakeman SE, Larochelle MR, Ameli O, et al. Comparative Effectiveness of Different Treatment Pathways for Opioid Use Disorder. JAMA Netw Open. 2020;3(2):e1920622. doi:10.1001/jamanetworkopen.2019.20622
3. Larochelle MR, Bernson D, Land T, Stopka TJ, Wang N, Xuan Z, Bagley SM, Liebschutz JM, Walley AY. Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and Association With Mortality: A Cohort Study. Ann Intern Med. 2018 Aug 7;169(3):137-145. doi: 10.7326/M17-3107. Epub 2018 Jun 19. PMID: 29913516; PMCID: PMC6387681.
4. Kilaru AS, Xiong A, Lowenstein M, et al. Incidence of Treatment for Opioid Use Disorder Following Nonfatal Overdose in Commercially Insured Patients. JAMA Netw Open. 2020;3(5):e205852. Published 2020 May 1. doi:10.1001/jamanetworkopen.2020.5852
5. D'Onofrio G, O'Connor PG, Pantalon MV, Chawarski MC, Busch SH, Owens PH, Bernstein SL, Fiellin DA. Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA. 2015 Apr 28;313(16):1636-44. doi: 10.1001/jama.2015.3474. PMID: 25919527; PMCID: PMC4527523.
6. Hawk KF, D’Onofrio G, Chawarski MC, et al. Barriers and Facilitators to Clinician Readiness to Provide Emergency Department–Initiated Buprenorphine. JAMA Netw Open. 2020;3(5):e204561. doi:10.1001/jamanetworkopen.2020.4561

EM Match Advice 35: Where did all the jobs go, and did the applicants follow?

In this episode of EM Match Advice, our panel takes on the tough issues of 2021. Specifically we discuss the American College of Emergency Physicians (ACEP) Workforce Study that projects fewer jobs for emergency physicians and the hot-off-the-press ERAS data showing a drop in the number of EM residency applicants, compared to 2 years ago. Did one cause the other?

In this podcast, Dr. Mike Gisondi and Dr. Michelle Lin host an esteemed panel of 3 program directors, Dr. Cassandra Bradby (East Carolina University), Dr. Adam Kellogg (Baystate Health), and Dr. Craig Krausz (Saint Louis University).

INFODEMIC 01: Introduction and COVID-19 Update

This session for the INFODEMIC Conference features speakers, Dr. Seema Yasmin and Dr. Yvonne Maldonado. INFODEMIC is a Stanford conference on social media and COVID-19 misinformation in 2021, has released open access podcasts of their discussions.