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E John Gallagher

Publications and source records attributed to E John Gallagher.

18 recordsLinked to original sources
PubMed2003

Interexaminer agreement on the American Board of Emergency Medicine oral certification examination.

STUDY OBJECTIVE: One of the principal criticisms of performance assessments, particularly those using an oral format to evaluate physician performance, is the lack of interrater reliability. The objective of this study was to assess interexaminer agreement in the scoring of candidates taking the American Board of Emergency Medicine (ABEM) oral certification examination. METHODS: Examiner-observer pairs independently scored individual candidates on each of the 6 simulated cases selected for the October 1999 examination. Simple proportionate agreement for "acceptable" and "unacceptable" scores on critical actions and performance ratings were used to measure interexaminer (examiner-observer) agreement. Further analyses were performed to assess interexaminer agreement at the level of the raw scores of all performance ratings. The candidate's actual score was determined entirely by the examiner administering the case. The study examiner was present only to observe and independently score the candidate. Examiners were blinded to each other's scoring. All examiner-observer, examiner-candidate, and observer-candidate pairings were uniquely randomized and occurred only once during the examination. RESULTS: Of 564 candidates, 186 were randomly selected for scoring by examiner-observer pairs drawn from a pool of 107 trained oral examiners. Interexaminer agreement for 47 critical actions was 97% (95% confidence interval [CI] 96% to 98%), and interexaminer agreement for 68 performance ratings was 95% (95% CI 94% to 96%). Further analyses of raw scores of performance ratings indicated that 94% (95% CI 93% to 95%) of 2,648 pairs of ratings differed by 1 point or less. CONCLUSION: High interexaminer agreement on the scoring of the ABEM oral certification examination supports the reliability of this final step in the certification process. On the basis of these findings, ABEM has incorporated this methodology into the administration of each oral examination as an ongoing quality control measure.

Adult↗
PubMed2003

Status report: Development of emergency medicine research since the Macy Report.

In Williamsburg, VA, April 17 to 20, 1994, the Josiah Macy, Jr. Foundation sponsored a conference entitled "The Role of Emergency Medicine in the Future of American Medical Care," a report on which was published in Annals in 1995. This report promulgated recommendations for the development and enhancement of academic departments of emergency medicine and a conference to develop an agenda for research in emergency medicine. The American College of Emergency Physicians' Research Committee, along with several ad hoc members, presents updates in several of the areas addressed by the Macy Report and subsequent conferences, as a status report for the development of emergency medicine research as a whole, as of late 2002.

Congresses as Topic↗
PubMed2003

Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department.

OBJECTIVES: Verbally administered numerical rating scales (NRSs) from 0 to 10 are often used to measure pain, but they have not been validated in the emergency department (ED) setting. The authors wished to assess the comparability of the NRS and visual analog scale (VAS) as measures of acute pain, and to identify the minimum clinically significant difference in pain that could be detected on the NRS. METHODS: This was a prospective cohort study of a convenience sample of adults presenting with acute pain to an urban ED. Patients verbally rated pain intensity as an integer from 0 to 10 (0 = no pain, 10 = worst possible pain), and marked a 10-cm horizontal VAS bounded by these descriptors. VAS and NRS data were obtained at presentation, 30 minutes later, and 60 minutes later. At 30 and 60 minutes, patients were asked whether their pain was "much less," "a little less," "about the same," "a little more," or "much more." Differences between consecutive pairs of measurements on the VAS and NRS obtained at 30-minute intervals were calculated for each of the five categories of pain descriptor. The association between VAS and NRS scores was expressed as a correlation coefficient. The VAS scores were regressed on the NRS scores in order to assess the equivalence of the measures. The mean changes associated with descriptors "a little less" or "a little more" were combined to define the minimum clinically significant difference in pain measured on the VAS and NRS. RESULTS: Of 108 patients entered, 103 provided data at 30 minutes and 86 at 60 minutes. NRS scores were strongly correlated to VAS scores at all time periods (r = 0.94, 95% CI = 0.93 to 0.95). The slope of the regression line was 1.01 (95% CI = 0.97 to 1.06) and the y-intercept was -0.34 (95% CI = -0.67 to -0.01). The minimum clinically significant difference in pain was 1.3 (95% CI = 1.0 to 1.5) on the NRS and 1.4 (95% CI = 1.1 to 1.7) on the VAS. CONCLUSIONS: The findings suggest that the verbally administered NRS can be substituted for the VAS in acute pain measurement.

Acute Disease↗
PubMed2002

Effect of written feedback by editors on quality of reviews: two randomized trials.

CONTEXT: Better peer review is needed, but proven methods to improve quality are unknown. Our objective was to determine whether written feedback to reviewers improves subsequent reviews. METHODS: Eligible reviewers were randomized to intervention or control (receiving other reviewers' unscored reviews and the editor's decision letter). Study 1 (September 1998-September 2000) included reviewers with a median quality score of 3 or lower; study 2 (April 2000-January 2002), reviewers with median score of 4 or lower. Study 1 was designed with a power of 0.80 to detect a difference in score of 1; study 2, with a power of 0.80 to detect a difference of 0.5. All reviewers were at a peer-reviewed journal (Annals of Emergency Medicine). The main outcome measure was the editor's routine quality rating (1-5) of all reviews (blinded to study enrollment). RESULTS: For study 1, 51 reviewers were eligible and randomized and 35 had sufficient data (182 reviews) for analysis. The mean individual reviewer rating change was 0.16 (95% confidence interval [CI], -0.26 to 0.58) for control and -0.13 (-0.49 to 0.23) for intervention. For study 2, 127 reviewers were eligible and randomized, and 95 had sufficient data (324 reviews). Controls had a mean individual rating change of 0.12 (95% CI, -0.20 to 0.26) and intervention reviewers, 0.06 (-0.19 to 0.31). CONCLUSIONS: In study 1, minimal feedback from editors on review quality had no effect on subsequent performance of poor-quality reviewers, and the trend was toward a negative effect. In study 2, feedback to average reviewers was more extensive and supportive but produced no improvement in reviewer performance. Simple written feedback to reviewers seems to be an ineffective educational tool.

Evaluation Studies as Topic↗
PubMed2002

Reliability and validity of a visual analog scale for acute abdominal pain in the ED.

The objective of the study was to assess the validity and reliability of the visual analog scale (VAS) in the measurement of acute abdominal pain, and to identify the minimum clinically significant difference in VAS scores among patients with acute abdominal pain. The study was undertaken in preparation for a randomized clinical trial of opioid use in acute abdominal pain. A prospective, observational cohort study of a convenience sample of patients presenting to 2 urban EDs with the chief complaint of acute abdominal pain was conducted. At time 0 and 1 minute later each subject indicated pain severity on a 100mm VAS. This was repeated every 30 minutes for 2 hours. Patients were also asked to contrast their current pain severity with their pain in the preceding 30 minutes using one of 5 graded verbal descriptors: "much less pain," "little less pain," "the same pain," "little more pain," and "much more pain." Validity was assessed by performing an analysis of variance for linear trend on the association between the 5 categorical pain descriptors and change in VAS scores. Reliability was assessed using the intra-class correlation coefficient (ICC) between VAS scores taken 1 minute apart, supplemented by a Bland-Altman analysis. The minimum clinically significant difference in pain was defined as the mean difference between sequential VAS scores obtained 30 minutes apart when the patient noted a "little less" or "little more" pain. Differences in VAS scores increased linearly as pain descriptors escalated from "much less" to "much more" pain (P <.001). Reliability was high, ICC = 0.99 [95%CI 0.989 to 0.992] for 0 and 1 minute VAS scores. The minimum clinically significant difference in acute abdominal pain was 16 mm (95% CI 13, 18 mm). VAS measures of acute abdominal pain are valid and reliable. The 95% CI surrounding the minimum clinically significant difference of approximately 16 mm overlaps with the 95% CI of minimum clinically significant difference of approximately 13 mm reported previously in traumatic and other types of acute pain. We conclude that the VAS is a methodologically sound instrument for quantitative assessment of acute abdominal pain and for detecting clinically important changes in such pain.

Abdominal Pain↗
PubMed2002

Evolution of Academic Emergency Medicine over a decade (1991-2001).

OBJECTIVE: To test the hypothesis that emergency medicine (EM) has made significant, quantifiable progress within U.S. academic medicine over the past ten years, 1991-2001. METHODS: Baseline (7/1/1991) and comparison (7/1/2001) data sets contained all Liaison Committee on Medical Education (LCME)-accredited schools, Association of Academic Chairs of Emergency Medicine (AACEM)-recognized academic departments of EM, Residency Review Committee (RRC)-accredited EM residencies, and Association of American Medical Colleges (AAMC)-designated academic medical centers. The increase over ten years in the two primary variables of academic departmental status, and EM residencies located at academic medical centers, was examined in the aggregate, then stratified by medical schools grouped by academic rank. Differences over time are expressed as simple proportions, bounded by 95% confidence intervals (95% CIs). RESULTS: Between 1991 and 2001, the proportion of academic departments of EM at medical schools increased from 18% to 48% (95% CI for difference of 30% = 19% to 41%). The proportion of EM residencies at academic medical centers increased from 42% to 66% (95% CI for a difference of 24% = 11% to 36%). The largest increment of 37% (95% CI = 22% to 52%) in academic departments of EM, and of 36% (95% CI = 20% to 52%) in EM residencies located at academic medical centers, occurred within medical schools whose academic rank was above the median. CONCLUSIONS: A quantitatively and statistically significant increase in academic departments of EM within medical schools and EM residency programs at academic medical centers has occurred over the past decade. Half of all medical schools now have academic departments of EM, and two-thirds of academic medical centers house EM residency programs. This has taken place largely within institutions whose academic ranking places them among the top half of all U.S. medical schools.

Academic Medical Centers↗
PubMed2002

Heart rate variability in emergency department patients with sepsis.

OBJECTIVE: To test the hypothesis that heart rate variability (HRV) can provide an early indication of illness severity among patients presenting to the emergency department (ED) with sepsis. METHODS: The authors enrolled a convenience sample of 15 ED patients meeting the American College of Chest Physicians/Society of Critical Care Medicine criteria for sepsis. Each patient had continuous Holter monitoring performed in the ED. Acute Physiology and Chronic Health II (APACHE II) and Sequential Organ Failure (SOFA) scores were calculated for the day of presentation. Holter tapes obtained in the ED were analyzed off-line to calculate HRV variables for the 5-minute segment with the least artifact and non-sinus beats. These variables were correlated with APACHE II and SOFA scores. RESULTS: LFnu (normalized low-frequency power), an assessment of the relative sympathetic contribution to overall HRV, was correlated with increased illness severity as calculated using APACHE II (r = -0.67, r(2) = 0.43) and SOFA (r = -0.80, r(2) = 0.64) scores. LF/HF ratio (low-frequency/high-frequency ratio), a measure of sympathovagal balance, was correlated with the SOFA score [r = -0.54 (95% CI = -0.83 to -0.01), r(2) = 0.29]. All five patients who required critical care monitoring or ventilatory support or who died during the first 5 days of their hospitalization had LFnu values below 0.5 and LF/HF ratios less than 1.0. None of the patients with measurements greater than these threshold values died or required these interventions during the five days following admission. CONCLUSIONS: A single variable, LFnu, which reflects sympathetic modulation of heart rate, accounted for 40-60% of the variance in illness severity scores among patients presenting to the ED with sepsis. HRV, as reflected in LFnu and the LF/HF ratio and measured with a single brief (5-minute) period of monitoring while in the ED, may provide the emergency physician with a readily available, noninvasive, early marker of illness severity. The threshold effect of LFnu and LF/HF in the prediction of early clinical deterioration was an unexpected finding and should be regarded as hypothesis-generating, pending further study.

APACHE↗
PubMed2002

IV magnesium sulfate in the treatment of acute severe asthma: a multicenter randomized controlled trial.

BACKGROUND: Studies of IV magnesium sulfate as a treatment for acute asthma have had mixed results, with some data suggesting a benefit for acute severe asthma, but not for mild-to-moderate asthma. In a multicenter cohort, this study tests the hypothesis that administration of magnesium sulfate improves pulmonary function in patients with acute severe asthma. DESIGN: Placebo-controlled, double-blind, randomized clinical trial. SETTING: Emergency departments (EDs) of eight hospitals. PATIENTS: Patients aged 18 to 60 years presenting with acute asthma and FEV1 < or = 30% predicted on arrival to the ED. INTERVENTION: All patients received nebulized albuterol at regular intervals and IV methylprednisolone. Two grams of IV magnesium sulfate or placebo were administered 30 min after ED arrival. The primary efficacy end point was FEV1 at 240 min, and the data analysis was intent to treat. RESULTS: Two hundred forty-eight patients were included, and the mean FEV1 on ED arrival was 22.9% predicted. At 240 min, patients receiving magnesium had a mean FEV1 of 48.2% predicted, compared to 43.5% predicted in the placebo-treated group (mean difference, 4.7%; 95% confidence interval [CI], 0.29 to 9.3%; p = 0.045). A regression model confirmed the effect of magnesium compared to placebo was greater in patients with a lower initial FEV1 (p < 0.05). If the initial FEV1 was < 25% predicted, the final FEV1 was 45.3% predicted in the magnesium-treated group and 35.6% predicted in the placebo-treated group (mean difference, 9.7%; 95% CI, 4.0 to 15.3%; p = 0.001). If the initial FEV was > or = 25% predicted, magnesium administration was not beneficial; the final FEV1 was 51.1% predicted in the magnesium-treated group and 53.9% predicted in the placebo-treated group (mean difference, - 2.9%, 95% CI, - 9.4 to 3.7; p = not significant). Overall, the use of magnesium sulfate did not improve hospital admission rates. CONCLUSION: Administration of 2 g of IV magnesium sulfate improves pulmonary function when used as an adjunct to standard therapy in patients with very severe, acute asthma.

Acute Disease↗