Emergency medicine journal : EMJ
The importance of end of life care (EoLC) for patients and their families is well documented, however, the skills and knowledge of emergency clinicians in delivering EoLC is not widely understood but it is clear from the existing literature that we fall short in delivering consistently good EoLC although there is recognition of the need to improve. This paper will acknowledge the challenges of delivering good EoLC in the emergency department (ED) but more importantly consider practical ways of improving EoLC in the ED in line with best practice guidelines on EoLC.
Who are EM3?
EM3 or ‘East Midlands Emergency Medicine Educational Media’ is an online emergency medicine educational resource, based out of Leicester Royal Infirmary ED. While their web presence is the foundation of their online resources, they are most interesting for the very successful way they translate emergency medicine research and education through multi-platform social media and FOAMed.
So, what happened?
In late October there were two inadvertent errors in educational resources simultaneously posted by EM3 to Twitter, Instagram, Facebook and Reddit. The errors were quickly identified and corrected, but despite this the incorrect posts continued to be shared, reaching some 15,000 people.
Edwards and Roland carefully describe the events, the approach EM3 took to correcting the errors, and analysis of the potential impact. They discuss the challenges when correcting what is by its very nature a dynamic resource, and one for which there is limited control once released. EM3 discuss the additional oversight added to their peer review process in response.
Their report is a cautionary tale for the FOAMed community and a useful resource for avoiding and managing SM errors when they inevitably occur.
Don’t be hasty...
Acknowledging that the reach and velocity offered by social media and FOAMed also bring accuracy and credibility concerns, traditional academic publishing is not without its own problems.
Whether outright academic fraud, replication crises or information overload, we already know that incorrect medical information persists for decades after being disproven. This is not a new problem, though FOAMed does accelerate the speed and scope for both good and bad.
Between the lines
The context of the article’s publication reveals the ongoing tension between FOAMed and the reality of traditional academic publishers, such as the BMJ: ‘Learning from mistakes on social media’ is not itself open access...summary
To determine whether the impact of a thoracic CT scan on community-acquired pneumonia (CAP) diagnosis and patient management varies according to emergency physician's experience (≤10 vs >10 years). ⋯ In clinical practice, less-experienced emergency physicians were more likely to accurately modify their CAP diagnosis and patient management based on thoracic CT scan than more experienced emergency physicians.
Recent terror attacks and assassinations involving highly toxic chemical weapons have stressed the importance of sufficient respiratory protection of medical first responders and receivers. As full-face respirators cause perceptual-motor impairment, they not only impair vision but also significantly reduce speech intelligibility. The recent introduction of electronic voice projection units (VPUs), attached to a respirator, may improve communication while wearing personal respiratory protection. ⋯ We found that the Avon C50 is the preferred model among the tested respirators. In our model, electronic voice projection modules improved loudness but not speech intelligibility. The Respirex PRPS NHS-suit was rated significantly less favourably in respect of medical communication and speech intelligibility.
Multiple pitfalls can occur with the conduct and analysis of a study of diagnostic tests, resulting in biased accuracy. Our conceptual model includes three stages: patient selection, interpretation of the index test and disease verification. ⋯ However, there are circumstances when certain choices in study design are unavoidable, and result in biased test characteristics. In this case, the informed reader will better judge the quality of a study by recognising the potential biases and limitations by being methodical in their approach to understanding the methods, and in turn, better apply studies of diagnostic tests into their clinical practice.