AEM Early Access

AEM Education and Training 09: Looking Through the Prism - Caring for LGBTQI Patients in the ED

Welcome to the ninth episode of AEM Education and Training, a podcast collaboration between the Academic Emergency Medicine E&T Journal and Brown Emergency Medicine. Each quarter, we'll give you digital open access to AEM E&T Articles or Articles in Press, with an author interview podcast and links to curated supportive educational materials for EM learners and medical educators.

Find this podcast series on iTunes here.

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DISCUSSING (CLICK ON TITLE TO ACCESS):

Looking Through the Prism: Comprehensive Care of Sexual Minority and Gender‐nonconforming Patients in the Acute Care Setting. Angela F. Jarman MD, MPH; Alyson J. McGregor MD, MA; Joel L. Moll MD ; Tracy E. Madsen MD, ScM; Elizabeth A. Samuels MD, MPH; Mollie Chesis; Bruce M. Becker MD.

LISTEN NOW: AUTHOR INTERVIEW WITH angela jarman, MD, Mph

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Angela Jarman, MD, MPH

Assistant Professor, Department of Emergency Medicine

University of California, Davis

This interview discusses a commentary in AEM E&T which synthesizes a didactic session co‐led by the SAEM Sex and Gender in Emergency Medicine Interest Group and the Academy for Diversity and Inclusion, which was presented by the authors at the SAEM 2018 annual meeting in Indianapolis, Indiana.

The National Institutes of Health have recently recognized LGBTQ (lesbian, gay, bisexual, transgender, queer) as an official health disparity and designated the Sexual and Gender Minority Research Office in an effort to support evidence‐based medical care for this underserved patient population. As the front line of medical care for the underserved, emergency medicine (EM) physicians need to be equipped with the tools to care for these patients in a culturally competent and clinically appropriate manner. EM providers must develop an understanding of their patients’ social and medical context to provide both sensitive and effective care and to teach residents and other learners. A significant number of patients who seek treatment in the emergency department define themselves as LGBTQI—lesbian, gay, bisexual, transgender, queer, or intersex. This commentary combines both affective and objective information on the importance of semantics and language, appropriate communication, and confronting our own implicit biases in caring for this vulnerable population, creating a unique perspective and paradigm for the practice of EM and a blueprint for education. 

The authors have provided this handout for further information:

https://drive.google.com/file/d/1WDyk0HcCCP3DKmgGRdom53s8LKZB5Znz/view?usp=sharing

Excerpt:

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ADDITIONAL REFERENCES:

“Don’t be a jerk” EM Pulse Podcast, Episode 9. https://ucdavisem.com/2018/07/17/dont-be-a-jerk/

http://www.transstudent.org/gender/

NIH ORWH sex/gender. Available at https://orwh.od.nih.gov/research/sex-gender.

Institute of Medicine (US) Committee on Lesbian, Gay, Bisexual and Transgender Health Issues and Research Gaps and Opportunities. The health of lesbian, gay, bisexual, and transgender people. National Academies Press (US), Washington, DC; 2011

Clayton JA, Tannenbaum C. Reporting Sex, Gender, or Both in Clinical Research? JAMA 2016; 316(18):1863-1864

Madsen TE, Bourjeily G, Hasnain M, Jenkins MJ, Morrison MF, Sandberg K, Tong IL, Trott J. Sex- and Gender-Based Medicine: The Need for Precise Terminology. Gender and the Genome;1(3):122-28.

Schuster MA, Reisner SL, Onorato SE. Beyond bathrooms — meeting the health needs of transgender people. NEJM 2016;375:101–103.

Soc Sci Med. 2014 Feb;103:33-41. doi: 10.1016/j.socscimed.2013.06.005. Epub 2013 Jun 18.

Structural stigma and all-cause mortality in sexual minority populations. Soc Sci Med. 2014 Feb;103:33-41. doi: 10.1016/j.socscimed.2013.06.005. Epub 2013 Jun 18.

The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding Editors: Institute of Medicine (US) Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities.

Bauer GR, Scheim AI, Deutsch MB, et al. Reported Emergency Department Avoidance, Use, and Experiences of Transgender Persons in Ontario, Canada: Results From a Respondent-Driven Sampling Survey. Annals of Emergency Medicine. 2014;63(6):713-720.

Brown JF, Fu J. Emergency department avoidance by transgender persons: another broken thread in the "safety net" of emergency medicine care. Annals of Emergency Medicine. 2014;63(6):721-722.

Center of Excellence for Transgender Health, Department of Family and Community Medicine, University of California San Francisco. Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People; 2nd edition. Deutsch MB, ed. June 2016. Available at www.transhealth.ucsf.edu/guidelines .

Chisolm-Straker M, Jardine L, Bennouna C, Morency-Brassard N, Coy L, Egemba MO, Shearer PL (2017) Transgender and gender nonconforming in emergency departments: a qualitative report of patient experiences, Transgender Health 2:1, 8-16, DOI: 10.1089/trgh.2016.0026.

Deutsch MB, Jamison Green, Keatley J, Mayer G, Hastings J, Hall AM. Electronic medical records and the transgender patient: recommendations from the World Professional Association for Transgender Health. J Am Med Inform Assoc. 2013;20:700-703

IOM. Collecting sexual orientation and gender identity data in electronic health records: Workshop summary. Washington, DC: Institute of Medicine;2013.

James SE, Herman JL, Rankin S, et al. The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality;2016.

Jalali S, Sauer LM. Improving Care for Lesbian, Gay, Bisexual, and Transgender Patients in the Emergency Department. Annals of Emergency Medicine. 2015;66(4):417-423.

Lambda legal. Creating equal access to quality health care for transgender patients: transgender-affirming hospital policies. May 2016. Http://assets.Hrc.Org//files/assets/resources/transaffirming-hospitalpolicies-2016.Pdf?_Ga=2.179968679.225917522.1494296888-1373396650.1480810731

Samuels EA, Tape C, Garber N, Bowman S, Choo EK. “Sometimes you feel like the freak show”: A Qualitative Assessment of Emergency Care Experiences Among Trans and Gender Non-Conforming Patients. Ann Emerg Med 2017: doi:10.1016/j.annemergmed.2017.05.002.

World Professional Association for Transgender Health, Standards of Care for the Health of Transexual, Transgender, and Gender Nonconforming People 5 (7th ed.), http://www.wpath.org/uploaded_ les/140/ les/Stan- dards%20of%20Care,%20V7%20Full%20Book.pdf

AEM Early Access 21: Long-term Mortality in Pediatric Firearm Assault Survivors

Welcome to the twenty-first episode of AEM Early Access, a FOAMed podcast collaboration between the Academic Emergency Medicine Journal and Brown Emergency Medicine. Each month, we'll give you digital open access to an recent AEM Article or Article in Press, with an author interview podcast and suggested supportive educational materials for EM learners.

Find this podcast series on iTunes here.

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DISCUSSING (CLICK ON LINK FOR FULL TEXT, OPEN ACCESS THROUGH DECEMBER 31):

Long-term mortality in pediatric firearm assault survivors: a multi-center, retrospective, comparative cohort study. Ashkon Shaahinfar, MD, MPH, Irene H. Yen, PhD, MPH, Harrison J. Alter, MD, MS, Ginny Gildengorin, PhD, Sun-Ming J. Pan, James M. Betts, MD and Jahan Fahimi, MD, MPH.

listen now: first author interview with ashkon shaahinfar md mph

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Ashkon Shaahinfar, MD, MPH

Attending Physician and Emergency Ultrasound Director

Division of Emergency Medicine

UCSF Benioff Children’s Hospital Oakland

ABSTRACT

Objectives: The objective was to determine whether children surviving to hospital discharge after firearm assault (FA) and nonfirearm assault (NFA) are at increased risk of mortality relative to survivors of unintentional trauma (UT). Secondarily, the objective was to elucidate the factors associated with long-term mortality after pediatric trauma.

Methods: This was a multicenter, retrospective cohort study of pediatric patients aged 0 to 16 years who presented to the three trauma centers in San Francisco and Alameda counties, California, between January 2000 and December 2009 after 1) FA, 2) NFA, and 3) UT. The Social Security Death Master File and the California Department of Public Health Vital Statistics (2000–2014) were queried through December 31, 2014, to identify those who died after surviving their initial hospitalization and to delineate cause of death. Multivariate Cox proportional hazards regression was performed to determine associations between exposure to assault and long-term mortality.

Results: We analyzed 413 FA, 405 NFA, and 7,062 UT patients who survived their index hospital visit. A total of 75 deaths occurred, including 3.9, 3.2, and 0.7% of each cohort, respectively. Two-thirds of all long-term deaths were due to homicide. After multivariate adjustment, adolescent age, male sex, black race/ethnicity, and public insurance were independent risk factors for long-term mortality. FA (adjusted hazard ratio [AHR] = 1.8, 95% confidence interval [CI] = 0.82–4.0) and NFA (AHR = 1.9, 95% CI = 0.93–3.9) did not convey a statistically significant difference in risk of long-term mortality compared to UT. Being assaulted by any means (with or without a firearm), however, was an independent risk factor for long-term mortality in the full study population (AHR = 1.9, 95% CI = 1.01–3.4) and among adolescents (AHR = 1.9, 95% CI = 1.01–3.6).

Conclusion: Children and adolescents who survive assault, including by firearm, have increased long-term mortality compared to those who survive unintentional, nonviolent trauma.

AEM Early Access 20: Tracking Assault-Injured, Drug-Using Youth in Longitudinal Research

Welcome to the twentieth episode of AEM Early Access, a FOAMed podcast collaboration between the Academic Emergency Medicine Journal and Brown Emergency Medicine. Each month, we'll give you digital open access to an recent AEM Article or Article in Press, with an author interview podcast and suggested supportive educational materials for EM learners.

Find this podcast series on iTunes here.

DISCUSSING (click on link for full text, open access through november 30):

Tracking Assault-Injured, Drug-Using Youth in Longitudinal Research: Follow Up Methods. Jessica S. Roche, MPH, Michael J. Clery, MD, MPP, Patrick M. Carter, MD, Aaron Dora-Laskey, MD, MS, Maureen A. Walton, MPH, PhD, Quyen M. Ngo, PhD, and Rebecca M. Cunningham, MD.

LISTEN NOW: FIRST AUTHOR INTERVIEW WITH JESSICA ROCHE, MPH

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Jessica Roche, MPH

Managing Director

University of Michigan Injury Prevention Center

Abstract

Objectives: Violence is one of the leading causes of death among youth ages 14-24. Hospital and ED-based violence prevention programs are increasingly becoming a critical part of public health efforts; however, evaluation of prevention efforts is needed to create evidence-based best practices. Retention of study participants is key to evaluations, though little literature exists regarding optimizing follow-up methods for violently-injured youth. This study aims to describe the methods for retention in youth violence studies and the characteristics of hard-to-reach participants.

Methods: The Flint Youth Injury (FYI) Study is a prospective study following a cohort of assault-injured, drug-using youth recruited in an urban ED, and a comparison population of drug using youth seeking medical or non-violence-related injury care. Validated survey instruments were administered at baseline and four follow-up time points (6, 12, 18, 24 months). Follow-up contacts used a variety of strategies and all attempts were coded by type and level of success. Regression analysis was used to predict contact difficulty and follow-up interview completion at 18 24 months.

Results: 599 patients (ages 14-24) were recruited from the ED (mean age=20.1 years, 41.2% female, 58.2% African American), with follow-up rates at 6, 12, 18, and 24 months of 85.3%, 83.7%, 84.2%, and 85.3%, respectively. Participant contact efforts ranged from 2 to 53 times per follow-up timeframe to complete a follow-up appointment, and more than 20% of appointments were completed off-site at community locations (e.g., participants' homes, jail/prison).Participants who were younger (p<.05) and female (p<.01) were more likely to complete their 24-month follow-up interview. Participants who sought care in the ED for assault injury (p<.05) and had a substance use disorder (p<.01) at baseline required fewer contact attempts to complete their 24-month follow-up, while participants reporting a fight within the immediate 3 months before their 24-month follow-up (p<.01) required more intensive contact efforts.

Conclusions: The FYI study demonstrated that achieving high follow-up rates for a difficult-to track, violently-injured ED population is feasible through the use of established contact strategies and a variety of interview locations. Results have implications for follow-up strategies planned as part of other violence prevention studies.