Emergency Medicine Gender‐specific Education

The 2014 Academic Emergency Medicine consensus conference has taken the first step in identifying gender‐specific care as an area of importance to both emergency medicine (EM) and research. To improve patient care, we need to address educational gaps in this area concurrent with research gaps. In this article, the authors highlight the need for sex‐ and gender‐specific education in EM and propose guidelines for medical student, resident, and faculty education. Specific examples of incorporating this content into grand rounds, simulation, bedside teaching, and journal club sessions are reviewed. Future challenges and strategies to fill the gaps in the current education model are also described.     

Funding Mechanisms for Gender‐specific Research: Proceedings from a Panel Discussion at the 2014 Academic Emergency Medicine Consensus Conference

As part of the 2014 Academic Emergency Medicine (AEM) consensus conference “Gender‐Specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes,” we assembled a diverse panel of representatives from federal and nonfederal funding agencies to discuss future opportunities for sex‐ and gender‐specific research. The discussion revolved around the mission and priorities of each organization, as well as its interest in promoting sex‐ and gender‐specific research. The panelists were asked to provide specific examples of funding lines generated or planned for as pertinent to emergency care. Training opportunities for future researchers in this area were also discussed.     

Future Directions in Sex‐ and Gender‐specific Emergency Medicine

The 2014 Academic Emergency Medicine (AEM) consensus conference “Gender‐Specific Research in Emergency Medicine: Investigate, Understand, and Translate How Gender Affects Patient Outcomes” convened a diverse group of stakeholders to target gaps in emergency medicine (EM) sex‐ and gender‐specific research and identify research priorities. At the close of the conference, the executive committee sought feedback from group leaders and conference attendees about the next critical steps in EM sex‐ and gender‐specific research, goals for their own future research, and anticipated barriers in pursuing this research. This article summarizes this feedback on the future directions in sex‐ and gender‐specific research in emergency care and strategies to overcome barriers.     

Gender‐specific aspects in the clinical presentation of cardiovascular disease

More than a quarter of a million women die each year in the industrialized countries from cardiovascular diseases (CVD), and current projections indicate that this number will continue to rise with our ageing population. Important sex‐related differences in the prevalence, presentation, management and outcomes of different CVD have discovered in the last two decades of cardiovascular research. Nevertheless, much evidence supporting contemporary recommendations for testing, prevention and treatment of CVD in women is still extrapolated from studies conducted predominantly in men. The compendium of CVD indicates that current research and strategy development must focus on gender‐specific issues to address the societal burden and costs related to these incremental shifts in female gender involvement. Indeed, this significant burden of CVD in women places unique diagnostic, treatment and financial encumbrances on our society that are only further intensified by a lack of public awareness about the disease on the part of patients and clinicians alike. This societal burden of the disease is, in part, related to our poor understanding of gender‐specific pathophysiologic differences in the presentation and prognosis of CVD and the paucity of diagnostic and treatment guidelines tailored to phenotypic differences in women. In this, scenario is of outmost importance to know these differences to provide the best care for female patients, because under‐recognition of CVD in women may contribute to a worse clinical outcome. This review will provide a synopsis of available evidence on gender‐based differences in the initial presentation, pathophysiology and clinical outcomes of women affected by CVD.     

Gender‐specific Issues in Traumatic Injury and Resuscitation: Consensus‐based Recommendations for Future Research

Traumatic injury remains an unacceptably high contributor to morbidity and mortality rates across the United States. Gender‐specific research in trauma and emergency resuscitation has become a rising priority. In concert with the 2014 Academic Emergency Medicine consensus conference “Gender‐specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes,” a consensus‐building group consisting of experts in emergency medicine, critical care, traumatology, anesthesiology, and public health convened to generate research recommendations and priority questions to be answered and thus move the field forward. Nominal group technique was used for the consensus‐building process and a combination of face‐to‐face meetings, monthly conference calls, e‐mail discussions, and preconference surveys were used to refine the research questions. The resulting research agenda focuses on opportunities to improve patient outcomes by expanding research in sex‐ and gender‐specific emergency care in the field of traumatic injury and resuscitation.     

Gender‐ and Sex‐specific Sports‐related Injury Research in Emergency Medicine: A Consensus on Future Research Direction and Focused Application

Title IX, the commercialization of sports, the social change in sports participation, and the response to the obesity epidemic have contributed to the rapid proliferation of participation in both competitive organized sports and nontraditional athletic events. As a consequence, emergency physicians are regularly involved in the acute diagnosis, management, disposition, and counseling of a broad range of sports‐related pathology. Three important and highly publicized mechanisms of injury in sports relevant to emergency medicine (EM) include concussion, heat illness, and sudden cardiac death. In conjunction with the 2014 Academic Emergency Medicine consensus conference “Gender‐specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes,” a consensus group consisting of experts in EM, emergency neurology, sports medicine, and public health convened to deliberate and develop research questions that could ultimately advance the field of sports medicine and allow for meaningful application in the emergency department (ED) clinical setting. Sex differences in injury risk, diagnosis, ED treatment, and counseling are identified in each of these themes. This article presents the consensus‐based priority research agenda.     

Gender‐specific Research on Mental Illness in the Emergency Department: Current Knowledge and Future Directions

Mental illness is a growing, and largely unaddressed, problem for the population and for emergency department (ED) patients in particular. Extensive literature outlines sex and gender differences in mental illness' epidemiology and risk and protective factors. Few studies, however, examined sex and gender differences in screening, diagnosis, and management of mental illness in the ED setting. Our consensus group used the nominal group technique to outline major gaps in knowledge and research priorities for these areas, including the influence of violence and other risk factors on the course of mental illness for ED patients. Our consensus group urges the pursuit of this research in general and conscious use of a gender lens when conducting, analyzing, and authoring future ED‐based investigations of mental illness.     

Gender‐specific aspects of treatment of cardiovascular risk factors in primary and secondary prevention

In men, cardiovascular diseases (CVD) increase steadily by the age of 35 years and reach a plateau in the 7th decade of life, whereas in women few years after the menopause, from about 50 years, the incidence of cardio‐cerebro‐vascular diseases progressively increases, becoming the leading cause of mortality and morbidity. Because of the greater incidence of CVD in men until the early 1980s, the information on cardiovascular risk factors has been gathered mainly from men and then translated in women. But sex steroid milieu has a different impact on cardiovascular risk profile, as cardiovascular risk factors have a different importance in determining future cardiovascular events in the two sexes and therapeutic strategies have a different impact on reducing cardiovascular risk in the two sexes. Aim of this study is to review the gender‐specific aspects influencing the development of cardiovascular risk factors and cardiovascular preventative strategies both in primary and in secondary prevention.     

Gender‐specific features of plasmatic and circulating cell alterations as risk factors in cardiovascular disease

Cardiovascular disease (CVD) is the leading cause of death in the Western countries. Several epidemiological studies have hypothesized a gender disparity in the pathogenesis and progression of CVD. For instance, women develop CVD when they are about 10 years older than men and, typically, after menopause. However, considering that women are often excluded from research studies, sex differences in CVD remains a frontier for discovery. Very important is thus the identification of risk factors allowing us to diagnose or predict cardiovascular events taking into account gender disparities. In this review, we will examine some of the major challenges in the discovery and validation of cardiovascular biomarkers in a gender perspective. In particular, we will consider classical (hypertension, smoking, diabetes, dyslipidemia, physical inactivity) and novel (inflammation markers, markers of endothelial dysfunction, markers of coronary disease) risk factors reporting gender differences. The aim of this review was to provide an overview on current knowledge on sex‐associated cardiovascular determinants with the aim to improve CVD diagnostic and prognostic clinical courses and to develop new and gender‐biased prevention strategies.     

Injury Due to Mechanical Falls: Future Directions in Gender‐specific Surveillance,Screening, and Interventions in Emergency Department Patients

The Centers for Disease Control and Prevention report that among older adults (≥65 years), falls are the leading cause of injury‐related death. Fall‐related fractures among older women are more than twice as frequent as those for men. Gender‐specific evidence‐based fall prevention strategy and intervention studies show that improved patient‐centered outcomes are elusive. There is a paucity of emergency medicine literature on the topic. As part of the 2014 Academic Emergency Medicine (AEM) consensus conference on “Gender‐Specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes,” a breakout group convened to generate a research agenda on priority questions to be answered on this topic. The consensus‐based priority research agenda is presented in this article.     

Sex‐ and Gender‐specific Research Priorities in Cardiovascular Resuscitation: Proceedings from the 2014 Academic Emergency Medicine Consensus Conference Cardiovascular Resuscitation Research Workgroup

Significant sex and gender differences in both physiology and psychology are readily acknowledged between men and women; however, data are lacking regarding differences in their responses to injury and treatment and in their ultimate recovery and survival. These variations remain particularly poorly defined within the field of cardiovascular resuscitation. A better understanding of the interaction between these important factors may soon allow us to dramatically improve outcomes in disease processes that currently carry a dismal prognosis, such as sudden cardiac arrest. As part of the 2014 Academic Emergency Medicine consensus conference “Gender‐Specific Research in Emergency Medicine: Investigate, Understand, and Translate How Gender Affects Patient Outcomes,” our group sought to identify key research questions and knowledge gaps pertaining to both sex and gender in cardiac resuscitation that could be answered in the near future to inform our understanding of these important issues. We combined a monthly teleconference meeting of interdisciplinary stakeholders from largely academic institutions with a focused interest in cardiovascular outcomes research, an extensive review of the existing literature, and an open breakout session discussion on the recommendations at the consensus conference to establish a prioritization of the knowledge gaps and relevant research questions in this area. We identified six priority research areas: 1) out‐of‐hospital cardiac arrest epidemiology and outcome, 2) customized resuscitation drugs, 3) treatment role for sex steroids, 4) targeted temperature management and hypothermia, 5) withdrawal of care after cardiac arrest, and 6) cardiopulmonary resuscitation training and implementation. We believe that exploring these key topics and identifying relevant questions may directly lead to improved understanding of sex‐ and gender‐specific issues seen in cardiac resuscitation and ultimately improved patient outcomes.     

Challenges and Regulatory Considerations in the Acoustic Measurement of High‐Frequency (>20 MHz) Ultrasound

This article examines the challenges associated with making acoustic output measurements at high ultrasound frequencies (>20 MHz) in the context of regulatory considerations contained in the US Food and Drug Administration industry guidance document for diagnostic ultrasound devices. Error sources in the acoustic measurement, including hydrophone calibration and spatial averaging, nonlinear distortion, and mechanical alignment, are evaluated, and the limitations of currently available acoustic measurement instruments are discussed. An uncertainty analysis of acoustic intensity and power measurements is presented, and an example uncertainty calculation is done on a hypothetical 30‐MHz high‐frequency ultrasound system. This analysis concludes that the estimated measurement uncertainty of the acoustic intensity is +73%/?86%, and the uncertainty in the mechanical index is +37%/?43%. These values exceed the respective levels in the Food and Drug Administration guidance document of 30% and 15%, respectively, which are more representative of the measurement uncertainty associated with characterizing lower‐frequency ultrasound systems. Recommendations made for minimizing the measurement uncertainty include implementing a mechanical positioning system that has sufficient repeatability and precision, reconstructing the time‐pressure waveform via deconvolution using the hydrophone frequency response, and correcting for hydrophone spatial averaging.