Department of Emergency Medicine (UCI)

BACKGROUND: Case studies have shown ChatGPT can run clinical simulations at the medical student level. However, no data have assessed ChatGPTs reliability in meeting desired simulation criteria such as medical accuracy, simulation formatting, and robust feedback mechanisms. OBJECTIVE: This study aims to quantify ChatGPTs ability to consistently follow formatting instructions and create simulations for preclinical medical student learners according to principles of medical simulation and multimedia educational technology. METHODS: Using ChatGPT-4 and a prevalidated starting prompt, the authors ran 360 separate simulations of an acute asthma exacerbation. A total of 180 simulations were given correct answers and 180 simulations were given incorrect answers. ChatGPT was evaluated for its ability to adhere to basic simulation parameters (stepwise progression, free response, interactivity), advanced simulation parameters (autonomous conclusion, delayed feedback, comprehensive feedback), and medical accuracy (vignette, treatment updates, feedback). Significance was determined with χ² analyses using 95% CIs for odds ratios. RESULTS: In total, 100% (n=360) of simulations met basic simulation parameters and were medically accurate. For advanced parameters, 55% (200/360) of all simulations delayed feedback, while the Correct arm (157/180, 87%) delayed feedback was significantly more than the Incorrect arm (43/180, 24%; P<.001). A total of 79% (285/360) of simulations concluded autonomously, and there was no difference between the Correct and Incorrect arms in autonomous conclusion (146/180, 81% and 139/180, 77%; P=.36). Overall, 78% (282/360) of simulations gave comprehensive feedback, and there was no difference between the Correct and Incorrect arms in comprehensive feedback (137/180, 76% and 145/180, 81%; P=.31). ChatGPT-4 was not significantly more likely to conclude simulations autonomously (P=.34) and provide comprehensive feedback (P=.27) when feedback was delayed compared to when feedback was not delayed. CONCLUSIONS: These simulations have the potential to be a reliable educational tool for simple simulations and can be evaluated by a novel 9-part metric. Per this metric, ChatGPT simulations performed perfectly on medical accuracy and basic simulation parameters. It performed well on comprehensive feedback and autonomous conclusion. Delayed feedback depended on the accuracy of user inputs. A simulation meeting one advanced parameter was not more likely to meet all advanced parameters. Further work must be done to ensure consistent performance across a broader range of simulation scenarios.

BACKGROUND: Although alcohol has been illegal in Iran for over four decades, its consumption persists. This study aims to determine the prevalence and determinants of alcohol consumption in Tehran, the Middle Easts third-largest city, using data from the Tehran Cohort Study (TeCS). METHODS: Our study encompasses data from 8420 individuals recorded between March 2016 and March 2019. We defined alcohol use as the lifetime consumption of alcoholic beverages and/or products. We calculated the age- and sex-weighted prevalence of alcohol use in addition to crude frequencies. We also determined the weighted prevalence of alcohol use in both genders. Multivariable logistic regressions were employed to investigate the adjusted odds ratios for the determinants of alcohol use. RESULTS: The mean age of participants was 53.8 ± 12.7 years. The lifetime prevalence of alcohol use was 9.9% (95% confidence interval [95% CI]: 8.3-11.8%) among the total population, with a prevalence of 3.3% (95% CI: 2.4-4.5%) among females and 16.6% (95% CI: 14.3-19.3%) among males. Alcohol use showed a decreasing trend with age in both sexes (women: 4.4% and men: 1.5% per year) as well as in the total population (1.7%). The geographical distribution of alcohol use in Tehran indicated a significantly higher concentration (95% CI: 6.5-13%) in the southern regions compared to other areas. Younger age, higher education levels, smoking, opium use, hyperlipidemia, physical activity, and being overweight determined a higher prevalence of alcohol use. CONCLUSIONS: The prevalence of alcohol use in Tehran is significant and exceeds previous estimates. Policymakers must address the rising incidence of alcohol use, particularly among the younger population.

BACKGROUND: Research demonstrates that Point-of-care ultrasound (POCUS) improves clinical outcomes for patients. Improving clinician satisfaction with POCUS should promote utilization into everyday practice, leading to improved clinical outcomes. Despite this benefit, there are still barriers to use including POCUS workflow. This project was undertaken to improve the functionality of the existing POCUS workflow and move toward an encounter-based system by automating worklist generation. It aimed to streamline the POCUS workflow, primarily determine if there was improved clinician satisfaction with the new workflow, and secondarily determine the change in revenue generation from decreased errors in data entry. METHODS: A new workflow was created which automatically populated every registered Emergency Department (ED) patient into the worklist upon patient registration. Clinician feedback on their use of the new workflow was sought via survey after implementation. The number of medical record number (MRN) entry errors prior to and following implementation was manually reviewed and calculated. RESULTS: There was a strong preference for the new workflow, with 36 of 38 (94.7%) clinicians finding it to be more convenient and 37 of 38 (97.4%) finding it to be preferable to use compared to the old workflow. Implementation also resulted in a 36% reduction in database studies containing an MRN data entry error. CONCLUSIONS: An encounter-based workflow is strongly preferred over manual data entry for POCUS workflow among clinicians. Additionally, there was no cost to the intervention and the total data entry errors were significantly reduced, allowing for improved quality review and increased revenue.

BACKGROUND AND AIMS: In the current study, we aimed to identify the association between major and minor electrocardiographic abnormalities and cardiovascular risk factors. METHODS: We used the Tehran cohort study baseline data, an ongoing multidisciplinary, longitudinal study designed to identify cardiovascular disease risk factors in the adult population of Tehran. The electrocardiograms (ECGs) of 7630 Iranian adults aged 35 years and above were analyzed. ECG abnormalities were categorized into major or minor groups based on their clinical importance. Results were obtained by multivariable logistic regression and are expressed as odds ratios (ORs). RESULTS: A total of 756 (9.9%) participants had major ECG abnormalities, while minor abnormalities were detected in 2526 (33.1%). Males comprised 45.8% of the total population, and 41.8% of them had minor abnormalities. Individuals with older age, diabetes (OR = 1.35; 95% CI: 1.11-1.64), and hypertension (OR = 2.21; 95% CI: 1.82-2.68) had an increased risk of major ECG abnormalities. In contrast, intermediate (OR = 0.69; 95% CI: 0.57-0.84) and high physical activity levels (OR = 0.66; 95% CI: 0.51-0.86) were associated with a lower prevalence of major abnormalities. Male sex, older age, hypertension, and current smoking were also associated with an increased prevalence of ECG abnormalities combined (major or minor). CONCLUSION: Major and minor ECG abnormalities are linked with important cardiovascular risk factors such as diabetes and hypertension. Since these abnormalities have been associated with poor outcomes, screening patients with cardiovascular risk factors with an ECG may distinguish high-risk individuals who require appropriate care and follow-up.

Cognitive rumination, a transdiagnostic symptom across mental health disorders, has traditionally been assessed through self-report measures. However, these measures are limited by their temporal nature and subjective bias. The rise in wearable technologies offers the potential for continuous, real-time monitoring of physiological indicators associated with rumination. This scoping review investigates the current state of research on using wearable technology to detect cognitive rumination. Specifically, we examine the sensors and wearable devices used, physiological biomarkers measured, standard measures of rumination used, and the comparative validity of specific biomarkers in identifying cognitive rumination. The review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines on IEEE, Scopus, PubMed, and PsycInfo databases. Studies that used wearable devices to measure rumination-related physiological responses and biomarkers were included (n = 9); seven studies assessed one biomarker, and two studies assessed two biomarkers. Electrodermal Activity (EDA) sensors capturing skin conductance activity emerged as both the most prevalent sensor (n = 5) and the most comparatively valid biomarker for detecting cognitive rumination via wearable devices. Other commonly investigated biomarkers included electrical brain activity measured through Electroencephalogram (EEG) sensors (n = 2), Heart Rate Variability (HRV) measured using Electrocardiogram (ECG) sensors and heart rate fitness monitors (n = 2), muscle response measured through Electromyography (EMG) sensors (n = 1) and movement measured through an accelerometer (n = 1). The Empatica E4 and Empatica Embrace 2 wrist-worn devices were the most frequently used wearable (n = 3). The Rumination Response Scale (RRS), was the most widely used standard scale for assessing rumination. Experimental induction protocols, often adapted from Nolen-Hoeksema and Morrow's 1993 rumination induction paradigm, were also widely used. In conclusion, the findings suggest that wearable technology offers promise in capturing real-time physiological responses associated with rumination. However, the field is still developing, and further research is needed to validate these findings and explore the impact of individual traits and contextual factors on the accuracy of rumination detection.

OBJECTIVE: This study aimed to assess patients interest in education content delivered through electronic modalities and identify trends in internet access and use among emergency department patients of various socioeconomic statuses. METHODS: A prospective, cross-sectional survey with 50 questions was completed by 241 English and Spanish-speaking patients in 2014 and repeated with 253 participants in 2019 at the University of California, Irvine Medical Centers Emergency Department (UCIMCED). RESULTS: Internet access increased from 83.8 % in 2014 to 88.1 % in 2019. Most internet-using patients owned smartphones (80.1 % in 2014, 89.7 % in 2019). Patients used electronic devices, such as fit bits and activity trackers, to obtain health information. Email was the preferred method for receiving discharge instructions. CONCLUSIONS: As of 2019, 88.1 % of UCIMCED patients have access to the internet or email, making electronic media a reasonable venue for patient education. Given that we have a predominantly low-income patient population-61 % and 32 % of respondents in 2014 and 2019, respectively, reporting an income of less than $25,000-these results are provide new avenues to reach patients of all socioeconomic statuses. INNOVATION: The implications of this study can be used to develop electronic resources tailored to educate emergency department patients about their healthcare beyond the confines of a hospital.

The declaration of a second Public Health Emergency of International Concern (PHEIC) for mpox in August 2024 underscores the urgent need for a comprehensive understanding of the evolving epidemiology [1] clinical manifestations, and zoonotic potential of this emerging threat [2]. This work delves into the intricate interplay between human and animal mpox infections, with a specific focus on the unique characteristics of various viral clades and their implications for individual and public health. There is a critical need to elucidate the factors driving multiple spillover events and the subsequent emergence of new clades better adapted to human-to-human transmission. We hypothesize that anthropogenic changes, including deforestation, urbanization, and climate change are facilitating increased human-to-animal contact, leading to more frequent zoonotic transmissions and viral adaptations. Our conceptual framework integrates One Health principles, evolutionary virology, and epidemiological modeling to investigate the demographic, clinical, and treatment differences among mpox clades in both humans and animals. We employ a mixed-methods approach, combining genomic analysis, clinical data review, and ecological surveys to construct a comprehensive picture of mpoxs changing dynamics. The research questions explore the differences in epidemiological and clinical profiles among mpox clades and the factors that likely contribute to successful cross-species transmission and human adaptation. This manuscript introduces an updated Identify, Isolate, Inform (3I) Tool meticulously redesigned to significantly improve the early detection, containment, and reporting of mpox cases across diverse settings. By integrating clinical, virological, and ecological data, this work aims to lay the groundwork for enhanced risk assessment, targeted interventions, and global preparedness strategies in the face of this evolving zoonotic threat.

Abdominal pain is one of the most common presenting chief complaints in the emergency department. Erector spinae plane block (ESPB) is an ultrasound-guided nerve block with proven effectiveness in treating visceral and somatic abdominal pain. Despite the increasing popularity of ESPB, its role in the management of nonsurgical abdominal pain has not yet been characterized. Our scoping review aims to synthesize current knowledge on the safety and efficacy of ESPB in the management of patients experiencing intractable, nonsurgical abdominal pain. We searched PubMed and Scopus to evaluate the existing literature on ESPB for nonsurgical abdominal pain. A total of 14 journal articles were included: 12 case-based studies, one systematic review, and one narrative review. All cases described the successful use of ESPB in treating abdominal pain refractory to oral or intravenous analgesic medications, and no complications were reported in any cases. This scoping review provides support for the use of ESPB to manage intractable, nonsurgical abdominal pain. ESPB has demonstrated efficacy in alleviating various conditions such as functional abdominal pain, renal colic, pancreatitis, herpetic pain, and cancer-related pain. Theoretical risks such as pneumothorax, bleeding, and infection are possible, although the studies reviewed did not report such complications.

BACKGROUND: The characteristics of electrocardiogram (ECG) abnormalities related to cardiac channelopathies potentially linked to sudden cardiac death (SCD) are not widely recognized in Iran. We examined the prevalence of such ECG patterns and their related factors among adult residents of Tehran, Iran. METHODS: The clinical characteristics and 12-lead ECGs of Tehran Cohort Study participants were examined. Long QT intervals, short QT intervals, Brugada syndrome (BrS) patterns, and early repolarization (ER) were evaluated using computer-based assessment software validated by cardiologists. Logistic regression models were employed to identify the factors associated with the prevalence of different ECG patterns. RESULTS: Out of 7678 available ECGs, 7350 were included in this analysis. Long QT interval, ER pattern, BrS patterns, and short QT interval were found in 3.08%, 1.43%, 0.31%, and 0.03% of participants, respectively. The prevalence of long QT interval increased with age, opium consumption, and presence of hypertension. Younger age, lower body mass index (BMI), alcohol use and male sex were independently linked to an elevated prevalence of ER pattern. Most individuals with BrS patterns were men (95%) and had lower BMI, high- and low-density lipoprotein, and total cholesterol compared to those without the BrS pattern. At a mean follow-up of 30.2 ± 5.5 months, all-cause mortality in the group exhibiting abnormal ECG patterns (6.3%) was approximately twice as high as that in the group without such patterns (2.96%). CONCLUSION: Abnormal ECG patterns corresponding to channelopathies were relatively rare among adult residents of the Tehran population, and their prevalence was influenced by various factors. CLINICAL TRIAL NUMBER: Not applicable.

OBJECTIVES: In the United States, pediatric emergency department (ED) visits for behavioral health (BH) are increasing. We sought to determine ED-level characteristics associated with having recommended BH-related policies. METHODS: We conducted a retrospective serial cross-sectional study of National Pediatric Readiness Project assessments administered to US EDs in 2013 and 2021. Changes in responses related to BH items over time were examined. Multivariable logistic regression models examined ED characteristics associated with the presence of specific BH-related policies in 2021. RESULTS: Of 3554 EDs that completed assessments in 2021, 73.0% had BH-related policies, 66.5% had transfer guidelines for children with BH issues, and 38.6% had access to BH resources in a disaster. Of 2570 EDs that completed assessments in both 2013 and 2021, presence of specific BH-related policies increased from 48.6% to 72.0% and presence of appropriate transfer guidelines increased from 56.2% to 64.9%. The adjusted odd ratios (aORs) of having specific BH-related policies were lower in rural (aOR 0.73; 95% confidence interval [CI] 0.57, 0.92) and remote EDs (aOR 0.65; 95% CI 0.48, 0.88) compared to urban EDs; lower among EDs with versus without trauma center designation (aOR 0.80; 95% CI 0.67, 0.95); and higher among EDs with a nurse and physician pediatric emergency care coordinator (PECC) (aOR 1.89; 95% CI 1.54, 2.33) versus those without a PECC. CONCLUSION: Although pediatric readiness for BH conditions increased from 2013 to 2021, gaps remain, particularly among rural EDs and designated trauma centers. Having nurse and physician PECCs is a modifiable strategy to increase ED pediatric readiness pertaining to BH.