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Interactions between emergency department (ED) staff and sexual assault (SA) survivors can be a source of retraumatization for survivors, increasing their risk of posttraumatic stress and decreasing utilization of longitudinal medical care. Little is known about nationwide trends in ED staff attitudes and behaviors toward survivors, including the impact of survivor identity. We conducted a survey to determine if survivor identity influenced ED staff behaviors. A nationwide survey of SA patient advocates was conducted between June and August 2021. Advocates are volunteers or staff dispatched from rape crisis centers to support survivors during ED care. Advocates participated in an online survey to determine the frequency of observing six potentially retraumatizing provider attitudes and behaviors. Adaptive questioning was used to explore the impact of survivor identity on each attitude or behavior and which identity groups were more likely to be affected. Three hundred fifteen advocates responded to the survey. Less than 10% indicated that ED staff often or always convey disbelief or blame to survivors. Almost 75% of advocates indicated that they often or always observe ED staff showing empathy to survivors. Disparities were found in provider attitudes. Over 75% of advocates observed that survivors’ mental health status or substance use impacted conveyed belief from providers. Patients who were intoxicated when assaulted, had psychiatric disorders, were Black, Hispanic/LatinX, or indigenous, or were not cis-females were more likely to experience disbelief. Patients who were white and/or cis-gender females were more likely to be pressured by ED staff to complete the forensic exam and/or report to the police. Our study documents disparities in ED staff behavior towards SA survivors according to survivor identity. Given that post-assault ED interactions are critical turning points in survivors’ future medical processes, disparities in ED care may be linked to larger disparities in healing from trauma.

Background: While primary care providers regularly engage in Advance Care Planning (ACP) conversations, it is not well known what challenges resident physicians face to achieving this core competency. Objectives: We aimed to assess resident perceptions of barriers and potential interventions to outpatient ACP. Methods: We distributed an electronic survey to Internal Medicine and Medicine-Psychiatry residents at our institution in 2022. Questions addressed outpatient ACP barriers and potential interventions in several domains: structural issues, personal knowledge, and communication skills. We reported results using descriptive statistics and Wilcoxon rank-sum tests, comparing responses by residency year (interns vs upperyears). Likert-scale responses were dichotomized to a “not at all or slightly” vs “moderate or extreme” barrier or helpful intervention. Results: Of 149 residents, 71 completed the survey (48%). Highest scoring barriers were structural, including 1) lack of clinic time (99%), 2) need to prioritize other medical problems (94%), and 3) lack of patient continuity (62%). Highest scoring interventions included the ability to schedule dedicated ACP visits with themselves (96%) or another clinician (82%). Interns were statistically significantly less confident in their ability to conduct ACP, and more likely to report lack of knowledge (i.e., not understanding ACP, patient prognosis, or how to complete paperwork, P < .05). Conclusions: Residents report significant structural barriers to outpatient ACP, including limitations in time, continuity, and competing medical priorities, that may warrant greater program attention to interventions such as clinic schedules and work-flow. Additional trainings may be most beneficial if targeted to the beginning of intern year.

The international pediatric oncology community has a long history of research collaboration. In the United States, the 2019 launch of the Children's Cancer Data Initiative puts the focus on developing a rich and robust data ecosystem for pediatric oncology. In this spirit, we present here our experience in constructing the Pediatric Cancer Data Commons (PCDC) to highlight the significance of this effort in fighting pediatric cancer and improving outcomes and to provide essential information to those creating resources in other disease areas. The University of Chicago's PCDC team has worked with the international research community since 2015 to build data commons for children's cancers. We identified six critical features of successful data commons design and implementation: (1) establish the need for a data commons, (2) develop and deploy the technical infrastructure, (3) establish and implement governance, (4) make the data commons platform easy and intuitive for researchers, (5) socialize the data commons and create working knowledge and expertise in the research community, and (6) plan for longevity and sustainability. Data commons are critical to conducting research on large patient cohorts that will ultimately lead to improved outcomes for children with cancer. There is value in connecting high-quality clinical and phenotype data to external sources of data such as genomic, proteomics, and imaging data. Next steps for the PCDC include creating an informed and invested data-sharing culture, developing sustainable methods of data collection and sharing, standardizing genetic biomarker reporting, incorporating radiologic and molecular analysis data, and building models for electronic patient consent. The methods and processes described here can be extended to any clinical area and provide a blueprint for others wishing to develop similar resources.

OBJECTIVES Recent sepsis studies have defined patients as "infected" using a combination of culture and antibiotic orders rather than billing data. However, the accuracy of these definitions is unclear. We aimed to compare the accuracy of different established criteria for identifying infected patients using detailed chart review. DESIGN Retrospective observational study. SETTING Six hospitals from three health systems in Illinois. PATIENTS Adult admissions with blood culture or antibiotic orders, or Angus International Classification of Diseases infection codes and death were eligible for study inclusion as potentially infected patients. Nine-hundred to 1,000 of these admissions were randomly selected from each health system for chart review, and a proportional number of patients who did not meet chart review eligibility criteria were also included and deemed not infected. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The accuracy of published billing code criteria by Angus et al and electronic health record criteria by Rhee et al and Seymour et al (Sepsis-3) was determined using the manual chart review results as the gold standard. A total of 5,215 patients were included, with 2,874 encounters analyzed via chart review and a proportional 2,341 added who did not meet chart review eligibility criteria. In the study cohort, 27.5% of admissions had at least one infection. This was most similar to the percentage of admissions with blood culture orders (26.8%), Angus infection criteria (28.7%), and the Sepsis-3 criteria (30.4%). Sepsis-3 criteria was the most sensitive (81%), followed by Angus (77%) and Rhee (52%), while Rhee (97%) and Angus (90%) were more specific than the Sepsis-3 criteria (89%). Results were similar for patients with organ dysfunction during their admission. CONCLUSIONS Published criteria have a wide range of accuracy for identifying infected patients, with the Sepsis-3 criteria being the most sensitive and Rhee criteria being the most specific. These findings have important implications for studies investigating the burden of sepsis on a local and national level.

Purpose The Lung Allocation Score (LAS) relies on the performance of two cox proportional hazards models that estimate waitlist and post-transplant survival. These models were developed using data from 2005-2008; it is unknown if they remain accurate. Methods Observational cohort study of all lung transplant candidates and recipients greater than 12 years listed or transplanted between February, 19th 2015 to February, 19th 2019 in the Scientific Registry of Transplant Recipients database. We evaluated the discrimination of the waitlist and post-transplant models with the concordance probability estimate and the calibration of each model by comparing predicted versus observed one-year restricted mean survival times. We evaluated the overall accuracy of LAS by comparing a non-parametric estimate of the observed LAS with the actual LAS at transplant for each recipient percentile. Results During the study period, 11,539 eligible candidates were listed for transplant and 9,377 eligible recipients were transplanted. The waitlist model ranked candidates in the correct risk order 72% of the time (95% CI 71 - 73%) and underestimated survival by 59 days (95% CI 57 - 61 days) on average. The miscalibration increased from 6 days of error (95% CI 4 - 9 days) in the lowest risk decile to 136 days (95% CI 107-164 days) in the highest risk decile. The post-transplant model ranked recipients in the correct risk order 57% of the time (95% CI 55 - 58%) and underestimated post-transplant survival by 25 days (95% CI 23-27 days) on average. The miscalibration increased from 10 days of error in the lowest risk decile (95% CI 7 - 14 days) to 70 days (95% CI 64 - 77) in the highest risk decile. Overall, a recipient's LAS at transplant explained only 56% of variation in the observed LAS. Conclusion The waitlist and the post-transplant models that form the backbone of LAS are inaccurate, limiting the ability of the system to rank candidates in the correct order. The LAS should be updated using a modern cohort patient cohort.

Emergency department (ED) providers serve as the primary point-of-contact for many survivors of sexual assault but are often ill-prepared to address their unique treatment needs. Sexual assault nurse examiners (SANEs) are therefore an important resource for training other ED providers. The objective of this project was to create a SANE-led educational intervention addressing this training gap. We achieved this objective by (a) conducting a needs assessment of ED providers' self-reported knowledge of, and comfort with, sexual assault patient care at an urban academic adult ED and, (b) using these results to create and implement a SANE-led educational intervention to improve emergency medicine residents' ability to provide sexual assault patient care. From the needs assessment survey, ED providers reported confidence in medical management but not in providing trauma-informed care, conducting forensic examinations, or understanding hospital policies or state laws. Less than half of the respondents felt confident in their ability to avoid retraumatizing sexual assault patients, and only 29% felt comfortable conducting a forensic examination. On the basis of these results, a SANE-led educational intervention was developed for emergency medicine residents, consisting of a didactic lecture, two standardized patient cases, and a forensic pelvic examination simulation. Preintervention and postintervention surveys showed an increase in respondents' self-perceived ability to avoid retraumatizing patients, comfort with conducting forensic examinations, and understanding of laws and policies. These results show the value of an interprofessional collaboration between physicians and SANEs to train ED providers on sexual assault patient care.

Purpose The use of extracorporeal membranous oxygenation (ECMO) as a bridge to lung transplantation has increased dramatically. However, the Lung Allocation Score (LAS) does not use a dedicated ECMO variable; instead, ECMO is proxied by mechanical ventilation with 100% oxygen. We aimed to determine if this approximation accurately reflects the transplantation urgency for ECMO patients. Methods Lung transplant candidates and recipients greater than 12 years of age between 2008-2014 were selected from the SRTR database. For both the wait-list (WL) and post-transplant (PT) time periods, predicted survival functions were calculated using the LAS model and compared to observed survival functions estimated by Kaplan-Meier. Differences between predicted and observed WL survival and PT survival were calculated for candidates and recipients, stratified by ECMO support at listing or transplant. The errors in WL and PT survival were then combined to estimate the LAS error for each group. Results During the study period, 16,259 candidates were listed; 236 were on ECMO at listing. A total of 12,169 patients were transplanted; 363 were on ECMO at transplant. Non-ECMO candidates survived a mean of 336 days from listing compared to a LAS prediction of 328 days, leading to a WL error of 9 days. ECMO candidates survived a mean of 199 days from listing compared to a LAS prediction of 123 days, leading to a WL error of 77 days. Non-ECMO recipients survived a mean of 333 days from transplant compared to a LAS prediction of 315 days, leading to a PT error of 17 days. ECMO recipients survived a mean of 296 days from transplant compared to a LAS prediction of 248 days, leading to a PT error of 48 days (Fig 1). ECMO was associated with an overestimation of the LAS by 10 points, compared to a non-ECMO underestimation of 0.04 points. Conclusion The LAS ECMO correction underestimates both WL and PT one-year survival, leading to an overall upward bias in the LAS compared to non-ECMO candidates. This suggests that ECMO candidates have a lower transplantation urgency than implied by their LAS.