- Email: [email protected]
Prescription Opioids in the Twittersphere: A Contextual Analysis of Tweets About Prescription Drugs
Research Forum Abstracts and if they were willing to share it for review. Curricular goals and objectives of participating residencies were compared to identify common training components. Descriptive statistics were used to analyze curricular components. Results: All 160 ACGME-approved emergency medicine residencies were contacted; 105 (65%) responded. Sixty-eight (65%) of these participated in some aspect of air medical training. Twenty-five (37%) of responding programs had explicit goals and objectives for the training and 15 (60%) provided their curricula to us. Components of these reviewed curricula included: aircraft orientation (53%), safety training (60%), medical knowledge (66%), administrative (60%), team training (46%), financial operations (7%), procedure/protocols (80%), research (20%), medical direction (online and offline control) (27%), and air medical systems education (67%). Three (21%) programs explicitly stated in their goals and objectives that their training would be directed towards development of air medical directors. Three programs (21%) explicitly stated in their goals and objectives that training was directed towards becoming a crew member of an air medical transport team. Conclusions: A current, evidence-based, model curriculum for the air medical training of emergency medicine residents to become either crew members or medical directors does not exist. Existing air medical curricula vary widely among emergency medicine residency programs. A model curriculum that prepares residents to function as crew members and/or medical directors of air medical transport agencies would be useful to emergency medicine residency programs.
343
Incentive for Conference Attendance in an Academic Faculty
Druck J, Moreira M/University of Colorado, Aurora, CO; Denver Health, Denver, CO
Background: The ACGME resident questionnaire begins with “How many faculty attend and meaningfully participate in scheduled weekly conferences?” The impetus to maintain an adequate faculty presence at conference is one that concerns program directors. As a result, a variety of methods are often offered as methods to create appropriate faculty attendance. Study Objective: We sought to see if a faculty incentive encouraged attendance at conference. Methods: Faculty based at our two main institutions have a disparate financial structure, with one group of faculty having a specific incentive that provided for 5% of the overall incentive, paid out every six months (approximately a 250 dollar value), for attendance at 50% of all M and M conferences with credit given for working during conference or on the overnight before. Non-incented faculty were told they were expected to attend conference if they had no other obligations. Faculty attendance was taken at each conference and was compared between the two faculties. Results: A total of 20 non-incented faculty and 22 incented faculty were involved in this evaluation. A nine-month period of evaluation from August of 2010 until May of 2011 was used as a convenience sample. Overall, a total of 634 conference attendance episodes were recorded. For non-incented faculty, average percentage attendance was 37.027% with a 95% confidence interval of 6.6219, and a range from 5 conferences attended to 22. For incented faculty, average percentage attendance was 43.8573% with a 95% confidence interval of 5.7676 and a range from 1 conference attended to 30. When exempting faculty with less than 4 conference attendances, the incented faculty numbers changed to a average percentage attendance of 50.7735% with a 95% confidence interval of 5.8618. Conclusions: Overall, adding an incentive of 250 dollars did not change mean faculty attendance at conference significantly (overlapping confidence intervals). However, with the removal of three faculty members who attended very few conferences (and thereby were not eligible for incentives), the incentive increased faculty attendance (non-overlapping confidence intervals). This suggests some faculty may look at payment as not worth the time commitment, resulting in a disincentive to attend conference.
344
Prescription Opioids in the Twittersphere: A Contextual Analysis of Tweets About Prescription Drugs
Shutler L, Perrone J, Portelli I, Nelson LS, Blachford CR/New York Hospital of Queens, Flushing, NY; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; New York University Langone Medical Center, New York, NY; New York University School of Medicine, New York, NY
Study Objectives: Emergency physicians are concerned about misuse, abuse and diversion of prescription opioids (PO) from the emergency department (ED). Twitter
S122 Annals of Emergency Medicine
is a social media communication tool with 500 million registered users and disseminates information in 140 character “tweets.” Twitter users’ descriptions of prescription opioid use may lend insight into the prescription drug epidemic. We qualitatively assessed prescription opioid tweets in order to characterize their content according to: 1) abuse vs therapeutic use and 2) having a positive or negative connotation. Methods: Six keywords for POs (Percocet, Percs, Oxycontin, Oxys, Vicodin, and Hydros) were utilized to search tweets. A total of 2100 tweets (50 for each PO keyword for 7 days) were reviewed. Tweets were collected utilizing Twitter Archiving Google Spreadsheet®. Retweets and foreign language tweets were excluded. The investigators determined whether the tweet represented: abuse (i.e., use to get high), not abuse (i.e., use as analgesic), or was not characterizable (e.g.,“I need a percocet”). The tweets were also categorized as to whether the connotation was positive (i.e., promote psychoactive or analgesic use, would use again), negative (i.e., adverse event, would not use again), or not characterizable. Investigators were asked to identify contextual themes among the tweets. Twenty percent of the tweets were assessed by all three investigators and analyzed for agreement. This analysis compared responses provided by two of the three investigators in each possible combination on the basis of a predefined operational definition and coding rule. Non-agreement occurred only when the two observers had complete disagreement (e.g., observer 1 categorized the tweet as abuse and observer 2 categorized the tweet as not abuse). An agreement for each set of stratified tweets was calculated and analyzed in a blinded manner (per investigator) and the results aggregated (per group). Means for qualitative agreement across the three groups were calculated for each keyword. Results: Table illustrates the frequency of PO keywords associated with abuse or with a positive vs negative connotation and corresponding measures of agreement.
Keyword
Abuse(%)
Agreement(%)
Positive(%)
Agreement(%)
Percocet Percs Oxycontin Oxys Vicodin Hydros
39.6 55 53.9 65 44.6 37.5
97.1 97.8 96 97.1 96.8 93
69.3 70 66 72 72.9 75
97.3 96.9 95.4 97.3 95.2 97.2
Although abuse was commonly described with each keyword, ranging from 37.5-65% of tweets, neither the street name (e.g. Percs) nor the trade name (e.g. Percocet) was consistently more highly associated with abuse. The majority of terms (>66%) were “tweeted” with a positive connotation. Mean percentage agreement was excellent. Kappa coefficients were calculated and ranged from 0.85 to 0.96. Common themes included: receiving PO for dental procedures, obtaining PO from a doctor or ED visit, obtaining PO from friends to treat pain, taking PO for sleep, PO side effects, and getting high while taking PO for pain. Conclusions: Twitter content about prescription opioids is often about abuse. PO use or abuse is described favorably in the majority of tweets. Visits to the ED and dentist were among identified themes. Twitter can be a resource to improve understanding of PO use and abuse and trends in perceptions about prescription opioids.
345
In Vitro Neutralization With Trypsin or Rosmarinic Acid Reduces the Toxicity of Micrurus Fulvius Venom
Parker Cote JL, Brewer KL, O'Rourke D, Rosenbaum M, Meggs WJ/East Carolina University-Brody School of Medicine/Vidant Medical Center, Greenville, NC
Study Objectives: Currently, in the United States there is no unexpired FDA approved coral snake antivenom. Antivenom is not always readily available in other countries. An effective inexpensive treatment is needed when definitive treatment with antivenin is not available. This study investigates the ability of in vitro incubation of trypsin, a proteolytic enzyme, or rosmarinic acid (RA), a phospholipase A2 inhibitor, to neutralize eastern coral snake (Micrurus fulvius) venom using a murine model of envenomation. Methods: A randomized controlled blinded study of the efficacy of trypsin or RA, incubated in vitro with coral snake venom, to neutralize the venom was
Volume 62, no. 4s : October 2013
343
Incentive for Conference Attendance in an Academic Faculty
Druck J, Moreira M/University of Colorado, Aurora, CO; Denver Health, Denver, CO
Background: The ACGME resident questionnaire begins with “How many faculty attend and meaningfully participate in scheduled weekly conferences?” The impetus to maintain an adequate faculty presence at conference is one that concerns program directors. As a result, a variety of methods are often offered as methods to create appropriate faculty attendance. Study Objective: We sought to see if a faculty incentive encouraged attendance at conference. Methods: Faculty based at our two main institutions have a disparate financial structure, with one group of faculty having a specific incentive that provided for 5% of the overall incentive, paid out every six months (approximately a 250 dollar value), for attendance at 50% of all M and M conferences with credit given for working during conference or on the overnight before. Non-incented faculty were told they were expected to attend conference if they had no other obligations. Faculty attendance was taken at each conference and was compared between the two faculties. Results: A total of 20 non-incented faculty and 22 incented faculty were involved in this evaluation. A nine-month period of evaluation from August of 2010 until May of 2011 was used as a convenience sample. Overall, a total of 634 conference attendance episodes were recorded. For non-incented faculty, average percentage attendance was 37.027% with a 95% confidence interval of 6.6219, and a range from 5 conferences attended to 22. For incented faculty, average percentage attendance was 43.8573% with a 95% confidence interval of 5.7676 and a range from 1 conference attended to 30. When exempting faculty with less than 4 conference attendances, the incented faculty numbers changed to a average percentage attendance of 50.7735% with a 95% confidence interval of 5.8618. Conclusions: Overall, adding an incentive of 250 dollars did not change mean faculty attendance at conference significantly (overlapping confidence intervals). However, with the removal of three faculty members who attended very few conferences (and thereby were not eligible for incentives), the incentive increased faculty attendance (non-overlapping confidence intervals). This suggests some faculty may look at payment as not worth the time commitment, resulting in a disincentive to attend conference.
344
Prescription Opioids in the Twittersphere: A Contextual Analysis of Tweets About Prescription Drugs
Shutler L, Perrone J, Portelli I, Nelson LS, Blachford CR/New York Hospital of Queens, Flushing, NY; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; New York University Langone Medical Center, New York, NY; New York University School of Medicine, New York, NY
Study Objectives: Emergency physicians are concerned about misuse, abuse and diversion of prescription opioids (PO) from the emergency department (ED). Twitter
S122 Annals of Emergency Medicine
is a social media communication tool with 500 million registered users and disseminates information in 140 character “tweets.” Twitter users’ descriptions of prescription opioid use may lend insight into the prescription drug epidemic. We qualitatively assessed prescription opioid tweets in order to characterize their content according to: 1) abuse vs therapeutic use and 2) having a positive or negative connotation. Methods: Six keywords for POs (Percocet, Percs, Oxycontin, Oxys, Vicodin, and Hydros) were utilized to search tweets. A total of 2100 tweets (50 for each PO keyword for 7 days) were reviewed. Tweets were collected utilizing Twitter Archiving Google Spreadsheet®. Retweets and foreign language tweets were excluded. The investigators determined whether the tweet represented: abuse (i.e., use to get high), not abuse (i.e., use as analgesic), or was not characterizable (e.g.,“I need a percocet”). The tweets were also categorized as to whether the connotation was positive (i.e., promote psychoactive or analgesic use, would use again), negative (i.e., adverse event, would not use again), or not characterizable. Investigators were asked to identify contextual themes among the tweets. Twenty percent of the tweets were assessed by all three investigators and analyzed for agreement. This analysis compared responses provided by two of the three investigators in each possible combination on the basis of a predefined operational definition and coding rule. Non-agreement occurred only when the two observers had complete disagreement (e.g., observer 1 categorized the tweet as abuse and observer 2 categorized the tweet as not abuse). An agreement for each set of stratified tweets was calculated and analyzed in a blinded manner (per investigator) and the results aggregated (per group). Means for qualitative agreement across the three groups were calculated for each keyword. Results: Table illustrates the frequency of PO keywords associated with abuse or with a positive vs negative connotation and corresponding measures of agreement.
Keyword
Abuse(%)
Agreement(%)
Positive(%)
Agreement(%)
Percocet Percs Oxycontin Oxys Vicodin Hydros
39.6 55 53.9 65 44.6 37.5
97.1 97.8 96 97.1 96.8 93
69.3 70 66 72 72.9 75
97.3 96.9 95.4 97.3 95.2 97.2
Although abuse was commonly described with each keyword, ranging from 37.5-65% of tweets, neither the street name (e.g. Percs) nor the trade name (e.g. Percocet) was consistently more highly associated with abuse. The majority of terms (>66%) were “tweeted” with a positive connotation. Mean percentage agreement was excellent. Kappa coefficients were calculated and ranged from 0.85 to 0.96. Common themes included: receiving PO for dental procedures, obtaining PO from a doctor or ED visit, obtaining PO from friends to treat pain, taking PO for sleep, PO side effects, and getting high while taking PO for pain. Conclusions: Twitter content about prescription opioids is often about abuse. PO use or abuse is described favorably in the majority of tweets. Visits to the ED and dentist were among identified themes. Twitter can be a resource to improve understanding of PO use and abuse and trends in perceptions about prescription opioids.
345
In Vitro Neutralization With Trypsin or Rosmarinic Acid Reduces the Toxicity of Micrurus Fulvius Venom
Parker Cote JL, Brewer KL, O'Rourke D, Rosenbaum M, Meggs WJ/East Carolina University-Brody School of Medicine/Vidant Medical Center, Greenville, NC
Study Objectives: Currently, in the United States there is no unexpired FDA approved coral snake antivenom. Antivenom is not always readily available in other countries. An effective inexpensive treatment is needed when definitive treatment with antivenin is not available. This study investigates the ability of in vitro incubation of trypsin, a proteolytic enzyme, or rosmarinic acid (RA), a phospholipase A2 inhibitor, to neutralize eastern coral snake (Micrurus fulvius) venom using a murine model of envenomation. Methods: A randomized controlled blinded study of the efficacy of trypsin or RA, incubated in vitro with coral snake venom, to neutralize the venom was
Volume 62, no. 4s : October 2013