Gary Gaddis, M.D., Missouri Endowed Chair for Emergency Medicine, gave two lectures at the Fifth World Congress of Emergency Medicine conducted Nov. 19-22 in Guadalajara, Jalisco, Mexico. He also traveled to Daejeon, South Korea, where he gave two talks on Oct. 15 at the Pan-Pacific Emergency Medicine Congress. He then spent Nov. 7 and 8 in Irving, Texas., presenting 14 hours of instruction in biostatistics at the American College of Emergency Physicians Emergency Medicine Basic Research Skills course.
In Mexico, Gaddis spoke on how to recognize and treat drug related problems in the emergency room and gave another talk on the muscle disease Rhabdomyolysis and its adverse consequences. He presented his topics to more than 300 Mexican emergency medicine physicians and nurses with the help of Saint Luke’s medical interpreter Carlos Rodriguez who aided in translating the presentations into Spanish.
His presentations in South Korea included a keynote/plenary presentation “Medication Related Problems in the Emergency Department: How to Recognize Them and What Do About Them,” and a research methods presentation, “Testing for Non-Inferiority: An Overview.”
Gaddis said the official recognition of the emergency medicine specialty in South Korea and the existence of emergency medicine residency training programs has a much shorter history in Korea than in the United States. Many of the struggles of the specialty in Korea are the same struggles that the specialty of emergency medicine underwent in the United States 20 to 30 years ago, Gaddis said.
The American Academy of Emergency Medicine partnered with the Korean Society of Emergency Medicine to present the congress to foster education and the development of the specialty. The American academy has partnered with a number of emergency medicine societies around the world to foster development of the specialty.
Gaddis said his keynote talk on medication-related problems covered a common, yet poorly recognized issue by emergency physicians.
“In Korea, as in the United States, patients may not fill all of their prescriptions with one pharmacy,” Gaddis said. “They may not understand their medications. They may be taking problem-prone medications and their medication regimens may be confounded by extreme poly-pharmacy.”
Gaddis made practical suggestions to make the audience more aware of medication-related problems so that physicians might be able to recognize them more frequently and act upon them more appropriately.
His second presentation explored how most clinical studies are concerned with demonstrating a hypothesized difference between groups being studied. A “non-inferiority” study design should be utilized when a new treatment might or might not be similarly effective as the current treatment, and when that new treatment constitutes less burden to the patient or to the medical team delivering it, he said. The main question when evaluating for “non-inferiority” is how much difference between the new, less burdensome treatment and the standard treatment can be tolerated to permit the conclusion that the two treatments are so similar that the difference between them is too small to matter.
Gaddis used a highly animated presentation to demonstrate that these studies are not as complex or as difficult to understand as most physicians believe. The key to understanding non-inferiority designs is to understand how to set the “cutoff” for the margin of difference between treatments and to understand the use of the confidence intervals for the amount of difference between treatments to determine whether or not the two treatments are sufficiently similar that “non-inferiority” can be concluded.
More than 800 physicians attended the joint effort between the Korean Society of Emergency Medicine and the American Academy of Emergency Medicine. The event promotes the exchange of academic advancements in emergency medicine through three days of workshops and lectures from renowned scholars and experts. This year’s event also celebrated the 25th anniversary of the Korean emergency medicine society.
The emergency physicians’ November research course offered at the American College of Emergency Physicians’ national headquarters is a mini research fellowship for early-career emergency physicians who are beginning their research careers. During a 10-day period in November, younger physicians receive help in preparing an initial research project that they will implement at their home institution. They receive mentoring throughout the period between the initial classes in November and a presentation of their results in April.
Faculty, including Gaddis, who is mentoring three attendees from Lithuania, provide their research experience to mentor younger physicians to plan and execute their own research projects.