Albert B Fiorello

Interests

Research

Point of Care Ultrasound, Emergent Infectious Disease, Resident Education

Teaching

Point of Care Ultrasound, Emergent Infectious Disease, Resident Education

Courses

No activities entered.

Scholarly Contributions

Books

• Fiorello, A. B. (2010). Avoiding Common Errors in the Emergency Department. Lippencott.
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  Section editor.

Chapters

• Groke, S., & Fiorello, A. B. (2014). Cardiopulmonary Resuscitation. In Top Pediatric Clinical Problems. Emergency Medicine Residents' Association.
• Fiorello, A. B. (2010). RUQ Pain - Do not over-rely on ultrasound findings in patients with RUQ pain.. In Avoiding Common Errors in the Emergency Department(pp 22-24). Lippencott.
• Fiorello, A. B. (2008). Cardiopulmonary Resuscitation. In Top Pediatric Clinical Problems(pp 13-24). Emergency Medicine Resident's Association.

Journals/Publications

• Stolz, L. A., Amini, R., Situ-LaCasse, E., Acuña, J., Irving, S. C., Friedman, L., Fiorello, A. B., Stea, N., Fan, H., & Adhikari, S. (2018). Multimodular Ultrasound Orientation: Residents' Confidence and Skill in Performing Point-of-care Ultrasound. Cureus, 10(11), e3597.
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  Introduction The objectives of this study were to determine if a multimodular introductory ultrasound course improved emergency medicine intern confidence in performing a point-of-care ultrasound and if our educational objectives could be met with our chosen structure. Methods This is a prospective, observational study evaluating three consecutive incoming emergency medicine residency classes from three residency programs. A one-day introductory ultrasound course was delivered. The course consisted of 1) flipped classroom didactics, 2) in-person, case-based interactive teaching sessions, and 3) check-listed, goal-driven, hands-on instruction. Results Over three years, 73 residents participated in this study. There was no significant difference in performance on the written test (p = 0.54) or the skills assessment (p = 0.16) between years. Performance on the written pre-test was not a predictor of performance on the skills test (R= 0.028; p = 0.19). Prior to training, residents were most confident in performing a focused assessment with sonography for trauma examination (median confidence 5.5 (interquartile range (IQR): 3 - 7) on a 10-point Likert scale where 1 represents low confidence and 10 represents high confidence). They reported the lowest confidence in performing a cardiac ultrasound (3 (IQR: 2 - 6)). Following training, residents reported increased confidence with all applications (p < 0.001). Eighty-five percent (confidence interval (CI): 73, 92) of residents agreed that the online ultrasound lectures effectively teach point-of-care ultrasound applications and 98% (CI: 88, 100) agreed that case-based interactive sessions helped them understand how ultrasound changes the management of acutely ill patients. Conclusions A written test of knowledge regarding the use of point-of-care ultrasound does not correlate with procedural skills at the start of residency, suggesting that teaching and evaluation of both types of skills are necessary. Following a multimodular introductory ultrasound course, residents showed increased confidence in performing the seven basic ultrasound applications. Residents reported that an asynchronous curriculum and case-based interactive sessions met the learning objectives and effectively taught point-of-care ultrasound applications.
• Min, A. A., Leetch, A., Nuño, T., & Fiorello, A. B. (2016). How well will you FIT? Use of a modified MMI to assess applicants’ compatibility with an emergency medicine residency program. Medical Education Online, 21(1), 29587. doi:10.3402/meo.v21.29587
• Min, A. A., Leetch, A., Nuño, T., & Fiorello, A. B. (2016). How well will you FIT? Use of a modified MMI to assess applicants' compatibility with an emergency medicine residency program. Medical education online, 21, 29587.
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  Emergency medicine residency programs have evaluated the use of Multiple Mini Interviews (MMIs) for applicants. The authors developed an MMI-style method called the Fast Interview Track (FIT) to predict an applicant's 'fit' within an individual residency program.
• Stoneking, L. R., Winkler, J. P., DeLuca, L. A., Stolz, U., Stutz, A., Luman, J. C., Gaub, M., Wolk, D. M., Fiorello, A. B., & Denninghoff, K. R. (2015). Physician documentation of sepsis syndrome is associated with more aggressive treatment. The western journal of emergency medicine, 16(3), 401-7.
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  Timely recognition and treatment of sepsis improves survival. The objective is to examine the association between recognition of sepsis and timeliness of treatments.
• Adhikari, S., & Fiorello, A. (2014). Emergency ultrasound fellowship training: a novel team-based approach. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 33(10), 1821-6.
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  To describe our experience with implementation of a novel team-based emergency ultrasound (EUS) fellowship training program.
• Adhikari, S., Amini, R., Stolz, L., O'Brien, K., Gross, A., Jones, T., Fiorello, A., & Keim, S. M. (2014). Implementation of a novel point-of-care ultrasound billing and reimbursement program: fiscal impact. The American journal of emergency medicine, 32(6), 592-5.
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  The aim of this study was to determine the fiscal impact of implementation of a novel emergency department (ED) point-of-care (POC) ultrasound billing and reimbursement program.
• Adhikari, S., Fiorello, A., Stolz, L., Jones, T., Amini, R., Gross, A., O'Brien, K., Mosier, J., & Blaivas, M. (2014). Ability of emergency physicians with advanced echocardiographic experience at a single center to identify complex echocardiographic abnormalities. The American journal of emergency medicine, 32(4), 363-6.
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  To determine the ability of emergency physicians to detect complex abnormalities on point-of-care (POC) echocardiograms.
• Amini, R., Adhikari, S., & Fiorello, A. (2014). Ultrasound Competency Assessment in Emergency Medicine Residency Programs. Academic Emergency Medicine, 21(7), 799-801. doi:10.1111/acem.12408
• Amini, R., Adhikari, S., & Fiorello, A. (2014). Ultrasound competency assessment in emergency medicine residency programs. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 21(7), 799-801.
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  In the Model of the Clinical Practice of Emergency Medicine (EM), bedside ultrasound (US) is listed as one of the essential procedural skills. EM milestones released by Accreditation Council for Graduate Medical Education and American Board of Emergency Medicine require residents to demonstrate competency in bedside US. The purpose of this study was to assess the current methods used by EM residency training programs to evaluate resident competency in bedside US.
• Beskind, D. L., Hiller, K. M., Stolz, U., Bradshaw, H., Berkman, M., Stoneking, L. R., Fiorello, A., Min, A., Viscusi, C., & Grall, K. J. (2014). Does the experience of the writer affect the evaluative components on the standardized letter of recommendation in emergency medicine?. The Journal of emergency medicine, 46(4), 544-50.
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  The Standardized Letter of Recommendation (SLOR) was developed in an attempt to standardize the evaluation of applicants to an emergency medicine (EM) residency.
• Mosier, J. M., Stolz, L. A., Bloom, J. W., Malo, J., Snyder, L. S., Fiorello, A. B., & Adhikari, S. R. (2014). Resuscitative Echocardiography for the Evaluation and Management of Shock: The RECES protocol. Southwest Journal of Pulmonary and Critical Care, 8(2), 110-25.
• Stoneking, L., Deluca, L. A., Fiorello, A. B., Munzer, B., Baker, N., & Denninghoff, K. R. (2014). Alternative methods to central venous pressure for assessing volume status in critically ill patients. Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association, 40(2), 115-23.
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  Early goal-directed therapy increases survival in persons with sepsis but requires placement of a central line. We evaluate alternative methods to measuring central venous pressure (CVP) to assess volume status, including peripheral venous pressure (PVP) and stroke volume variation (SVV), which may facilitate nurse-driven resuscitation protocols.
• Stoneking, L. R., Patanwala, A. E., Winkler, J. P., Fiorello, A. B., Lee, E. S., Olson, D. P., & Wolk, D. M. (2013). Would earlier microbe identification alter antibiotic therapy in bacteremic emergency department patients?. The Journal of emergency medicine, 44(1), 1-8.
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  Although debate exists about the treatment of sepsis, few disagree about the benefits of early, appropriately targeted antibiotic administration.
• Fiorello, A. B. (2010). Code Sepsis: Rapid Methods To Diagnose Sepsis and Detect Hematopathogens Part II: Challenges to the Laboratory Diagnosis of Sepsis. Clinical Microbiology Newsletter, 32(6), 41-49. doi:http://dx.doi.org/10.1016/j.clinmicnews.2010.03.001
• Fiorello, A. B. (2010). Code Sepsis: Rapid Methods to Diagnose Sepsis and Detect Hematopathogens Part I: The Impact and Attributes of Sepsis. Clinical Microbiology Newsletter, 32(5), 33-37. doi:http://dx.doi.org/10.1016/j.clinmicnews.2010.02.001
• Heard, K. J., Peberdy, M. A., Sayre, M. R., Sanders, A., Geocadin, R. G., Dixon, S. R., Larabee, T. M., Hiller, K., Fiorello, A., Paradis, N. A., & O'Neil, B. J. (2010). A randomized controlled trial comparing the Arctic Sun to standard cooling for induction of hypothermia after cardiac arrest. Resuscitation, 81(1), 9-14.
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  Hypothermia improves neurological outcome for comatose survivors of out-of-hospital cardiac arrest. Use of computer controlled high surface area devices for cooling may lead to faster cooling rates and potentially improve patient outcome.
• Fiorello, A. B. (2006). Use of ultrasound in the diagnosis and treatment of peritonsillar abscess.. ACEP News, 25(7), 11-12.
• Green, D. M., Fiorello, A., Zevon, M. A., Hall, B., & Seigelstein, N. (1997). Birth defects and childhood cancer in offspring of survivors of childhood cancer. Archives of pediatrics & adolescent medicine, 151(4), 379-83.
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  To determine the effect of chemotherapy for cancer during childhood and adolescence on subsequent pregnancy outcome and the occurrence of cancer in the offspring.
• Jehle, D., Fiorello, A. B., Brader, E., Cottington, E., & Kozak, R. J. (1994). Hemoconcentration during cardiac arrest and CPR. The American journal of emergency medicine, 12(5), 524-6.
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  The objective of this study was to determine if hemoconcentration occurs during cardiac arrest and cardiopulmonary resuscitation (CPR). The design was an animal model of cardiac arrest and CPR performed at a research institute using six mongrel dogs. After the induction of cardiac arrest, animals were subjected to 4 minutes of ventricular fibrillation followed by 20 minutes of CPR. Resuscitation was then achieved using countershocks, drugs, and intravenous fluids. Hemoglobin concentrations were obtained before arrest and every 5 minutes during CPR. An average peak increase in hemoglobin concentration of 21% was observed during CPR. Hemoconcentration occurs during cardiac arrest and CPR, and this may be a result of a shift in volume from the intravascular to the extravascular space.
• Moscati, R., Jehle, D., Ellis, D., Fiorello, A., & Landi, M. (1994). Positive-outcome bias: comparison of emergency medicine and general medicine literatures. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 1(3), 267-71.
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  The existence of positive-outcome bias in the medical literature is well established. Positive-outcome bias in two emergency medicine journals was compared with that found in two general medicine journals.
• Wilcox, D. T., Fiorello, A. B., & Glick, P. L. (1993). Hypovolemic shock and intestinal ischemia: a preventable complication of incomplete formula labeling. The Journal of pediatrics, 122(1), 103-4.
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  A 19-day-old male infant was seen with full-thickness gangrene of the transverse colon. Hyperosmolar formula feedings caused by inadequate "directions for use" was the probable cause. Improved formula labeling might prevent further cases.

Presentations

• Adhikari, S. R., Fan, H., Stea, N., Fiorello, A. B., Friedman, L., Amini, R., Irving, S., Acuna, J., Situ-LaCasse, E., & Stolz, L. A. (2018, May). Multimodular Ultrasound Orientation: Residents’ Confidence and Skill in Performing Point-of-care Ultrasound. Society of Academic Emergency Medicine Annual Meeting. Indianapolis, IN: Society of Academic Emergency Medicine.
• Adhikari, S. R., Stolz, L. A., Amini, R., & Fiorello, A. B. (2015, April). Point-of-care ultrasound in the evaluation of intravenous drug users with soft tissue infection.. American Institute of Ultrasound in Medicine Annual Convention. Las Vegas, NV: American Institute of Ultrasound in Medicine.
• Amini, R., Stolz, L. A., Thompson, M., Stea, N., Hawbaker, N., Kartchner, J. Z., Joshi, R., Fiorello, A. B., & Adhikari, S. R. (2015, May). Ultrasound-Based Algorithm as an Educational and Competency Assessment Tool for Emergency Medicine Residents. Society of Academic Emergency Medicine Annual Meeting.
• Lovett, M., Reid, S., Prescher, H., Biffar, D. B., Fiorello, A. B., & Hamilton, A. J. (2016, January). Development and Testing of a Thoracostomy Assessment Tool Through Self, Peer, and Expert Evaluation in a Simulation Environment. International Meeting for Simulation in Healthcare. San Diego, CA: Society for Simulation in Healthcare.

Poster Presentations

• Stolz, L., Fiorello, A. B., & Adhikari, S. R. (2015, October). Emergency Medicine Ultrasound Milestones: Resident Opinion and Perceptions of the Guidelines. American College of Emergency Medicine Scientific Assembly. Boston, MA: American College of Emergency Physicians.

Others

• Lowry, J. S., Scott, C., & Fiorello, A. B. (2008, April). Ultrasound guided abscess drainage. Western SAEM 2008.