Merfeld, John

Background and Objectives: Despite wide agreement on the importance of building research capacity to the specialty of family medicine, no standard exists for defining or measuring that growth. Previous work to address this gap yielded the Productivity and Capacity Evaluation in Research (PACER) Tool, a list of quantitative research metrics grouped into seven categories. We surveyed family medicine department chairs to understand which categories of PACER metrics they considered most valuable in evaluating their department’s research capacity. We also aimed to compare reported research capacity in 2024 with answers given by family medicine department chairs in 2021. Methods: A cross-sectional survey administered through the Council of Academic Family Medicine Educational Research Alliance (CERA) was used to gather information from family medicine department chairs in the United States and Canada. One question asked chairs to evaluate their department’s research capacity, and nine questions assessed the relative importance of the seven PACER Tool categories. Results: A total of 218 surveys were delivered, with 111 (50.9%) completed. Survey results demonstrated that program chairs determined funding to be the most impactful category. We found no clear trend in the second most important or least important categories. Results also showed no statistically significant change in reported research capacity between 2021 and 2024. Conclusions: Funding emerged as the category of research metrics viewed as most important by the greatest number of family medicine department chairs. Although other categories of metrics also were viewed as important, this survey demonstrated no clear pattern of their relative importance in this population.

Abstract Pulmonary embolism (PE) is one of the most common etiologies of cardiovascular mortality. It could be linked to several risk factors including advanced age. The pathogenesis of PE is dictated by the Virchow's triad that includes venous stasis, endothelial injury, and a hypercoagulable state. The diagnosis of PE is difficult and is often missed due to the nonspecific symptomatology. Hypoxia is common in the setting of PE, and the degree of respiratory compromise is multifactorial and influenced by underlying cardiac function, clot location, and ability to compensate with respiratory mechanics. Right ventricular dysfunction/failure is the more profound cardiovascular impact of acute PE and occurs due to sudden increase in afterload. This is also the primary cause of death in PE. High clinical suspicion is required in those with risk factors and presenting signs or symptoms of venous thromboembolic disease, with validated clinical risk scores such as the Wells, Geneva, and pulmonary embolism rule out criteria in estimating the likelihood for PE. Advancement in capture time and wider availability of computed tomographic pulmonary angiography and D-dimer testing have further facilitated the rapid evaluation and diagnosis of suspected PE. Treatment is dependent on clinical presentation and initially involves providing adequate oxygenation and stabilizing hemodynamics. Anticoagulant therapy is indicated for the treatment of PE. Treatment is guided by presence or absence of shock and ranges from therapeutic anticoagulation to pharmacologic versus mechanical thrombectomy. The prognosis of patients can vary considerably depending on the cardiac and pulmonary status of patient and the size of the embolus.