Joshua Niforatos

Physician | Researcher | Writer

About

I'm a resident physician in emergency medicine at The Johns Hopkins University School of Medicine. I work as a senior resident in the Emergency Departments at The Johns Hopkins Hospital, The Johns Hopkins Bayview Medical Center, The Johns Hopkins Children’s Center, and Howard County General Hospital.I was co-founder, research section editor, and daily columnist at Brief19. Brief19 was an online website providing daily reviews of Covid-19 research and policy by Doctors on the Frontlines. I wrote approximately 115 daily Briefs during the peak of the pandemic in 2020-2021.My work has been published in a variety of journals, such as ACEP Now, JAMA, JAMA Network Open, JAMA Internal Medicine, The British Medical Journal, Annals of Emergency Medicine, Academic Emergency Medicine, Lancet Respiratory Medicine, JACEP, Mayo Clinic Proceedings, Annals of Family Medicine, Annals of Surgery, Circulation, and Journal of Hospital Medicine amongst others.My long-term career interests include identifying drivers of physician practice variation, evidence-based medicine, identifying and de-implementing low value care in the Emergency Department, and Emergency Department clinical pathways. Additionally, I have a strong desire to be actively involved in residency research education and teaching residents clinical core content from the viewpoint of evidence-based medicine.

Postdoctoral Training

  • 2019 - Present: Emergency Medicine Residency, The Johns Hopkins School of Medicine

Education

  • 2019: M.D., with Special Qualification in Biomedical Research, Cleveland Clinic Lerner College of Medicine, Cleveland, OH

  • 2014: M.T.S., Boston University School of Theology, Boston, MA

  • 2012: B.A., Biology/Chemistry, University of New Mexico, Albuquerque, NM

  • 2010: B.A., Ethnology/Linguistics, University of New Mexico, Albuquerque, NM

Please follow the links below to learn more about me:

  • LinkedIn profile (contact, education/training, experiences)

  • Doximity profile (contact, education / training)

  • Google Scholar profile (publications)

  • PubMed profile (publications)

  • Research Editor at Brief19, a daily #Covid-19 Resource

The following is a list of resources that I use regularly in residency, ranging from evidence-based medicine resources to reference managers to presentation guides.

Quick Evidence-Based Medicine Reviews

Less is More / Low Value Care

ACEP Resources

  • ACEP Clinical Policies

  • Also located conveniently on MDCalc

  • ACEP Point of Care Tools: these POC tools are for management: Atrial Fibrillation, Ischemic Stroke Risk for Atrial Fibrillation, Delirium in the ED, Autism Spectrum Disorder Patients, Bariatrics (Exam, Assessment, Management), Buprenorphine, Septic Shock, ED Vaccinations, Identifying Suicidal Patients, Acute Pain Management, and discharge smart phrases

Understanding Statistical / Epidemiology Concepts

#FOAMed #EBM Resources

Last Updated 12/21/2021
The majority of my research to date has focused on two areas, namely, meta-research and infectious disease. Regarding meta-research, I have focused on trends in published research, financial conflicts of interest that impact published research, and limitations to statistical approaches in the published literature. The other area of publication has been infectious diseases, specifically focusing on HIV/STI related research as it applies in the Emergency Department.Please see below publications categorized by focused areas.

#Covid-19 Publications

  • Raja AS, Niforatos JD, Anaya N, Graterol J, Rodriquez RM. Vaccine hesitancy and reasons for refusing the COVID-19 vaccination among the US public: A cross-sectional survey. medRxiv. 2021. doi: https://doi.org/10.1101/2021.02.28.21252610.

  • Niforatos JD, Chaitoff A, Zheutlin AR, Feinstein MM, Raja AS. Barriers to emergency department usage during the COVID-19 pandemic. JACEP Open. 2020;1–8. November 20, 2020. doi: 10.1002/emp2.12316. PMID: pending.

  • Putman MS, Ruderman EM, Niforatos JD. Publication Rate and Journal Review Time of COVID-19-Related Research. Mayo Clin Proc. 2020;95(10):2290-2291. doi: 10.1016/j.mayocp.2020.08.017. PMID: 33012362.

  • Feinstein MM, Niforatos JD, Hyun I, et al. Considerations for ventilator triage during the COVID-19 pandemic. Lancet Respir Med. 2020;8(6):e53. doi: [10.1016/S2213-2600(20)30192-2](https://doi.org/10.1016/S2213-2600(20@blank). PMID: 32444270.

  • Niforatos JD, Johansen ME. Hydroxychloroquine Use in the United States and the Potential Impact of Critical Shortages from SARS-CoV-2. April 10, 2020. Annals of Family Medicine. Covid-19 collection. https://deepblue.lib.umich.edu/handle/2027.42/154736.

  • Niforatos JD, Melnick ER, Faust JS. Covid-19 fatality is likely overestimated. BMJ. 2020;368:m1113. doi: 10.1136/bmj.m1113. PMID: 32198267.

ACEP Now #Covid19 Publications

Trends in Published Research

  • Chaitoff A, Zheutlin A, Roy S, Niforatos JD. Death of the Hypothesis: Researchers Do Not Report A Priori Beliefs in General Medicine Journals. __J Gen Intern Med__. 2021 March 31; PMID: 33791933.

  • Shi X, Ross JS, Amancharla N, Niforatos JD, Krumholz HM, Wallach JD. Assessment of Concordance and Discordance Among Clinical Studies Posted as Preprints and Subsequently Published in High-Impact Journals. JAMA Netw Open. 2021;4(3):e212110. PMID: 33734411 .

  • Niforatos JD, Zheutlin AR, Putman MS, Weaver M, Chaitoff A. Trends in Published Clinical Trial Phases Among Surgical Specialties, 2007-2017. 2020 Dec 18. Ann Surg. 2020. PMID: 33351473.

  • Putman MS, Chaitoff A, Niforatos JD. Publication Trends in Rheumatology Systematic Reviews and Randomized Clinical Trials, 1995-2017. J Rheumatol. 2020 Oct 15; PMID: 33060312.

  • Zheutlin AR, Niforatos JD, Stulberg E, Sussman J. Research Waste in Randomized Clinical Trials: a Cross-Sectional Analysis. J Gen Intern Med. 2020 Oct;35(10):3105-3107. Epub 2019 Nov 12. PMID: 31720964.

  • Putman MS, Ruderman EM, Niforatos JD. Publication Rate and Journal Review Time of COVID-19-Related Research. Mayo Clin Proc. 2020 Oct;95(10):2290-2291. Epub 2020 Aug 31. PMID: 33012362.

  • Zheutlin AR, Niforatos JD, Stulberg E, Sussman JB. Failure of Cardiovascular Phase 3 Randomized Clinical Trials to Report Pre-trial and Post-trial Parameters: a Cross-sectional Analysis of ClinicalTrials.gov. J Gen Intern Med. 2020 Jun 24. PMID: 32583344.

  • Niforatos JD, Chaitoff A, Weaver M, Feinstein MM, Johansen ME. Pediatric literature shift: Growth of meta-analyses was 23 times greater than growth of randomized trials. J Clin Epidemiol. 2020 May;121:112-114. PubMed PMID: 32004671.

  • Niforatos JD, Weaver M, Johansen ME. Assessment of Publication Trends of Systematic Reviews and Randomized Clinical Trials, 1995 to 2017. JAMA Intern Med. 2019 Jul 29. PMID: 31355871.

Statistics and Methods

  • Chaitoff A, Zheutlin A, Niforatos JD. The Fragility Index and Trial Significance. JAMA Intern Med. 2020 Sep 21 [Epub ahead of print]. PMID: 32955584.

  • Niforatos JD, Zheutlin AR, Chaitoff A, Pescatore RM. The fragility index of practice changing clinical trials is low and highly correlated with P-values. J Clin Epidemiol. 2020 Mar;119:140-142. PMID: 31711911.

  • Niforatos JD, Zheutlin AR, Pescatore RM. Fragility Measures: More Limitations Considered. Ann Emerg Med. 2019 Jun;73(6):696-697. PMID: 31133190.

  • Niforatos JD. How Will Our Research Affect Our Patients?. Ann Emerg Med. 2018 Jun;71(6):798-799. PMID: 29776506.

Financial Conflicts of Interest

  • Niforatos JD, Narang J, Trueger NS. Financial Conflicts of Interest Among Emergency Medicine Journals' Editorial Boards. Ann Emerg Med. 2020 Mar;75(3):418-422. PMID: 30955988.

  • Niforatos JD, Chaitoff A, Mercer MB, Yu PC, Rose SL. Association Between Public Trust and Provider Specialty Among Physicians With Financial Conflicts of Interest. Mayo Clin Proc. 2019 Dec;94(12):2467-2475. PMID: 31806100.

  • Boas SR, Cai Y, Wee C, Niforatos JD, Isbester K, Ruthberg J, Kumar A. Industry Relationships of Craniofacial Surgeons. J Craniofac Surg. 2019 Sep;30(6):1928. PMID: 31335578.

  • Boas SR, Niforatos JD, Summerville L, Isbester K, Chaturvedi A, Wee C, Kumar AR. The Open Payments Database and Top Industry Sponsors of Plastic Surgeons: Companies and Related Devices. Plast Reconstr Surg. 2019 Sep;144(3):530e-532e. PMID: 31461072.

  • Niforatos JD, Lin L, Narang J, James A, Singletary A, Rose E, Yax JA, Stull MJ. Financial Conflicts of Interest Among Emergency Medicine Contributors on Free Open Access Medical Education (FOAMed). Acad Emerg Med. 2019 Jul;26(7):814-817. PMID: 31204793.

  • Niforatos JD, Pescatore RM. Financial relationships with industry among guideline authors for the management of acute ischemic stroke. Am J Emerg Med. 2019 May;37(5):921-923. PMID: 30704949.

  • Niforatos JD, Boas S, Hertz S, Ozgur A, Raja AS. Analysis of current financial relationships between emergency physicians and industry. Am J Emerg Med. 2019 Apr;37(4):722-725. PMID: 30611579.

Trends in Medication Prescribing / Medication Costs

  • Johansen ME, Niforatos JD, Sussman JB. The Ecology of Antihypertensives in the United States, 1997-2017. J Gen Intern Med. 2020 Sep 23;. doi: 10.1007/s11606-020-06214-1. [Epub ahead of print]. PMID: 32968967.

  • Niforatos JD, Dorner SC, Pescatore RM, Raja AS. Buprenorphine charges to uninsured patients at top-ranked U.S. hospitals. Am J Emerg Med. 2019 Dec;37(12):2253-2254. PMID: 31047741.

  • Johansen ME, Niforatos JD. Benzodiazepine Use in the USA Is Driven by Long-term Users: a Repeated Cross-sectional Study of MEPS 2002-2016. J Gen Intern Med. 2019 Dec;34(12):2717-2719. PMID: 31044410.

Infectious Diseases

  • Sheele JM, Niforatos JD, Elkins JM, Campos SC, Thompson CL. Prediction model for gonorrhea, chlamydia, and trichomoniasis in the emergency department. Am J Emerg Med. 2021 Nov 7;51:313-319. PMID: 34798573.

  • Yax JA, Niforatos JD, Summers DL, Bigach MH, Schmotzer C, Gripshover BM, Avery A. A Model for Syphilis Screening in the Emergency Department. Public Health Rep. 2020 Nov 9. PMID: 33166486.

  • Niforatos JD, Wanta JW, Durbak E, Cavendish J, Yax JA. Prevalence of Human Immunodeficiency Virus and Opportunistic Infections Among Transgender Patients in the Clinical Setting: An All-Payer Electronic Health Record Database Study. Transgend Health. 2020;5(3):191-195. PMID: 32923669.

  • Sheele JM, Smith J, Niforatos JD, Wessling E, Hilliker B, Bragg B, Mandac E. History, Physical Examination, and Laboratory Findings Associated with Infection and the Empiric Treatment of Gonorrhea and Chlamydia of Women in the Emergency Department. Cureus. 2019 Dec 27;11(12):e6482. PMID: 32025406.

  • Niforatos JD, Nowacki AS, Avery A, Gripshover BM, Yax JA. Clinical knowledge of human immunodeficiency virus and sexually transmitted infections among emergency medicine providers. Int J STD AIDS. 2019 Nov;30(13):1290-1297. PMID: 31718468.

  • Niforatos JD, Nowacki AS, Cavendish J, Gripshover BM, Yax JA. Emergency provider documentation of sexual health risk factors and its association with HIV testing: A retrospective cohort study. Am J Emerg Med. 2019 Jul;37(7):1365-1367. PMID: 30559017.

  • Pescatore R, Niforatos JD, Rezaie S, Swaminathan A. Evidence-Informed Practice: Diagnostic Questions in Urinary Tract Infections in the Elderly. West J Emerg Med. 2019 Jul;20(4):573-577. PMID: 31316695.

  • Niforatos JD, Wanta JW, Durbak E, Cavendish J, Yax JA. Assessing the National Prevalence of HIV Screening in the United States using Electronic Health Record Data. Cureus. 2019 Jun 30;11(6):e5043. PMID: 31501734.

  • Niforatos JD, Pescatore R. Search Engine Queries for Pediatric Fever During "Cold and Flu" Season. Cureus. 2019 Apr 16;11(4):e4464. PMID: 31249742.

  • Niforatos JD, Yax JA. Treatment and resources for patients with non-occupational HIV exposure presenting to the emergency department. Am J Emerg Med. 2018 Aug;36(8):1519-1520. PMID: 29321119.

General (Emergency) Medicine / Substance Use / Psychiatry

  • Niforatos JD, Zheutlin AR, Sussman JB. Increasing Access to Preventive Services Is Needed-No Medicare Beneficiary Left Behind. JAMA Netw Open. 2021;4(11):e2137603. Published 2021 Nov 1. PMID: 34846531.

  • Niforatos JD, Zheutlin AR, Sussman JB. Prevalence of Third-Party Data Tracking by US Hospital Websites. JAMA Netw Open. 2021 Sep 1;4(9):e2126121. PubMed PMID: 34550385.

  • Niforatos JD, Zheutlin A, Chaitoff A, Hilal T. Choosing Wisely: Rasburicase for Adult Patients with Tumor Lysis Syndrome. J Hosp Med. 2021 July 16. PMID: forthcoming.

  • Johansen ME, Niforatos JD. Decreasing Use of Primary Care: A Repeated Cross-Sectional Study of MEPS 2007-2017. Ann Fam Med. 2021;19(1):41-43. PMID: 33431390.

  • Zheutlin AR, Niforatos JD, Sussman JB. Data-Tracking on Government, Non-profit, and Commercial Health-Related Websites. J Gen Intern Med. 2021;1-3. PMID: 33742302.

  • Chaitoff A, Cifu AS, Niforatos JD. Initial Management of Acute Pancreatitis. JAMA. 2020 Jun 9;323(22):2331-2332. PMID: 32379267.

  • Niforatos JD, Chaitoff A. Factitious disorder commonly presents as dermatitis factitia: A U.S. population-based study. Gen Hosp Psychiatry. 2020 May - Jun;64:129-130. PMID: 32081412.

  • Kazimi M, Deo SV, Altarabsheh SE, Deo VS, Niforatos JD, Elgudin YE. Acute aortic dissection in patients presenting to US emergency department, 2006-2014. Am J Emerg Med. 2020 Apr 23. PMID: 32354527.

  • Kazimi M, Niforatos JD, Yax JA, Raja AS. Discharges against medical advice from U.S. emergency departments. Am J Emerg Med. 2020 Jan;38(1):159-161. PMID: 31208842.

  • Wanta JW, Niforatos JD, Durbak E, Viguera A, Altinay M. Mental Health Diagnoses Among Transgender Patients in the Clinical Setting: An All-Payer Electronic Health Record Study. Transgend Health. 2019;4(1):313-315. PMID: 31701012.

  • Niforatos JD, Zheutlin AR, Pescatore RM, Raja AS. Public interest in medication-assisted treatment for opioid used disorder in the United States. Am J Emerg Med. 2019 Oct;37(10):1983-1985. PMID: 31056384.

  • Niforatos JD, Zheutlin AR, Pescatore RM. Public interest in gun control in the USA. Inj Prev. 2019 Sep;25(Suppl 1):i16-i17. PMID: 30992330.

  • Niforatos JD, Feinstein MM, Pescatore RM. Search engine queries as a metric of public interest in anesthesia. Anaesth Intensive Care. 2019 May;47(3):302-304. PMID: 31116023.

  • Niforatos JD, Wanta JW, Shapiro AP, Yax JA, Viguera AC. How should I treat acute agitation in pregnancy?. Cleve Clin J Med. 2019 Apr;86(4):243-247. PMID: 30951449.

  • Salloum RH, Sandridge S, Patton DJ, Stillitano G, Dawson G, Niforatos JD, Santiago L, Kaltenbach JA. Untangling the effects of tinnitus and hypersensitivity to sound (hyperacusis) in the gap detection test. Hear Res. 2016 Jan;331:92-100. PMID: 26520582.

Medical Education / FOAMed

  • Pescatore RM, Niforatos JD, Rezaie SR, Swaminathan A, Morrison M, Reid M, Motov S. FOAM Impact: The Influence of Open-access Medical Education on Practice Uptake. AEM Educ Train. 2020 Jul;4(3):239-243. PMID: 32704593.

  • Feinstein MM, Niforatos JD, Mosteller L, Chelnick D, Raza S, Otteson T. Association of Doximity Ranking and Residency Program Characteristics Across 16 Specialty Training Programs. J Grad Med Educ. 2019 Oct;11(5):580-584. PMID: 31636829.

  • Chaitoff A, Niforatos JD, Vega J. Exploring the effects of medical trainee naming: a randomized experiment. Perspect Med Educ. 2016 Apr;5(2):114-21. PMID: 26975743.

Medical Humanities / Ethics / Medical Anthropology

  • Feinstein MM, Adegboye J, Niforatos JD, Pescatore RM. Informed consent for invasive procedures in the emergency department. Am J Emerg Med. 2020 Jan 28. PMID: 32037122.

  • Niforatos JD. Hidden behind "Not Otherwise Specified". J Palliat Med. 2019 May;22(5):598-599. PMID: 31063450.

  • Niforatos JD. The Love Song of the Pimped Student. Acad Psychiatry. 2018 Oct;42(5):725. PMID: 29404963.

  • Niforatos J, Rutecki G. “From Bench to Bedside and Beyond: The Legacy of Dr. Eric G.L. Bywaters.” Hektoen International: A Journal of Medical Humanities. Winter 2018 issue

  • Niforatos J, Rutecki G. “Rosencrantz, Guildenstern, and their Doctor are Dead.” _Hektoen International: A Journal of Medical Humanities*. Spring 2018 issue

  • Niforatos J, Rutecki G. “Telling the Truth in Therapeutic Encounters” _Ethics and Medicine*. Fall 2017; 33(3): 143-147.

  • Niforatos J. “Love, Cancer, and the Caregiver’s Faith of C.S. Lewis” Hektoen International: A Journal of Medical Humanities. Spring 2017 issue

  • Niforatos J. “Big Data, Gender Inequalities in Physician-Industry Relationships, and Liberating Research”. Bio Quarterly: Bioethics Network of Ohio. Winter 2015; 25(3).

  • Niforatos JD. Abracadabra. Acad Emerg Med. 2018 Jul;25(7):836. PMID: 29509289.

  • Niforatos J, Rutecki GW. Thornton Wilder and The Angel That Troubled the Waters: A Plea for Physician Healing. J Gen Intern Med. 2018 Jan;33(1):129-132. PMID: 28980118.

  • Niforatos JD. Stillness (in 5 minutes). Acad Psychiatry. 2017 Dec;41(6):770. PMID: 28861762.

  • Niforatos JD. The Decent Care Movement: Subsidiarity, Pragmatic Solidarity, and Cross-Cultural Resonance. J Relig Health. 2016 Feb;55(1):206-216. PMID: 25893474.

  • Page-Reeves J, Mishra SI, Niforatos J, Regino L, Bulten R. An Integrated Approach to Diabetes Prevention: Anthropology, Public Health, and Community Engagement. Qual Rep. 2013;18:1-22. PMID: 24490179.

  • Page-Reeves J, Niforatos JD, Mishra S, Regino L, Gingrich A, Bulten R. Health Disparity and Structural Violence: How Fear Undermines Health Among Immigrants at Risk for Diabetes. J Health Dispar Res Pract. 2013;6(2):30-47. PMID: 24052924.

  • Niforatos J, Marquis R, Mousavi A., Pogzeba A. “Ethnomedicine in the Amazon: Importance and Endangerment” Int J Trad Nat Med. 2012; 1(1): 20-40.

  • Besante J, Mousavi A, Niforatos J. “Cadmium in Rice: Disease and Social Considerations” Environmental Forensics. 2011; 12(2):121-23.

On-Shift and #FOAMed Resources

The following is a list of #FOAMed resources that you might find useful. This is for educational content only and should not be used for medical / clinical decision-making.

QUICK REFERENCES BY TOPIC

Miscellaneous: Sign-Out Sheet | Pathway Medical | Pyrls - Pharm | Medical Minute QRCritical Care: IBCC | IBNCC | ICU OnePager | REBEL EM QUICK ReviewsPOCUS: ED Critical Care Ultrasound | Highland EM Ultrasound-Guided ProceduresPediatrics: CHOP Pathways | DFTB Derm / Quick References | Harriet Lane Handbook | UTI Risk Calculator | PECARN Febrile InfantOB-GYN: ObG Project | LactMed NCBI | InfantRiskCritical Care: EMRA Pain Management GuideHigh-Yield: WikEM | CorePendium | DDxof | DynaMed | MDCalc | ACEP emPOC | GrepMed | EMUpdates | Emergency Consult | Northwestern Ortho Teachin Files | OrthobulletsThings I Like: US Reference | RCM | Pocket Card | SEM | PsychopharmacopeiaExpanding Differential: Isabel Symptom CheckerHopkins EM Web-App: Internal Web-App / iOS / Android App for Hopkins EM residentsHopkins EM Paper Chase: Monthly Update of the Latest Research 2021ECG Overview: My Glass Health Notebook on ECGs

A collection of #FOAMed Resources by topic: NUEM Recommend #FOAMed Resources
Quickly search all FOAMed content: nuMose search engine

Emergency Medicine

ECG

Pediatrics

Internal Medicine / Critical Care

Point of Care Ultrasound

Pharmacy

Psychiatry

The following is a list of resources that I use frequently and think you might find useful.

Presentations / Infographics / Diagrams

  • Visme: great for presentations and infographics / visual abstracts

  • SlidesGo: great Google Slides themes

  • Noun Project: icons and photos for presentations

  • Lucidchart: intelligent, beautiful diagrams

  • Piktochart: great visual abstract / infographic creator

  • Canva: great visual abstract / infographic creator

  • Visual Abstract Open Source Primer: fantastic free PDF primer on how to create a visual abstract by the initial Creative Director at Annals of Surgery

  • QR Code Generator: generate free QR codes for your presentations

  • Font Space: very unique, color fonts and styles for your presentations

  • Freepik: Free Vectors, Stock Photos, and PSD

  • Adobe Stock: fantastic mostly free stock images

  • Flaticon: > 5.3 million free vector icons and stickers

  • Clinical Photos from UCSD: MedPics

Create Your Own Website

Open Source Statistical Resources / Software

Keeping Up-To-Date with the Literature

Reference Managers

Welcome to My ECG Home Page

I am currently a PGY3 Emergency Medicine resident at The Johns Hopkins School of Medicine. Below is a collection of scripts / schemas for important ECG findings that cannot be missed by the emergency physician, which is really nothing more than a concise and organized collation of many FOAMed resources and journal articles by experts much smarter than myself. One of the best concise sources on STEMI patterns is the Internet Book of Critical Care chapter Type 1 Myocardial InfarctionThese are my personal notes on learning ECGs and should NOT BE USED AS OR CONSIDERED AS MEDICAL ADVICE! These are for learning purposes and pattern recognition only!

Ischemic Patterns on ECGs

Low Voltage Criteria

Approach to Tachydysrhythmia

Approach to Bradydysrhythmias and AV Blocks

Syncope-Related ECGs

  • Coming soon! (WPW, Brudgada, Long QT / Electrolytes, ARVD, HOCM, Trifasicular Blocks)

Presentations and Lecture Handouts in Residency

PGY4 (2022-2023)

PGY3 (2021-2022)

PGY2 (2020-2021)

PGY1 (2019-2020)

Dr. Niforatos' PGY4 Medical Minutes at 7:00AM

My Glass Health Notebook Collection of Medical Minutes
Please note, this is NOT medical advice. These are EBM reviews, synopses of recent papers, or clinical pearls for the purposes of on-shift clinical teaching.