Clinical and Experimental Emergency Medicine最新文献

Measuring Burnout and Professional Fulfillment Among Emergency Medicine Residency Program Leaders in the United States: A Cross-Sectional Survey Study. 衡量美国急诊医学住院医师项目负责人的职业倦怠和职业成就感：一项横断面调查研究。

IF 1.9

Clinical and Experimental Emergency Medicine Pub Date : 2024-09-06 DOI: 10.15441/ceem.24.255

Carl Preiksaitis, Kalen N Wright, Al'ai Alvarez, Teresa M Chan, Michael Gottlieb, Andrew G Little, Adaira Landry

{"title":"Measuring Burnout and Professional Fulfillment Among Emergency Medicine Residency Program Leaders in the United States: A Cross-Sectional Survey Study.","authors":"Carl Preiksaitis, Kalen N Wright, Al'ai Alvarez, Teresa M Chan, Michael Gottlieb, Andrew G Little, Adaira Landry","doi":"10.15441/ceem.24.255","DOIUrl":"https://doi.org/10.15441/ceem.24.255","url":null,"abstract":"Objective: Emergency medicine (EM) physicians face high burnout rates, even in academic settings. Research on burnout among EM residency program leaders is limited, despite their role in shaping the training environment and influencing resident well-being. This study aims to measure burnout and professional fulfillment among EM residency program leaders and identify contributing factors.Methods: A cross-sectional survey using the adapted Stanford Professional Fulfillment Index (SPFI) was conducted in 2023 to assess burnout and professional fulfillment among EM residency program leaders at US programs. The survey, tailored to EM leaders, was distributed to all current EM Program Directors (PDs) and Assistant or Associate Program Directors (APDs) from accredited US programs. Descriptive statistics and odds ratios were used to compare burnout and professional fulfillment across various groups.Results: A total of 112 of 281 PDs (39.9% response rate) and 130 of 577 APDs (22.5% response rate) participated. Professional fulfillment was reported by 59.8% of PDs and 58.5% of APDs. Burnout was experienced by 42.0% of PDs and 26.9% of APDs. Higher professional fulfillment correlated with alignment with expectations, positive work environments, and perceived appreciation, while burnout was strongly associated with negative impacts on personal health and relationships. About 27.7% of PDs and 23.8% of APDs expressed intentions to leave their current positions within 18 months.Conclusion: A significant portion of US EM residency program leaders experience burnout and low professional fulfillment. Addressing well-being in this population has important implications for education and mentorship provided to future physicians in the field.","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Nonocclusive mesenteric ischemia in a toddler during hypothermia after cardiac arrest: a case report. 心脏骤停后低体温时幼儿肠系膜非闭塞性缺血：病例报告。

IF 1.9

Clinical and Experimental Emergency Medicine Pub Date : 2024-09-06 DOI: 10.15441/ceem.24.213

Koji Kanno, Kentaro Watanabe, Yu Kanokogi, Marina Tsujimura, Akira Yoshida, Tomoya Hanada, Yuji Yamagami, Yusuke Ito

引用次数: 0

A Physician Nurse Team Adjacent to Triage Improves Length of Stay and Decreases Left Without Being Seen. 与分诊室毗邻的医生护士团队可缩短住院时间，减少未就诊时间。

IF 1.9

Clinical and Experimental Emergency Medicine Pub Date : 2024-09-06 DOI: 10.15441/ceem.24.248

Samita M Heslin, Robert Schwaner, Peter Viccellio, Candice King, Alison Rowe, Henry Thode, Adam J Singer

{"title":"A Physician Nurse Team Adjacent to Triage Improves Length of Stay and Decreases Left Without Being Seen.","authors":"Samita M Heslin, Robert Schwaner, Peter Viccellio, Candice King, Alison Rowe, Henry Thode, Adam J Singer","doi":"10.15441/ceem.24.248","DOIUrl":"https://doi.org/10.15441/ceem.24.248","url":null,"abstract":"Introduction: Staffing significantly influences ED throughput, however there is a shortage of Registered Nurses (RNs), impacting ED flow and crowding. Non-RN providers, like Licensed Practical Nurses (LPNs), could potentially assist with tasks traditionally assigned to RNs. To improve the front-end ED process, we implemented an Attending Physician-Licensed Practical Nurse Team (PNT) positioned next to triage and utilized existing ED hallway space.Methods: This study took place at a tertiary care ED with over 110,000 annual visits. We compared postintervention (Post-PNT) data (11/1/22-2/28/23) to pre-intervention (Pre-PNT) data (7/31/22-10/31/22). The PNT, positioned adjacent to triage, expedited care for ED patients awaiting open rooms. They selected patients from the waiting room to bypass the Main ED, evaluated them in a private room, and then moved them to the hallway pending further care. Multivariable Regression Analysis was utilized to measure the impact of different factors on ED Length of Stay (LOS).Results: We analyzed 23516 patient visits, 10288 in the Pre-PNT period and 13288 in the Post-PNT period. Post-PNT consisted of 2454 PNT visits and 10834 non-PNT visits. The intervention led to significant improvements, including a decrease in mean ED LOS from 492 to 425 minutes, decrease in 72-hour revisits from 5.1% to 4.0%, decrease in Left Without Being Seen from 6.7% to 3.3%, and decrease in mean Arrival-to-Provider time from 74 minutes to 60 minutes. Multivariable Regression Analysis showed that ED LOS was significantly lower for Post-PNT patients than Pre-PNT.Conclusion: By leveraging the scope of LPNs and utilizing existing ED space, the PNT model successfully reduced front-end bottlenecks, leading to improved throughput, revisit rate, and LWBS rate.","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Applications of Ocular Point-of-Care Ultrasound for Optic Nerve Sheath Assessment in the Emergency Setting: A Systematic Review. 眼科护理点超声波在急诊视神经鞘评估中的应用：系统回顾。

IF 1.9

Clinical and Experimental Emergency Medicine Pub Date : 2024-09-06 DOI: 10.15441/ceem.24.249

Christopher D Yang, Christine K Kim, Melissa M Chang, Pooya Khosravi, Ajeet Pal Bayo Bhatia, Amanda Dos Santos, Kyle Dornhofer, Megan Guy, Edmund Hsu, Soheil Saadat, John C Fox

{"title":"Applications of Ocular Point-of-Care Ultrasound for Optic Nerve Sheath Assessment in the Emergency Setting: A Systematic Review.","authors":"Christopher D Yang, Christine K Kim, Melissa M Chang, Pooya Khosravi, Ajeet Pal Bayo Bhatia, Amanda Dos Santos, Kyle Dornhofer, Megan Guy, Edmund Hsu, Soheil Saadat, John C Fox","doi":"10.15441/ceem.24.249","DOIUrl":"https://doi.org/10.15441/ceem.24.249","url":null,"abstract":"Objective: To evaluate the current body of literature pertaining to the use of ocular point-of-care ultrasound (POCUS) in the emergency department.Methods: A comprehensive literature search was conducted on SCOPUS, Web of Science, MEDLINE, and Cochrane CENTRAL. Inclusion criteria included studies written in English only and primary clinical studies involving ocular POCUS scans in an emergency department setting. Exclusion criteria included non-primary studies (e.g. reviews or case reports), studies written in a non-English language, non-human studies, studies performed in a non-emergency setting, studies involving non-POCUS ocular ultrasound modalities, or studies published outside of the last decade. Data extraction was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations.Results: The initial search yielded 391 results with 153 duplicates. Of the remaining 238 studies selected for retrieval and screening, 24 met inclusion criteria. These 24 included studies encompassed 2448 patients across prospective, retrospective, cross sectional, and case series study designs. We found that a majority of included studies focus on the use of POCUS in the emergency department to measure ONSD as a proxy for papilledema and metabolic aberrations, while a minority use ocular POCUS to assist in the diagnosis of orbital fractures or posterior segment pathology.Conclusion: The vast majority of articles investigating the use of ocular POCUS in recent years emphasize its utility in measuring ONSD and fluctuations in intracranial pressure, though additional outcomes of interest include posterior segment, orbit, and globe pathology.","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A rapid non-invasive wearable device for assessing cardiac troponin. 用于评估心肌肌钙蛋白的快速无创可穿戴设备。

IF 1.9

Clinical and Experimental Emergency Medicine Pub Date : 2024-09-06 DOI: 10.15441/ceem.24.294

William Franklin Peacock, Karina Melissa Soto-Ruiz, Allan S Jaffe, Brian R Tiffany, Simon A Mahler, Brian W Patterson, Alan Hb Wu, Robert Christenson

{"title":"A rapid non-invasive wearable device for assessing cardiac troponin.","authors":"William Franklin Peacock, Karina Melissa Soto-Ruiz, Allan S Jaffe, Brian R Tiffany, Simon A Mahler, Brian W Patterson, Alan Hb Wu, Robert Christenson","doi":"10.15441/ceem.24.294","DOIUrl":"https://doi.org/10.15441/ceem.24.294","url":null,"abstract":"Background: Chest pain, a common emergency department 35 (ED) presentation, requires rapid evaluation. Optical technology-based non-invasive wearable devices (Infrasensor, RCE, Carlsbad, CA) rapidly and transcutaneously assesses cardiac Troponin I (cTnI).Objectives: To perform a pilot study describing the performance of the Infrasensor in cTnI defined cohorts.Methods: This was a 10-hospital prospective observational study in healthy US subjects with a normal cTnI, and in patients with an elevated local cTnI. Healthy subjects were without disease, defined by a negative questionnaire and bloodwork, had a 3-minute Infrasensor measurement and blood samples for high-sensitivity cardiac troponin I (hs-cTnI), n-terminal pro-B-type natriuretic peptide (NTproBNP), creatinine, and glycosylated hemoglobin (HbA1c). Elevated cTnI's patients had the same Infrasensor and blood sample measurements. Using a cross validation technique, a cTnI based binary classification model that did, and did not, include age was trained with 80%, and validated on 20% (n=168; elevated hs-cTnI equally distributed across 5 folds) of the overall cohort.Results: Of 840 patients, 727 (87.5%) were non-elevated cTnI controls and the remainder, n=113, had elevated cTnI. Median (25th, 75th percentiles) age was 61 (52, 71) and 48 (32, 57) years for the elevated and healthy control cohorts, respectively. Overall, 50.5% were female, with 29.2% and 52.7% in the elevated and non-elevated troponin cohorts respectively. Overall, the sensitivity, specificity, negative and positive predictive values of the Infrasensor for identifying an elevated cTnI were 0.9, 0.7, 0.98 and 0.48 respectively, with a C-statistic of 0.90 (0.89-0.99).Conclusions: The Infrasensor identifies elevated cTnI within 3 minutes of application.","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Tricuspid Annular Plane Systolic Excursion (TAPSE) in COPD Patients, A Systematic Review and Meta-Analysis. 慢性阻塞性肺病患者的三尖瓣瓣环平面收缩期偏移 (TAPSE)，系统回顾和元分析。

IF 1.9

Clinical and Experimental Emergency Medicine Pub Date : 2024-09-06 DOI: 10.15441/ceem.24.228

M Groussis, Q K Tran, M Hoffer, J Ahari, A Pourmand

{"title":"Tricuspid Annular Plane Systolic Excursion (TAPSE) in COPD Patients, A Systematic Review and Meta-Analysis.","authors":"M Groussis, Q K Tran, M Hoffer, J Ahari, A Pourmand","doi":"10.15441/ceem.24.228","DOIUrl":"https://doi.org/10.15441/ceem.24.228","url":null,"abstract":"Introduction: Tricuspid annular plane systolic excursion (TAPSE) is an echocardiographic parameter that serves as a prognostic indicator for severity of COPD clinical course. This study, consisting of a systematic review and meta-analysis, evaluates the current literature to elucidate the relationship between TAPSE measurement in COPD patients versus control subjects to discern baseline evidence of right heart strain.Methods: PubMedTM, ScopusTM, CINAHL, Web of Science, and Cochrane Review databases were searched from their beginning through November 1, 2023, for eligible studies. Outcomes included the difference of TAPSE measurement and right ventricular wall thickness between COPD patients and control patients. The Newcastle-Ottawa Scale was applied to assess risk of bias; Q-statistics and I2 values were used to assess for heterogeneity; and Egger's and Begg's test used to assess for publication bias.Results: The search yielded eleven studies reporting TAPSE values involving 1671 patients, 800 (47.9%) patients with COPD. The unadjusted mean TAPSE values for COPD patients was 18.9 mm (SD+/- 4), while the mean TAPSE value for control patients was 22.2 mm (SD+/- 0.8). The presence of COPD was significantly associated with decreased TAPSE values with the meta-analysis reporting the mean difference of TAPSE value between COPD and control patients was -3.0 (95% CI -4.3 to -1.7, P=0.001). Six studies reported the RV free wall thickness. The unadjusted mean RV free wall thickness for COPD patients was 4.9 mm (SD+/- 1.2), and control patients was 3.4 mm (SD+/- 0.7), respectively.Conclusions: This meta-analysis demonstrated statistically-significantly lower TAPSE values and thicker RV free wall among COPD patients versus control patients.","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Optimizing dispatcher-bystander dyadic collaboration in emergency medical communication to improve cardiac arrest response. 优化紧急医疗通信中调度员与旁观者之间的合作，改善心脏骤停响应。

IF 1.9

Clinical and Experimental Emergency Medicine Pub Date : 2024-09-06 DOI: 10.15441/ceem.24.296

Guglielmo Imbriaco, Nicola Ramacciati

引用次数: 0

A multicenter retrospective cohort study on incidence and diagnostics in emergency department patients with acute vestibular syndrome. 一项关于急诊科急性前庭综合征患者发病率和诊断的多中心回顾性队列研究。

IF 1.9

Clinical and Experimental Emergency Medicine Pub Date : 2024-07-19 DOI: 10.15441/ceem.24.225

Renske Eveline Henriëtte Maria Bijl, Domenique Wilhelmina Antonia Maria Zaunbrecher, Petra Mathilda de Muynck, Ryanne Eggink, Ronique Timmer, Evian Willems, Sam Koning, Marieke Saskia Sanders, Kim Ellis Jie

{"title":"A multicenter retrospective cohort study on incidence and diagnostics in emergency department patients with acute vestibular syndrome.","authors":"Renske Eveline Henriëtte Maria Bijl, Domenique Wilhelmina Antonia Maria Zaunbrecher, Petra Mathilda de Muynck, Ryanne Eggink, Ronique Timmer, Evian Willems, Sam Koning, Marieke Saskia Sanders, Kim Ellis Jie","doi":"10.15441/ceem.24.225","DOIUrl":"https://doi.org/10.15441/ceem.24.225","url":null,"abstract":"Objective: Acute vestibular syndrome (AVS) is a common symptom presented by emergency department (ED) patients. Differentiating peripheral from central etiology poses a challenge and clinical practice lacks a uniform diagnostic approach. This study aims to provide insight on incidence and diagnostics in ED patients presenting with AVS in the Netherlands.Methods: A multicenter retrospective cohort study on ED patients presenting with AVS in two hospitals during 3 years. Primary endpoints are incidence, diagnostics and diagnosis at ED versus follow-up. A secondary endpoint includes therapy.Results: 500 AVS cases were included. The annual incidence was 0.1%. 85 ED patients (17.0%) were diagnosed with stroke, 285 (57.0%) with non-stroke and 130 (26.0%) with an unsure etiology. At follow-up, diagnosis was corrected in 145 patients (29.0%), with stroke missed in 29 (5.8%). A triad of clinical tests (HINTS) was reported in 106 (21.2%) patients, a CT in 342 (68.2%) and a MRI in 153 (30.6%). Antiplatelet therapy was prescribed in 135 cases. In 69% of these, initial diagnosis was corrected to non-stroke. For 8 patients who received thrombolysis, initial diagnosis was corrected in 3. Of those patients where stroke was initially not identified, 23 (79%) received suboptimal treatment in lieu of antiplatelet therapy.Conclusion: The annual incidence of AVS in Dutch ED patients is 0.1%. ED diagnosis is often uncertain, with one-third of diagnoses corrected. This study substantiates clinical practice lacks a uniform diagnostic pathway with an overuse of CT and underuse of HINTS. Further research on optimal diagnostic approach is warranted to improve treatment of AVS.","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Barriers to utilisation of Intraosseous vascular access in Paediatric Emergencies. 在儿科急诊中使用骨内血管通路的障碍。

IF 1.9

Clinical and Experimental Emergency Medicine Pub Date : 2024-07-19 DOI: 10.15441/ceem.24.247

Hussein Omari Sombi

引用次数: 0

Is Plasmalyte beneficial in resuscitation of diabetic ketoacidosis patients? A narrative review. 血浆蛋白对糖尿病酮症酸中毒患者的复苏有益吗？综述。

IF 1.9

Clinical and Experimental Emergency Medicine Pub Date : 2024-07-19 DOI: 10.15441/ceem.24.209

Resshme Kannan Sudha, Kinza Moin, Falaah Abdul Hameed, Hamid Aizaz Chatha

引用次数: 0