Emergency Medicine Journal最新文献

{"title":"Strengthening emergency care in Pakistan: priorities for reform.","authors":"Zeeshan Ahsan","doi":"10.1136/emermed-2025-215287","DOIUrl":"https://doi.org/10.1136/emermed-2025-215287","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic accuracy of the STANDING algorithm in patients with isolated vertigo: a multicentre prospective study (STANDING-M).","authors":"Mattia Ronchetti, Paola Bartalucci, Giuseppe Pepe, Giulia Canaroli, Simone Magazzini, Ersilia De Curtis, Federico Di Sacco, Maurizio Bartolucci, Rudi Pecci, Claudia Casula, Lorenzo Pelagatti, Ginevra Fabiani, Andrea Pavellini, Cosimo Caviglioli, Peiman Nazerian, Paolo Vannucchi, Simone Vanni","doi":"10.1136/emermed-2025-214902","DOIUrl":"https://doi.org/10.1136/emermed-2025-214902","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the diagnostic accuracy of the STANDING algorithm for central vertigo across different emergency departments (EDs). Secondary outcomes compared STANDING with usual care in terms of diagnostic accuracy, resource utilisation and length of stay (LOS).</p><p><strong>Methods: </strong>We prospectively enrolled adult patients presenting with vertigo at one 'hub' and three 'spoke' EDs in Tuscany. Patients were assessed using either STANDING or 'usual care', depending on the availability of a trained emergency physician. Imaging tests, consultations and dispositions were made independently of the study. The final diagnosis of central vertigo was determined by an expert panel, based on clinical data, along with a 30-day follow-up.</p><p><strong>Results: </strong>A total of 456 patients were included, with 242 (53%) assessed by STANDING. There were no statistically significant differences in age, gender or cardiovascular risk factors between the STANDING and usual care groups. The prevalence of central vertigo was 8.6%, with ischaemic stroke (4.2%) as the leading cause, with no differences between groups. The STANDING algorithm had a sensitivity of 88.2%, specificity of 91.6%, positive predictive value of 44.1%, and negative predictive value of 99%. Usual care showed lower specificity and positive predictive value (36.5% and 14.7%, respectively, p<0.05). Additionally, the STANDING group had both fewer non-contrast head CT (NCCT) requests (48.3% vs 66.8%) and a shorter LOS (median 271 vs 339 min) (p<0.05).</p><p><strong>Conclusions: </strong>The STANDING algorithm demonstrated high diagnostic accuracy and a very high negative predictive value for central vertigo across EDs and appears to be associated with improved specificity, reduced use of NCCT and shorter LOS compared with 'usual care'.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Person-centred emergency care: translation and cross-cultural validation of the Australian Emergency Department Patient-Reported Experience Measure (ED PREM) in the Netherlands.","authors":"Renée A M Tuinte, Claudia Bull, Job M Hoonhorst, Reinier P Akkermans, Marie Louise Moors, Jaap Ten Oever, Marlies Ejl Hulscher, Jacobien J Hoogerwerf","doi":"10.1136/emermed-2024-214536","DOIUrl":"https://doi.org/10.1136/emermed-2024-214536","url":null,"abstract":"<p><strong>Background: </strong>Measuring and evaluating patient experience in the emergency department (ED) is essential for improving the quality of emergency care. However, specific and validated tools to measure patient experience in the ED are lacking in many countries. The aim of this study was therefore to translate and cross-culturally validate the Australian ED Patient-Reported Experience Measure (ED PREM) for the Dutch setting.</p><p><strong>Methods: </strong>A single-centre validation study was conducted in a Dutch academic hospital. Step 1 involved forward and backward translation to produce a Dutch translation of the ED PREM (prototype). Step 2 involved establishing face and content validity of the Dutch prototype through cognitive patient interviews and researcher team consensus meetings. Step 3 involved administering the resultant Dutch pilot ED PREM to an ED population (n=527), to be able to perform psychometric analyses on this sample. Descriptive statistics and item reduction analyses were conducted prior to confirmatory factor analysis (CFA). CFA was used to confirm the structural validity of the Dutch ED PREM, and internal consistency was assessed.</p><p><strong>Results: </strong>The face and content validity of the prototype Dutch ED PREM was 'good' after 15 cognitive interviews and expert consultation. Over two-thirds of participants (357/527) completed the Dutch pilot ED PREM. Scores were high across all four domains. Several items were removed due to high ceiling effects and a large number of 'not applicable' responses. The final 18-item Dutch ED PREM showed acceptable model fit with CFA (χ²(df) 7519.55 (153), p<0.001, Root Mean Square Error of Approximation=0.090, Tucker-Lewis Index=0.942, Comparative Fit Index=0.951, Standardised Root Mean Square Residual=0.035). Internal consistency was high (Cronbach's alpha ranged 0.85-0.97 per domain).</p><p><strong>Conclusions: </strong>The final 18-item Dutch ED PREM showed good validity and reliability for measuring ED patient experience. It is suitable and feasible for use in clinical practice to assess and improve the person-centredness of emergency care.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of a portable therapeutic baby nest designed for neonates on physiological parameters, comfort and pain levels during venous blood sampling: a randomised controlled trial.","authors":"Aylin Arıkan, Figen Işık Esenay","doi":"10.1136/emermed-2024-214660","DOIUrl":"10.1136/emermed-2024-214660","url":null,"abstract":"<p><strong>Background: </strong>In Turkey, paediatric emergency departments often lack the specialised environments required for invasive procedures on neonates. Given their developmental vulnerability, it is crucial to use interventions that reduce discomfort and support physiological stability. This study introduces the portable therapeutic baby nest (PTBN), designed to provide developmentally supportive care aligned with the principles of the Newborn Individualized Developmental Care and Assessment Program.</p><p><strong>Methods: </strong>This two-phase study included 80 term neonates (40 per group). First, the PTBN was developed from February to April 2022. Second, its effectiveness was evaluated through a randomized controlled trial conducted from May to September 2022. The experimental group underwent venous blood sampling in the PTBN, and the control group on a standard stretcher. All procedures were video-recorded and assessed by two blinded nurses using the Physiological Parameter Monitoring Form, COMFORTneo and Neonatal Infant Pain Scale (NIPS).</p><p><strong>Results: </strong>Baseline characteristics were similar across groups (p>0.05). During and after sampling, the PTBN group had significantly lower heart and respiratory rates, higher oxygen saturation and lower NIPS and COMFORTneo scores compared with controls (p<0.05).</p><p><strong>Conclusion: </strong>The PTBN improved physiological stability, comfort and pain outcomes during venous sampling in neonates.</p><p><strong>Trial registration number: </strong>NCT05442619.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practitioner experiences of developing and implementing two UK ED-based hospital violence intervention programmes: a process evaluation.","authors":"Simon Moore, Jordan Van Godwin, Graham Moore, Megan Hamilton, David O'Reilly","doi":"10.1136/emermed-2024-214333","DOIUrl":"10.1136/emermed-2024-214333","url":null,"abstract":"<p><strong>Background: </strong>EDs can address modifiable risks of patients attending due to violence. Hospital-based violence intervention programmes (HVIPs) can reduce patients' exposure to violence but can place additional burdens on staff. We explored practitioners' views on two nurse-led HVIPs' design and delivery, response to patient need, engagement with ED health professionals, adaptation to local context and analysed documents relevant to these objectives.</p><p><strong>Methods: </strong>This was a qualitative process evaluation, from January to September 2023, of two nurse-led HVIPs implemented in a major trauma centre and a large urban hospital in the UK. Interview participants (N=49) were involved with the commission and implementation of the HVIPs, or worked within the broader violence-prevention ecology. We gathered perspectives on intervention implementation and undertook documentary analysis on local and national policies, and guidance relating to HVIPs development, implementation and delivery (N=46). Documentary data were subject to thematic and content analyses, interview data to thematic analysis.</p><p><strong>Results: </strong>HVIPs were developed in response to a perceived under-provision of services for patients attending EDs due to violence. The HVIP nurses had access to clinical records facilitating the identification of eligible patients. They provided patient-centred care, addressing needs through referrals into health and community-based services. Over 60% of eligible patients engaged. The nurses were seen as credible champions working towards a minimally burdensome service that supported and trained ED staff. Embedding HVIPs into usual care took time and was limited by the perceived short-term nature of the intervention.</p><p><strong>Conclusion: </strong>The implementation of nurse-led HVIPs enables access to clinical records, facilitating patient engagement, and can provide an additional service aligned to usual emergency care, supporting both patients and ED staff.</p><p><strong>Pre-registration: </strong>The protocol was pre-registered (ISRCTN 15286575; March 13, 2023) and published before data collection was complete.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"536-541"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ending nuclear weapons, before they end us.","authors":"Chris Zielinski","doi":"10.1136/emermed-2025-215161","DOIUrl":"10.1136/emermed-2025-215161","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"e2"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When fast gets dangerous.","authors":"Andre Briosa E Gala, Arthur Yue, Eunice Onwordi","doi":"10.1136/emermed-2024-214806","DOIUrl":"https://doi.org/10.1136/emermed-2024-214806","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":"42 8","pages":"549-562"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sudden-onset diplopia in an 83-year-old man.","authors":"Ken Yamada, Hirofumi Yamashita","doi":"10.1136/emermed-2024-214506","DOIUrl":"https://doi.org/10.1136/emermed-2024-214506","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":"42 8","pages":"495-533"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary embolism diagnosis and the D-dilemma.","authors":"Daniel Horner, Lara N Roberts","doi":"10.1136/emermed-2025-215058","DOIUrl":"10.1136/emermed-2025-215058","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"560-561"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic analysis of approaches used in cardiac arrest trials to inform relatives about trial enrolment of non-surviving patients.","authors":"Helen Pocock, Abigail Dove, Laura Pointeer, Keith Couper, Gavin D Perkins","doi":"10.1136/emermed-2023-213648","DOIUrl":"10.1136/emermed-2023-213648","url":null,"abstract":"<p><strong>Background: </strong>The recruitment of patients to emergency research studies without the requirement for prior informed consent has furthered the conduct of randomised studies in cardiac arrest. Frameworks enabling this vary around the world depending on local legal or ethical requirements. When an enrolled patient does not survive, researchers may take one of three approaches to inform relatives of their enrolment: a direct (active) approach, providing information indirectly (passively) and inviting relatives to seek further information if they choose, or providing no information about the trial (no attempt). Previous studies have described experiences of US researchers' active approach but there is little known about approaches elsewhere.We aimed to conduct a structured investigation of methods used in cardiac arrest trials to provide information about trial enrolment to relatives of non-surviving patients.</p><p><strong>Methods: </strong>We systematically searched trial registries to identify randomised clinical trials that recruited cardiac arrest patients. Trials were eligible for inclusion if they recruited adults during cardiac arrest (or within 1 hour of return of spontaneous circulation) between 2010 and 2022 (in the decade prior to study conception). We extracted data from trial registries and, where relevant, published papers and protocols. Investigators were contacted and asked to describe the style, rationale and timing of approach to relatives of non-surviving patients. We present descriptive statistics.</p><p><strong>Results: </strong>Our trial registry search identified 710 unique trials, of which 108 were eligible for inclusion. We obtained information from investigators for 64 (62%) trials. Approximately equal numbers of trials attempted to actively inform relatives of non-survivors (n=28 (44% (95% CI; 31% to 57%))), or made no attempt (n=25 (39% (95% CI; 27% to 52%))). The remaining studies provided general information about the trial to relatives but did not actively inform them (n=11 (17% (95% CI; 8% to 29%))).</p><p><strong>Conclusions: </strong>There is wide variability in the approach taken to informing relatives of non-surviving patients enrolled in cardiac arrest randomised clinical trials.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"488-495"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140904040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}