Emergency Medicine Journal最新文献

{"title":"Point-of-care ultrasound for foreign bodies.","authors":"Arianna Thompson, Sally Graglia","doi":"10.1136/emermed-2024-214399","DOIUrl":"10.1136/emermed-2024-214399","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766146","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":"Can digital stethoscopes improve auscultation in aircraft cabins.","authors":"Abílio Tiago Barros Oliveira","doi":"10.1136/emermed-2024-214364","DOIUrl":"https://doi.org/10.1136/emermed-2024-214364","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750490","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":"Is emergency doctors' tolerance of clinical uncertainty on a novel measure associated with doctor well-being, healthcare resource use and patient outcomes?","authors":"Luke Budworth, Brad Wilson, Joanna Sutton-Klein, Subhashis Basu, Colin O'Keeffe, Suzanne M Mason, Andrew Ang, Sally Anne-Wilson, Kevin Reynard, Susan Croft, Anoop D Shah, Sakarias Bank, Mark Conner, Rebecca Lawton","doi":"10.1136/emermed-2023-213256","DOIUrl":"https://doi.org/10.1136/emermed-2023-213256","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency doctors routinely face uncertainty-they work with limited patient information, under tight time constraints and receive minimal post-discharge feedback. While higher uncertainty tolerance (UT) among staff is linked with reduced resource use and improved well-being in various specialties, its impact in emergency settings is underexplored. We aimed to develop a UT measure and assess associations with doctor-related factors (eg, experience), patient outcomes (eg, reattendance) and resource use (eg, episode costs).</p><p><strong>Methods: </strong>From May 2021 to February 2022, emergency doctors (specialty trainee 3 and above) from five Yorkshire (UK) departments completed an online questionnaire. This included a novel UT measure-an adapted Physicians' Reaction to Uncertainty scale collaboratively modified within our team according to Hillen <i>et al</i>'s (2017) UT model. The questionnaire also included well-being-related measures (eg, Brief Resilience Scale) and assessed factors like doctors' seniority. Patient encounters involving prespecified 'uncertainty-inducing' problems (eg, headache) were analysed. Multilevel regression explored associations between doctor-level factors, resource use and patient outcomes.</p><p><strong>Results: </strong>39 doctors were matched with 384 patients. The UT measure demonstrated high reliability (Cronbach's <i>α</i>=0.92) and higher UT was significantly associated with better psychological well-being including greater resilience (Pearson's r=0.56; 95% CI=0.30 to 0.74) and lower burnout (eg, Cohen's d=-2.98; -4.62 to -1.33; mean UT difference for 'no' vs 'moderate/high' burnout). UT was not significantly associated with resource use (eg, episode costs: β=-0.07; -0.32 to 0.18) or patient outcomes including 30-day readmission (eg, OR=0.82; 0.28 to 2.35).</p><p><strong>Conclusions: </strong>We developed a reliable UT measure for emergency medicine. While higher UT was linked to doctor well-being, its impact on resource use and patient outcomes remains unclear. Further measure validation and additional research including intervention trials are necessary to confirm these findings and explore the implications of UT in emergency practice.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750491","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 SARS-CoV-2 and influenza antigen test in Omicron age in hospital emergency department: real-life analysis during 2023.","authors":"Celia García-Rivera, Isabel Escribano, Maria Paz Ventero, Iryna Tyshkovska, Sandra López-Hurtado, Alicia Doña, Pere Llorens, Esperanza Merino, José Manuel Ramos, José Sánchez-Payá, Pilar Gallardo, Raissa Silva-Afonso, Juan Carlos Rodríguez","doi":"10.1136/emermed-2024-214160","DOIUrl":"https://doi.org/10.1136/emermed-2024-214160","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715672","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":"Conservative management of traumatic haemothoraces: a UK single-centre trauma unit retrospective audit.","authors":"Tom Roberts, Kirk Ramharack, Avinash Aujayeb","doi":"10.1136/emermed-2024-214305","DOIUrl":"https://doi.org/10.1136/emermed-2024-214305","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695391","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":"Emerging technology solutions to support national emergency workforce capacity-building initiatives: lessons from Ugandan policy and practice.","authors":"Emily McMullen, Solomon Kamurari, Richard Price, Moses Mulimira, Jonathan James, Andrew Fryer, Daudi Jjingo","doi":"10.1136/emermed-2024-213947","DOIUrl":"https://doi.org/10.1136/emermed-2024-213947","url":null,"abstract":"<p><p>Trauma and emergency care is a national priority in Uganda due to the high burden of injury, impacting a primarily young and rural population. With a significant gap in qualified emergency medicine professionals, a need exists to rapidly upskill the current health workforce and to strengthen access to learning for non-specialist emergency care providers nationally. This review was completed in partnership with the Ugandan Ministry of Health and a consortium of UK partners to support national emergency workforce capacity building in Uganda and East Africa. The review built on policy and practice expertise to explore the feasibility of using emerging digital solutions, such as virtual and augmented reality, to meet the challenges of delivering rapid and equitable access to emergency care training at scale. Data collection included a narrative literature review, key informant interviews, an expert focus group, a technical workshop and field observations. Findings included (1) the identification of local technology expertise and experience, in direct contrast to literature and global perceptions of low-resource environments, (2) high and broad levels of national engagement with digital solutions, (3) existing ambition and infrastructure available to feasibly deliver training at scale and (4) delivery implications for comparable contexts. The review concludes that these emerging technologies should be considered a practical option in the design and delivery of health workforce training at scale. A series of recommendations are proposed for the policy and practice of health professional education and training in Uganda and for comparable contexts.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695393","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":"Suicide and self-injury-related emergency department visits and homelessness among adults 25-64 years old from 2016 to 2021 in the USA.","authors":"Theodoros Giannouchos, Gahssan Mehmood, Dahai Yue","doi":"10.1136/emermed-2024-214115","DOIUrl":"10.1136/emermed-2024-214115","url":null,"abstract":"<p><strong>Background: </strong>Despite pronounced increases in homelessness and mental health problems in the USA over the past decade, further exacerbated during the pandemic, and the higher prevalence of mental health conditions among individuals experiencing homelessness, no study has examined trends in self-injury-related ED visits by individuals experiencing homelessness using up-to-date nationwide data. To address this gap, we aimed to investigate the association of self-injury-related ED visits with homelessness and to examine trends in these ED visits by individuals experiencing homelessness.</p><p><strong>Methods: </strong>We conducted a retrospective secondary data analysis using a nationally representative sample of ED visits by adults aged 25-64 years in the USA from the 2016-2021 National Hospital Ambulatory Medical Care Survey. We examined whether intentional self-injury-related ED visits and hospitalisations resulting from an ED visit were associated with homeless status using survey-weighted multivariable generalised linear regression models and whether trends in such visits changed over the study period.</p><p><strong>Results: </strong>Our analysis covered 419.4 million ED visits from 2016 to 2021. Individuals experiencing homelessness constituted 1.8% (7.4 million) of ED visits. Overall, 1.8% of ED visits (7.7 million) were related to intentional self-injuries. Nearly 1 in every 10 ED visits (9.6%) by individuals experiencing homelessness were related to self-injuries, compared with 1.7% among housed counterparts (p<0.001). The adjusted incidence rate ratio for self-injury-related ED visits was 3.14 (95% CI 2.05 to 4.83) for individuals experiencing homelessness compared with housed individuals. Finally, individuals experiencing homelessness accounted for 12.0% and 11.7% of self-injury-related ED visits in 2020 and 2021, respectively (pandemic years), compared with an average of 8.4% in the previous years.</p><p><strong>Conclusion: </strong>Among adults aged 25-64 years, experiencing homelessness was significantly associated with self-injury-related ED visits, and an increase in the rate of such visits among individuals experiencing homelessness was observed during 2020 and 2021. Future studies should assess longer-term trends in these visits and explore interventions to address the societal, health and mental healthcare needs in order to improve the health outcomes of these marginalised individuals.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"749-756"},"PeriodicalIF":2.7,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11672009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Objective capillary refill to rapidly detect haemorrhage at the bedside.","authors":"David Sheridan, Dalton Wesemann, Ravi Samatham, Payton Fischer, Jacob Kimball","doi":"10.1136/emermed-2023-213709","DOIUrl":"10.1136/emermed-2023-213709","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"767"},"PeriodicalIF":2.7,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141300373","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":"Olanzapine postinjection delirium/sedation syndrome after long-acting olanzapine depot injection presenting to the emergency department: practical guidelines for diagnosis and management.","authors":"Sietske A Kochen, Charlotte S Hakkers, Freek van Gorp, Dylan W de Lange, Lenneke E M Haas","doi":"10.1136/emermed-2024-213972","DOIUrl":"10.1136/emermed-2024-213972","url":null,"abstract":"<p><p>Olanzapine long-acting injection is a commonly used antipsychotic drug formulation in the treatment of schizophrenia. Postinjection delirium/sedation syndrome (PDSS) is a potential side effect of this intramuscular depot, for which patients are often presented at the ED. In this article, we give an overview of the current literature outlining the key aspects of managing this syndrome in a critical care setting, illustrated by a typical fictional clinical case. We discuss several useful and practical aspects of PDSS for emergency physicians and critical care physicians, including pharmacological background, common symptoms, diagnostic criteria and therapeutic options.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"759-763"},"PeriodicalIF":2.7,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141626309","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":"Cross-cultural limitations in the discussion of evidence-based versus person-centred approaches to care for older, frail patients.","authors":"Mohd Idzwan Zakaria","doi":"10.1136/emermed-2024-214380","DOIUrl":"10.1136/emermed-2024-214380","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"772"},"PeriodicalIF":2.7,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616978","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}