Emergency Medicine Journal最新文献

{"title":"Implementing peer recovery coaches to increase linkages to recovery services among patients with substance use disorders seen in emergency departments.","authors":"Joseph Carpenter, Umedjon Ibragimov, Alaina Steck, Tatiana Getz, Yan Li, Nicholas Giordano","doi":"10.1136/emermed-2023-213700","DOIUrl":"10.1136/emermed-2023-213700","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"757-758"},"PeriodicalIF":2.7,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11581905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105487","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":"Transient Ischaemic attack Emergency Referral (TIER): randomised feasibility trial results.","authors":"Alan Watkins, Jenna Katherine Jones, Khalid Ali, Richard Dewar, Adrian Edwards, Bridie Angela Evans, Lyn Evans, Gary A Ford, Chelsey Hampton, Roger John, Charlene Jones, Chris Moore, Michael Obiako, Alison Porter, Alan Pryce, Tom Quinn, Anne C Seagrove, Helen Snooks, Shirley Whitman, Nigel Rees","doi":"10.1136/emermed-2021-212230","DOIUrl":"10.1136/emermed-2021-212230","url":null,"abstract":"<p><strong>Background: </strong>Early assessment of patients with suspected transient ischaemic attack (TIA) is crucial to provision of effective care, including initiation of preventive therapies and identification of stroke mimics. Many patients with TIA present to emergency medical services (EMS) but may not require hospitalisation. Paramedics could identify and refer patients with low-risk TIA, without conveyance to the ED. Safety and effectiveness of this model is unknown.</p><p><strong>Aim: </strong>To assess the feasibility of undertaking a fully powered randomised controlled trial (RCT) to evaluate clinical and cost-effectiveness of paramedic referral of patients who call EMS with low-risk TIA to TIA clinic, avoiding transfer to ED.</p><p><strong>Methods: </strong>The Transient Ischaemic attack Emergency Referral (TIER) intervention was developed through a survey of UK ambulance services, a scoping review of evidence of prehospital care of TIA and convening a specialist clinical panel to agree its final form. Paramedics in South Wales, UK, were randomly allocated to trial intervention (TIA clinic referral) or control (usual care) arms, with patients' allocation determined by that of attending paramedics.Predetermined progression criteria considered: proportion of patients referred to TIA clinic, data retrieval, patient satisfaction and potential cost-effectiveness.</p><p><strong>Results: </strong>From December 2016 to September 2017, eighty-nine paramedics recruited 53 patients (36 intervention; 17 control); 48 patients (31 intervention; 17 control) consented to follow-up via routine data. Three intervention patients, of seven deemed eligible, were referred to TIA clinic by paramedics. Contraindications recorded for the other intervention arm patients were: Face/Arms/Speech/Time positive (n=13); ABCD2 score >3 (n=5); already anticoagulated (n=2); crescendo TIA (n=1); other (n=8). Routinely collected electronic health records, used to report further healthcare contacts, were obtained for all consenting patients. Patient-reported satisfaction with care was higher in the intervention arm (mean 4.8/5) than the control arm (mean 4.2/5). Health economic analysis suggests an intervention arm quality-adjusted life-year loss of 0.0094 (95% CI -0.0371, 0.0183), p=0.475.</p><p><strong>Conclusion: </strong>The TIER feasibility study did not meet its progression criteria, largely due to low patient identification and referral rates. A fully powered RCT in this setting is not recommended.</p><p><strong>Trial registration number: </strong>ISRCTN85516498.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"710-716"},"PeriodicalIF":2.7,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399761","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":"Correspondence on 'Four-factor prothrombin complex concentrate versus andexanet alfa for the reversal of traumatic brain injuries' by Sadek <i>et al</i>.","authors":"Ilya Danelich, Veruska Di Sena, James Williams, Gregory Oreste","doi":"10.1136/emermed-2024-214250","DOIUrl":"https://doi.org/10.1136/emermed-2024-214250","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681173","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":"Best evidence topic report: can intradermal sterile water injections provide effective pain relief in patients with renal colic?","authors":"Alexander Hunt, Niall Pumfrey","doi":"10.1136/emermed-2024-214587","DOIUrl":"https://doi.org/10.1136/emermed-2024-214587","url":null,"abstract":"<p><p>A short systematic review was undertaken to assess whether intradermal sterile water injections (ISWI) provide effective pain relief in adult patients presenting to the Emergency Department (ED) with renal colic. MEDLINE, Embase, Cochrane and Google Scholar databases were searched, identifying seven relevant studies. Study information, patient characteristics, key results and methodological weaknesses were tabulated. Our results indicate that ISWI provides rapid and effective pain relief within the first 15-30 min, comparable to non-steroidal anti-inflammatory drugs, with fewer adverse effects. The short follow-up periods, exclusion of more comorbid patients and variability in study design limit the generalisability of the findings. Further research is needed to establish the long-term effectiveness of ISWI in the management of renal colic in the ED.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681171","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":"Correspondence on 'Four-factor prothrombin complex concentrate versus andexanet alfa for the reversal of traumatic brain injuries' by Sadek <i>et al</i>.","authors":"Erin Sadek, Jason Hecht","doi":"10.1136/emermed-2024-214565","DOIUrl":"https://doi.org/10.1136/emermed-2024-214565","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681177","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 it time to reframe resuscitation in trauma?","authors":"Rich Carden, Daniel Horner","doi":"10.1136/emermed-2024-214422","DOIUrl":"https://doi.org/10.1136/emermed-2024-214422","url":null,"abstract":"<p><p>Trauma remains a significant cause of mortality and morbidity. Non-compressible torso haemorrhage is one of the key drives of these mortality data. Our contemporary management has focused on damage control resuscitation, with a focus on haemorrhage control, haemostatic resuscitation and permissive hypotension. The evidence for permissive hypotension lacks the robustness as other treatments, such as tranexamic acid. Despite this clinicians still target arbitrary systolic blood pressure cutoffs as both goals and ceilings of therapy. In this paper, we suggest that perhaps more consideration should be given to the diastolic blood pressure in bleeding trauma patients. The diastolic blood pressure is critical for coronary perfusion, and in turn the cardiac output responsible for cerebral blood flow. We suggest that a move to reframing resuscitation in terms of physiology may change the way that we resuscitate these patients and allow for more nuanced treatment strategies.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675461","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":"Are there differences in low-acuity emergency department visits between culturally and linguistically diverse migrants and people with English-speaking background: a population-based linkage study of adults over 45.","authors":"Flavio Ayala-Diaz, Ben Harris-Roxas, Mark Harris, Margo Barr, A Y M Alamgir Kabir, Damian P Conway, Anurag Sharma","doi":"10.1136/emermed-2023-213442","DOIUrl":"https://doi.org/10.1136/emermed-2023-213442","url":null,"abstract":"<p><strong>Background: </strong>Growing numbers of avoidable low-acuity visits to emergency departments (ED) are a major health policy concern globally and are thought to contribute to ED crowding. This study explores the differences in the utilisation of low-acuity ED visits between culturally and linguistically diverse (CaLD) migrants and English-speaking background (ESB) population.</p><p><strong>Methods: </strong>A study based on a cross-sectional survey of individuals aged 45 or over linked to routinely collected ED visit records in New South Wales. We employed a negative binomial regression model to compare the number of yearly low-acuity ED visits between individuals from ESB and CaLD backgrounds after adjusting for relevant health-related and sociodemographic characteristics.</p><p><strong>Results: </strong>We analysed 227 681 individuals with a mean age of 61, two-thirds of whom came from an ESB. Among individuals with a CaLD background, only those born in Australia had comparable rates of low-acuity ED visits as those with an ESB. In contrast, individuals with CaLD backgrounds who were born overseas were significantly less likely to make low-acuity visits to the ED compared with those from an ESB irrespective of year of arrival-for those who had migrated less than 20 years ago (relative risk (RR) 0.72, 95% CI 0.62 to 0.83) and those who migrated more than 20 years ago (RR 0.91, 95% CI 0.88 to 0.95).</p><p><strong>Conclusion: </strong>Foreign-born migrants aged 45 and over from CaLD backgrounds tend to have the lowest rates of low-acuity ED visits, particularly those who migrated more recently indicating low-acuity visits by CaLD patients are unlikely to contribute to ED crowding.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616975","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":"How can we improve on advanced clinical practitioner training?","authors":"Ruth Brown","doi":"10.1136/emermed-2024-214632","DOIUrl":"https://doi.org/10.1136/emermed-2024-214632","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616984","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":"Inverse linear association between blood haemoglobin and oxygen saturation accuracy measured by pulse oximetry: a cross-sectional analysis in individuals with COVID-19 infection.","authors":"Colin J Crooks, Joe West, Jo R Morling, Mark Simmonds, Irene Juurlink, Steve Briggs, Simon Cruickshank, Susan Hammond-Pears, Dominick Shaw, Tim R Card, Andrew W Fogarty","doi":"10.1136/emermed-2023-213712","DOIUrl":"10.1136/emermed-2023-213712","url":null,"abstract":"<p><strong>Background: </strong>Pulse oximetry measures oxygen saturation non-invasively by using differential absorption of infrared signals which are dependent on the oxyhaemoglobin:deoxyhaemoglobin ratio. We tested the hypothesis that pulse oximetry error in measurements of blood oxygen saturations may be associated with blood haemoglobin levels.</p><p><strong>Methods: </strong>The study design was an observational study of all adult patients admitted to a large teaching hospital with suspected or confirmed COVID-19 infection from February 2020 to December 2021 who had arterial blood gases (ABG) drawn. The pulse oximetry reading was compared with the arterial saturation on the ABG and the measurement error was determined according to the ABG haemoglobin. A secondary analysis was performed among a subset of patients with venous haemoglobins drawn within 24 hours, comparing measurement error between ABG arterial saturation and pulse oximetry readings between those with normal (150 g/L) and low (70 g/L) haemoglobins.</p><p><strong>Results: </strong>The analysis used 5922 paired oxygen saturations from 3994 patients with contemporaneous haemoglobin measurements by ABG. A 1 g/L decrease in blood haemoglobin was associated with an 0.021% (95% CI: +0.008% to +0.033%) increase in the measurement error (in the direction of a falsely elevated reading.). In the 1086 patients who had had a venous haemoglobin there was a 0.055% (95% CI: +0.020% to +0.090%) increase in the measurement error of oxygen saturation per 1 g/L decrease in blood haemoglobin. The measurement error was thus greater in those with anaemia than in those with normal haemoglobin.</p><p><strong>Conclusion: </strong>As blood haemoglobin decreases, the oxygen saturation measurement derived from a pulse oximeter reads erroneously higher than the true value measured by ABG. While this study was confined to patients with COVID-19, physicians should be aware of this potential discrepancy among all patients with haemorrhage or known anaemia.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616998","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":"Experiences and perceptions of acute testicular pain, with a focus on reasons for delayed presentation to hospital: a qualitative evidence synthesis.","authors":"Elizabeth Anderson, Wendy J Chaplin, Chloe Turner, Graham D Johnson, Holly Blake, Andrew Tabner","doi":"10.1136/emermed-2024-214125","DOIUrl":"https://doi.org/10.1136/emermed-2024-214125","url":null,"abstract":"<p><strong>Background: </strong>The annual incidence of testicular torsion is approximately 1 in 4000 males under the age of 25. Despite the 97% testicular salvage rate when surgical intervention is within 6 hours of onset, orchidectomy is required in 40% of cases. These comparatively poor outcomes are driven by delays to intervention, the majority of which take place prior to presentation to healthcare. This study synthesises existing evidence to understand factors leading to delayed presentation to hospital in individuals with acute scrotal pain.</p><p><strong>Methods: </strong>A comprehensive literature search was performed with support from an information scientist. Two authors performed article screening, data extraction and inductive thematic synthesis independently, with disagreements resolved by discussion at each stage. An assessment of confidence in the review findings was performed using the ConQual approach.</p><p><strong>Results: </strong>The search identified 1251 unique articles for screening, with five eligible for inclusion; all included publications were drawn from two PhD projects. Synthesis of these articles revealed five descriptive themes with five subthemes. A lack of knowledge and education about testicular health, embarrassment and reliance on others for access to healthcare are major factors leading to delays in presentation. Societal and cultural impacts on health-seeking behaviour and denial were also causes of delayed presentation to healthcare.</p><p><strong>Discussion: </strong>A lack of knowledge about testicular anatomy and health among both adults and children is amenable to improvement through education, and would likely impact many of the factors identified as contributory to delays. Communication was an overarching factor connecting the descriptive themes.</p><p><strong>Prospero registration number: </strong>CRD42023469435.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616980","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}