European Journal of Emergency Medicine最新文献

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Clinician suspicion of unintentional carbon monoxide exposure in emergency department attendees. 临床医生对急诊科就诊者无意接触一氧化碳的怀疑。
IF 3.1 4区 医学
European Journal of Emergency Medicine Pub Date : 2024-10-01 Epub Date: 2024-08-27 DOI: 10.1097/MEJ.0000000000001160
Heather Jarman, Richard W Atkinson, Isabella Myers, Timothy W Gant, Tim Marczylo, Shirley Price
{"title":"Clinician suspicion of unintentional carbon monoxide exposure in emergency department attendees.","authors":"Heather Jarman, Richard W Atkinson, Isabella Myers, Timothy W Gant, Tim Marczylo, Shirley Price","doi":"10.1097/MEJ.0000000000001160","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001160","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Involvement of relatives during end-of-life care in emergency departments: comparison between the perceptions of physicians and nurses. 急诊科临终关怀中亲属的参与:医生和护士看法的比较。
IF 3.1 4区 医学
European Journal of Emergency Medicine Pub Date : 2024-10-01 Epub Date: 2024-08-27 DOI: 10.1097/MEJ.0000000000001154
Mélanie Roussel, Claire Fourcade, Marion Douplat, Philippe Le Conte, Yonathan Freund, Jennifer Truchot
{"title":"Involvement of relatives during end-of-life care in emergency departments: comparison between the perceptions of physicians and nurses.","authors":"Mélanie Roussel, Claire Fourcade, Marion Douplat, Philippe Le Conte, Yonathan Freund, Jennifer Truchot","doi":"10.1097/MEJ.0000000000001154","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001154","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association between pre-arrest left ventricular ejection fraction and survival in nontraumatic out-of-hospital cardiac arrest. 非创伤性院外心脏骤停患者骤停前左心室射血分数与存活率之间的关系。
IF 3.1 4区 医学
European Journal of Emergency Medicine Pub Date : 2024-09-16 DOI: 10.1097/MEJ.0000000000001181
Yi-Ju Ho, Chun-Ju Lien, Ren-Jie Tsai, Cheng-Yi Fan, Chi-Hsin Chen, Chien-Tai Huang, Ching-Yu Chen, Yun-Chang Chen, Chun-Hsiang Huang, Wen-Chu Chiang, Chien-Hua Huang, Chih-Wei Sung, Edward Pei-Chuan Huang
{"title":"Association between pre-arrest left ventricular ejection fraction and survival in nontraumatic out-of-hospital cardiac arrest.","authors":"Yi-Ju Ho, Chun-Ju Lien, Ren-Jie Tsai, Cheng-Yi Fan, Chi-Hsin Chen, Chien-Tai Huang, Ching-Yu Chen, Yun-Chang Chen, Chun-Hsiang Huang, Wen-Chu Chiang, Chien-Hua Huang, Chih-Wei Sung, Edward Pei-Chuan Huang","doi":"10.1097/MEJ.0000000000001181","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001181","url":null,"abstract":"<p><strong>Background and importance: </strong>Out-of-hospital cardiac arrest (OHCA) poses major public health issues. Pre-arrest heart function is a prognostic factor, but the specific contribution of pre-arrest echocardiographic evaluation in predicting OHCA outcome remains limited.</p><p><strong>Objective: </strong>The primary objective was to investigate the association between left ventricular ejection fraction (LVEF) measured in echocardiography prior to OHCA and survival to hospital discharge.</p><p><strong>Design, settings, and participants: </strong>This multicenter retrospective cohort study analyzed data from the National Taiwan University Hospital and its affiliated hospitals. We included adult nontraumatic OHCA patients who were treated by the emergency medical services (EMS) and underwent echocardiography within 6 months prior to the OHCA event from January 2016 to December 2022. Data included demographics, preexisting diseases, resuscitation events, and echocardiographic reports.</p><p><strong>Outcomes measure and analysis: </strong>The primary outcome was the survival to hospital discharge after post-arrest care. Statistical analysis involved multivariable logistic regression to modify potential confounders, reported as adjusted odds ratio (aOR) and 95% confidence interval (CI), and evaluate the association between echocardiographic findings and survival to hospital discharge.</p><p><strong>Main results: </strong>This study analyzed 950 patients, with 33.6% surviving to discharge. A higher pre-arrest LVEF was independently associated with increased survival. Compared to patients with LVEF < 40%, those with LVEF between 40% and 60% had significantly higher odds of survival (aOR = 3.68, 95% CI = 2.14-6.35, P < 0.001), and those with LVEF > 60% had even greater odds of survival (aOR = 5.46, 95% CI = 3.09-9.66, P < 0.001). There was also an association between lower tricuspid regurgitation pressure gradient and survival (aOR = 0.98, 95% CI = 0.97-1.00, P = 0.015). Younger age, male gender, dyslipidemia, stroke, cancer, witnessed arrest, initial shockable rhythm, and shorter low-flow time are other significant predictors of survival.</p><p><strong>Conclusion: </strong>In adult, nontraumatic, EMS-treated OHCA patients, a higher LVEF 6 months prior to OHCA was associated with improved survival at hospital discharge.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Global emergency medicine research priorities: a mapping review. 全球急诊医学研究重点:绘图审查。
IF 3.1 4区 医学
European Journal of Emergency Medicine Pub Date : 2024-09-16 DOI: 10.1097/MEJ.0000000000001182
Erin Kim, Prashant Mahajan, Chris Barousse, Vijaya A Kumar, Shu-Ling Chong, Apoorva Belle, Dominik Roth
{"title":"Global emergency medicine research priorities: a mapping review.","authors":"Erin Kim, Prashant Mahajan, Chris Barousse, Vijaya A Kumar, Shu-Ling Chong, Apoorva Belle, Dominik Roth","doi":"10.1097/MEJ.0000000000001182","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001182","url":null,"abstract":"<p><p>Recognizing and prioritizing research areas in emergency care is crucial for generating evidence and advancing research programs, aiming to enhance health outcomes for both individuals and populations. The objective of this review is to document global clinical and nonclinical research priorities. The Emergency Medicine Education and Research by Global Experts network, consisting of 22 sites across six continents, conducted a mapping review of publications on emergency medicine research priorities (2000-2022) across seven databases. We included studies with replicable methodologies for determining research priorities, excluding those limited to individual diseases. Three reviewers independently screened, selected, and categorized results into clinical and nonclinical topics. Discrepancies were resolved by an independent investigator and consensus. Outcomes measures and analysis include descriptive analysis of research priorities grouped into clinical and nonclinical topics, characteristics of publications including countries represented in the author list, target audience (such as researchers or policy makers), participants (e.g. patients), and methods (e.g. Delphi) of priority setting. Among 968 screened papers, 57 publications from all WHO regions were included. Most (36, 63%) had authors from only a single country, primarily in North America and Europe. Patient representatives were included in only 10 (18%). Clinical research priorities clustered into resuscitation, cardiology, central nervous system, emergency medical services, infectious disease, mental health, respiratory disease, and trauma. Distribution was broad in North America and Europe but focused on infectious diseases and resuscitation in Africa and Asia. Eleven nonclinical topics included access to care, health policy, screening/triage, social determinants of health, staffing, technology/simulation, shared decision making, cross-sectoral collaboration, education, patient-centered care, and research networks. Nonclinical topics were broad in Europe and America, focused on access to care and health screening in Africa, and mostly absent in other WHO regions. Published research priorities in emergency medicine are heterogeneous and geographically limited, mostly containing groups of authors from the same country. The majority of publications in global research priority setting stem from Western countries, covering a broad spectrum of clinical and nonclinical topics. Research priorities from Africa and Asia tend to focus on specific issues more prevalent in those regions of the world.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Laryngeal mask vs. laryngeal tube trial in paediatric patients (LaMaTuPe): a single-blinded, open-label, randomised-controlled trial. 儿科患者喉罩与喉管试验(LaMaTuPe):单盲、开放标签、随机对照试验。
IF 4.4 4区 医学
European Journal of Emergency Medicine Pub Date : 2024-09-12 DOI: 10.1097/mej.0000000000001178
Stephan Katzenschlager,Stefan Mohr,Nikolai Kaltschmidt,Franziska Peterstorfer,Frank Weilbacher,Patrick Günther,Markus Ries,Markus A Weigand,Erik Popp
{"title":"Laryngeal mask vs. laryngeal tube trial in paediatric patients (LaMaTuPe): a single-blinded, open-label, randomised-controlled trial.","authors":"Stephan Katzenschlager,Stefan Mohr,Nikolai Kaltschmidt,Franziska Peterstorfer,Frank Weilbacher,Patrick Günther,Markus Ries,Markus A Weigand,Erik Popp","doi":"10.1097/mej.0000000000001178","DOIUrl":"https://doi.org/10.1097/mej.0000000000001178","url":null,"abstract":"BACKGROUNDIn hypoxemic children with difficult airway, or for minor elective procedures, the use of a supraglottic airway device may be preferred to endotracheal intubation, whether with a laryngeal mask or laryngeal tube. Second-generation laryngeal masks may offer a better safety profile. Whether they should be preferred to laryngeal tubes is unknown. This study aimed to compare the efficacy and safety of second-generation laryngeal masks and laryngeal tubes in children.METHODSThis randomised-controlled trial was conducted in a single university hospital in children <18 years undergoing elective anaesthesia in urology, minor paediatric surgery and gynaecology. Patients were 1 : 1 randomised to the laryngeal mask or laryngeal tube group. Children were allocated a second-generation laryngeal tube or a second-generation laryngeal mask as the primary airway device. The primary endpoint was insertion time. Secondary endpoints included first-attempt success, overall success and complications, which included hypoxia (SpO2 < 90%), laryngospasm, bronchospasm, aspiration and bleeding.RESULTSIn total, 135 patients were randomised, with 61 allocated to the laryngeal tube and 74 to the laryngeal mask group, with a median age of 5.4 and 4.9 years, respectively. Median insertion time was significantly longer in the laryngeal tube group (37 vs. 31 s; difference of medians: 6.0 s; 95% confidence interval: 0.0-13.0). The laryngeal tube had a significantly lower first-attempt (41.0%) and overall success rate (45.9%) than the laryngeal mask (90.5% and 97.3%, respectively). Those allocated to the laryngeal tube group had a higher ratio of complications (27.8%) compared to the laryngeal mask group (2.7%).CONCLUSIONThis randomised-controlled trial reported that in children undergoing elective anaesthesia, the use of a laryngeal tube was associated with a longer insertion time.","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142187171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Biomarkers of COVID-19 short-term worsening: a multiparameter analysis within the prospective multicenter COVIDeF cohort. COVID-19 短期恶化的生物标志物:前瞻性多中心 COVIDeF 队列中的多参数分析。
IF 4.4 4区 医学
European Journal of Emergency Medicine Pub Date : 2024-09-12 DOI: 10.1097/mej.0000000000001175
Marta Cancella de Abreu,Jacques Ropers,Nathalie Oueidat,Laurence Pieroni,Corinne Frère,Michaela Fontenay,Krystel Torelino,Anthony Chauvin,Guillaume Hekimian,Anne-Geneviève Marcelin,Beatrice Parfait,Florence Tubach,Pierre Hausfater,
{"title":"Biomarkers of COVID-19 short-term worsening: a multiparameter analysis within the prospective multicenter COVIDeF cohort.","authors":"Marta Cancella de Abreu,Jacques Ropers,Nathalie Oueidat,Laurence Pieroni,Corinne Frère,Michaela Fontenay,Krystel Torelino,Anthony Chauvin,Guillaume Hekimian,Anne-Geneviève Marcelin,Beatrice Parfait,Florence Tubach,Pierre Hausfater,","doi":"10.1097/mej.0000000000001175","DOIUrl":"https://doi.org/10.1097/mej.0000000000001175","url":null,"abstract":"BACKGROUNDDuring a pandemic like COVID-19, hospital resources are constrained and accurate severity triage of the patients is required.OBJECTIVEThe objective of this study is to estimate the predictive performances of candidate biomarkers for short-term worsening (STW) of COVID-19.DESIGNProspective, multicenter (20 hospitals in Paris) cohort study of consecutive COVID-19 patients with systematic biobanking at admission, during the first waves of COVID-19 in France in 2020 (COVIDeF cohort).SETTING AND PARTICIPANTSConsecutive COVID-19 patients were screened for inclusion. They were excluded in presence of severity criteria defined by either an ICU admission, mechanical ventilation (including noninvasive ventilation), acute respiratory distress, or in-hospital death before sampling. Routine blood tests measured during usual care and centralized systematic measurement of creatine kinase, C-reactive protein (CRP), procalcitonin, soluble urokinase plasminogen activator receptor (suPAR), high-sensitive troponin T (TnT-hs), N terminal pro-B natriuretic peptide (NT-proBNP), calprotectin, platelet factor 4, mid-regional pro-adrenomedullin (MR-proADM), and proendothelin were performed.OUTCOME MEASURES AND ANALYSESThe primary outcome was STW, defined by a severity criteria within 7 days. A backward stepwise logistic regression model and a 'best subset' approach were used to identify independent association, and the area under the receiving operator characteristics (AUROC) was computed.RESULTSFive hundred and eleven patients were analyzed, of whom 60 (11.7%) experienced STW. Median time to occurrence of a severity criteria was 3 days. At admission, lower values of eosinophils, lymphocytes, platelets, alanine aminotransferase, and higher values of neutrophils, creatinine, urea, CRP, TnT-hs, suPAR, NT-proBNP, calprotectin, procalcitonin, MR-proADM, and proendothelin were predictive of worsening. Stepwise logistic regression identified three biomarkers significantly associated with worsening: CRP [adjusted odds ratio (aOR): 1.10, 95% confidence interval (95% CI): 1.06-1.15 for a 10-unit increase, AUROC: 0.73 (0.66-0.79)], procalcitonin [aOR: 0.42, 95% CI: 0.22-0.81, AUROC: 0.69 (0.64-0.88)], and MR-proADM [aOR: 2.85, 95% CI: 1.74-4.69, AUROC: 0.75 (0.69-0.81)]. These biomarkers outperformed clinical variables except diabetes and cancer comorbidities.CONCLUSIONIn this multicenter prospective study that assessed a large panel of biomarkers for COVID-19 patients, CRP, procalcitonin, and MR-proADM were independently associated with the risk of STW.TRIAL REGISTRATIONClinicalTrials.gov NCT04352348.","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142263971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Videodistraction to reduce agitation in elderly patients in the emergency department: an open label parallel group randomized controlled trial. 通过视频牵引减少急诊科老年患者的躁动:一项开放标签平行分组随机对照试验。
IF 4.4 4区 医学
European Journal of Emergency Medicine Pub Date : 2024-09-12 DOI: 10.1097/mej.0000000000001179
Enver Güvec,Uwe Koedel,Sophia Horster,Vera Pedersen,Stefanie Völk,Michaela Waldow,Florian Weber,Matthias Klein
{"title":"Videodistraction to reduce agitation in elderly patients in the emergency department: an open label parallel group randomized controlled trial.","authors":"Enver Güvec,Uwe Koedel,Sophia Horster,Vera Pedersen,Stefanie Völk,Michaela Waldow,Florian Weber,Matthias Klein","doi":"10.1097/mej.0000000000001179","DOIUrl":"https://doi.org/10.1097/mej.0000000000001179","url":null,"abstract":"BACKGROUND AND IMPORTANCEAgitation of elderly patients in the emergency department (ED) often complicates workup and therapy.OBJECTIVEIn this study, we investigated if agitation in the ED can be reduced by showing calming video sequences in elderly agitated patients.DESIGNSProspective randomized intervention study.SETTINGS AND PARTICIPANTSED patients aged ≥65 years were screened for the risk of agitation/delirium using the 4-A's test (4-AT) test. In case of ≥4 4-AT points, patients were scored using the Richmond Agitation-Sedation Scale (RASS) and the Nursing Delirium Screening Scale (Nu-DESC). They were included in the study if RASS was ≥+2 and Nu-DESC ≥ 4 after informed consent of the legal representative. Patients were then randomized to the intervention or control group. A total of n = 57 patients were included in the study.INTERVENTIONPatients in the intervention group were exposed to projections of calming video sequences for 60 min. Patients in the control group received standard care.OUTCOME MEASURES AND ANALYSISChanges in RASS and Nu-DESC were assessed 30 and 60 min after the intervention was started.MAIN RESULTSA total of 57 patients were included in the study, with 30 patients in the intervention group and 27 patients in the control group. Before the intervention, the median (interquartile range) RASS scores were comparable between the intervention group [3 (2-3)] and the control group [3 (2-3)]. After 30 min of exposure to calming video sequences, patients in the intervention group showed significantly lower RASS and Nu-DESC scores compared to the control group [RASS: 1 (0-1) vs. 2 (1.5-3), P < 0.001; Nu-DESC: 3 (2-4) vs. 5 (4-6), P < 0.001]. This difference persisted at 60 min [RASS: 0 (0-1) vs. 2 (1-2.5), P < 0.001; Nu-DESC: 2 (2-3) vs. 5 (4-6), P < 0.001]. Additionally, fewer patients in the intervention group required additional sedating or antipsychotic medication (1/30) compared to the control group (9/27), with this difference being statistically significant (P = 0.004).CONCLUSIONIn this randomized controlled trial, the use of calming video sequences in elderly patients with agitation in the ED resulted in significant reductions in agitation and the need for additional sedative or antipsychotic medication.","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142187168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Testing the validity of three acute care assessment tools for assessing residents' performance during in situ simulation: the ACAT-SimSit study. 测试三种急症护理评估工具的有效性,以评估住院医师在原位模拟中的表现:ACAT-SimSit 研究。
IF 3.1 4区 医学
European Journal of Emergency Medicine Pub Date : 2024-08-01 Epub Date: 2024-03-19 DOI: 10.1097/MEJ.0000000000001133
Anne-Laure Philippon, Antoine Lefevre-Scelles, Xavier Eyer, Carine Zumstein, Aiham Ghazali, Simon Audibert, Pierrick Le Borgne, Emmanuel Triby, Jennifer Truchot
{"title":"Testing the validity of three acute care assessment tools for assessing residents' performance during in situ simulation: the ACAT-SimSit study.","authors":"Anne-Laure Philippon, Antoine Lefevre-Scelles, Xavier Eyer, Carine Zumstein, Aiham Ghazali, Simon Audibert, Pierrick Le Borgne, Emmanuel Triby, Jennifer Truchot","doi":"10.1097/MEJ.0000000000001133","DOIUrl":"10.1097/MEJ.0000000000001133","url":null,"abstract":"<p><strong>Background: </strong>The assessment of technical and nontechnical skills in emergency medicine requires reliable and usable tools. Three Acute Care Assessment Tools (ACATs) have been developed to assess medical learners in their management of cardiac arrest (ACAT-CA), coma (ACAT-coma) and acute respiratory failure (ACAT-ARF).</p><p><strong>Objective: </strong>This study aims to analyze the reliability and usability of the three ACATs when used for in situ (bedside) simulation.</p><p><strong>Methods: </strong>This prospective multicenter validation study tested ACATs using interprofessional in situ simulations in seven emergency departments and invited training residents to participate in them. Each session was rated by two independent raters using ACAT. Intraclass correlation coefficients (ICC) were used to assess interrater reliability, and Cronbach's alpha coefficient was used to assess internal consistency for each ACAT. The correlation between ACATs' scores and the learners' level of performance was also assessed. Finally, a questionnaire and two focus groups were used to assess the usability of the ACATs.</p><p><strong>Results: </strong>A total of 104 in situ simulation sessions, including 85 residents, were evaluated by 37 raters. The ICC for ACAT-CA, ACAT-coma and ACAT-ARF were 0.95 [95% confidence interval (CI), 0.93-0.98], 0.89 (95% CI, 0.77-0.95) and 0.92 (95%CI 0.83-0.96), respectively. The Cronbach's alphas were 0.79, 0.80 and 0.73, respectively. The ACAT-CA and ARF showed good construct validity, as third-year residents obtained significantly higher scores than first-year residents ( P  < 0.001; P  < 0.019). The raters supported the usability of the tools, even though they expressed concerns regarding the use of simulations in a summative way.</p><p><strong>Conclusion: </strong>This study reported that the three ACATs showed good external validity and usability.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140179472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Using case vignettes to study the presence of outcome, hindsight, and implicit bias in acute unplanned medical care: a cross-sectional study. 利用病例小故事研究急性计划外医疗护理中存在的结果、后见之明和隐性偏见:一项横断面研究。
IF 3.1 4区 医学
European Journal of Emergency Medicine Pub Date : 2024-08-01 Epub Date: 2024-02-16 DOI: 10.1097/MEJ.0000000000001127
Patricia Plaum, Laura N Visser, Bas de Groot, Marlies E B Morsink, Wilma L J M Duijst, Bart G J Candel
{"title":"Using case vignettes to study the presence of outcome, hindsight, and implicit bias in acute unplanned medical care: a cross-sectional study.","authors":"Patricia Plaum, Laura N Visser, Bas de Groot, Marlies E B Morsink, Wilma L J M Duijst, Bart G J Candel","doi":"10.1097/MEJ.0000000000001127","DOIUrl":"10.1097/MEJ.0000000000001127","url":null,"abstract":"<p><strong>Background and importance: </strong>Various biases can impact decision-making and judgment of case quality in the Emergency Department (ED). Outcome and hindsight bias can lead to wrong retrospective judgment of care quality, and implicit bias can result in unjust treatment differences in the ED based on irrelevant patient characteristics.</p><p><strong>Objectives: </strong>First, to evaluate the extent to which knowledge of an outcome influences physicians' quality of care assessment. Secondly, to examine whether patients with functional disorders receive different treatment compared to patients with a somatic past medical history.</p><p><strong>Design: </strong>A web-based cross-sectional study in which physicians received case vignettes with a case description and care provided. Physicians were informed about vignette outcomes in a randomized way (no, good, or bad outcome). Physicians rated quality of care for four case vignettes with different outcomes. Subsequently, they received two more case vignettes. Physicians were informed about the past medical history of the patient in a randomized way (somatic or functional). Physicians made treatment and diagnostic decisions for both cases.</p><p><strong>Setting and participants: </strong>One hundred ninety-one Dutch emergency physicians (EPs) and general practitioners (GPs) participated.</p><p><strong>Outcome measures and analysis: </strong>Quality of care was rated on a Likert scale (0-5) and dichotomized as adequate (yes/no). Physicians estimated the likelihood of patients experiencing a bad outcome for hindsight bias. For the second objective, physicians decided on prescribing analgesics and additional diagnostic tests.</p><p><strong>Main results: </strong>Large differences existed in rated quality of care for three out of four vignettes based on different case outcomes. For example, physicians rated the quality of care as adequate in 44% (95% CI 33-57%) for an abdominal pain case with a bad outcome, compared to 88% (95% CI 78-94%) for a good outcome, and 84% (95% CI 73-91%) for no outcome ( P  < 0.01). The estimated likelihood of a bad outcome was higher if physicians received a vignette with a bad patient outcome. Fewer diagnostic tests were performed and fewer opioids were prescribed for patients with a functional disorder.</p><p><strong>Conclusion: </strong>Outcome, hindsight, and implicit bias significantly influence decision-making and care quality assessment by Dutch EPs and GPs.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11198948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139746449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Authors' response to comment on 'Acute heart failure in elderly patients admitted to the emergency department with acute dyspnea: a multimarker approach diagnostic study'. 作者对 "急诊科收治的急性呼吸困难老年患者的急性心力衰竭:多标志物诊断研究 "评论的回复。
IF 3.1 4区 医学
European Journal of Emergency Medicine Pub Date : 2024-08-01 Epub Date: 2024-06-25 DOI: 10.1097/MEJ.0000000000001125
Omide Taheri, Frédéric Mauny, Patrick Ray, Thibaut Desmettre
{"title":"Authors' response to comment on 'Acute heart failure in elderly patients admitted to the emergency department with acute dyspnea: a multimarker approach diagnostic study'.","authors":"Omide Taheri, Frédéric Mauny, Patrick Ray, Thibaut Desmettre","doi":"10.1097/MEJ.0000000000001125","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001125","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141456057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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