Western Journal of Emergency Medicine最新文献

{"title":"Evaluation of Point-of-Care Ultrasound Use in Emergency Medicine Residents: An Observational Study.","authors":"Michael Fareri, Matthew VandeHei, Benjamin Schnapp, Corlin Jewell, Michael R Lasarev, Roxana Alexandridis, Dana Resop, Sara Damewood, Hani I Kuttab","doi":"10.5811/westjem.21200","DOIUrl":"10.5811/westjem.21200","url":null,"abstract":"<p><strong>Introduction: </strong>Point-of-care ultrasound (POCUS) is integral to emergency medicine (EM) training. It is unclear how EM residents use POCUS and how these skills are maintained as they progress in residency training. The purpose of this study was to evaluate resident use of POCUS at various timepoints in EM training.</p><p><strong>Methods: </strong>This was a retrospective cohort study of EM residents at a single, three-year training program between July 1, 2014-June 30, 2022. Residents were included if they had completed three consecutive years of training and an ultrasound rotation in their postgraduate year (PGY)-1. The following time points were assessed: PGY-1 rotation and 3-, 6-, 12-, 18-, and 24-months post-rotation. Number of scans, accuracy of interpretation, acceptability for credit, and percentage of technically limited studies (TLS) were collected at each point. We analyzed performance characteristics using mixed-effects binomial logistic regression with time as a fixed effect and resident as a random effect. Models were fit separately for each performance characteristic and likelihood ratio tests were performed to determine whether performance varied over time.</p><p><strong>Results: </strong>A total of 65 residents were included with a total of 13,229 exams performed during the study period. Cardiac and focused assessment with sonography in trauma examinations were performed most commonly. Overall accuracy of all exams during the examination period was 97.1% (95% confidence interval [CI] 96.2-98.0%), TLS was 14.5% (95% CI 9.7-20.6%), and acceptability was 82.9% (95% CI 76.3-88.2%). Trend over time (3, 6, 12, 18, and 24 months) found no differences in accuracy (P = 0.84), TLS (P = 0.20), or acceptability (P = 0.28). Further analyses by individual exam types also showed no significant differences in accuracy, acceptability, nor TLS.</p><p><strong>Conclusion: </strong>Accuracy, acceptability, and percentage of technically limited scans did not significantly vary over time, suggesting that POCUS skills are maintained from PGY-1 rotation to each time point evaluated in this study.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"478-485"},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498131","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":"Patient Sociodemographic Factors Are Associated with Receiving Point-of-care Ultrasound in the Emergency Department.","authors":"Brandon M Wubben, Devin Spolsdoff, Karisa K Harland, Marina Del Rios","doi":"10.5811/westjem.21297","DOIUrl":"10.5811/westjem.21297","url":null,"abstract":"<p><strong>Background: </strong>Point-of-care ultrasound (POCUS) is widely used in emergency medicine (EM) and increasingly throughout healthcare. Prior studies have revealed disparities in the use of imaging in the emergency department (ED) based on sociodemographic factors; however, the association between these factors and POCUS use is unknown. Our aim was to compare the odds of receiving POCUS in the ED based on patient race and ethnicity, language, sex, and type of insurance.</p><p><strong>Methods: </strong>We reviewed electronic health records (EHR) matched to a departmental POCUS database from November 2021-June 2023 at an academic Level I trauma center. We included ED patients diagnosed with an International Classification of Diseases code mapped to chest or flank pain, who had a cardiac troponin obtained, or had been evaluated as a trauma activation or alert. Our primary outcome was whether a patient received transthoracic echocardiography (cardiac), renal, or focused assessment with sonography in trauma. Predictor variables were race/ethnicity group (non-Hispanic [NH] White, NH Black, Hispanic, other), patient language, sex assigned at birth, and insurance type as recorded in the EHR. We performed descriptive analyses and logistic regression (adjusted odds ratio [aOR], 95% confidence interval [CI]) controlling for body mass index, age, comorbidities, and triage hypotension or tachycardia.</p><p><strong>Results: </strong>Of the 25,389 ED patients meeting inclusion criteria, 79.5% were NH White, 95.3% listed English as their primary language, 51.5% were female, and 33.4% had private payor insurance. After adjusting for confounding, patients had lower odds of receiving POCUS if they were \"other\" race/ethnicity as compared to NH White (aOR 0.65, CI 0.42-0.99, P = .04), female as compared to male (aOR 0.81, CI 0.69-0.94, P = .007), or if they had Medicare (aOR 0.67, CI 0.54-0.84, P <.001) or Medicaid (aOR 0.66, CI 0.52-0.83, P = .001) as compared to private payors.</p><p><strong>Conclusion: </strong>Overall, patients of female sex and patients with Medicaid or Medicare had lower odds of receiving point-of-care ultrasound in the ED. Although we did not find a difference in POCUS use among non-Hispanic White, NH Black, and Hispanic patients, patients belonging to other race/ethnicity categories had lower odds of receiving POCUS compared to NH White patients.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"486-490"},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498142","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":"Age-stratified Association Between Plasma Adiponectin Levels and Mortality in Septic Patients.","authors":"Hui Wang, Ming Ma, Jingfeng Dong, Jun Duan","doi":"10.5811/westjem.35607","DOIUrl":"10.5811/westjem.35607","url":null,"abstract":"<p><strong>Background: </strong>Plasma adiponectin (APN) levels might be affected by age. In this study we aimed to study the association between plasma APN levels and age and the effects of APN levels on mortality in age-stratified septic patients.</p><p><strong>Methods: </strong>We conducted this single-center, retrospective study with 173 patients with sepsis and 57 controls. Physical and demographic characteristics were recorded, and blood samples were collected to measure plasma APN levels. Using this data, we determined the association between plasma APN levels and age, and the effect of plasma APN levels on mortality in age-stratified septic patients.</p><p><strong>Results: </strong>We stratified patients into three age groups: < 60 years (middle age); 60-80 years (advanced age); and elderly (≥ 80 years). Plasma APN levels increased with increasing age in both the control group and the sepsis group. Mortality also increased with age: 12.3% in the < 60 group; 24.6% in those 60-80 years of age; and 36.2% in elderly patients >80 years (P<0.001). In middle-aged and advanced-age patients, APN levels were found to be associated with 28-day mortality based on the receiver operating characteristic curve analysis. Furthermore, APN levels remained independently associated with 28-day mortality in patients < 80 years. However, in elderly patients the APN levels showed no significant association with 28-day mortality.</p><p><strong>Conclusion: </strong>We found a positive association between plasma adiponectin levels and age in septic patients. Low circulating levels of APN were associated with 28-day mortality in septic patients < 80 years of age. We found no significant association between APN and mortality in sepsis patients who were > 80 years of age.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"609-616"},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498152","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":"Emergency Medical Service Responders' Perspectives on Transgender, Intersexual, and Non-Binary Patients in Germany.","authors":"Torben Brod, Kambiz Afshar, Christoph Schroeder, Carsten Stoetzer, Stephanie Stiel","doi":"10.5811/westjem.39705","DOIUrl":"10.5811/westjem.39705","url":null,"abstract":"<p><strong>Introduction: </strong>Gender minorities, including transgender, intersexual and non-binary (TIN) individuals, are at risk of receiving suboptimal care in emergency departments due to clinicians' limited knowledge and formal training in TIN-specific needs. Little evidence is available regarding emergency medical service (EMS) responders, including paramedics (EMT-P), emergency medical technicians (EMT) ,and prehospital emergency physicians (EP). Therefore, in this study we aimed to explore the experiences and knowledge, attitudes, and education/training needs of EMS professionals in Germany regarding the care of TIN patients.</p><p><strong>Methods: </strong>In April 2023, we electronically surveyed EMTs, EMT-Ps and prehospital EPs from ambulance stations across Germany. Participants completed a questionnaire consisting of 15 closed-ended items assessing their experience and knowledge, attitudes, and education/training needs regarding the care of TIN patients. We used standard descriptive statistics and tested for group differences using the chi-square test.</p><p><strong>Results: </strong>Of the 2,925 potential respondents, 906 completed the survey and were eligible for further analysis (response rate: 31%). Of these, 218 (24%) were prehospital EPs and 688 (76%) were EMTs and EMT-Ps, the latter two being significantly younger and less experienced. Almost half of the respondents reported having experience in caring for TIN patients as EMS responders (45% of EMTs/EMT-Ps vs 40% of prehospital EPs) but demonstrated significant gaps in non-medical and medical knowledge. Attitudes toward TIN patients were generally positive, but there were discrepancies between perceived comfort and actual communication behavior, with up to 25% of respondents overall avoiding questions they would ask non-TIN patients. Most respondents had no formal training in the appropriate management of TIN patients: only 7% of EMTs/EMT-Ps and 5% of prehospital EPs indicated having received such training during their professional or medical training. Our survey showed that 63% of EMTs/EMT-Ps and 62% of prehospital EPs agreed that there is an urgent need to increase awareness for TIN patients among EMS responders.</p><p><strong>Conclusion: </strong>Despite generally positive attitudes toward transexual, intersexual and non-binary patients, EMS responders in Germany demonstrated deficits in knowledge and clinical preparedness to care for this vulnerable patient population, indicating that the care of TIN patients has not yet become routine in EMS and highlighting a strong need for improved education and training.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"458-464"},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498175","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":"Descriptive Analysis of Resources Used to Learn About Residency Programs Since Transition to Virtual Interviews.","authors":"Richard Bounds, John Priester, Benjamin Lewis, Roz King, Skyler Lentz","doi":"10.5811/westjem.33574","DOIUrl":"10.5811/westjem.33574","url":null,"abstract":"<p><strong>Introduction: </strong>The transition to virtual interviews over the past four years has been associated with changes to the ways that applicants collect information on residency programs.</p><p><strong>Methods: </strong>Our program collected free-response data from questionnaires completed by applicants prior to their virtual interview days over the course of four recruitment cycles. We performed a descriptive analysis of these responses to identify the frequency with which students have been accessing various resources to learn about programs, and to learn how that has changed over time.</p><p><strong>Results: </strong>Our findings over four years and 322 applicants (of 391 surveyed, response rate 82%) indicated that the three most common sources of information were individual program websites, the Emergency Medicine Resident's Association (EMRA) Match website, and Instagram. These sources were reported more frequently than personal experience, word of mouth, and advice from mentors. Other online resources were rarely used.</p><p><strong>Conclusion: </strong>These findings may help program leaders to direct their limited time and attention towards marketing their programs through online resources most commonly used by applicants.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"569-572"},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498162","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":"Ultrasound-guided Emergency Pericardiocentesis Simulation on Human Cadavers: A Scoping Review.","authors":"Luca Ünlü, Felix Margenfeld, Adib Zendehdel, Johannes A Griese, Amélie Poilliot, Magdalena Müller-Gerbl, Christian H Nickel, Mirza Dedic","doi":"10.5811/westjem.39696","DOIUrl":"10.5811/westjem.39696","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency pericardiocentesis is a critical but infrequently performed procedure in emergency medicine, necessitating effective training modalities for emergency physicians. In this scoping review we aimed to identify existing literature on simulation of ultrasound-guided pericardiocentesis in human cadavers.</p><p><strong>Methods: </strong>We carried out a scoping review based on a search on the use of sonography on human cadavers. The following databases were searched: MEDLINE; EMBASE; CENTRAL; BIOSIS Previews; and Web of Science Core Collection. Additionally, we performed a gray literature search. Title and abstract screening were done by a single reviewer, and full-text review was performed by two independent reviewers. Studies included were limited to those published in English or German, focusing specifically on ultrasound-guided pericardiocentesis training models in human cadavers, with no restrictions on publication year or outcomes.</p><p><strong>Results: </strong>Our search strategy yielded 9,821 publications and 1,440 reports were assessed for eligibility. Ultimately, four studies met the inclusion criteria. All were conducted in the USA; two used soft-embalmed cadavers, one reported using fresh frozen cadavers, and one did not specify the cadaver type used. All studies accessed the pericardial sac using large-bore catheters or peripheral lines, filling it with (colored) water for simulation.</p><p><strong>Conclusions: </strong>Evidence on ultrasound-guided emergency pericardiocentesis simulation on human cadavers remains limited, but based on the four studies we reviewed human cadavers could be used for (emergency) pericardiocentesis simulation.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"685-691"},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498172","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":"Field vs. Emergency Department Intubation: A Retrospective Review of Hospital Outcomes of Trauma Patients.","authors":"Mitchell Vorce, Sagar Galwankar, Jarrod Shuck, Amit Agrawal","doi":"10.5811/westjem.41184","DOIUrl":"10.5811/westjem.41184","url":null,"abstract":"<p><strong>Introduction: </strong>Definitive airway management is crucial for severely injured trauma patients when basic pre-hospital interventions fail to provide adequate oxygenation and ventilation. Endotracheal intubation by emergency medical service (EMS) personnel is often necessary before reaching the emergency department (ED). While some studies suggest that advanced airway protocols in the pre-hospital setting improve survival in patients with severe head injuries, others indicate potential complications and adverse outcomes associated with pre-hospital intubation. In this study we aimed to evaluate whether trauma patients who underwent intubation by EMS in the field experienced different hospital outcomes compared to those intubated by physicians in the ED. Specifically, it assessed the impact of pre-hospital intubation on the number of days requiring mechanical ventilation, intensive care unit length of stay (ICU LOS), and overall hospital LOS.</p><p><strong>Methods: </strong>We conducted a retrospective chart review at a single, level II trauma center from January 1, 2019-December 31, 2023, involving trauma patients requiring intubation. Patients were divided into two groups: 608 patients ED department (ED ETT). Primary outcomes included days on mechanical ventilation, while secondary outcomes included ICU and hospital LOS. An independent t-test was performed to compare the differences in mean ventilator days, ICU LOS, and hospital LOS between the two groups, accepting P-value of <0.10 as significant.</p><p><strong>Results: </strong>The study included 1,010 patients, with a mean age of 55.5 years in the ED group and 52.5 years in the pre-hospital group. No statistically significant differences were found in mean ventilator days (4.1 ± 4.6 days for the ED group and 4.1 ± 5.7 days for the pre-hospital group), ICU LOS (5.8 ± 6.1 days in the ED ETT group vs 5.6 ± 7.4 days in the pre-hospital ETT group), or overall hospital LOS (10.1 ± 13.6 days in the ED group vs 10.2 ± 17.5 days in the pre-hospital group).</p><p><strong>Conclusion: </strong>These findings indicate no significant differences in patient outcomes between those intubated pre-hospital and those intubated in the ED. Further research is needed to make modifications to airway management protocols in the pre-hospital setting.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"751-757"},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498134","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":"Moving Beyond \"Check A Box\": Shifting Physician Perceptions and Culture with an Antiracism and Equity Curriculum.","authors":"Hannah Barber Doucet, Timmy Lin, Taneisha Wilson","doi":"10.5811/westjem.20797","DOIUrl":"10.5811/westjem.20797","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this study was to evaluate the impact of the Discussing Anti-Racism and Equity (DARE) curriculum on individual physician knowledge and practice, as well as on perceptions of group culture.</p><p><strong>Methods: </strong>DARE was a longitudinal multimodal curriculum targeted at pediatric and adult emergency medicine (EM) trainees and faculty, made up of 12 lectures/workshops, three simulations, five book clubs, and two movie screenings. We used a multiphase, parallel convergent mixed-methods approach. Focus groups before and after DARE explored prior education, antiracism attitudes and behaviors, perceived impact of intervention curriculum, and perceptions of departmental medical culture. We elucidated themes using thematic analysis. Surveys of trainees and attendings evaluated individual attitudes and practices related to equity and antiracism.</p><p><strong>Results: </strong>We held nine focus groups with a total of 52 participants. Half of participants were EM residents (26), and half were faculty (12 pediatric EM and 14 general EM). Four major themes emerged around antiracism education and DARE. Both trainees and faculty reported a lack of standardized or effective prior education, although trainees are beginning to report increased exposure in medical school. Participants reported an overall positive impact of DARE on individual knowledge and practice, with continued room for improvement. Focus groups particularly highlighted a perceived shift in departmental antiracist culture post-DARE. Finally, future curricular aims were elucidated. A total of 56 surveys showed significant improvement in all realms of antiracism medical- practice questions when posed as retrospective pre-post questions (P < 0.01).</p><p><strong>Conclusion: </strong>The DARE curriculum increased individual antiracism awareness and cultivated culture shift among the targeted clinician group. Focus groups provided clear next steps for ongoing and expanded education.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"441-451"},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498139","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":"Practical Status and Social Background of Current Mobile Stroke Units Worldwide: A Survey and Investigation.","authors":"Masahiko Hiroki, Mototsugu Kohno, Yutaka Kohno, Masaki Misawa","doi":"10.5811/westjem.21267","DOIUrl":"10.5811/westjem.21267","url":null,"abstract":"<p><strong>Background: </strong>We aimed to clarify the current challenges involved in introducing and operating mobile stroke units (MSU) in new regions, considering the social background of regions with MSUs.</p><p><strong>Methods: </strong>We conducted a questionnaire survey on the operational and financial status of all active MSU programs worldwide as of March 2023, and investigated the demographic, economic, and healthcare backgrounds of areas with and without active MSUs. We compared the data for the two groups at the country, state, or city level. We then correlated data gathered from the survey and the investigation.</p><p><strong>Results: </strong>Of the 33 MSU programs contacted, 19 (59%) responded. The responding programs treated a range of 52-1,663 (median 781) patients at an MSU per year. The most commonly reported hours of operation were eight hours every weekday (5, 26%). The majority had four staff on board (11, 58%). No physicians were on board in six MSUs (32%). The catchment area radius ranged from 5-250 (median 22) kilometers. The start-up costs and subsequent annual operation costs of an MSU ranged from $0.7-1.8 million (median 1.0) and $0.7-1.7 (median 1.0) million US dollars, respectively. Reimbursement was obtained by eight (47%), with full reimbursement by two (12%). A negative gross financial balance was reported in eight MSUs (53%, of 15), and a financial challenge was reported in 17 (94%, of 18). Compared to the non-MSU group at the country level, active MSU groups had a significantly higher population, nominal gross domestic product, healthcare access and quality index, and physician density. They also had significantly lower age-standardized stroke incidence rates and age-standardized stroke disability-adjusted life year rate. The MSU operation time was significantly positively correlated with age-standardized stroke incidence rate and negatively with physician density.</p><p><strong>Conclusion: </strong>Despite facing serious financial problems, mobile stroke units currently operate around the world. However, the social context of MSUs appears relatively advanced. For future implementation of MSUs, cost-saving strategies and reimbursements should be addressed, and national or regional social backgrounds should be considered.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"700-711"},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498144","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":"Ending Nuclear Weapons, Before They End Us.","authors":"Kamran Abbasi, Parveen Ali, Virginia Barbour, Marion Birch, Inga Blum, Peter Doherty, Andy Haines, Ira Helfand, Richard Horton, Kati Juva, Jose F Lapena, Robert Mash, Olga Mironova, Arun Mitra, Carlos Monteiro, Elena N Naumova, David Onazi, Tilman Ruff, Peush Sahni, James Tumwine, Carlos Umaña, Paul Yonga, Chris Zielinski","doi":"10.5811/westjem.47301","DOIUrl":"10.5811/westjem.47301","url":null,"abstract":"","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"378-380"},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498178","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}