Western Journal of Emergency Medicine最新文献

{"title":"Personality Traits and Burnout in Emergency Medicine Residents.","authors":"Brendan Freeman, Lukasz Cygan, Laura Melville, Theodore Gaeta","doi":"10.5811/westjem.21139","DOIUrl":"10.5811/westjem.21139","url":null,"abstract":"<p><strong>Background: </strong>Burnout is prevalent in medical training, and some data indicates certain personality types are more susceptible. The criterion reference for measurement of burnout is the Maslach Burnout Inventory (MBI), which scores three factors: emotional exhaustion (EE); depersonalization (DP); and personal accomplishment (PA). Emotional exhaustion most closely correlates with burnout. Studies have yet to evaluate a link between burnout markers and certain personality traits in emergency medicine (EM) residents. The personality traits of openness, agreeableness, extraversion, conscientiousness, and neuroticism can be measured with a 50-item International Personality Item Pool (IPIP) Big 5 survey. Our goal in this study was to be the first to examine the relationship between personality traits and burnout among EM residents and guide future research on potential predictors of burnout and targeted interventions for resident well-being.</p><p><strong>Methods: </strong>This was an observational, cross-sectional study conducted in March and April of 2023 in an urban, Level II trauma center, involving all EM residents at a three-year residency program. Two surveys, the IPIP and MBI-Human Services Survey, were distributed to all residents, and their responses were anonymous. We calculated raw/mean scores and standard deviations for each personality trait/burnout measure and compared them by the Pearson correlation coefficient.</p><p><strong>Results: </strong>All 38 residents completed the surveys. A total of 31% of the cohort reported high exhaustion, 13% reported high DP, and 42% reported low PA. Two of 38 (5%) residents reported the combination of high EE, high DP, and low PA. There was a statistically significant negative correlation between conscientiousness and EE (<i>n</i> = 38; Pearson <i>r</i> = -0.40, <i>P</i> < 0.001) and a positive correlation between conscientiousness and PA (<i>n</i> = 38; Pearson <i>r</i> = 0.36, <i>P</i> = 0.03).</p><p><strong>Conclusion: </strong>In our sample, residents who were more conscientious reported experiencing lower levels of emotional exhaustion and a greater sense of personal accomplishment. Programs may cautiously explore the potential of assessing resident personality traits as part of broader efforts to identify predictors of burnout, but further research with larger, multicenter, longitudinal samples is needed to corroborate these results. The small sample size and single-center design may limit generalizability of these findings, and the use of self-reported measures introduces the risk of response bias.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"241-245"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721486","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":"Analysis of the Highest Altmetrics-scored Articles in Emergency Medicine Journals.","authors":"Başak Bayram, Murat Cetin, Önder Limon, Brit Long, Michael Gottlieb","doi":"10.5811/westjem.21201","DOIUrl":"10.5811/westjem.21201","url":null,"abstract":"<p><strong>Introduction: </strong>Alternative metrics (altmetrics) have emerged as invaluable tools for assessing the influence of scholarly articles. In this study we aimed to evaluate correlations between Altmetric Attention Scores (AAS), and sources and actual citations in articles displaying the highest AAS within emergency medicine (EM) journals.</p><p><strong>Methods: </strong>We conducted an analysis of EM journals listed in the Science Citation Index Expanded (SCIE) using the Altmetric Explorer tool. We analyzed the journals that received the highest number of mentions, the sources of AAS, the regions most frequently mentioned, and the geographical distribution of mentions. In the subsequent stage of our analysis, we conducted an examination of the 200 top-ranked articles that had received high AAS and were published in SCIE EM journals from January 1, 2013-January 1, 2023. We sought to determine the correlations between the AAS and the citation counts of articles on Google Scholar and the Web of Science (WOS).</p><p><strong>Results: </strong>Of 40,840 research outputs evaluated, there were 510,047 shares across multiple platforms. The AAS were present for 36,719 articles (89.9%), while 10.1% had no score. In the review of the top 200 articles with the highest AAS, the median score was 382.5 (interquartile range 301.3-510.8). Of the research output evaluated, 38% were observational studies, 13% case reports, and 13% reviews/meta-analyses. The most common research topics were emergency department (ED) management and COVID-19. There was no correlation between AAS and WOS citation numbers (r_s = -0.041, <i>P</i> = 0.563, 95% confidence interval [CI] -0.175-0.087). There was a weak correlation identified between WOS citations and mentions on X, and a moderate correlation observed for WOS citations and blog mentions (r_s = 0.330, <i>P</i> < .001, 95% CI 0.174 to 0.458; r_s ² = 0.109, and r_s = 0.452, <i>P</i> < .001, 95% CI 0.320-0.566; and r_s ² = 0.204, respectively). However, we found a strong positive correlation between WOS citations and the number of Mendeley readers (r_s = 0.873, <i>P</i> < .001, 95% CI 0.82-0.911, r_s ² = 0.762).</p><p><strong>Conclusion: </strong>While most articles in EM journals received an AAS, we found no correlation with traditional citation metrics. However, Mendeley readership numbers showed a strong positive correlation with citation counts, suggesting that academic platform engagement may better predict scholarly impact.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"353-363"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721606","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":"Virtual Interviews Correlate with Home and In-State Match Rates at One Emergency Medicine Program.","authors":"Christine Motzkus, Casey Frey, Aloysius Humbert","doi":"10.5811/westjem.21292","DOIUrl":"10.5811/westjem.21292","url":null,"abstract":"<p><strong>Introduction: </strong>Incorporating virtual interviews into residency recruitment may help diversify access to residency programs while reducing the cost involved with travel and lodging. Programs may be more likely to rank students they have met in person at an interview when compared to unknown virtual applicants. Our objective was to characterize home institution, in-state, and in-region match rates to emergency medicine (EM) residency programs for fourth-year medical students.</p><p><strong>Methods: </strong>We used National Residency Matching Program data available to the program director to identify medical school and match location of fourth-year medical students who interviewed at a large EM residency program in the Midwest from 2018-2023. Students' medical schools and ultimately matched programs were mapped to Electronic Residency Application Service geographic regions; subgroup analyses evaluated allopathic and osteopathic medical students separately. We used chi-square tests to compare proportions of students matching to home, in-state, or in-region programs across years.</p><p><strong>Results: </strong>There were 1,401 applicants with match information available. The percentage of students matching to a home institution remained stable over the course of the study. The percentage of students matching to an in-state institution increased over the first two years of virtual interviews rising from 23.2% in the 2020 match to 30.8% in-state matches for the 2022 match. Chi-square tests did not reveal any significant differences among groups for all applicants. Allopathic medical students demonstrated a significant increase in matches to home institutions. In-region matches stayed relatively stable over the study time frame regardless of subgroup.</p><p><strong>Conclusion: </strong>Virtual interviews changed the landscape of residency interviews. Home institution and in-state matches may be more likely for applicants from allopathic schools who participated in a virtual interview as both programs and applicants are more familiar with each other; however, our study did not find convincing evidence of this possibility among all applicants. Additional study is needed to determine ongoing effects of the transition to virtual interviews.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"285-289"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721630","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":"Effort During Ethanol Breath Testing Impacts Correlation with Serum Ethanol Concentration.","authors":"Samuel J Stellpflug, William H Menton, Bjorn C Westgard, Ryan D Johnsen, Alexander M Coomes, Robert C LeFevere, Michael D Zwank","doi":"10.5811/westjem.24998","DOIUrl":"10.5811/westjem.24998","url":null,"abstract":"<p><strong>Introduction: </strong>The gold standard for quantifying ethanol intoxication in patients is serum testing. However, breath testing is faster, less expensive, and less invasive. It is unknown whether perceived effort during a breath ethanol test impacts the accuracy of the test and the correlation with serum concentration. In this study we analyzed whether perceived \"poor\" effort during breath ethanol testing would result in worse correlation than perceived \"normal\" breath-testing effort with respect to serum ethanol concentration.</p><p><strong>Methods: </strong>Subjects were identified retrospectively over a 49-month period if they had both a breath ethanol test and a serum ethanol test obtained during the same ED visit within 60 minutes of each other, if they had their effort during the breath test recorded as \"normal\" or \"poor\" by the person administering the test, and had non-zero breath and serum ethanol concentrations. We completed descriptive and correlation analyses.</p><p><strong>Results: </strong>A total of 480 patients were enrolled, 245 with normal and 235 with poor effort. The patients with normal breath-test effort had mean breath and serum concentrations of 0.19 grams per deciliter (g/dL) and 0.23 g/dL, respectively. The patients with poor breath-test effort had mean breath and serum concentrations of 0.19 and 0.29 g/dL, respectively. The correlation coefficient between breath and serum ethanol values was 0.92 (95% confidence interval (CI) 0.84-0.96) for good effort and 0.63 (95% CI 0.53-0.74) for poor effort.</p><p><strong>Conclusion: </strong>The assessment of breath exhalation effort is meaningful in determining how well a patient's breath ethanol level correlates with the serum ethanol concentration. Poor breath effort, when compared to normal breath effort, was associated with higher ethanol levels as well as a larger difference and a greater variability between breath and serum values. If an accurate ethanol level is important for clinical decision-making, a physician should not rely on a poor-effort breathalyzer value.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"364-366"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721661","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":"Survey of Firearm Storage Practices and Preferences Among Parents and Caregivers of Children.","authors":"Meredith B Haag, Catlin H Dennis, Steven McGaughey, Tess A Gilbert, Susan DeFrancesco, Adrienne R Gallardo, Benjamin D Hoffman, Kathleen F Carlson","doi":"10.5811/westjem.21205","DOIUrl":"10.5811/westjem.21205","url":null,"abstract":"<p><strong>Introduction: </strong>The American College of Emergency Physicians supports community- and hospital-based programs that intervene to prevent firearm-related injury. To this end, the distribution of firearm locks or storage devices in the emergency department (ED) may help achieve this target. To inform secure firearm storage programs for households with children and firearms, we examined firearm storage practices, device preferences, and cost tolerance among parents/caregivers of children.</p><p><strong>Methods: </strong>Between April 2018-November 2019, we conducted and analyzed an in-person survey of 294 caregivers, aged ≥18, with both children and firearms in the home. Surveys assessed reasons for firearm ownership, storage practices and device preferences among five storage-device options, and prices participants were willing to pay for devices. Practices and preferences were examined by participant characteristics. We used logistic regression to estimate odds ratios and 95% confidence intervals for associations of interest.</p><p><strong>Results: </strong>Most participants (73%) reported personal protection as a reason for owning firearms, and nearly 80% owned at least one firearm storage device. Over half (55%) owned cable locks, but only 36% of owners reported regularly using them. Rapid-access devices (electronic and biometric lockboxes) were less commonly owned (26%) but more likely to be regularly used (73%). The most highly rated storage device features were the following: the ability to store the firearm unloaded (87.3%); the ability to store the firearm loaded (79.1%); and device affordability (65%). Most participants (78%) preferred rapid-access devices over other options. Participants were willing to pay more for products that afforded rapid access to the firearm. Participants reported they would pay a median of $100 for a pushbutton rapid-access product ($80 retail), and $150 for a biometric lockbox ($210 retail).</p><p><strong>Conclusion: </strong>Understanding the storage practices and preferences among firearm-owning households with children can help inform ED injury-prevention screening and firearm safety practice implementation. Our results suggest that rapid-access devices may be the most preferable firearm storage devices for distribution by secure storage programs, and costs are likely minimal given parental/caregiver willingness to pay.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 1","pages":"142-146"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366154","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":"Preparation for Rural Practice with a Multimodal Rural Emergency Medicine Curriculum.","authors":"Ashley K Weisman, Skyler A Lentz, Julie T Vieth, Joseph M Kennedy, Richard B Bounds","doi":"10.5811/westjem.18573","DOIUrl":"10.5811/westjem.18573","url":null,"abstract":"","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 1","pages":"62-65"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366149","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":"Leadership Perceptions, Educational Struggles and Barriers, and Effective Modalities for Teaching Vertigo and the HINTS Exam: A National Survey of Emergency Medicine Residency Program Directors.","authors":"Mary McLean, Justin Stowens, Ryan Barnicle, Negar Mafi, Kaushal Shah","doi":"10.5811/westjem.20787","DOIUrl":"10.5811/westjem.20787","url":null,"abstract":"<p><strong>Introduction: </strong>The utility of the three-part bedside oculomotor exam HINTS (head impulse test, nystagmus, test of skew) in the hands of emergency physicians remains under debate despite being supported by the most recent literature. Educators historically lack consensus on how specifically to teach this skill to emergency medicine (EM) residents, and it is unknown whether and how EM residency programs have begun to implement HINTS training into their curricula. We aimed to characterize the state of HINTS education in EM residency and develop a needs assessment.</p><p><strong>Methods: </strong>In this cross-sectional study, we administered a survey to EM residency directors, the themes of which centered around HINTS education perceptions, practices, resources, and needs. We analyzed Likert scales with means and 95% confidence intervals for normally distributed data, and with medians and interquartile ranges for non-normally distributed data. Frequency distributions, means, and standard deviations were used in all other analyses.</p><p><strong>Results: </strong>Of 250 eligible participants, 201 (80.4%) responded and consented. Of the 192 respondents providing usable data, 149/191 (78.0%) believed the HINTS exam is valuable to teach; 124/192 (64.6%) reported HINTS educational offerings in conference; and 148/192 (77.1%) reported clinical bedside teaching by faculty. The most-effective educational modalities were clinical bedside teaching, online videos, and simulation. Subtopic teaching struggles with regard to HINTS were head impulse test and test-of-skew conduction and interpretation, selection of the correct patients, and overall HINTS interpretation. Teaching barriers centered around lack of faculty expertise, concern for poor HINTS reproducibility, and lack of resources. Leadership would dedicate a mean of 2.0 hours/year (SD 1.3 hours/year) to implementing a formal, standardized HINTS curriculum.</p><p><strong>Conclusion: </strong>Despite controversy surrounding the utility of the HINTS exam in EM, most residency directors believe it is important to teach. This needs assessment can guide development of formal educational and simulation curricula focusing on residency directors' cited HINTS exam educational struggles, barriers, and reported most-effective teaching modalities.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 1","pages":"70-77"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366125","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":"A Pilot Study Assessing Left Ventricle Diastolic Function in the Parasternal Long-axis View.","authors":"Mümin Murat Yazici, Nurullah Parça, Enes Hamdioğlu, Meryem Kaçan, Özcan Yavas I, Özlem Bilir","doi":"10.5811/westjem.21272","DOIUrl":"10.5811/westjem.21272","url":null,"abstract":"<p><strong>Introduction: </strong>Spectral Doppler echocardiography is used to evaluate diastolic dysfunction of the heart. However, it is difficult to assess diastolic function with this modality in emergency department (ED) settings. Based on the hypothesis that E-point septal separation (EPSS) measured by M-mode in the parasternal long-axis (PSLA) view may facilitate the assessment of diastolic function in emergency patient care, we aimed to investigate whether EPSS measured by M-mode in the PSLA view correlates with spectral Doppler assessment in patients with grade 1 diastolic dysfunction.</p><p><strong>Methods: </strong>We performed this prospective, observational, single-center study was performed in the ED of a tertiary training and research hospital. All patients who presented to the emergency critical care unit with symptoms of heart failure were evaluated by the cardiology department, had grade 1 diastolic dysfunction confirmed by the cardiology department, and did not meet any of the study's exclusion criteria. The study population of 40 (included rate 14%) was formed after the exclusion criteria were applied to 285 patients who met these conditions. Patients included in the study underwent spectral Doppler measurements in the apical four-chamber (A4C) view followed by M-mode measurements in the PSLA view. We then compared the measurements.</p><p><strong>Results: </strong>The correlation between the early diastolic velocity of the mitral inflow to the late diastolic velocity (E/A) ratio in spectral Doppler measurements and the EPSS/ A-point septal separation (APSS) ratio in M-mode was strong (correlation coefficient 0.677, <i>P</i> = 0.001). Similarly, the correlation between E in spectral Doppler measurements and the EPSS/APSS ratio in M-mode measurements was also moderately strong (correlation coefficient 0.557, <i>P</i> = 0.001).</p><p><strong>Conclusion: </strong>A significant correlation exists between the M-mode EPSS/APSS ratio measurement in the PSLA view and the spectral Doppler E/A ratio measurement in the A4C window to evaluate grade 1 diastolic dysfunction. This association suggests that M-mode measurements in the PSLA may be used in diastolic dysfunction.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 1","pages":"1-9"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365832","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":"Characteristics and Outcomes of Implementing Emergency Department-based Intensive Care Units: A Scoping Review.","authors":"Jutamas Saoraya, Liran Shechtman, Paweenuch Bootjeamjai, Khrongwong Musikatavorn, Federico Angriman","doi":"10.5811/westjem.24874","DOIUrl":"10.5811/westjem.24874","url":null,"abstract":"<p><strong>Introduction: </strong>The prolonged stay of critically ill patients in the emergency department (ED) may lead to worse clinical outcomes. An emergency department (ED)-based intensive care unit (ICU) is one of the proposed solutions to deliver critical care in the ED. We thus aimed to characterize existent ED-ICU models and their reported association with clinical outcomes in critically ill adult patients.</p><p><strong>Methods: </strong>We searched the Ovid MEDLINE database from inception to October 2, 2023. We included studies that report an ED-ICU structure, defined as a space capable of providing ICU-level care within or adjacent to the ED, and its characteristics. We excluded personnel-focused intervention (without the presence of a separated space) or a space without ICU-level care capability. We collected information on process measures, patient-related outcomes, and cost-related outcomes.</p><p><strong>Results: </strong>We screened 2,824 studies, of which 125 full-text articles were assessed for eligibility and 31 studies were included in this scoping review. Studies reported on 14 ED-ICUs across seven countries, with capacities ranging from 3-17 beds. All ED-ICUs served early and ongoing critical care needs in the ED, including three distinct themes: short-stay; palliative care; and disaster-response ICUs. Implementing the ED-ICU was associated with decreased time to ICU-level care and reduced number of inpatient ICU admissions, but it was not consistently associated with improved survival.</p><p><strong>Conclusion: </strong>Several ED-ICUs have been established around the world with different characteristics depending on local needs. Implementation of the ED-ICU may be associated with improved clinical outcomes and patient flow.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 1","pages":"78-85"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366016","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":"Needs Assessment and Tailored Training Pilot for Emergency Care Clinicians in the Prehospital Setting in Rwanda.","authors":"Naz Karim, Jeanne D'Arc Nyinawankusi, Mikaela S Belsky, Pascal Mugemangango, Zeta Mutabazi, Catalina Gonzalez Marques, Angela Y Zhang, Janette Baird, Jean Marie Uwitonze, Adam C Levine","doi":"10.5811/westjem.18698","DOIUrl":"10.5811/westjem.18698","url":null,"abstract":"<p><strong>Background: </strong>In low- and middle-income countries (LMIC), 45% of deaths could be addressed by implementation of an emergency medical services (EMS) system. Prehospital care is a critical component of EMS worldwide, and basic, affordable training has been shown to improve EMS systems. However, patient outcome impact is unclear. In this study we aimed to assess the current state of prehospital care in Kigali, Rwanda, through a needs assessment, focused training intervention, and analysis of current practices and patient outcomes.</p><p><strong>Methods: </strong>We identified 30 clinicians through the prehospital medical command office and included them in the study. A prospective, nonrandomized, interrupted time-series approach was used. Data collected through closed- and open-ended questionnaires included age, sex, training, and knowledge assessment. We used the data to create a tailored, 18-hour training after which immediate and 11-month post-tests were administered. Linked prehospital and hospital care datasets allowed for evaluation of patient outcomes and prehospital process indicators that included training skill application, airway intervention, intravenous fluid administration, and glucose administration.</p><p><strong>Results: </strong>Of 30 clinicians, 18 (60%) were female, 19 were nurses, and 11 were nurse anaesthetists. Median age was 36, and median years providing care was 10 (IQR 7-11). Twenty-four (80%) participants completed immediate and post-test assessments. Mean knowledge across 12 core skills significantly improved from a pre-test mean of 59.7% (95% confidence interval [CI] 42.2-77.20) to a post-test mean of 87.8% (95% CI 74.7-100). At 11 months post-training, the score improvement maintained, with a mean score of 77.6% (95% CI 59.2-96.8). For patient outcomes, the total sample size was 572 patients; 324 of these patients were transported to the ED during the pre-training period (56.4%), while 248 were transported post-training. Prehospital oxygen administration for patients with a saturation level of <95% significantly increased pre- to post-training (66.7% to 71.7%; Δ = 5.0%; Δ95% CI 1.9,-8.1%). No significant changes were noted in patient treatment outcomes or other process indicators due to small sample sizes.</p><p><strong>Conclusion: </strong>This study provides insights on Rwandan EMS and demonstrates that a tailored intervention targeting education on prehospital process indicators has positive impacts on clinician knowledge and practice.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 1","pages":"103-110"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366127","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}