Open Access Emergency Medicine最新文献

{"title":"Impact of Different Treatments for Disseminated Intravascular Coagulation on Patients with or without Biliary Drainage for Severe Biliary Tract Infection","authors":"Makoto Kobayashi, Shun Takai, Kyohei Sakurai, Yoshimatsu Ehama","doi":"10.2147/oaem.s423097","DOIUrl":"https://doi.org/10.2147/oaem.s423097","url":null,"abstract":"Objective: Sepsis caused by severe acute cholangitis requires biliary drainage to decrease the intra-biliary pressure. Furthermore, several studies showed that anticoagulant treatment can improve the outcomes of patients with sepsis-associated disseminated intravascular coagulation (DIC). There were reports examining the efficacy of anti-DIC drugs in patients undergoing biliary drainage with sepsis-associated DIC, and no reports compared the efficacy of DIC treatments when no drainage is performed. In this study, the influence of antithrombin (AT) replacement therapy and recombinant thrombomodulin (rTM) preparations on the overall survival (OS) of patients with and without biliary drainage was analyzed. Patients and Methods: This retrospective cohort study in a single institution involved patients with sepsis-associated DIC caused by severe biliary tract infection. In total, 71 patients treated by either AT replacement therapy or rTM preparation were assessed for inclusion. The two groups were patients with biliary drainage (n = 45) and without drainage (n = 26). To assess the clinical efficacy of anti-DIC drugs in each group, the 60-day OS was determined through estimated survival analysis. Results: Focusing on the effects of different therapeutic agents for DIC, in the group of patients with biliary drainage, OS showed no difference between patients treated by rTM and AT. However, in patients without biliary drainage, the survival curves of patients treated with AT replacement were lower than those of patients with rTM preparation. Conclusion: This study revealed that the OS of patients without biliary drainage differed depending on the DIC therapeutic agent for sepsis-associated DIC caused by acute cholangitis. We would recommend the use of rTM preparation over AT replacement therapy for patients who cannot undergo biliary drainage. Keywords: sepsis, antithrombin, recombinant thrombomodulin, DIC treatment, acute cholangitis","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"27 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135765483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Clinical Value of Comprehensive Nursing Intervention in Preventing Severe Lymphopenia and Improving the Survival Rate Among Patients with Sepsis.","authors":"Lin Zhang,&nbsp;Chao Xu,&nbsp;Lin Bai,&nbsp;Lin Li,&nbsp;Jinyan Guo,&nbsp;Yanyi Li","doi":"10.2147/OAEM.S433980","DOIUrl":"10.2147/OAEM.S433980","url":null,"abstract":"<p><strong>Background: </strong>Intensive care unit (ICU) patients with sepsis who experience severe lymphopenia are at a higher risk of mortality, and they serve as a more accurate indicator of bacteremia compared to traditional infection markers.</p><p><strong>Aim: </strong>Our study aimed to examine the influence of severe lymphopenia on ICU mortality and outcomes in sepsis patients, while also evaluating the clinical significance of comprehensive nursing intervention in preventing severe lymphopenia.</p><p><strong>Methods: </strong>Patients with sepsis in the ICU at our hospital between January 2015 and January 2021 were split into a control group and a test group.The control group received regular nursing care, while the test group was provided with comprehensive nursing care in addition to the control group. The results encompassed mortality rates of 28 days, mortality rates of 1 year, and lengths of stay in the ICU.</p><p><strong>Results: </strong>Our attention was directed towards day 4 absolute lymphocyte counts, taking into account the receiver operating characteristic (ROC) outcome. Patients with severe lymphopenia were older, more patients with 2 above comorbidities, higher co-infection rates and SOFA score. In addition, patients with severe lymphopenia required longer days stay in ICU (<i>P</i><0.001), and presented with higher 28-day mortality (<i>P</i>=0.038) and 1-year mortality (<i>P</i>=0.004). Patients in control group have a higher incidence of severe lymphopenia (<i>P</i>=0.006), 28-day mortality (<i>P</i>=0.015) and 1-year mortality (<i>P</i>=0.019) compared with the test group.</p><p><strong>Conclusion: </strong>Comprehensive nursing intervention can prevent the occurrence of severe lymphopenia, improve patients satisfaction and reduce mortality.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"15 ","pages":"393-403"},"PeriodicalIF":1.5,"publicationDate":"2023-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/75/e9/oaem-15-393.PMC10599247.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54231528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Adverse Outcome and Its Predictors After Emergency Laparotomy Among Sigmoid Volvulus Patients: Retrospective Follow-Up Study.","authors":"Tilahun Deresse,&nbsp;Esubalew Tesfahun,&nbsp;Zenebe Abebe Gebreegziabher,&nbsp;Mandante Bogale,&nbsp;Dawit Alemayehu,&nbsp;Megbar Dessalegn,&nbsp;Tewodros Kifleyohans,&nbsp;George Eskandar","doi":"10.2147/OAEM.S430193","DOIUrl":"10.2147/OAEM.S430193","url":null,"abstract":"<p><strong>Background: </strong>Acute sigmoid volvulus is a surgical emergency with closed-loop obstruction of the colon that often requires emergency laparotomy, which is associated with a multitude of post-operative complications. Although sigmoid volvulus is the main cause of intestinal obstruction in Ethiopia, local studies of its management outcomes are limited.</p><p><strong>Objective: </strong>To assess the magnitude and predictors of adverse perioperative outcomes of emergency laparotomy for acute sigmoid volvulus in the Debre Markos Comprehensive Specialized Hospital (DMCSH), Amhara region, Ethiopia in 2023.</p><p><strong>Methods: </strong>This was a retrospective follow-up study. Descriptive statistics were used to measure perioperative outcomes and other study variables. Bivariable and multivariable logistic regression models were used to identify the predictors of adverse surgical outcomes. Associations were considered significant at p < 0.05 (95% confidence interval).</p><p><strong>Results: </strong>In total, 170 study participants were enrolled, with a response rate of 91.4%. Forty-nine patients (28.8%) developed perioperative adverse outcomes. Pneumonia (29 patients, 28.1%), surgical site infection (19 patients, 18.4%), and wound dehiscence (10 patients, 9.7%) were the most common complications. Pre-operative shock [AOR: 3.87 (95% CI: (1.22, 12.28))], pus or fecal matter contamination of the peritoneum [AOR: 4.43 (95% CI: (1.35, 14.47)], and a higher American Society of Anesthesiologists (ASA) score [AOR: 2.37 (95% CI: (1.05, 5.34))] were identified as predictors of perioperative adverse events.</p><p><strong>Conclusion: </strong>The perioperative adverse outcomes in this study were higher than those reported in Ethiopian national and global reports following emergency laparotomies. Hypotension at presentation, pus and/or fecal matter contamination of the peritoneum, and higher ASA scores are strong predictors of increased perioperative adverse outcomes. Therefore, healthcare providers and institutions involved in the delivery of emergency surgical care should emphasize the importance of early surgical intervention, adequate resuscitation, and patient monitoring to improve perioperative outcomes.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"15 ","pages":"383-392"},"PeriodicalIF":1.5,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ef/e2/oaem-15-383.PMC10591608.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50159035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Triage of Suspected COVID-19 Cases in Sudan's Emergency Settings: A Clinical Audit.","authors":"Bayan E Ibrahim,&nbsp;Rahba Osman El-Amin,&nbsp;Safia Tarig Adam Abdulla","doi":"10.2147/OAEM.S433240","DOIUrl":"10.2147/OAEM.S433240","url":null,"abstract":"<p><strong>Background: </strong>The inevitable coronavirus disease 2019 global pandemic has severely affected Sudan's fragile healthcare system. The authors share the experience of COVID-19 triage in the emergency departments of five public hospitals in Khartoum state, Sudan.</p><p><strong>Methods: </strong>A clinical audit was conducted in December 2020 using the Centers for Disease Control and Prevention Checklist and Monitoring Tool for Triage of Suspected COVID-19 Cases. The tool was categorised into 5 domains and 38 indicators.</p><p><strong>Results: </strong>Only three hospitals had hand hygiene stations in their triage areas: Ibrahim Malik, Omdurman, and Al-Nau. Omdurman Teaching Hospital was the sole hospital with a designated respiratory waiting area. At Al-Nau and Omdurman Hospitals, all respiratory symptomatic patients wore a facemask or alternative. Ibrahim Malik and Bahri Teaching Hospitals had 60% and 50% compliance, respectively, while none at El-Tamayouz Hospital did. No posters or job aids were present in donning and doffing areas. Heavy duty gloves were worn only at Ibrahim Malik (50%) and Omdurman (20%). 100% of staff wore closed-toe footwear at Ibrahim Malik and Omdurman, 75% at El-Tamayouz, 63% at Bahri, and none at Al-Nau.</p><p><strong>Conclusion: </strong>The healthcare facilities displayed significant shortcomings in preparedness and response to COVID-19, with variations across hospitals in infrastructure, human resources, and procedures. To better combat future outbreaks, systemic improvements and a focused approach on consistent staff training, standard triage algorithms, and adequate PPE availability are imperative.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"15 ","pages":"373-382"},"PeriodicalIF":1.5,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b5/aa/oaem-15-373.PMC10590591.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49693013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing Door-In to Door-Out Time for Patients Receiving a Mechanical Thrombectomy Using AutoLaunch Protocol.","authors":"Devin M Howell,&nbsp;Timmy Li,&nbsp;Elizabeth Quellhorst,&nbsp;Jeffrey M Katz,&nbsp;Rohan Arora,&nbsp;Jonathan Berkowitz","doi":"10.2147/OAEM.S427945","DOIUrl":"10.2147/OAEM.S427945","url":null,"abstract":"<p><strong>Background: </strong>Door-in to door-out (DIDO) time for large vessel occlusion (LVO) stroke is an emerging stroke performance measure. Initial presentation at a non-Comprehensive Stroke Center (CSC) requires a transfer process that minimizes delays. Our objective was to assess whether DIDO time for stroke patients was reduced after implementation of an AutoLaunch protocol for interfacility transfers.</p><p><strong>Methods: </strong>This was a pre-post analysis of an AutoLaunch protocol for all acute stroke patients transferred to a CSC for mechanical thrombectomy. The distribution of DIDO times between patients transferred via the AutoLaunch and traditional dispatch protocols were compared.</p><p><strong>Results: </strong>We evaluated 92 interfacility transfers, with 22 utilizing the AutoLaunch protocol and 70 utilizing traditional dispatch. Among AutoLaunch transfers, the median DIDO time was 85 minutes (IQR: 71, 133), while the median DIDO time among the traditional transfers was 109 minutes (IQR, 84, 144) (p=0.044).</p><p><strong>Conclusion: </strong>Implementation of an AutoLaunch protocol for patients with suspected LVO was associated with a reduction in DIDO time to CSCs. Further studies should evaluate patient outcomes based on transfer strategies.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"15 ","pages":"367-371"},"PeriodicalIF":1.5,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/39/6b/oaem-15-367.PMC10590110.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49693014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Factors of Oxygen Therapy Failure in Patients with COVID-19 in the Emergency Department.","authors":"Karn Suttapanit,&nbsp;Peeraya Lerdpaisarn,&nbsp;Pitsucha Sanguanwit,&nbsp;Praphaphorn Supatanakij","doi":"10.2147/OAEM.S430600","DOIUrl":"10.2147/OAEM.S430600","url":null,"abstract":"<p><strong>Background: </strong>Most patients with coronavirus disease 2019 (COVID-19) pneumonia require oxygen therapy, including standard oxygen therapy and a high-flow nasal cannula (HFNC), in the Emergency Department (ED), and some patients develop respiratory failure. In the COVID-19 pandemic, the intensive care unit (ICU) was overburdening. Therefore, prioritizing patients who require intensive care is important. This study aimed to find predictors and develop a model to predict patients at risk of requiring an invasive mechanical ventilator (IMV) in the ED.</p><p><strong>Methods: </strong>We performed a retrospective, single-center, observational study. Patients aged ≥18 years who were diagnosed with COVID-19 and required oxygen therapy in the ED were enrolled. Cox regression and Harrell's C-statistic were used to identifying predictors of requiring IMV. The predictive model was developed by calculated coefficients and the ventilator-free survival probability. The predictive model was internally validated using the bootstrapping method.</p><p><strong>Results: </strong>We enrolled 333 patients, and 97 (29.1%) had required IMV. Most 66 (68.0%) failure cases were initial oxygen therapy with HFNC. Respiratory rate-oxygenation (ROX) index, interleukin-6 (IL-6) concentrations ≥20 pg/mL, the SOFA (Sequential Organ Failure Assessment) score without a respiratory score, and the patient's age were independent risk factors of requiring IMV. These factors were used to develop the predictive model. ROX index and the predictive model at 2 hours showed a good performance to predict oxygen therapy failure; the c-statistic was 0.814 (95% confidence level [CI] 0.767-0.861) and 0.901 (95% CI 0.873-0.928), respectively. ROX index ≤5.1 and the predictive model score ≥8 indicated a high probability of requiring IMV.</p><p><strong>Conclusion: </strong>The COVID-19 pandemic was limited resources, ROX index, IL-6 ≥20 pg/mL, the SOFA score without a respiratory score, and the patient's age can be used to predict oxygen therapy failure. Moreover, the predictive model is good at discriminating patients at risk of requiring IMV and close monitoring.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"15 ","pages":"355-365"},"PeriodicalIF":1.5,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b0/8e/oaem-15-355.PMC10560766.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41215568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systematic Review on Outcomes of Patients with Heatstroke and Heat Exhaustion.","authors":"Hassan Adnan Bukhari","doi":"10.2147/OAEM.S419028","DOIUrl":"https://doi.org/10.2147/OAEM.S419028","url":null,"abstract":"<p><strong>Introduction: </strong>Heatstroke (HS) is a severe form of heat-related illness (HRI) associated with high morbidity and mortality, representing a condition that includes long-term multiorgan dysfunction and susceptibility to further heat illness.</p><p><strong>Methods: </strong>In a systematic review searching Medline PubMed from the studies conducted between 2009 and 2020, 16 papers were identified.</p><p><strong>Results: </strong>A hallmark symptom of heat stroke is CNS dysfunction (a hallmark sign of HS) which manifests as mental status changes, including agitation, delirium, epilepsy, or coma at the time of the collapse. Acute kidney injury (AKI), gut ischemia, blood clots in the stomach and small intestine, cytoplasmic protein clumps in the spleen, and injury of skeletal muscle (rhabdomyolysis) are all characteristics of peripheral tissue damage. Severe heat stroke tends to be complicated by rhabdomyolysis, especially in patients with exertional heat stroke. Rhabdomyolysis may lead to systemic effects, including the local occurrence of compartment syndrome, hyperkalemic cardiac arrest, and/or lethal disseminated intravascular coagulopathy. Untreated heat stroke might exacerbate psychosis, lactic acidosis, consumptive coagulopathy, hematuria, pulmonary edema, renal failure, and other metabolic abnormalities. Core body temperature and level of consciousness are the most significant indicators to diagnose the severity of heat stroke and prevent unfavorable consequences. Heatstroke is a life-threatening illness if not promptly recognized and effectively treated.</p><p><strong>Discussion: </strong>This review highlighted that core body temperature and white blood cell count are significant contributing factors affecting heat stroke outcomes. Other factors contributing to the poor outcome include old age, low GCS, and prolonged hospital stay. The prevalence of both classic and exertional heatstroke can be reduced by certain simple preventive measures, such as avoiding strenuous activity in hot environments and reducing exposure to heat stress.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"15 ","pages":"343-354"},"PeriodicalIF":1.5,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/15/7d/oaem-15-343.PMC10522494.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41178766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Impact of Hs-CRP and IL-6 for Acute Coronary Syndrome in Patients Admitted to the ED with Chest Pain: Added Value to the HEART Score?","authors":"Khalil Rafiqi,&nbsp;Camilla Bang Hoeks,&nbsp;Bo Løfgren,&nbsp;Martin Bødtker Mortensen,&nbsp;Jens M Bruun","doi":"10.2147/OAEM.S425319","DOIUrl":"https://doi.org/10.2147/OAEM.S425319","url":null,"abstract":"<p><strong>Objective: </strong>To investigate whether hs-CRP and IL-6 provide additional diagnostic value beyond that achieved by the HEART score in patients with chest pain suggestive of acute coronary syndrome (ACS) admitted to the emergency department (ED).</p><p><strong>Methods: </strong>This was a post hoc analysis using data from the RACING-MI study. Baseline data, including hs-CRP and IL-6 levels, were analyzed using the plasma from the biobank. A total of 818 patients with chest pain suggestive of ACS were included in this analysis. Of these, 98 were diagnosed with ACS (12%). Logistic regression was used to identify the independent predictors of ACS development in patients with chest pain.</p><p><strong>Results: </strong>hs-CRP levels >2 mg/L were observed in 50% of all ACS cases. IL-6 levels >1.3 pg/mL were observed in 71% of all ACS cases. hs-CRP had a sensitivity of 50% and specificity of 51% for the diagnosis of ACS, whereas IL-6 had a sensitivity of 71% and specificity of 29%. The diagnostic likelihood ratios for ACS was 1.0 for hs-CRP>2 mg/L and IL-6 > 1.3 pg/mL, respectively. Logistic regression analysis revealed that age, male gender, and ongoing smoking were associated with ACS in patients with acute chest pain. No association was found between IL-6 or hs-CRP level and ACS. This was observed for both IL-6 and hs-CRP, whether assessed on a continuous scale or using prespecified cut-off values.</p><p><strong>Conclusion: </strong>Among the 818 patients admitted to the ED with chest pain suggestive of ACS, neither hs-CRP nor IL-6 provided an independent added diagnostic value. Our results suggest that inflammatory markers have limited diagnostic value in detecting patients with ACS in the ED.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"15 ","pages":"333-342"},"PeriodicalIF":1.5,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0c/18/oaem-15-333.PMC10519209.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41169143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lasting Effects of COVID-19 Pandemic on Prehospital Emergency Medical Service Missions.","authors":"Isabella Metelmann,&nbsp;Matthes Nagel,&nbsp;Bastian Schneider,&nbsp;Bernd Krämer,&nbsp;Sebastian Kraemer","doi":"10.2147/OAEM.S425272","DOIUrl":"https://doi.org/10.2147/OAEM.S425272","url":null,"abstract":"<p><strong>Purpose: </strong>The COVID-19 pandemic confronted prehospital emergency medical services (PHEMS) with immense challenges. This study aimed to investigate the development of PHEMS mission numbers and times in the COVID-affected region of Southwest Saxony (SWS).</p><p><strong>Patients and methods: </strong>This was a retrospective analysis of PHEMS in SWS during lockdown periods and equal time spans in the previous and following years. Differences were tested for statistical significance using the chi-squared test and one-way analysis of variance (ANOVA).</p><p><strong>Results: </strong>The total number of missions showed a substantial drop during the first (-16.6%) and the second (-4.5%) lockdown period compared with the previous year. Next-year periods showed a recovery that was nearly equivalent to the starting point. The first lockdown period was not associated with longer overall mission times. The minutes spent at the scene differed significantly between the first lockdown period (31.1 ± 3.52 min), previous year (28.4 ± 4.84 min), and follow-up period (31.8 ± 0.98 min). During the second lockdown, the overall mission times (71.6 ± 2.91 min), response times in minutes (8.9 ± 0.49 min), and minutes spent at the scene (31.4 ± 2.99 min) were significantly longer. The minutes spent at the scene (32.3 ± 18.68 min) and the overall mission time (69.6 ± 1.92 min) remained significantly longer during the control period.</p><p><strong>Conclusion: </strong>Our data confirm the impact of the SARS-CoV-2 pandemic on German PHEMS. It can be concluded that nationwide lockdown measures led to lasting effects regarding a reduction in the total mission number, transport-on-site released-ratio, and emergency time intervals in the following year, without lockdown restrictions. The lasting effects on the transport-on-site released-ratio and emergency time intervals call for a re-evaluation of the delivery of emergency services during pandemics. These findings can inform future policy decisions and resource allocations to ensure optimal emergency medical services.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"15 ","pages":"325-332"},"PeriodicalIF":1.5,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/50/4a/oaem-15-325.PMC10516217.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41153037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of the aggressive emergency department patient: non-pharmacological perspectives and evidence base.","authors":"Sandra K Richardson,&nbsp;Michael W Ardagh,&nbsp;Russell Morrison,&nbsp;Paula C Grainger","doi":"10.2147/OAEM.S192884","DOIUrl":"https://doi.org/10.2147/OAEM.S192884","url":null,"abstract":"<p><strong>Introduction: </strong>Aggression in the Emergency Department (ED) remains an ongoing issue, described as reaching epidemic proportions, with an impact on staff recruitment, retention, and ability to provide quality care. Most literature has focused on the definition (or lack of) core concepts, efforts to quantify the phenomenon or provide an epidemiological profile. Relatively little offers evidence-based interventions or evaluations of the same.</p><p><strong>Aim: </strong>To identify the range of suggested practices and the evidence base for currently recommended actions relating to the management of the aggressive Emergency Department patient.</p><p><strong>Methods: </strong>A meta-synthesis of existing reviews of violence and aggression in the acute health-care setting, including management of the aggressive patient, was undertaken. This provided the context for critical consideration of the management of this patient group in the ED and implications for clinical practice.</p><p><strong>Results: </strong>An initial outline of issues was followed by a systematic search and 15 reviews were further assessed. Commonly identified interventions are grouped around educational, interpersonal, environmental, and physical responses. These actions can be focused in terms of overall responses to the wider issues of violence and aggression, targeted at the pre-event, event, or post-event phase in terms of strategies; however, there is a very limited evidence base to show the effectiveness of strategies suggested.</p><p><strong>Clinical implications: </strong>The lack of evidence-based intervention strategies leaves clinicians in a difficult situation, often enacting practices based on anecdote rather than evidence. Local solutions to local problems are occurring in a pragmatic manner, but there needs to be clarification and integration of workable processes for evaluating and disseminating best practice.</p><p><strong>Conclusion: </strong>There is limited evidence reporting on interventional studies, in addition to identification of the need for high quality longitudinal and evaluation studies to determine the efficacy of those responses that have been identified.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"11 ","pages":"271-290"},"PeriodicalIF":1.5,"publicationDate":"2019-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/OAEM.S192884","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49683416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}