medRxiv - Emergency Medicine最新文献

{"title":"Diagnostic performance of serum CA-125 for overall and complicated acute appendicitis: a systematic review and meta-analysis","authors":"Javier Arredondo Montero, Blanca Paola Pérez Riveros, Oscar Emilio Bueso Asfura","doi":"10.1101/2023.12.16.23300068","DOIUrl":"https://doi.org/10.1101/2023.12.16.23300068","url":null,"abstract":"<strong>Background</strong> This study aimed to analyze the diagnostic performance of serum CA-125 in acute appendicitis (AA).","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138820058","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":"Variation in ambulance pre-alert process and practice: Cross-sectional survey of ambulance clinicians","authors":"Joanne Coster, Fiona Sampson, Rachel O’Hara, Jaqui Long, Fiona Bell, Steve Goodacre","doi":"10.1101/2023.12.14.23299969","DOIUrl":"https://doi.org/10.1101/2023.12.14.23299969","url":null,"abstract":"<strong>Background</strong> Ambulance clinicians use pre-alerts calls to alert emergency departments (EDs) about the arrival of critically ill patients. We explored ambulance clinician’s views and experiences of pre-alert practice and processes using a national online survey.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"34 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138714682","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":"What influences ambulance clinician decisions to pre-alert Emergency Departments: a qualitative exploration of decision-making in three UK Ambulance Services","authors":"Rachel O’Hara, Fiona Sampson, Jaqui Long, Joanne Coster, Richard Pilbery","doi":"10.1101/2023.12.14.23299973","DOIUrl":"https://doi.org/10.1101/2023.12.14.23299973","url":null,"abstract":"<strong>Background</strong> Ambulance clinicians use pre-alerts to inform receiving hospitals of the imminent arrival of a time-critical patient considered to require immediate attention, enabling the receiving Emergency Department or other clinical area to prepare. Pre-alerts are key to ensuring immediate access to appropriate care, but unnecessary pre-alerts can divert resources from other patients and fuel ‘pre-alert fatigue’ amongst ED staff. This research aims to provide a better understanding of pre-alert decision-making practice.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"239 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138714679","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":"Time of surgery for aneurysmal subarachnoid hemorrhage in patients ≥70 years","authors":"Hengrui Zhang, Bangyue Wang, Ruyi Wang, Chao Peng, Changkai Hou, Yan Zhao, Linchun Huan, Yanfen Chai, Xinyu Yang, Jianjun Yu","doi":"10.1101/2023.12.12.23299889","DOIUrl":"https://doi.org/10.1101/2023.12.12.23299889","url":null,"abstract":"<strong>Objective</strong> To establish a time-to-surgery threshold for elderly aneurysmal subarachnoid hemorrhage patients before the risk of mortality increases.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138714885","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":"What factors predict ambulance pre-alerts to the emergency department? Analysis of routine data from 3 UK ambulance services.","authors":"Fiona C Sampson, Richard Pilbery, Esther Herbert, Steve Goodacre, Fiona Bell, Rob Spaight, Andy Rosser, Peter Webster, Mark Millins, Andy Pountney, Joanne Coster, Jacqui Long, Rachel O'Hara, Alexis Foster, Jamie Miles, Janette Turner, Aimee Boyd","doi":"10.1101/2023.12.07.23299650","DOIUrl":"https://doi.org/10.1101/2023.12.07.23299650","url":null,"abstract":"Objective\u0000Ambulance clinicians use pre-alert calls to advise emergency departments (EDs) of the arrival of patients requiring immediate review or intervention. Consistency of pre-alert practice is important in ensuring appropriate EDs response. We used routine data to describe pre-alert practice and explore factors affecting variation in practice.\u0000Methods\u0000We undertook an observational study using a linked dataset incorporating 12 months' ambulance patient records, ambulance clinician data and emergency call data for three UK ambulance services. We used LASSO regression to identify candidate variables for multivariate logistic regression models to predict variation in pre-alert use, analysing clinician factors (role, experience, qualification, time of pre-alert during shift), patient factors (NEWS2 score, clinical working impression, age, sex) and hospital factors (receiving ED, ED handover delay status). Results\u0000From the dataset of 1,363,274 patients conveyed to ED, 142,795 (10.5%) were pre-alerted, of whom only a third were for conditions with clear pre-alert pathways (e.g. sepsis, STEMI, major trauma). Casemix (illness acuity score, clinical diagnostic impression) was the strongest predictor of pre-alert use but male patient gender, clinician role, receiving hospital, and hospital turnaround delay at receiving hospitals were also statistically significant predictors, after adjusting for casemix. There was no evidence of higher pre-alert rates in the final hour of shift.\u0000Conclusions\u0000Pre-alert decisions are determined by factors other than illness acuity and clinical diagnostic impression. Research is required to determine whether our findings are reproducible elsewhere and why non-clinical factors (e.g. patient gender) may influence pre-alert practice.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138559621","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":"Development and Evaluation of a Digital Scribe: Conversation Summarization Pipeline for Emergency Department Counseling Sessions towards Reducing Documentation Burden","authors":"Emre Sezgin, Joseph Sirrianni, Kelly Kranz","doi":"10.1101/2023.12.06.23299573","DOIUrl":"https://doi.org/10.1101/2023.12.06.23299573","url":null,"abstract":"Objective: We present a proof-of-concept digital scribe system as an ED clinical conversation summarization pipeline and report its performance. Materials and Methods: We use four pre-trained large language models to establish the digital scribe system: T5-small, T5-base, PEGASUS-PubMed, and BART-Large-CNN via zero-shot and fine-tuning approaches. Our dataset includes 100 referral conversations among ED clinicians and medical records. We report the ROUGE-1, ROUGE-2, and ROUGE-L to compare model performance. In addition, we annotated transcriptions to assess the quality of generated summaries. Results: The fine-tuned BART-Large-CNN model demonstrates greater performance in summarization tasks with the highest ROUGE scores (F1ROUGE-1=0.49, F1ROUGE-2=0.23, F1ROUGE-L=0.35) scores. In contrast, PEGASUS-PubMed lags notably (F1ROUGE-1=0.28, F1ROUGE-2=0.11, F1ROUGE-L=0.22). BART-Large-CNN's performance decreases by more than 50% with the zero-shot approach. Annotations show that BART-Large-CNN performs 71.4% recall in identifying key information and a 67.7% accuracy rate. Discussion: The BART-Large-CNN model demonstrates a high level of understanding of clinical dialogue structure, indicated by its performance with and without fine-tuning. Despite some instances of high recall, there is variability in the model's performance, particularly in achieving consistent correctness, suggesting room for refinement. The model's recall ability varies across different information categories. Conclusion: The study provides evidence towards the potential of AI-assisted tools in reducing clinical documentation burden. Future work is suggested on expanding the research scope with larger language models, and comparative analysis to measure documentation efforts and time.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138554095","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":"Normobaric Hyperoxia Combined with Endovascular Treatment Based on Temporal Gradient: A dose-escalation study","authors":"Weili Li, Sifei Wang, Lan Liu, Jiaohao Chen, Jing Lan, Jiayue Ding, Zhiying Chen, Shuhua Yuan, Zhifeng Qi, Ming Wei, Xunming Ji","doi":"10.1101/2023.12.05.23299563","DOIUrl":"https://doi.org/10.1101/2023.12.05.23299563","url":null,"abstract":"BACKGROUND: Normobaric hyperoxia (NBO) has neuroprotective effects in acute ischemic stroke (AIS). Thus, we aimed to identify the optimal NBO treatment duration combined with endovascular treatment (EVT).\u0000METHODS: Patients with acute stroke who had an indication for EVT at Tianjin Huanhu Hospital were included and randomly assigned to four groups (1:1 ratio) based on NBO therapy duration: 1) Sham-NBO group (oxygen 1 L/min continuously for 4 h); 2) NBO-2h group (10 L/min continuously for 2 h); 3) NBO-4h group (10 L/min continuously for 4 h); and 4) NBO-6h group (10 L/min continuously for 6 h). The primary outcome was cerebral infarction volume at 72 h after randomization. The primary safety outcome was the 90-d mortality rate.\u0000RESULTS: A total of 100 patients were included (Sham-NBO group, n=25; NBO-2h group, n=25; NBO-4h group, n=25; and NBO-6h group, n=25). The 72-h cerebral infarct volumes were 39.4 ± 34.3 ml, 30.6 ± 30.1ml, 19.7 ± 15.4 ml, and 22.6 ± 22.4 ml, respectively (P=0.013). The NBO-4h and NBO-6h groups exhibited significant differences compared to the Sham-NBO group (adjusted P values: 0.011 and 0.027, respectively). No significant differences were found between the NBO-4h and NBO-6h groups. The National Institute of Health Stroke Scale (NIHSS) scores at 24 h, 72 h, and 7 d, and the changes in NIHSS scores from baseline to 24 h were significantly different in the NBO-4h and NBO-6h groups compared with the Sham-NBO group (P&lt;0.05). No significant differences were observed between the NBO-4h and NBO-6h groups in the NIHSS assessments. No significant differences were noted among groups in the 90-d mortality rate, symptomatic intracranial haemorrhage, early neurological deterioration, and severe adverse events.\u0000CONCLUSIONS:The effectiveness of NBO therapy was associated with oxygen administration duration. In patients with AIS who undergone EVT, NBO treatment for 4-6 h may yield better outcomes than other oxygen therapy regimens or low flow oxygen therapy.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138552775","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":"ChatGPT Provides Inconsistent Risk-Stratification of Patients With Atraumatic Chest Pain","authors":"Thomas F. Heston, Lawrence M. Lewis","doi":"10.1101/2023.11.29.23299214","DOIUrl":"https://doi.org/10.1101/2023.11.29.23299214","url":null,"abstract":"<strong>BACKGROUND</strong> ChatGPT is a large language model with promising healthcare applications. However, its ability to analyze complex clinical data and provide consistent results is poorly known. This study evaluated ChatGPT-4’s risk stratification of simulated patients with acute nontraumatic chest pain compared to validated tools.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"39 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138523152","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":"Protecting Emergency Medical Services (EMS) Staff from Aggression and Violence in Conflict Encounters (PEACE1): A survey of Wales Adults attitudes in 2022","authors":"Nigel Rees, Daniel Todd, Francesca Fiorentino, Peter O’Meara, Lauren Williams, Julia Williams, Claire Hawkes","doi":"10.1101/2023.11.30.23299241","DOIUrl":"https://doi.org/10.1101/2023.11.30.23299241","url":null,"abstract":"<strong>Background</strong> Emergency Medical Services (EMS) staff frequently encounter violence and aggression (V&amp;A) directed towards them, which negatively affects their wellbeing and provision of services. This is an international problem and employers and others are tackling it through policy, education, legislation, and public information campaigns. The aim of this study was to explore the Welsh public’s views of V&amp;A directed at EMS staff and their awareness of policy changes and the reach of media campaigns associated with recent policy changes.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138523154","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":"Psychological impact of COVID-19 on frontline healthcare workers during the early months of the pandemic and responses to reduce the burden, helping to prepare for Disease X: A systematic review","authors":"Jarryd S. Ludski","doi":"10.1101/2023.11.28.23299078","DOIUrl":"https://doi.org/10.1101/2023.11.28.23299078","url":null,"abstract":"<strong>Objective</strong> The COVID-19 pandemic placed enormous strain on healthcare workers (HCW) and systems. With currently over 766 million cases, a high risk of workplace-acquired infection and a constantly evolving disease trajectory, COVID-19 placed an incredible burden on frontline HCWs. Studies from previous pandemics highlight significant psychological distress in these workers, yet mental health remained a secondary consideration in many hospitals pandemic response. This review explores the psychological impact of COVID-19 on frontline HCWs during the early stages of the pandemic and describes responses implemented by health services to reduce this impact. Additionally, it aims to provide a framework for future evidence-based programs that support the wellbeing of frontline HCWs throughout the ongoing pandemic and into the future, helping to prepare for Disease X.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138523155","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}