Academic Emergency Medicine最新文献

{"title":"Parental Stress in Academic Emergency Medicine Physicians.","authors":"Deborah B Diercks, Michelle Lall, Anne Messman, Ellen O'Connell, Meagan Hunt, Mia Karamatsu, Katie Pettit, D Mark Courtney","doi":"10.1111/acem.70145","DOIUrl":"https://doi.org/10.1111/acem.70145","url":null,"abstract":"<p><strong>Background: </strong>Recent publications have shown that women are more likely to leave emergency medicine at a younger age than men. We aim to describe the prevalence of parental stress in academic emergency medicine and its association with scheduling practices and desire to leave medicine.</p><p><strong>Methods: </strong>Blinded survey sent to eight geographically diverse academic sites. Survey included five domains: academic rank and perception of progress, child and childcare characteristics, clinical scheduling practices, plans to leave medicine, and validated psychometric measures including the Parental Stress Scale (PSS: normal population score 35-45). Likert scale responses were dichotomized as either moderate/extremely likely versus less than moderately likely/unsure. Descriptive statistics were calculated, and linear and multivariate regression analyses were performed using STATA 16.</p><p><strong>Results: </strong>A total of 280 surveys were accessed, and 225 (80%) surveys had PSS completed. Of this cohort, there were 90 females, 123 men, 1 intersex, and 15 surveys had no sex reported. The median number of children was 2 (IQR 1-3), and the median age of the youngest child was 4 (IQR 1-9). The parental stress scale median score was 40 (IQR 35-46). There was no significant difference in the parental stress scale by sex. The number of children (B-coeff -1.88, p = 0.007), age of the youngest child (B-coeff -4.2, p = 0.000), use of daycare (B-coeff 3.8, p = 0.027), ability to preference times of shifts (day, swing, night shift) (B-coeff -2.4, p = 0.046), being a nocturnist (B-coeff 2.75, p = 0.006), and being able to completely set their own schedule in terms of days and times worked (B-coeff -2.19, p = 0.03) were associated with the PSS score. The parental stress scale was not associated with the likelihood to leave emergency medicine or leave the current job in 5 years.</p><p><strong>Conclusion: </strong>Academic emergency physicians had parental stress scale scores similar to the general population. Parental stress scale score was not associated with a plan to leave emergency medicine.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145051320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Altitude Pulmonary Edema Response to Continuous Airway Positive Pressure: A Randomized Controlled Trial: The HAPER CAPER Trial.","authors":"Todd Bolotin, Sachin Subedi, Sushil Dahal, Christina Walker, Kimberly Chung, Ava Martz, David Gemmel, Quincy Chopra, Chad Donley","doi":"10.1111/acem.70126","DOIUrl":"https://doi.org/10.1111/acem.70126","url":null,"abstract":"<p><strong>Background: </strong>Morbidity and mortality in cardiogenic pulmonary edema have been reduced by noninvasive positive-pressure airway maneuvers. The value of continuous positive airway pressure (CPAP) for the treatment of high-altitude pulmonary edema (HAPE) is uncertain. The purpose of this study was to evaluate the efficacy and speed of CPAP for HAPE resolution.</p><p><strong>Methods: </strong>A prospective, investigator-initiated, multicenter, randomized, double-blind controlled trial of high-flow oxygen with CPAP versus sham CPAP with high-flow oxygen (oxygen-only group) was conducted. Sixty-four dyspneic adults with maximum oxygen saturation < 85%, recent arrival at high altitude, and noncardiogenic pulmonary edema on chest radiography were randomized to receive CPAP treatment plus usual care or usual care (oxygen-only) delivered through a sham CPAP mask. The primary endpoint was the clinical resolution of HAPE.</p><p><strong>Results: </strong>HAPE resolution in the CPAP plus high FiO₂ group and the high flow oxygen alone group was similar. However, this finding should be interpreted cautiously due to this study being slightly underpowered. There was no significant difference in time to resolution (CPAP ~158 min vs. oxygen ~178 min, p = 0.297). Both therapies were effective, with a mean time to resolution of HAPE of approximately 2.5 to 3 h. No treatment-related adverse outcomes, intubations, or mortality were observed in either group.</p><p><strong>Conclusion: </strong>Both CPAP with high-flow oxygen and high-flow oxygen alone are highly effective for the treatment of HAPE. CPAP conferred no improvement in the time to resolution of HAPE. High-flow oxygen therapy requires significantly less resource utilization for similar benefits in the treatment of HAPE.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT04186598.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145038814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemodynamics Following Dexmedetomidine Loading Dose From Infusion.","authors":"Deepika Sivakumar, Andrew J Webb, Emily Porter, Nicholas Petrucelli, Bryan D Hayes","doi":"10.1111/acem.70147","DOIUrl":"https://doi.org/10.1111/acem.70147","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145038765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Wang Letter Regarding \"Psychological Comorbidity in Patients Presenting to the Emergency Department With Low-Risk Chest Pain and Anxiety\".","authors":"Kurt Kroenke, Paul I Musey","doi":"10.1111/acem.70149","DOIUrl":"https://doi.org/10.1111/acem.70149","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145028794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Show Me the Money: A Movement Towards Transparency in Pediatric Emergency Medicine Compensation.","authors":"Jasmyne Jackson, Corrie E Chumpitazi, Deborah Hsu, Mariju Baluyot, Lindsey Barrick, Sing-Yi Feng, Selena Hariharan, Shari Platt, Harold K Simon, Rachel Stanley, Melissa L Langhan, Jennifer L Reed","doi":"10.1111/acem.70146","DOIUrl":"https://doi.org/10.1111/acem.70146","url":null,"abstract":"<p><strong>Background: </strong>National studies report sustained gender-based differences in physician compensation, even after adjustment for workplace factors such as academic rank, specialty type, and work hours. This study examines differences in compensation among pediatric emergency medicine (PEM) fellows' first job after training.</p><p><strong>Methods: </strong>Between May 2023 and June 2023, we distributed an electronic survey to all United States PEM fellowship program directors (FPDs), requesting they forward it to their graduating fellows. Survey completion was anonymous and voluntary, and included demographics, employment characteristics, and compensation package questions. We defined underrepresented in medicine (URiM) as individuals who self-identified as Black, Hispanic, Native American, Alaskan, or Pacific Islander.</p><p><strong>Results: </strong>The survey was forwarded by 39 PEM FPDs to 107 eligible graduating PEM fellows, 80 (75%) of whom responded to the survey. Most respondents (71.3%) were women, 92.5% completed Pediatric residency, and 70.1% identified as White. The reported median base salary was $255,000 (IQR 222,000, 288,811). A high proportion of respondents were unaware of financial benefits beyond salary, such as employer retirement contributions. Compared to Pediatric hiring departments, Emergency Medicine (EM) departments had a significantly higher mean base salary (EM $277,079 vs. Pediatrics $239,540 p = 0.036) and annual clinical hours (EM 1393 vs. Pediatrics 1269, p = 0.035). While there were no statistical differences for base salary, annual clinical hours, sign-on bonus, or relocation stipend by gender or by underrepresented in medicine (URiM)-status, the mean difference in base salary for men was $25,628 higher than that of women (95% CI -$7903, $59,159). The mean difference in base salary for non-URiM versus URiM was $20,440 (95% CI -$22,000, $63,000).</p><p><strong>Conclusion: </strong>While no statistically significant differences in salary by gender or race among PEM fellowship graduates were found, the difference in mean base salaries between genders is impactful over time. Transparency, financial education, and strategic action are important steps toward compensation equity.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Development of a Fall Risk Score for Older Adults Incorporating Electronic Health Record and Emergency Department Screening Measures.","authors":"Pawan Acharya, Tabitha Garwe, Zain G Hashmi","doi":"10.1111/acem.70144","DOIUrl":"https://doi.org/10.1111/acem.70144","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Success and Complication Rates of Endoscopic Exchange of the i-Gel Supraglottic Airway.","authors":"Sean M Trostel, Joseph H Blackwell, Keegan D Bradley, Stephen T Constantine, Douglas R Swanson, Michael A Gibbs","doi":"10.1111/acem.70139","DOIUrl":"https://doi.org/10.1111/acem.70139","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Video Ethnography and Stimulated Recall Interviews to Describe the Diagnostic Process in the Emergency Department.","authors":"Milisa Manojlovich, Caitlin Cassady, Sarah J Parker, Ellie Davis, Charlotte Ahr, David Ryamukuru, Anna Wang, Kalyan Pasupathy, Hardeep Singh, Prashant Mahajan","doi":"10.1111/acem.70142","DOIUrl":"https://doi.org/10.1111/acem.70142","url":null,"abstract":"<p><strong>Objectives: </strong>Understanding how physicians make diagnoses is challenging because cognitive processes are unobservable and partly unconscious, making it difficult for physicians to describe how they arrived at a diagnosis. Physicians who work in emergency departments (EDs) are especially vulnerable to making diagnostic errors because the ED is a fast-paced, dynamic setting where complex decision-making occurs under severe time, information, and resource constraints. The purpose of our study was to describe how the diagnostic process evolves for ED clinicians in both pediatric and adult ED settings.</p><p><strong>Methods: </strong>We used a qualitative, video ethnography study design to capture in situ, real-time ED physician practice for 11 participants from February 2022 to July 2023. Participants wore a head-mounted video camera while providing care to ED patients, and in subsequent stimulated recall interviews, revealed their thinking throughout the diagnostic process.</p><p><strong>Results: </strong>We recorded 24.42 h of video overall (average 2.22 h per participant). We identified four major themes in the ED diagnostic process: (1) quality communication facilitates information flow, (2) cognition is complex and distributed across patients and the ED team, (3) artifacts can enhance the diagnostic process, and (4) there is a need to balance efficiency with safety and accuracy.</p><p><strong>Conclusions: </strong>Illustrating physicians' cognitive processes through video ethnography coupled with stimulated recall interviews helped advance our understanding of the diagnostic process and is a foundational step for identifying improvement opportunities.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Letter on \"Diagnostic Accuracy and Application of Subarachnoid Hemorrhage Decision Rules Among Patients With Nontraumatic Acute Headache: A Systematic Review and Meta-Analysis\".","authors":"Mahdi Roostaei, Farzaneh Barzkar","doi":"10.1111/acem.70143","DOIUrl":"10.1111/acem.70143","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Wernicke's Encephalopathy When Receiving Dextrose Before Thiamine: A National Study of Veterans.","authors":"Jamie Jasti, Katherine Sherman, David Gummin, Andrew Farkas","doi":"10.1111/acem.70131","DOIUrl":"https://doi.org/10.1111/acem.70131","url":null,"abstract":"<p><strong>Background/objectives: </strong>A commonly taught principle when treating emergency department (ED) patients with acute alcohol intoxication is to give thiamine before dextrose to avoid precipitating Wernicke's encephalopathy (WE). We sought to evaluate the prevalence of WE among a national sample of veterans who presented to the ED with alcohol intoxication and who then received dextrose before thiamine.</p><p><strong>Methods: </strong>This is a retrospective, cross-sectional study of patients presenting to all Veterans Affairs (VA) Emergency Departments (ED) over a 10-year period (2010-2019). Data was obtained through a Microsoft SQL (Redmond, WA) query of the VA Corporate Data Warehouse. Inclusion criteria were any ED visit with an alcohol intoxication ICD9/10 code and/or serum ethanol result > 50 mg/dL, as well as administration of any intravenous fluids containing dextrose at any concentration. Exclusion criteria was administration of thiamine before dextrose infusion. The primary outcome was diagnosis of WE by ICD9/10 code or manual chart review in the ED, hospitalization, or follow-up visit within 90 days. Data was analyzed with descriptive statistics.</p><p><strong>Results: </strong>120 encounters by 114 individual patients met the inclusion/exclusion criteria, with a median age of 59 (IQR 49-64). There were 104 (91%) male patients, 77 (68%) were white, 27 (24%) were Black, and 6 (5%) were Hispanic. Most patients with a recorded AUDIT-C screened positive for AUD (94%) or had a documented history of alcohol abuse (90%). No cases of Wernicke's encephalopathy were identified by ICD code or manual chart review.</p><p><strong>Conclusion: </strong>Our data suggest that alcohol-intoxicated patients are unlikely to develop Wernicke's encephalopathy with acute dextrose administration. While administering thiamine in alcohol-intoxicated patients is low risk and potentially beneficial, we submit that hypoglycemia treatment should not be delayed for this intervention.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}