Academic Emergency Medicine最新文献

{"title":"Emergency department-initiated oral naltrexone for patients with moderate to severe alcohol use disorder: A pilot feasibility study.","authors":"Ethan Cowan, Clare O'Brien-Lambert, Erick Eiting, Edward Bull, Jacqueline Ryder, Yvette Calderon, Edwin Salsitz","doi":"10.1111/acem.15059","DOIUrl":"10.1111/acem.15059","url":null,"abstract":"<p><strong>Objectives: </strong>Alcohol use disorder (AUD) is the most common substance use disorder in the United States. Despite availability of four FDA-approved medications, fewer than 10% of patients are prescribed medication. This study aimed to evaluate the impact and feasibility of emergency department (ED)-initiated oral naltrexone in patients with moderate to severe AUD.</p><p><strong>Methods: </strong>This was a prospective, single-arm, open-label, nonrandomized clinical trial conducted a single ED. Consenting participants were adults with moderate to severe AUD who were provided a single 50-mg dose of oral naltrexone, a 14-day starter pack of naltrexone, and referral for treatment. Follow-up was conducted at 14 and 30 days post-ED visit. The primary outcome was engagement in formal addiction treatment. Secondary outcomes included alcohol consumption, craving, quality-of-life measures, satisfaction, and safety.</p><p><strong>Results: </strong>Of 761 patients screened, 21 enrolled and received at least one dose of naltrexone. At 14 days, 29% were engaged in treatment, increasing to 33% at 30 days. There was a decrease in the mean (±SD) number of drinks per day from 5.20 (±4.67) at baseline to 2.23 (±4.35) during the follow-up period (p = 0.078). There was a decrease in alcohol craving scores, with median scores dropping from 19 at baseline to 8.27 during the follow-up period (p < 0.001). Quality-of-life measures improved, with a statistically significant increase in the reported number of healthy days (p = 0.006) and decrease in depressive symptoms (p < 0.001). Reported side effects were mild and satisfaction with the screening process was high.</p><p><strong>Conclusions: </strong>ED-initiated oral naltrexone is feasible and acceptable for patients with moderate to severe AUD. While engagement in treatment was moderate, significant reductions in alcohol craving and improvements in quality of life suggest potential benefits. Further research is warranted to confirm these findings.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"488-497"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12077059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942424","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":"ERRATUM.","authors":"","doi":"10.1111/acem.70024","DOIUrl":"10.1111/acem.70024","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"592"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143612962","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":"Algorithmic identification of overlapping abstract submissions at the Society for Academic Emergency Medicine annual meeting.","authors":"Patrick Maher, Ryan LaFollette, Colin F Greineder, Paul I Musey","doi":"10.1111/acem.15062","DOIUrl":"10.1111/acem.15062","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"581-583"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142833410","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":"The private-sector \"auxiliary EMS\" model complementing formal EMS in Japan.","authors":"Shinji Nakahara, Mari Yokota, Masamichi Nishida","doi":"10.1111/acem.15068","DOIUrl":"10.1111/acem.15068","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"584-585"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827199","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":"Endovascular therapy for acute vertebrobasilar occlusion stroke.","authors":"Brit Long, Michael Gottlieb","doi":"10.1111/acem.70019","DOIUrl":"10.1111/acem.70019","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"578-580"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143612952","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":"From bias to knowledge: A necessary shift to understand diagnostic errors.","authors":"Thierry Pelaccia, Jonathan Sherbino, Peter Wyer","doi":"10.1111/acem.70056","DOIUrl":"https://doi.org/10.1111/acem.70056","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958089","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":"Reconsidering the validity of the PROM-OTED tool in geriatric emergency care transitions.","authors":"Brijesh Sathian, Hanadi Al Hamad, Javed Iqbal","doi":"10.1111/acem.70054","DOIUrl":"https://doi.org/10.1111/acem.70054","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958798","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 \"Reconsidering the validity of the PROM-OTED tool in geriatric emergency care transitions\".","authors":"Cameron J Gettel, Arjun K Venkatesh, Ivie Uzamere, James Galske, Tonya Chera, Marney A White, Ula Hwang","doi":"10.1111/acem.70053","DOIUrl":"https://doi.org/10.1111/acem.70053","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958525","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":"Racial, ethnic, and sex disparities in buprenorphine treatment from emergency departments by discharge diagnosis.","authors":"Neeraj Chhabra, Dale Smith, Natalie Parde, Nicole Hsing-Smith, Joseph M Bianco, R Andrew Taylor, Gail D'Onofrio, Niranjan S Karnik","doi":"10.1111/acem.70035","DOIUrl":"https://doi.org/10.1111/acem.70035","url":null,"abstract":"<p><strong>Objectives: </strong>Racial and sex disparities are noted in the administration and prescribing of buprenorphine from emergency departments (EDs) nationally. It is unknown whether disparities persist when accounting for the specific discharge diagnosis addressed during encounters such as opioid overdose or withdrawal.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of opioid-related ED encounters from January 2020 through December 2023 using a national database, Epic Cosmos. We analyzed the effect of opioid encounter subtype-overdose or withdrawal-on receipt of buprenorphine using multivariable logistic regression adjusting for demographics and measured confounding variables. Encounter subtypes were defined by diagnosis codes and buprenorphine receipt was defined as administration or prescribing. We evaluated for racial, ethnic, and sex disparities within encounter subtypes for withdrawal and overdose.</p><p><strong>Results: </strong>We examined 1,088,033 opioid-related encounters. Adjusted odds for buprenorphine receipt were greater for encounters involving withdrawal (odds ratio [OR] 2.22, 95% CI 2.18-2.26), though reduced for overdose (OR 0.52, 95% CI 0.51-0.53) and other opioid complications (OR 0.69, 95% CI 0.64-0.70). Males were more likely to receive buprenorphine (OR 1.18, 95% CI 1.16-1.19) than females. All racial minorities excepting American Indian/Native American patients (OR 1.04, 95% CI 1.00-1.08) were less likely to receive buprenorphine than White patients (Asian OR 0.85, 95% CI 0.79-0.81; Black OR 0.80, 95% CI 0.79-0.81; Native Hawaiian/Pacific Islander OR 0.79, 95% CI 0.71-0.89). Subtype analyses indicated decreased odds for buprenorphine receipt for female patients across all subtypes. An increased odds for buprenorphine receipt among Black patients (OR 1.04, 95% CI 1.01-1.07; ref. White race) was noted in encounters involving opioid withdrawal but disparities persisted for opioid overdose.</p><p><strong>Conclusions: </strong>The administration and prescribing of buprenorphine in the ED is heavily influenced by the presence of opioid withdrawal. Disparities disadvantage female patients and racial minorities. Some racial disparities, particularly among Black patients, are not evident when solely considering encounters involving opioid withdrawal. System-level interventions are needed to address disparities and improve the equitable uptake of ED-initiated buprenorphine.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958796","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 violence against health care workers among agitated patients in an urban emergency department.","authors":"Samuel A Boes, Jon B Cole, Michael A Puskarich, James R Miner, Sarah K S Knack, Matthew E Prekker, Brian E Driver","doi":"10.1111/acem.70045","DOIUrl":"https://doi.org/10.1111/acem.70045","url":null,"abstract":"<p><strong>Objective: </strong>Violence is a common hazard for those working in emergency departments (EDs), yet it remains understudied. We describe a prospectively derived estimate of the prevalence of violence against health care workers among agitated patients in an ED.</p><p><strong>Methods: </strong>This was a secondary analysis of two prospective, observational studies of patients receiving care in a dedicated portion of the ED meant primarily to observe patients with intoxication. We collected detailed data for patients with agitation, defined as a score of +1 or higher using the altered mental status scale, an ordinal agitation scale from -4 (coma) to 0 (normal) to +4 (most agitated). Trained observers present in the ED 24/7 recorded whether each encounter involved verbal abuse, threat of violence, or a violent act against a health care worker. The primary outcome was the occurrence of assault as defined by state statute (threat of violence or violent act). We compare observed events to those formally reported to the hospital.</p><p><strong>Results: </strong>From 17,873 encounters screened there were 4609 (25.8%) in which the patient had agitation. Alcohol or drug intoxication was present in 4108 (89.1%) encounters. The number of encounters with assault was 937 (20.3%, 95% confidence interval [CI] 19.1%-21.5%), which included 802 encounters (17.4%, 95% CI 16.3%-18.5%) with a threat of violence and 362 encounters (7.9%, 95% CI 7.1%-8.7%) with a violent act. Verbal abuse occurred in 1786 encounters (38.8%, 95% CI 37.3%-40.2%). Events were formally reported to the hospital in 9/1786 (0.5%) instances of verbal abuse and in 224/362 (61.9%) instances of a violent act.</p><p><strong>Conclusions: </strong>Verbal abuse, threats of assault, and violent acts occurred frequently in ED patients with agitation and were underreported.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952590","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}