Academic Emergency Medicine最新文献

{"title":"Leading Through Change: Reflections on Leadership in Academic Emergency Medicine.","authors":"Michelle D Lall, Sheryl L Heron","doi":"10.1111/acem.70358","DOIUrl":"https://doi.org/10.1111/acem.70358","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 6","pages":"e70358"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148275723","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":"Feasibility and Cost Effectiveness of a Program for Medically and Socially Complex Patients in the Emergency Department.","authors":"Elaine Hsiang, Mehran Teymourtash, Ayesha Khan","doi":"10.1111/acem.70368","DOIUrl":"https://doi.org/10.1111/acem.70368","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 6","pages":"e70368"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148256891","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":"PubMetric: Empowering Researchers and Improving Systematic Reviews/Meta-Analyses.","authors":"Clay Smith, Samuel Rouleau, Joshua Smith, Brit Long","doi":"10.1111/acem.70326","DOIUrl":"https://doi.org/10.1111/acem.70326","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 6","pages":"e70326"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148051819","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":"Point-of-Care Ultrasound for Pediatric Urethral Catheterization: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Henrique Faustino Vieira da Silva, Enzo Tatsumi Watanabe, Mariana Cosas Tavares, Ana Clara Ramos Bicalho, Luigi de Souza Dias Ferraro, Ana Cristina Simões E Silva","doi":"10.1111/acem.70342","DOIUrl":"10.1111/acem.70342","url":null,"abstract":"<p><strong>Background: </strong>Urethral catheterization is the standard method for obtaining sterile urine in nontoilet-trained children, but the conventional blind technique frequently results in futile attempts (\"dry taps\") on empty bladders. Point-of-care ultrasound (POCUS) offers the clinical advantage of confirming adequate urine volume to prevent mucosal trauma and procedural distress. However, its routine implementation may be limited by operator training requirements and potential workflow delays while waiting for bladder filling. Therefore, this study aims to evaluate the efficacy of real-time POCUS-assisted versus standard blind urethral catheterization in pediatric patients.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) adhering to PRISMA guidelines (PROSPERO: CRD420251247483). We searched PubMed, Embase, and CENTRAL for trials comparing POCUS-guided versus standard catheterization in children aged ≤ 36 months. The primary outcome was the first-attempt success rate. The certainty of evidence was evaluated using the GRADE approach.</p><p><strong>Results: </strong>Three trials comprising 337 participants were included. POCUS-assisted catheterization significantly increased first-attempt success compared to the conventional technique (89.7% vs. 72.5%; RR 1.25, 95% CI 1.08-1.45, p = 0.0022), yielding a Number Needed to Treat (NNT) of 6. Furthermore, ultrasound guidance significantly reduced the rate of \"dry taps\" (3.6% vs. 23.9%; RR 0.25, 95% CI 0.13-0.47, p < 0.0001), representing an NNT of 5 to prevent one futile attempt. The certainty of evidence for the primary outcome was rated as moderate. Secondary descriptive outcomes indicated higher caregiver satisfaction, lower perceived patient discomfort, and comparable overall workflow times despite required waiting periods for bladder filling.</p><p><strong>Conclusions: </strong>Real-time POCUS significantly improves first-attempt catheterization success and drastically reduces futile attempts in young children. Furthermore, it enhances caregiver satisfaction and minimizes patient distress without intrinsically delaying emergency department workflow. These highly actionable findings support the integration of ultrasound guidance into routine pediatric emergency care.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 6","pages":"e70342"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148161537","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":"Patient-Physician Agreement on Diagnosis in the ED, Part of Diagnostic Excellence. A Prospective Multicenter Study.","authors":"Lieke Claassen, Veerle M E P Baars, Jochen W L Cals, Patricia M Stassen, Gideon H P Latten","doi":"10.1111/acem.70365","DOIUrl":"10.1111/acem.70365","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 6","pages":"e70365"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13274553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148262853","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":"Did I Help?","authors":"Daniel J McCabe","doi":"10.1111/acem.70362","DOIUrl":"https://doi.org/10.1111/acem.70362","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 6","pages":"e70362"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148209764","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":"Palliative Care Utilization, Advance Care Planning, and Outcomes Among Older Adults With Cancer Presenting to the Emergency Department.","authors":"Meredith Janes, Nancy Wood, Emily Strong, Lisa Smith, Eric Snyder, Sule Yilmaz","doi":"10.1111/acem.70357","DOIUrl":"10.1111/acem.70357","url":null,"abstract":"<p><strong>Background: </strong>Older adults with cancer frequently present to the emergency department (ED) with complex care needs, yet palliative care remains underutilized. We aimed to characterize palliative care utilization and advance care planning (ACP) among older adults with cancer presenting to the ED and examine associated outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of a random sample of 200 patients aged ≥ 65 years with cancer who presented to the ED at a tertiary academic center in 2022. Data included demographics, oncologic factors, ED encounter characteristics, palliative care utilization, ACP documentation, and outcomes. Analyses were descriptive, with exploratory associations evaluated using chi-square tests and logistic regression.</p><p><strong>Results: </strong>Patients were older (mean age 74.3 years), and had frequent ED use, averaging 3.1 visits annually (SD = 1.9). Most were White (88.5%), male (52.5%), married (54.0%), and had a solid tumor malignancy (77.5%), with 28.5% receiving palliative-intent treatment. ED encounters frequently resulted in hospitalization (60.0%), with 18.3% of hospitalized patients requiring ICU admission. Palliative care consultation occurred in 2.5% of patients in the ED and 16.5% overall. ACP documentation increased from 65.5% at presentation to 75.0% following the encounter, largely driven by new MOLST completion and changes in code status. Mortality was high, with 24.4% dying during hospitalization and 49.0% within 6 months of the ED encounter. Among those who died within 6 months, 66.3% had not received palliative care consultation. In exploratory analyses, palliative care consultation, intensive care interventions, and ED visit frequency were associated with mortality.</p><p><strong>Conclusions: </strong>Older adults with cancer presenting to the ED experience high rates of hospitalization, intensive care use, and short-term mortality, yet palliative care remains underutilized. Although ACP documentation increased during acute care encounters, these changes often occur with clinical deterioration. The ED offers an opportunity to identify unmet palliative care needs and facilitate earlier integration.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 6","pages":"e70357"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148262838","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":"Diagnostic Accuracy of Physical Examination, Imaging, and LRINEC Score for Necrotizing Soft Tissue Infections.","authors":"Fatima Johari, Nicholas J Bove, Nazi Saljoughi","doi":"10.1111/acem.70363","DOIUrl":"https://doi.org/10.1111/acem.70363","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 6","pages":"e70363"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148238386","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":"Impact of Abortion Bans on Emergency Care for Patients With Vaginal Bleeding: An Ethnographic Analysis.","authors":"Andreia B Alexander, Kathryn J LaRoche, Risa Cromer, Brownsyne Tucker Edmonds, Lori Freedman","doi":"10.1111/acem.70328","DOIUrl":"10.1111/acem.70328","url":null,"abstract":"<p><strong>Background: </strong>The Dobbs decision enabled widespread state abortion bans, creating legal ambiguity for clinicians managing reproductive emergencies in the ED. While impacts on obstetricians are documented, less is known about how these laws influence emergency medicine practice. We explored how ED clinicians navigate care for patients with vaginal bleeding under Indiana's restrictive abortion ban.</p><p><strong>Methods: </strong>We conducted a team-based ethnographic study at an urban academic ED and Level 1 Trauma Center in Indiana between August 2023 and October 2024. Data included six weeks of site-based observations and semi-structured interviews with 20 emergency clinicians. Interviews explored clinical decision-making, documentation practices, and perceptions of legal risk following implementation of the abortion ban. Transcripts and field notes were analyzed using an iterative, consensus-based qualitative coding process informed by ethnographic methods.</p><p><strong>Results: </strong>Three interrelated themes shaped clinician decision-making: knowing, documentation, and reporting. Clinicians described altered approaches to history-taking, particularly around self-managed abortion, balancing medical relevance against concerns for patient stigma and legal harm. Documentation practices were characterized by uncertainty and fear, with many clinicians intentionally limiting chart detail to protect patients while simultaneously worrying about medico-legal vulnerability. Knowledge of state-mandated reporting requirements varied widely, contributing to anxiety, misinterpretation of the law, and defensive clinical behaviors. Across themes, clinicians reported persistent tension between ethical obligations to patient safety and autonomy and perceived pressure to ensure legal self-protection. Robust institutional support was identified as a critical mitigating factor.</p><p><strong>Conclusions: </strong>Indiana's abortion ban has introduced legal uncertainty into emergency care for patients with vaginal bleeding, reshaping clinician behavior around information gathering, documentation, and reporting. These shifts risk delayed or defensive care, erosion of patient trust, and widening inequities in time-sensitive emergency settings. Clear institutional guidance, interdisciplinary collaboration, and legal support are essential to safeguard evidence-based emergency care and uphold ethical practice in restrictive reproductive policy environments.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 6","pages":"e70328"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13238399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148161504","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":"Use of Weighted Blankets as Adjunct Therapy for Symptom Reduction Among Emergency Department Patients Receiving Buprenorphine for Opioid Withdrawal.","authors":"Kathy T LeSaint, Emily E Ager, Pranav Kaul, Curtis Geier, Craig G Smollin","doi":"10.1111/acem.70341","DOIUrl":"10.1111/acem.70341","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 6","pages":"e70341"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13242058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148175100","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}