Journal of the American College of Emergency Physicians open最新文献

{"title":"A Man With Acute Chest Pain and Dyspnea.","authors":"Han Cheng, Po-Wei Chiu","doi":"10.1016/j.acepjo.2024.100014","DOIUrl":"10.1016/j.acepjo.2024.100014","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 1","pages":"100014"},"PeriodicalIF":1.6,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517546","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":"National Evaluation of Emergency Medical Services Clinician Burnout and Workforce-Reducing Factors.","authors":"Jonathan R Powell, Christopher B Gage, Remle P Crowe, Laura J Rush, Sarah R MacEwan, Graham Dixon, Ann Scheck McAlearney, Ashish R Panchal","doi":"10.1016/j.acepjo.2024.100024","DOIUrl":"10.1016/j.acepjo.2024.100024","url":null,"abstract":"<p><strong>Objectives: </strong>Limited recent national data exist measuring burnout levels among emergency medical services (EMS) clinicians and the potential impact of burnout on workforce strength and stability. We aimed to measure current EMS burnout and its association with workforce-reducing factors.</p><p><strong>Methods: </strong>In April 2022, a random sample of nationally certified EMS clinicians was sent a survey that included the Copenhagen Burnout Inventory (CBI) to assess for burnout in 3 dimensions: personal, work-related, and patient-related. Descriptive statistics (count and percentage) and multivariable logistic regression (odds ratio [OR] and 95% CI) were used to identify and measure each domain of burnout and the relationship between these domains and workforce-reducing factors.</p><p><strong>Results: </strong>From 1838 survey responses (9% response rate), prevalence of EMS burnout was high in the personal (52%), work-related (49%), and patient-related (23%) domains. Burnout was higher for paramedics than for emergency medical technicians across all domains. Higher odds of reporting 10 or more sick days was observed for those with personal (OR, 2.66; 95% CI, 1.70-4.15), work-related (OR, 1.99; 95% CI, 1.31-3.01), or patient-related burnout (OR, 1.85; 95% CI, 1.20-2.86). Higher odds of reporting likelihood to leave the EMS profession was observed for those with personal (OR, 3.06; 95% CI, 2.16-4.33), work-related (OR, 3.34; 95% CI, 2.35-4.74), or patient-related burnout (OR, 3.42; 95% CI, 2.39-4.90).</p><p><strong>Conclusion: </strong>Nationally certified EMS clinicians demonstrated high burnout in 2022. Combined with increased absenteeism and intent to leave the profession associated with these high levels of burnout, these findings suggest that a renewed and deliberate focus on EMS clinician well-being is needed to ensure job satisfaction and workforce stability.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 1","pages":"100024"},"PeriodicalIF":1.6,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11853008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517361","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":"Man With Leg Pain.","authors":"Alejandro Avila, Riley Putnam, Ellen Shank","doi":"10.1016/j.acepjo.2024.100023","DOIUrl":"10.1016/j.acepjo.2024.100023","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 1","pages":"100023"},"PeriodicalIF":1.6,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11853354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517346","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 Man With Abdominal Wall Fluctuance.","authors":"Christopher Millman, Morgan Pike, David Ahmad Haidar","doi":"10.1016/j.acepjo.2024.100027","DOIUrl":"10.1016/j.acepjo.2024.100027","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 1","pages":"100027"},"PeriodicalIF":1.6,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11853010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517541","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":"An Innovative Traction-free Drugless Approach to Reduce Anterior Shoulder Dislocation: Axillary Massage Technique.","authors":"Ayşegül Islek Yuksel, Abdullah Ortadeveci, Nalan Kozaci, Osman Polat, Serkan Yuksel","doi":"10.1016/j.acepjo.2024.100017","DOIUrl":"10.1016/j.acepjo.2024.100017","url":null,"abstract":"<p><p>Although shoulder dislocation is one of the most common cases encountered in emergency departments, there is still no consensus on the method of reduction. Here, we reported 9 cases in which we used a new technique that did not require any traction, medication, or patient effort. This technique can give results in 20 seconds in some cases and provides high patient satisfaction. Due to its easy applicability and high success rate, we think that the technique will make a significant contribution to the literature and clinical practice.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 1","pages":"100017"},"PeriodicalIF":1.6,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517571","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":"Man With Ocular Trauma.","authors":"Seth Lotterman, Aaron Floch, Kesley Boch","doi":"10.1016/j.acepjo.2024.100019","DOIUrl":"10.1016/j.acepjo.2024.100019","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 1","pages":"100019"},"PeriodicalIF":1.6,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517348","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":"Impact of an Algorithm to Triage Patients Discharged From the Emergency Department With Blood Cultures Positive for <i>Staphylococcus aureus</i> or Coagulase-Negative <i>Staphylococcus</i>.","authors":"Amy Mackowiak, Ethan Brenneman, Thomas Holland, Hui-Jie Lee, Justin Jones, Elizabeth Keil, Jennifer Mando, Rebecca Theophanous, Rachel Toler, Rebekah Moehring, Rebekah Wrenn","doi":"10.1016/j.acepjo.2024.100010","DOIUrl":"10.1016/j.acepjo.2024.100010","url":null,"abstract":"<p><strong>Objectives: </strong>Blood cultures obtained in the emergency department (ED) may become positive after discharge. Healthcare professionals must determine if these results represent true infection or a likely contaminant. An institutional algorithm was developed to assist with healthcare professional response to positive blood cultures for <i>S. aureus</i> and coagulase-negative staphylococci (CoNS) in these situations.</p><p><strong>Methods: </strong>We conducted a single system, multisite cohort study comparing before and after implementation of an ED decision-making algorithm from November 2022 to December 2023. Adults were included if they were discharged from the ED before blood cultures became positive for <i>Staphylococcus</i> species. The primary outcome was the difference in rates of patients called back to the ED pre- and postalgorithm implementation. Secondary endpoints evaluated algorithm adherence and safety.</p><p><strong>Results: </strong>A total of 253 patients, 188 pre- and 65 postimplementation, were enrolled. There was a 7.3% reduction in patients called back to the ED after algorithm implementation (95% CI [-21.1 to 6.3], <i>P</i> = .3). Algorithm adherence after implementation was 84.6% with a difference in actual and algorithm-based callback rates of 4.6%. After algorithm implementation, no patients deemed to have a contaminant experienced an infectious-related safety event.</p><p><strong>Conclusions: </strong>This time-saving algorithm was well received by our ED professionals and served as a helpful tool in safely and effectively triaging patients who had positive blood cultures for <i>Staphylococcus</i> species after discharge to determine who should be called back for further evaluation. There was a nonstatistically significant but clinically meaningful reduction in callback rates. Postimplementation algorithm adherence was high, and the majority of callback decisions were appropriate.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 1","pages":"100010"},"PeriodicalIF":1.6,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517621","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":"Woman With Right Abdominal Pain.","authors":"Ang Joo Shiang","doi":"10.1016/j.acepjo.2024.100006","DOIUrl":"10.1016/j.acepjo.2024.100006","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 1","pages":"100006"},"PeriodicalIF":1.6,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11853351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517285","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":"Development of a Framework for the Enrollment of Children and Families in Emergency Department Research.","authors":"Aliya Redd, Rosemarie Fernandez, Diego Maldonado-Puebla, Julia Mortensen, Meredith Thompson, Antionette McFarlane, Colleen Gutman","doi":"10.1016/j.acepjo.2024.100018","DOIUrl":"10.1016/j.acepjo.2024.100018","url":null,"abstract":"<p><strong>Objectives: </strong>There remains a need to establish best practices for ethical and inclusive enrollment of children in emergency settings outside of established research networks. We aimed to develop a stakeholder-informed framework for enrolling children and families in emergency department (ED) research.</p><p><strong>Methods: </strong>We conducted a cross-sectional mixed-methods study using a convergent parallel design. Data collection tools were formulated by a multidisciplinary team. We approached caregivers of pediatric ED patients at a single site to complete a tablet-based questionnaire. We conducted 4-item structured interviews with (1) clinicians in a single pediatric ED and (2) pediatric ED researchers from across the United States. We calculated descriptive statistics for quantitative data and conducted a content analysis of qualitative data. These data were merged to develop a framework to support research recruitment and enrollment in the pediatric ED.</p><p><strong>Results: </strong>The questionnaire was completed by 225 caregivers (61% response). Caregivers' likelihood of participating in research was high but varied by type of research, perceived importance, and the clinical context. Researchers (n = 11) and clinicians (n = 8) identified barriers to and facilitators of research recruitment in the ED at the caregiver, clinician, and systems level. Merging these data, we developed a framework of 5 principles: (1) high-quality communication is essential; (2) discussions about research participation cannot be coercive; (3) partnership with clinical teams is necessary; (4) research teams must adapt to unpredictability; and (5) participation in research may be viewed as an opportunity by families.</p><p><strong>Conclusion: </strong>Our framework provides key considerations for conducting ED research with children and families.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 1","pages":"100018"},"PeriodicalIF":1.6,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517598","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":"The Eyes Cannot See What the Mind Does Not Know: Autochthonous Dengue in South Florida.","authors":"Sabrina Ginsburg, Elizabeth May-Smith, Erin Smith, Christopher Freeman","doi":"10.1016/j.acepjo.2024.100003","DOIUrl":"10.1016/j.acepjo.2024.100003","url":null,"abstract":"<p><p>Dengue is a mosquito-borne arbovirus that, when it infects humans, can cause a range of illnesses from asymptomatic infection to febrile illness and myalgias that, in rare cases, can be severe or fatal. Dengue has historically been considered a tropical disease in the United States, acquired only by international travelers. However, the incidence of locally transmitted (autochthonous) dengue in nontravelers is increasing in the United States, likely because of the expansion of the range of <i>Aedes aegypti</i> and <i>A. albopictus</i>, the virus's mosquito vector. Our case report describes a patient in Florida who was infected with dengue and had no international travel history. As the number of locally transmitted dengue cases is expected to rise, the diagnosis and management of dengue will be of increased importance to emergency medicine physicians in the United States.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 1","pages":"100003"},"PeriodicalIF":1.6,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517284","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}