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

{"title":"Assessment of Patient Satisfaction Among Patients Treated With Intravenous vs Subcutaneous Insulin for Diabetic Ketoacidosis.","authors":"Richard T Griffey, Ryan M Schneider, Margo Girardi, Gina LaRossa, Julianne Yeary, Michael Lehmkuhl, Dan Suarez, Rachel Ancona, Taylor Kaser, Paulina Cruz-Bravo","doi":"10.1016/j.acepjo.2024.100020","DOIUrl":"10.1016/j.acepjo.2024.100020","url":null,"abstract":"<p><strong>Objectives: </strong>We previously implemented the subcutaneous (SQ) insulin in diabetic ketoacidosis (DKA) (SQuID) protocol, demonstrating safe, effective treatment of low to moderate (LTM) severity DKA in a non-intensive care unit setting. SQuID replaces intravenous (IV) insulin with SQ injections and reduces glucose checks from hourly to every 2 hours. We are not aware of any data on patient satisfaction with treatment in DKA. Our objective was to compare satisfaction in patients treated with IV insulin to that in patients treated with the SQ protocol.</p><p><strong>Methods: </strong>We conducted a cross-sectional study in an urban academic hospital (March 2023 to March 2024) of emergency department patients treated for LTM DKA with SQ or IV insulin. Patients were contacted by phone in the hospital after the resolution of DKA. We used the validated 21-item Diabetic Treatment Satisfaction Questionnaire-Inpatient tool (DTSQ-IP) using 7-tier Likert-style options (0 = negative; 6 = positive) to assess patient satisfaction with treatment. We computed the DTSQ-IP composite treatment satisfaction score (using 15 of the 21 items), assessing differences between groups.</p><p><strong>Results: </strong>Of the 60 patients contacted, 52 (87%) completed the questionnaire. Median DTSQ-IP satisfaction scores for SQuID and IV insulin patients were 86.0 (IQR, 79.0, 88.0) and 81.0 (IQR, 77.0, 88.0), respectively. We found no difference in satisfaction between groups (difference 5.0; 95% CI, -3.0, 10.0).</p><p><strong>Conclusion: </strong>In this single-center study, patient satisfaction with DKA care was high, with no differences observed between patients treated with SQ vs IV insulin protocols. This is the first study we are aware of on patient satisfaction with treatment in DKA or treatment with SQ insulin. Though the sample size is small, these findings suggest that patient satisfaction should not represent a barrier to the implementation of SQ protocols for LTM severity DKA.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 1","pages":"100020"},"PeriodicalIF":1.6,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517575","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":"In Support of \"Propylene Glycol Toxicity in an Adolescent Secondary to Chronic Cornstarch Ingestion\".","authors":"Kristen Downey, Ryan Keklik, Benjamin Morrissey, Robert Barnes, Karina Reyner, Michael Emmett","doi":"10.1016/j.acepjo.2024.100007","DOIUrl":"10.1016/j.acepjo.2024.100007","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 1","pages":"100007"},"PeriodicalIF":1.6,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517623","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 Effects of an ISOBAR-Structured Patient Handover Conversation Between Rescue Services and Emergency Department Staff: The COPTER Trial.","authors":"Matthias Nuernberger, Sebastian Lang, Tabea Maass, Thomas Lehmann, Stefan Brodoehl, Jan-Christoph Lewejohann","doi":"10.1016/j.acepjo.2024.100011","DOIUrl":"10.1016/j.acepjo.2024.100011","url":null,"abstract":"<p><strong>Objectives: </strong>Communication errors are the main cause of adverse events in emergency medicine, underscoring the importance of patient handover conversations. This study aims to assess the impact of implementing the ISOBAR handover protocol for patient transfer between emergency medical services and emergency department (ED) personnel.</p><p><strong>Methods: </strong>We conducted a single-center implementation trial to evaluate the ISOBAR handover protocol efficacy in a German university hospital ED. We observed and analyzed 651 handover conversations involving adult patients, comparing those using the ISOBAR protocol to those following standard procedure without the protocol. Direct observation of handover processes was employed during alternating interventional periods across 6 trial phases. Primary outcome measure was the \"Key Information Transfer Efficiency\" score (KITE), a higher score indicating a more efficient patient handover conversation. Secondary outcome measure was the retention of key information by ED personnel, indicating successfully conveyed information.</p><p><strong>Results: </strong>The KITE score was significantly higher in the ISOBAR group (difference 0.12, 95% CI 0.02-0.22), showing a notable increase from baseline without ISOBAR to the final trial phase using ISOBAR (difference 0.16, 95% CI 0.02-0.34). Key information retention increased significantly: +18% for physicians (95% CI 9-28) and +19% (95% CI 10-28) for nurses. The number of questions asked after handover decreased by 29% (95% CI 5.81-41.46). The adherence to ISOBAR had no notable effect on outcome measures.</p><p><strong>Conclusion: </strong>The implementation of ISOBAR can enhance information transfer during handover. However, adherence to ISOBAR was not crucial, highlighting the importance of focusing on quality of communication during patient handover.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 1","pages":"100011"},"PeriodicalIF":1.6,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517283","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":"Examining How Gender, Race/Ethnicity, and Clinical Roles Moderate the Association Between Sleep and Burnout.","authors":"Tsion Firew, Maody Miranda, Nakesha Fray, Alvis Gonzalez, Alexandra M Sullivan, Diane Cannone, Joseph E Schwartz, Jordan F Karp, Bernard P Chang, Ari Shechter","doi":"10.1016/j.acepjo.2024.100004","DOIUrl":"10.1016/j.acepjo.2024.100004","url":null,"abstract":"<p><strong>Objectives: </strong>Sleep disturbance and burnout are common in emergency department health care workers (HCWs), and the 2 are linked. This cross-sectional study evaluated whether gender, race/ethnicity, and clinical roles moderate the association between sleep quality and burnout among emergency department HCWs (N = 129).</p><p><strong>Methods: </strong>Sleep was assessed with the Pittsburgh Sleep Quality Index (Pittsburgh Sleep Quality Index > 5: poor sleep) and Insomnia Severity Index (Insomnia Severity Index > 8: insomnia). The abbreviated Maslach Burnout Inventory-9 assessed the burnout dimensions of emotional exhaustion, depersonalization , and reduced personal accomplishment . Emotional exhaustion > 9 and either (or both) depersonalization > 6 or personal accomplishment < 9 indicated burnout. Logistic regressions were computed for the association of poor sleep and insomnia with burnout for gender, race/ethnicity, and job role separately.</p><p><strong>Results: </strong>Poor sleep quality, insomnia, and burnout were seen in 64%, 59%, and 24% of participants, respectively. Poor sleep was more frequently reported in Black, Indigenous, and People of Color (BIPOC) HCWs vs non-BIPOC (72.9% vs 52.5%, <i>P</i> = .017). Overall, poor (vs not poor) sleep quality was associated with burnout (odds ratio [OR], 3.14; 95% CI, 1.14-8.64). There was a significant poor sleep-burnout relationship in women (OR, 4.52; 95% CI, 1.10-18.60) that was not seen in men. The poor sleep-burnout relationship was significantly stronger in attending physicians (OR, 6.92; 95% CI, 1.44-33.24) vs registered nurses (OR, 0.28; 95% CI, 0.03-2.30; <i>P</i> value for group ∗ predictor interaction term = .021).</p><p><strong>Conclusion: </strong>BIPOC HCWs had worse sleep quality than non-BIPOC HCWs, and the relationship between sleep quality and burnout was affected by gender and clinical role. These findings highlight the importance of person-level factors in the sleep-burnout relationship in HCWs.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 1","pages":"100004"},"PeriodicalIF":1.6,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517604","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":"Hypoxia and a Concerning Chest Radiograph After 40 Years of Lupus.","authors":"Joseph Shiber, Casey Carr, Sumeet Jain","doi":"10.1016/j.acepjo.2024.100001","DOIUrl":"10.1016/j.acepjo.2024.100001","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 1","pages":"100001"},"PeriodicalIF":1.6,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517619","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":"Injection of Lidocaine With Epinephrine for Bee Sting Large Local Reactions.","authors":"Keith A Denkler, Rosalind F Hudson","doi":"10.1016/j.acepjo.2024.100009","DOIUrl":"10.1016/j.acepjo.2024.100009","url":null,"abstract":"<p><p>Bee stings are very common worldwide. About 5% to 15% of those afflicted have a large local reaction, defined as a skin reaction around the sting site with edema, erythema, itching, and an injury diameter >10 cm. Standard treatments for large local reactions include ice, nonsteroidal anti-inflammatory medications, antihistamine medications, and topical or systemic corticosteroids, none of which immediately treat the pain associated with the symptoms nor initiate immediate treatment of the allergic and inflammatory response. We present a dramatic and rapid reversal of a periorbital large local reaction treated with subcutaneous and intradermal injection of 1% lidocaine with epinephrine into the sting area. The lidocaine rapidly reversed the symptoms of pain and pressure, and the low dose of epinephrine, within 2 hours, significantly reversed the allergic periorbital and eyelid edema. No further symptoms evolved, suggesting that the epinephrine terminated the allergic cascade.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 1","pages":"100009"},"PeriodicalIF":1.6,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517624","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 Woman With Facial Swelling and Pharyngeal Bleeding.","authors":"Timothy J Batchelor, Alfredo Urdaneta, Ian P Brown","doi":"10.1016/j.acepjo.2024.100008","DOIUrl":"10.1016/j.acepjo.2024.100008","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 1","pages":"100008"},"PeriodicalIF":1.6,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11853011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517553","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":"Turbulence in the system: Higher rates of left-without-being-seen emergency department visits and associations with increased risks of adverse patient outcomes since 2020","authors":"Candace D. McNaughton MD, PhD,&nbsp;Peter C. Austin PhD,&nbsp;Anna Chu MHSc,&nbsp;Maria Santiago-Jimenez MSc,&nbsp;Emily Li BHsc,&nbsp;Jessalyn K. Holodinsky PhD,&nbsp;Noreen Kamal PEng, PhD,&nbsp;Mukesh Kumar PhD,&nbsp;Clare L. Atzema MD, MSc,&nbsp;Manav V. Vyas MBBS, PhD,&nbsp;Moira K. Kapral MD, MSc,&nbsp;Amy Y. X. Yu MD, MSc","doi":"10.1002/emp2.13299","DOIUrl":"https://doi.org/10.1002/emp2.13299","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine risks of severe adverse patient outcomes shortly after a left-without-being-seen emergency department (LWBS ED) visit since 2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this retrospective study using linked administrative data, we examined temporal trends in monthly rates of ED and LWBS visits for adults in Ontario, Canada, 2014‒2023. In patient-level analyses restricted to the first eligible LWBS ED visit, we used modified Poisson regression to compare the composite outcome of 7-day all-cause mortality or hospitalization following a LWBS ED visit for April 1, 2022‒March 31, 2023 (recent period) to April 1, 2014‒March 31, 2020 (baseline period), adjusted for age, sex, and Charlson comorbidity index.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Despite fewer monthly ED visits since 2020, temporal trends revealed sustained increases in monthly LWBS rates. LWBS ED visits after April 1, 2020 exceeded the baseline period's single-month LWBS maximum of 4.0% in 15 out of 36 months. The composite outcome of 7-day all-cause mortality or hospitalization was 3.4% in the recent period versus 2.9% in the baseline period (adjusted risk ratio [aRR] 1.14, 95% confidence interval [CI] 1.11‒1.18) and remained elevated at 30 days (6.2% vs. 5.8%, respectively; aRR 1.05, 95% CI 1.03‒1.07), despite similar rates of post-ED outpatient visits (7-day recent and baseline: 38.9% and 39.7%, respectively, <i>p</i> = 0.38; 30-day: 59.4% and 59.7%, respectively, <i>p</i> = 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The rate of short-term mortality or hospitalization after a LWBS ED visit has recently increased, despite fewer ED visits/month and similar proportion of post-ED outpatient encounters. This concerning signal should prompt interventions to address system- and population-level causes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"5 6","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13299","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142861646","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":"Telehealth in emergency medicine residency training: A model curriculum","authors":"Laura Oh MD,&nbsp;Rahul Bhat MD,&nbsp;Michael J. Carr MD,&nbsp;Aditi U. Joshi MD, MSc,&nbsp;Bruce M. Lo MD, MBA,&nbsp;Ashley C. Rider MD, MEHP,&nbsp;Lulu Wang MD,&nbsp;Michael C. Wadman MD,&nbsp;Samuel D. Luber MD, MPH","doi":"10.1002/emp2.13301","DOIUrl":"10.1002/emp2.13301","url":null,"abstract":"<p>Emergency physicians are well-positioned to take a leadership role in telehealth, particularly in emerging categories such as triage, direct acute unscheduled care, and virtual observation. However, the growth of telehealth has outpaced curricular development in emergency medicine (EM) residency programs. This manuscript presents a model longitudinal telehealth curriculum, developed by the consensus of education experts, including representatives from the telehealth interest groups from EM's two primary specialty societies: the American College of Emergency Physicians and the Society for Academic Emergency Medicine. The curriculum describes overarching goals and components that may serve as a foundation for individual institutions seeking to train future operational and academic leaders in telehealth.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"5 6","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11652387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856994","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":"Infant with lower extremity weakness","authors":"Abdullah Khan MD","doi":"10.1002/emp2.13273","DOIUrl":"10.1002/emp2.13273","url":null,"abstract":"&lt;p&gt;A 7-month-old infant, previously healthy, presented with intermittent fever, non-barking cough for the 7 days and decreased ability to move lower extremities for the last 3 days. Parents also noticed that she is not able to cruise and turn from side to side. Prior to the current presentation, the child had achieved appropriate developmental milestones for age. There was no history of constipation or urinary retention and a history of honey intake 3 days ago. On examination, the patient was able to move lower extremities against gravity with movement against resistance. Brisk patellar tendon reflexes and sustained ankle clonus were also noticed. The rest of the respiratory, cardiovascular, and gastroenterological examinations were normal. No palpable lymph nodes were appreciated.&lt;/p&gt;&lt;p&gt;Neurology was consulted and magnetic resonance imaging (MRI) of the brain and spine were scheduled. Considering the history of fever and cough, a frontal chest radiograph was obtained that showed a dense structure in the hemithorax (Figure 1, red arrow). A lateral radiograph suggested a dense mass in the posterior mediastinum (Figure 2, red arrow). A computed tomography (CT) scan of the chest was obtained with a mediastinal mass with intraspinal extension suspicious of neuroblastoma (Figure 3, blue arrow shows neuroblastoma and red arrow shows descending aorta engulfed in neuroblastoma; Figure 4, blue arrow shows neuroblastoma with calcifications and red arrow shows intraspinal extension). The patient was admitted to the oncology unit and biopsy of mass showed poorly differentiated neuroblastoma. The chemotherapy (carboplatin and etoposide) was started and showed excellent response.&lt;/p&gt;&lt;p&gt;In children, neuroblastoma is the most common extracranial solid tumor originating from the neural crest cells along the sympathetic nervous system and adrenal glands.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Thoracic neuroblastomas are posterior mediastinal tumors and account for one fourth of all cases of neuroblastoma but are the most common cause of mediastinal mass in children less than 2 years of age. It has a wide variety of presentations ranging from respiratory symptoms, such as cough and shortness of breath to neurologic symptoms such as paralysis, limping, and Horner syndrome.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; The chest radiographs are good initial screening tests with excellent sensitivity to identify thoracic masses, especially neuroblastoma. Neuroblastoma has an excellent prognosis. Almost half of the cases can regress spontaneously.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In evaluating infants and younger children with suspected thoracic masses, it is important to consider the appearance of normal thymus on chest radiographs. A normal thymus is visible on frontal chest radiographs till the age of 3 years.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Thymus is in the anterior and superior mediastinum. It has characteristics “thymic sail sign” on frontal chest radiograph, which is lateral triangular extension of normal","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"5 6","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11652315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856991","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}