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

{"title":"Asynchronous education improves emergency medical services clinician confidence and knowledge in caring for patients near the end-of-life","authors":"David H. Wang MD,&nbsp;Charles Dunn BS, EMT,&nbsp;Justin K. Brooten MD,&nbsp;Brian Gacioch MD, EMT-P,&nbsp;Michael Taigman MA, NREMT-P,&nbsp;Zili He MS,&nbsp;James Dziura PhD,&nbsp;Amelia M. Breyre MD, NREMT-P","doi":"10.1002/emp2.13331","DOIUrl":"10.1002/emp2.13331","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the impact of a nationally available continuing education online curriculum on Emergency Medical Services (EMS) clinician confidence and knowledge in caring for end-of-life (EOL) patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a prospective observational study of EMS clinicians (emergency medical technicians [EMTs], advanced EMTs [AEMTs], and paramedics). EMS clinicians and physicians with both EMS and palliative care expertise developed two 20-min modules regarding: (1) communication skills (including death notification) and (2) hospice knowledge. EMS clinicians’ subject confidence (modified Likert-scale) and knowledge were assessed electronically immediately before and after each module. Data analysis compared before and after module improvements in knowledge and confidence. Linear regressions analyzed baseline EOL skill confidence scores based on EMS agency, level of certification, and years of experience.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We analyzed completed datasets for 1825 EMS clinicians (979 EMTs, 112 AEMTs, and 734 paramedics) representing a heterogeneous cohort across different EMS agencies (617 private, 545 fire-based, 298 hospital-based, 61 third service, and 304 other) and all 50 states and the District of Columbia. After the communication module, the number of EMS clinicians who reported confidence in delivering bad news increased from 62% (1131/1825) to 80% (1468/1825) (<i>p</i> &lt; 0.001). After the hospice module, the number of EMS clinicians who reported confidence in knowing what services hospice provides increased from 51% (925/1825) to 75% (1375/1825) (<i>p</i> &lt; 0.001) and confidence in knowing what active dying patients look like from 57% (1033/1825) to 78% (1429/1835) (<i>p</i> &lt; 0.001) in knowing what active dying patients look like. Linear regression demonstrated that before modules, EMS clinicians with more monthly EOL calls, those with more years of experience, and paramedics were more confident in their EOL skills than their peers. After module completion, those with the fewest years of experience (0–3 years) and EMTs gained significantly more confidence in communication skills than their peers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Asynchronous, online continuing education improves EMS clinician knowledge and confidence in caring for patients near the EOL. The greatest benefit in improved confidence was for EMTs and those with the fewest years of EMS experience.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"5 5","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11499566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514250","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 multicenter randomized control trial: Point-of-care syndromic assessment versus standard testing in urgent care center patients with acute respiratory illness","authors":"Andrew C. Meltzer MD MS,&nbsp;Aditya Loganathan BS,&nbsp;Seamus Moran BS, MS,&nbsp;Soroush Shahamatdar BS,&nbsp;Luis W. Dominguez MD, MPH,&nbsp;Joel Willis DO,&nbsp;Wei Zhang PhD,&nbsp;Xinyi Zhang PHD,&nbsp;Yan Ma PhD","doi":"10.1002/emp2.13306","DOIUrl":"10.1002/emp2.13306","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Syndromic assessment with multiplex polymerase chain reaction (mPCR) testing in patients with acute respiratory illness (ARI) allows for simultaneous identification of multiple possible infectious etiologies. Point-of-care (POC) syndromic assessment can be conducted in a clinical setting, such as an urgent care center (UCC), without requiring certified laboratories. The primary objective of this study was to determine whether POC syndromic assessment improved patient satisfaction for patients seen at an UCC with ARI; secondary objectives included whether syndromic assessment reduced self-isolation time, increased diagnostic confidence, and reduced overall antibiotic utilization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted an unblinded multicenter randomized controlled trial on UCC patients with an ARI. Patients were randomized to either SC (defined as standard UCC testing for ARI) or syndromic assessment with POC mPCR. Patients were surveyed for patient satisfaction, self-isolation plans, diagnostic confidence, and overall antibiotic utilization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 360 patients enrolled, those in the syndromic assessment group were more satisfied with the time required to communicate the results (98.4% vs. 42.4%, <i>p</i> &lt; 0.001) on day of treatment, more likely to resume normal activities sooner (83.3% vs. 69.4%, <i>p</i> = 0.039), and more confident in their illness cause (60.7% vs. 29.6%, <i>p</i> &lt; 0.001); however, the rate of antibiotic utilization did not differ (33.5% vs. 26%, <i>p</i> = 1.0).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In conclusion, our study provides evidence supporting the use of syndromic assessment in UCCs for ARI diagnosis, including patient-centered outcomes such as greater confidence in diagnosis and more efficient isolation strategies. This study did not show a difference in more clinically oriented outcomes, such as a change in antibiotic utilization. Future studies should identify clinical care pathways to improve antibiotic stewardship for likely viral syndromes and whether the increased initial cost of syndromic assessment is offset by the clinical benefits and subsequent cost savings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"5 5","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11497039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514249","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":"Buprenorphine, oxycodone, hydrocodone, and methadone mortality in the United States (2010‒2017)","authors":"Karilynn M. Rockhill PhD,&nbsp;Gabrielle E. Bau MS,&nbsp;Angela DeVeaugh-Geiss PhD,&nbsp;Howard Chilcoat ScD,&nbsp;Richard Dart MD, PhD,&nbsp;Janetta Iwanicki MD,&nbsp;Joshua C. Black PhD","doi":"10.1002/emp2.13338","DOIUrl":"10.1002/emp2.13338","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Opioid overdose survivors present to emergency departments (EDs) and many EDs have developed programs to initiate buprenorphine. The impact of the increasing use of buprenorphine in ED and by other providers is unknown while opioid mortality continues to rise. Public mortality data do not distinguish buprenorphine from other prescription opioids. Our objective was to determine when changes in overdose mortality trends occurred comparing deaths involving buprenorphine to oxycodone, hydrocodone, and methadone.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This observational study utilized the drug-involved mortality database including US death certificates (2010‒2017) in which buprenorphine, oxycodone, hydrocodone, or methadone were contributing causes of death (determined through textual analysis). Population- and drug utilization-adjusted mortality rates were examined using disjointed linear regression. Buprenorphine-involved deaths were stratified by polysubstance involvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The population-adjusted mortality rates for buprenorphine-involved deaths were lowest compared to other opioids; however, the change in rate for buprenorphine increased faster than oxycodone, hydrocodone, and methadone at 8.9% each quarter-year (95% confidence interval [CI]: 8.0, 9.8) from 2010 to mid-2016 when it stabilized. After adjusting for changes in dispensing over the study period, buprenorphine-involved mortality rates were increasing at 5.3% (95% CI: 4.6, 6.1) each quarter-year. In 2017, 94% buprenorphine-involved deaths had at least one other drug contributing to the cause of death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Given the low mortality, high proportions of polysubstance mortality, and the mixed agonist/antagonist mechanism of action, use of buprenorphine alone likely presents a lower risk for overdose than comparators. Mortality rose faster than dispensing, signaling need to ensure people understand buprenorphine risks, particularly polysubstance use, balanced against importance for treating opioid use disorders.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"5 5","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11499299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514251","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":"Evaluation of an emergency department-based approach to reduce subsequent opioid overdoses","authors":"Eric N. Reed MD,&nbsp;Joan Papp MD,&nbsp;Yesol Oh MD,&nbsp;Kellie LeVine MD,&nbsp;Yasir Tarabichi MD,&nbsp;Estella Bastian BA,&nbsp;Kailee Pollock PharmD,&nbsp;Lance D. Wilson MD,&nbsp;Jonathan Siff MD,&nbsp;Joseph S. Piktel MD","doi":"10.1002/emp2.13304","DOIUrl":"10.1002/emp2.13304","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The purpose of this study was to determine the association of a multi-pronged treatment program in emergency department (ED) patients with an acute presentation of opioid use disorder (OUD) on the rate of subsequent opioid overdose (OD). This approach included ED-initiated take-home naloxone, prescription buprenorphine, and an ED-based peer support and recovery program.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective observational analysis of adult patients presenting to the ED at a large urban hospital system from November 1, 2017 to March 17, 2023. Patients with an ED discharge diagnosis of OD or OUD were included. Outcomes determined were subsequent 90-day OD and 180-day OD death. Post hoc analyses were performed to identify intervention utilization throughout the study period including the COVID-19 pandemic as well as ED characteristics associated with subsequent OD and OD death. Statistical comparisons were made using logistic regression and chi-squared test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 2634 patients presented to the ED with an opioid OD or diagnosis of OUD. Subsequent 90-day OD decreased significantly over time (11.5%–2.3%, odds ratio [OR] 0.85, confidence interval [CI] 0.82–0.89). No single intervention was independently associated with 90-day OD or 180-day OD death. Resource utilization was stable during the COVID-19 pandemic and increased afterward. A higher buprenorphine fill-rate among all patients and the Back race subgroup was associated with a decrease in 90-day OD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Subsequent OD and OD death decreased over time after implementation of a multi-pronged treatment program to ED patients with OUD. No single intervention was associated with a decrease of subsequent OD or OD death.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"5 5","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11496383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514252","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":"Young infant with umbilical protrusion","authors":"Yuto Otsubo MD,&nbsp;Ryoichi Yamaki MD,&nbsp;Yuho Horikoshi MD","doi":"10.1002/emp2.13323","DOIUrl":"10.1002/emp2.13323","url":null,"abstract":"<p>A 1-month-old male infant presented to a pediatric emergency department with a fever and poor activity. Physical examination revealed tachycardia, slightly mottled skin, abdominal distension, and an umbilical protrusion (Figure 1).</p><p>The symptom of umbilical protrusion raised the suspicion of a HPeV3 infection, polymerase chain reaction was performed, and HPeV was detected in the cerebrospinal fluid. A type analysis revealed HPeV3. His general condition, including the umbilical protrusion, resolved after a few days.</p><p>HPeV3 can cause a severe infection, such as sepsis or a central nervous system infection, in a young infant.<span>¹</span> Early diagnosis, though difficult, can enable the discontinuation of unnecessary antibiotic therapy and help predict the clinical course of the infection.</p><p>Umbilical protrusion is one of the characteristic symptoms of early infantile HPeV3 infection. In a previous study, eight of 43 young infants with HPeV3 (19%) presented with an umbilical protrusion.<span>²</span> Umbilical protrusion is typically observed in the presence of abdominal distention.<span>³</span> Abdominal distension caused by HPeV3 is sometimes severe and may be confused with a surgical condition.<span>⁴</span> The mechanism of umbilical protrusion is thought to be an increased abdominal pressure and the insufficient development of the umbilical ring in young infants. In young infantile cases of abdominal distention and umbilical protrusion accompanied by sepsis-like symptoms, HPeV3 should be considered in a differential diagnosis.</p><p>The authors declare no conflicts of interest.</p><p>There were no sources of funding for this study.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"5 5","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11492402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482482","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":"Assessing variations in care delivered to rural out of hospital cardiac arrest patients in the interfacility transfer setting","authors":"Michael J. Burla DO,&nbsp;Peter C. Michalakes BA,&nbsp;Jeanne S. Wishengrad MSc,&nbsp;Drew R. York BA,&nbsp;Holly A. Stevens BSN-RN,MHRT-CSP,&nbsp;Teresa L. May DO","doi":"10.1002/emp2.13330","DOIUrl":"10.1002/emp2.13330","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>There is significant variation in out-of-hospital cardiac arrest (OHCA) outcomes between different regions. We sought to evaluate outcomes of OHCA patients in the interfacility transfer (IFT) setting, between critical care transport (LifeFlight) and community Emergency Medical Services (EMS), in the state of Maine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective analysis of our institution's electronic medical record and the Maine EMS database. Data were collected from January 1, 2019, to December 31, 2021. Only adult OHCA encounters requiring an IFT for definitive post-cardiac-arrest care were included. Demographics, EMS agency, IFT vital signs, targeted temperature management (TTM) medications, cerebral performance category (CPC) scores, survival to discharge, and other descriptive variables were collected.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ninety-three patients met inclusion criteria, with LifeFlight transferring 30 of them (32.3%). LifeFlight was more likely to initiate TTM compared to other EMS agencies (<i>p</i> = 0.012), have run-sheets reported (<i>p</i> = 0.001), and serve rural areas (<i>p</i> = 0.036). LifeFlight was associated with more epinephrine (0.034) and norepinephrine (&lt;0.001) use. Only 37% of IFTs had physician orders, with none (0.0%) of them defining vital sign targets. No difference in survival to discharge or CPC scores was observed between LifeFlight and other EMS agencies. No significant variation in comorbidities or vital signs was observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There was no difference in survival to discharge or CPC scores between LifeFlight and ad hoc EMS agency. LifeFlight was associated with more TTM and vasopressor utilization during IFT. Most IFT encounters did not have dedicated physician orders, and none of the orders included vital sign targets.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"5 5","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11491542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482480","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":"Gastric outlet obstruction in a patient","authors":"Dragan Vasin,&nbsp;Miona Jevtovic MD,&nbsp;Sabina Fiuljanin MD,&nbsp;Katarina Trajković MD,&nbsp;Tarik Plojović MD,&nbsp;Marković Danilo MD,&nbsp;Dušan Micić,&nbsp;Ksenija Mijovic MD,&nbsp;Aleksandar Pavlović MD,&nbsp;Dragan Mašulović","doi":"10.1002/emp2.13285","DOIUrl":"10.1002/emp2.13285","url":null,"abstract":"<p>An 81-year-old man with a history of hypertension presented to the emergency department with epigastric pain, vomiting, hiccups, anorexia, and obstipation for 3 days. Physical examination was notable for a painful epigastric tenderness. Laboratory examinations revealed a white blood cell count of 22.1 (3.4–9.7)(10 × 9/L).</p><p>Plain abdominal radiography showed pneumobilia and an enlarged gastric bubble (Figure 1), and abdominal ultrasound also demonstrated an enlarged stomach with a large amount of content within a curvilinear focus of increased echogenicity with posterior shadowing in duodenal bulb (Figure 2). Subsequent computed tomography (CT) image is shown in Figure 3.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"5 5","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11491546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482481","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":"Overdiagnosis and overtreatment of infectious diseases at the intersection of individual disease diagnosis, treatment, and public health","authors":"Dan Mayer MD,&nbsp;Sangil Lee MD, MS,&nbsp;Malene Plejdrup Hansen MD, PhD,&nbsp;Michael Gottlieb MD,&nbsp;Michael Brown MD,&nbsp;Richard Sinert DO,&nbsp;Joshua Davis MD","doi":"10.1002/emp2.13307","DOIUrl":"https://doi.org/10.1002/emp2.13307","url":null,"abstract":"&lt;p&gt;Overdiagnosis occurs when people with or without symptoms are diagnosed with a disease that ultimately will not cause them to experience worsening physical symptoms, disability, or early death. Clinicians have been paying more attention to the problem of overdiagnosis as part of the more general problem of “overmedicalization” of society in general. This also includes overtreatment, diagnostic creep, and disease mongering.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In this issue of &lt;i&gt;JACEP Open&lt;/i&gt;, Meltzer et al demonstrated that a point-of-care multiplex polymerase chain reaction (PCR) analyzer identifying the microbiological cause of an infectious disease at an urgent care center (UCC) led to increased patient satisfaction.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Patients presenting to an UCC with respiratory symptoms were randomized to point-of-care multiplex PCR testing identifying viral and bacterial pathogens or a control group that got no testing. They found patients were more cognizant of the need to quarantine and take time off work when they knew the test results. There was no significant effect on antibiotic prescription, although the study was only powered for patients’ satisfaction.&lt;/p&gt;&lt;p&gt;Superficially, this seems reasonable for UCCs, and some may argue that this technology could be useful in the Emergency Department. However, this begs the question of whether the wider use of these diagnostic tools would increase the potential for overdiagnosis.&lt;/p&gt;&lt;p&gt;The definition of overdiagnosis was articulated in a 2018 editorial:&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; “identification of abnormalities that were never going to cause harm, abnormalities that do not progress, that progress too slowly to cause symptoms or harm during a person's remaining lifetime, or that resolve spontaneously.” They focused primarily on the overdiagnosis of cancers, but the concept is also applicable here. Overdiagnosis and over-testing are a complex problem, with many implications. The risk of overdiagnosis increases with the number of tests ordered that identify a disease not destined to meaningfully harm the patient, making the risks of testing outweigh the benefits. While difficult to determine at the individual level, this should be studied in population samples where the chance of an overdiagnosis in a particular situation can be estimated.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;It is understood that overdiagnosis has many harms including the cost of the tests, the need for follow-up testing, treatment for diseases that will not affect health or longevity, and giving patients either a false sense of security or causing unnecessary anxiety.  Patients may not understand why testing should be avoided and health care providers must spend more time counselling patients to avoid unnecessary testing.&lt;/p&gt;&lt;p&gt;Overused medical testing also effects patients’ life by involving them in more frequent medical encounters and potentially serious effects of unnecessary treatment.  Another harmful impact is that patients","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"5 5","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13307","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142448989","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":"Retrospective evaluation of implementation of caring contacts for youth suicide prevention in an emergency department","authors":"Sabrina Schalley LCSW,&nbsp;Kristi M. Goldenstein MSW, PLMPH,&nbsp;Trisha Graeve LCSW,&nbsp;Zebulon Timmons MD,&nbsp;Nadia Elshami LCSW,&nbsp;Rinad S. Beidas PhD,&nbsp;Jennifer A. Hoffmann MD, MS","doi":"10.1002/emp2.13322","DOIUrl":"https://doi.org/10.1002/emp2.13322","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Caring Contacts are brief caring messages sent to patients with suicidal thoughts or behaviors after an emergency department (ED) visit or hospitalization, which may decrease subsequent suicide attempts. We aimed to retrospectively evaluate the implementation of Caring Contacts in a children's hospital ED.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective observational study to evaluate the implementation of Caring Contacts within routine clinical care at an academic children's hospital ED from May 2020 to April 2023. Patients 5‒18 years old presenting for suicidal thoughts or behaviors were eligible to receive six handwritten cards with individualized caring messages, mailed over 12 months. We assessed enrollment rates (the percentage of patients offered Caring Contacts who agreed to receive them), fidelity to the intended schedule and card writer, return visits for suicidal ideation or behaviors while receiving Caring Contacts, and program costs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 627 encounters eligible for and offered Caring Contacts, 614 (98%) resulted in enrollment. Among instances of enrollment, 587 (96%) had cards sent per the intended schedule and 541 (88%) had cards written by the intended writer. A return ED visit for suicidal ideation or behaviors occurred for 168 (27%) during program participation. Costs per participant were $4.54 in materials and 0.9 h of personnel time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In a children's hospital ED, Caring Contacts were feasible to implement with low costs and high fidelity to the intended schedule and card writer. Prospective studies are needed to assess Caring Contacts’ effectiveness in reducing suicide risk among adolescents following an ED visit.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"5 5","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13322","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142448988","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":"Evaluating the current breadth of randomized control trials on cardiac arrest: A scoping review","authors":"Jake Toy DO, MS,&nbsp;Lauren Friend MD,&nbsp;Kelsey Wilhelm MD,&nbsp;Michael Kim MD,&nbsp;Claire Gahm MD,&nbsp;Ashish R. Panchal MD, PhD,&nbsp;David Dillon MD, PhD,&nbsp;Joelle Donofrio-Odmann DO,&nbsp;Juan Carlos Montroy MD, PhD,&nbsp;Marianne Gausche-Hill MD,&nbsp;Nichole Bosson MD, MPH,&nbsp;Ryan Coute DO,&nbsp;Shira Schlesinger MD, MPH,&nbsp;James Menegazzi PhD, MS","doi":"10.1002/emp2.13334","DOIUrl":"https://doi.org/10.1002/emp2.13334","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Despite the significant disease burden due to cardiac arrest, there is a relative paucity of randomized controlled trials (RCTs) to inform definitive management. We aimed to evaluate the current scope of cardiac arrest RCTs published between 2015 and 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a search in October 2023 of MEDLINE, Embase, and Web of Science for cardiac arrest RCTs. We included trials published between 2015 and 2022 enrolling human subjects suffering from non-traumatic cardiac arrest. Descriptive statistics were reported and the Mann Kendall test was used to evaluate for temporal trends in the number of trials published annually.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 1764 unique publications, 87 RCTs were included after title/abstract and full-text review. We found no significant increase in trials published annually (eight in 2015 and 16 in 2022, <i>p</i> = 1.0). Geographic analysis of study centers found 31 countries represented; Denmark (<i>n</i> = 13, 15%) and the United States (<i>n</i> = 9, 10%) conducted the majority of trials. Nearly all trials included adults (<i>n</i> = 84, 97%) and few included children (<i>n</i> = 9, 10%). The majority of trials focused on out-of-hospital cardiac arrest (<i>n</i> = 62, 71%). Thirty-eight (44%) trials used an intervention characterized as a <i>process improvement</i>; 28 (32%) interventions were characterized as a <i>drug</i> and 20 (23%) as a <i>device</i>. Interventions were implemented with similar frequency in the prehospital (33%) and intensive care unit (38%) setting, as well as similarly between the intra-arrest (53%) and post-arrest (46%) periods. Twenty (27%) trials selected a primary outcome of survival at ≥ 28 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Publication of cardiac arrest RCTs remained constant between 2015 and 2022. We identified significant gaps including a lack of trials examining in-hospital cardiac arrest and pediatric patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"5 5","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13334","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451259","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}