Archives of Academic Emergency Medicine最新文献

{"title":"Modulatory Effects of Methadone on Brain Network Instability in Methamphetamine Use; A Cross-sectional Study.","authors":"Javad Sheikhi Koohsar, Sadegh Masjoodi, Farzad Ashrafi, Mehran Arab-Ahmadi, Babak Jamshidi, Amir Khorasani, Alireza Azizi, Melika Boroomand-Saboor, Shahriyar Jamshidi Zargaran, Mohammad Bagher Tavakoli","doi":"10.22037/aaem.v14i1.3050","DOIUrl":"https://doi.org/10.22037/aaem.v14i1.3050","url":null,"abstract":"<p><strong>Introduction: </strong>While methadone maintenance therapy (MMT) is well established in opioid use disorder, its potential modulatory effects on brain network dynamics in methamphetamine use disorder (MUD) remain unclear. This study aimed to evaluate the association of MMT with normalization of disrupted brain network activity in MUD.</p><p><strong>Methods: </strong>In this cross-sectional study, resting-state functional magnetic resonance imaging (MRI) data were obtained from healthy controls, untreated methamphetamine users, and methamphetamine users receiving MMT who also met diagnostic criteria for opioid use disorder and were enrolled in supervised MMT programs. Dynamic functional connectivity was assessed using dynamic independent component analysis within the CONN toolbox. Clinical status was evaluated using the Positive and Negative Syndrome Scale (PANSS) and Brief Assessment of Cognition in Schizophrenia (BACS). Group comparisons were performed using general linear models controlling for age, education level, duration of methamphetamine use, and head-motion parameters.</p><p><strong>Results: </strong>110 participants (35 healthy controls, 45 untreated individuals with methamphetamine use, and 30 individuals with methamphetamine use receiving MMT) were studied. Cognitive performance assessed using BACS differed significantly across groups (p = 0.002, η² = 0.332), with untreated methamphetamine users demonstrating the lowest scores (19.88 ± 6.20), healthy controls the highest scores (30.38 ± 5.85), and MMT-treated participants showing intermediate performance (22.48 ± 7.61). Compared with untreated methamphetamine users, MMT-treated participants showed higher BACS scores, although the methamphetamine versus MMT effect was small-to-moderate (Cohen's d = -0.38, 95% confidence interval (CI): -0.85 to 0.08). PANSS positive, negative, and general psychopathology scores differed significantly across groups (all p < 0.001), with large effect sizes (η² range = 0.802-0.913). Untreated methamphetamine users exhibited the greatest symptom severity (Cohen's d = 2.74, 95% CI: 2.10-3.38), whereas MMT-treated participants showed lower symptom burden than untreated users (Cohen's d = 2.26, 95% CI: 1.67-2.85), although scores remained elevated relative to healthy controls (d = 4.22, 95% CI: 3.34, 5.11). The methamphetamine versus MMT effect sizes were large for PANSS positive (Cohen's d = 2.74, 95% CI: 2.10-3.38), PANSS negative (Cohen's d = 2.26, 95% CI: 1.67-2.85), and PANSS general psychopathology (Cohen's d = 1.64, 95% CI: 1.11-2.18).</p><p><strong>Conclusion: </strong>Methamphetamine use is associated with disrupted and unstable brain network dynamics that may underlie acute neurobehavioral disturbances seen in emergency settings. MMT was associated with partial stabilization of these alterations, suggesting a potential neurobiological benefit beyond opioid substitution. Persistent network abnormalities, however, indicate the need for adjun","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"14 1","pages":"e41"},"PeriodicalIF":2.8,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103215","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":"Physiological Factors Associated with Peri-intubation Severe Adverse Events and Derivation of an Exploratory Bedside Risk Score; A Cross-sectional Study.","authors":"Panvilai Tangkulpanich, Thayanon Boonchuay, Sukanya Siriyotha, Promphet Nuanprom","doi":"10.22037/aaem.v14i1.3064","DOIUrl":"10.22037/aaem.v14i1.3064","url":null,"abstract":"<p><strong>Introduction: </strong>Endotracheal intubation is a life-saving procedure, but it can result in complications such as hypotension, hypoxia, and cardiac arrest. This study aimed to identify physiological factors associated with difficult intubation in emergency departments (ED), in order to derive an exploratory bedside risk score.</p><p><strong>Methods: </strong>This retrospective cohort study included patients aged ≥15 years who underwent endotracheal intubation in the ED. Pre-intubation physiological variables, procedural characteristics, and peri-intubation severe adverse events (severe hypoxemia, hypotension, and cardiac arrest) were extracted from standardized intubation records and electronic medical records. Independent physiological predictors of peri-intubation severe adverse events were extracted using logistic regression analysis, and an exploratory point-based bedside risk score was derived and internally validated.</p><p><strong>Results: </strong>Among 720 eligible patients, 137 (19.0%) experienced peri-intubation severe adverse events. Five clinically relevant physiological predictors were retained in the exploratory score: suspected sepsis, pre-intubation hypoxemia, low serum bicarbonate level, vasopressor requirement before intubation, and shock index >0.9. The simplified score ranged from 0 to 11 points and showed modest discrimination, with an optimism-corrected C-statistic of 0.686. At a threshold of ≥5 points, the score had limited sensitivity (32.1%) but high specificity (90.1%), with a positive predictive value of 43.1% (95% confidence interval (CI): 33.4--53.3) and a positive likelihood ratio of 3.23 (95% CI: 2.29--4.56).</p><p><strong>Conclusion: </strong>The exploratory physiological difficulty score showed modest discrimination for peri-intubation severe adverse events. A threshold of ≥5 points identified a subgroup of patients who may require more preparation and closer monitoring before intubation. However, the score should not replace comprehensive clinical assessment and requires external validation.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"14 1","pages":"e40"},"PeriodicalIF":2.8,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896434","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":"Resuscitation Success and Survival to Hospital Discharge Following In-Hospital Cardiopulmonary Resuscitation in Iran: A Systematic Review and Meta-Analysis.","authors":"Seyed Hossein Mousavi, Zahra Khalighi, Hamideh Ebrahimi, Hojjat Farahmandnia, Ali Sahebi, Davoud Pirani","doi":"10.22037/aaem.v14i1.3036","DOIUrl":"10.22037/aaem.v14i1.3036","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiopulmonary Resuscitation (CPR) is a critical emergency procedure that needs to be promptly administered to prevent irreversible damage and enhance the chances of survival. This systematic review and meta-analysis aimed to determine the success rate of CPR and the rate of survival to hospital discharge among patients who underwent CPR in hospitals throughout Iran.</p><p><strong>Methods: </strong>This study followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, and the protocol was registered in International Prospective Register of Systematic Reviews (PROSPERO) (CRD420251185276). A comprehensive search was conducted without time restriction until July 2026 in PubMed, Scopus, Web of Science, Google Scholar, SID, and Magiran databases. A random-effects model was used for meta-analysis, and heterogeneity was assessed using the I² index. Publication bias was evaluated using Begg's test. Data analysis was performed using STATA software (version 14).</p><p><strong>Results: </strong>Initially, 903 records were identified, and after removing duplicates and applying screening procedures, 47 studies met the inclusion criteria. The pooled analysis revealed that the rates of successful CPR, survival to discharge among successful CPR cases, and survival to discharge among all CPR attempts were 29.48% (95% confidence interval (CI): 25.04--33.92), 32.11% (95% CI: 24.00--40.21; I²=95.7%), and 8.63% (95% CI: 6.72--10.53), respectively. Meta-regression indicated an increasing trend over time for successful CPR, a decreasing trend for survival to discharge among cases with Return of Spontaneous Circulation (ROSC), and a significant increase in overall survival to discharge.</p><p><strong>Conclusion: </strong>This systematic review highlights that while the initial quality of CPR in Iran is generally satisfactory, there is a notable gap between successful resuscitation and survival to hospital discharge, primarily attributed to limitations in post-resuscitation care. Enhancing post-CPR management, expanding ICU capacity, improving team coordination, and standardizing equipment could significantly impact patient outcomes.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"14 1","pages":"e38"},"PeriodicalIF":2.8,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896362","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":"Augmented Reality and Gamification vs. Traditional Surgical Instrument Training on Knowledge and Skills of Medical Students: A 2×2 Factorial Randomized Study.","authors":"Mohsen Masoumian Hosseini, Babak Sabet, Mitra Zolfaghari, Karim Qayumi, Seyedeh Toktam Masoumian Hosseini, Somayeh Rajabzadeh, Maryam Alizadeh","doi":"10.22037/aaem.v14i1.3033","DOIUrl":"10.22037/aaem.v14i1.3033","url":null,"abstract":"<p><strong>Introduction: </strong>Augmented reality (AR) and gamification have shown promise in medical education. This study aimed to examine their combined application in surgical instrument training for medical students.</p><p><strong>Methods: </strong>This 2×2 factorial randomized assignment involved 164 operating room students from two universities. Participants were categorized by university and randomly allocated to four intervention groups: Group A (AR + game-based learning; n = 41), Group B (AR only; n = 41), Group C (game only; n = 41), or Group D (traditional instruction; n = 41). The 3-week intervention comprised one 30-minute session per week. Outcomes included knowledge retention (assessed at baseline, 1 week, 1 month, and 3 months) and Objective Structured Clinical Examination (OSCE) performance, evaluating surgical suite recognition, instrument arrangement, instrument use, and time efficiency.</p><p><strong>Results: </strong>Group A (AR + game) showed better knowledge retention, with scores increasing from 44.7 ± 2.2 at baseline to 84.4 ± 2.7 at 1 week and remaining stable at 3 months (71.6 ± 1.9). Group D (traditional instruction) performed worst (56.7 ± 6.8 at 1 week; 48.6 ± 6.7 at 3 months). Total OSCE scores showed a similar trend: Group A scored 86.5 ± 4.3 out of 97, compared with Group D (62.7 ± 6.2). Factorial analysis confirmed significant benefits for AR versus non-AR (knowledge gain: 76.4 ± 9.1 vs. 62.3 ± 8.7; p < 0.001) and game versus non-game interventions (75.7 ± 8.9 vs. 63.0 ± 9.3; p < 0.001). Gender effects were sporadic and explained minimal variance.</p><p><strong>Conclusions: </strong>The integration of AR and gamification appeared to be the most effective approach in this study for improving knowledge retention and procedural proficiency in surgical instrument training. Gamification alone showed stable long-term retention and may serve as a cost-effective alternative when AR integration is not feasible.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"14 1","pages":"e39"},"PeriodicalIF":2.8,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896448","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":"Diagnostic Accuracy of DNA Methylation Markers for Detecting Cervical Precancer and Cervical Cancer: A Systematic Review and Meta-analysis.","authors":"Sham Tahir Abdulla Horamee, Mostafa Hosseini, Maedeh Arabpour, Mohammad Hossein Modarressi","doi":"10.22037/aaem.v14i1.3062","DOIUrl":"10.22037/aaem.v14i1.3062","url":null,"abstract":"<p><strong>Background: </strong>DNA methylation markers have been proposed as molecular triage tools for detecting cervical precancer and cancer, particularly among HPV-positive women. However, diagnostic performance varies across markers, assays, specimens, and clinical settings. This study aimed to evaluate the marker-specific diagnostic accuracy of DNA methylation markers and methylation panels for detecting CIN2+ and CIN3+ in cervical cancer screening, triage, and related diagnostic contexts.</p><p><strong>Methods: </strong>This systematic review and diagnostic test accuracy meta-analysis was reported according to PRISMA-DTA 10. Marker-specific analyses were performed separately by endpoint to avoid double counting. Pooled sensitivity, specificity, diagnostic odds ratio, clinical utility estimates, risk of bias, publication bias, and certainty of evidence were assessed using diagnostic test accuracy methods, QUADAS-2 11, Deeks' test 14, and GRADE-DTA 12,13.</p><p><strong>Results: </strong>The broad main diagnostic meta-analysis included 74 eligible studies 15-88, contributing 260 diagnostic test accuracy comparisons across 130 marker-endpoint-sample analyses. A strict sensitivity dataset included 164 comparisons from 51 studies. Seven marker analyses were available for CIN2+ and seven for CIN3+. Diagnostic performance varied by marker and endpoint. For CIN2+, S5 EPB41L3 plus HPV16/18/31/33 methylation showed the highest sensitivity but lower specificity, whereas PAX1, JAM3, SOX1, PAX1/JAM3, and Six-gene/GynTect showed higher specificity. For CIN3+, S5 showed the highest sensitivity, while PAX1/JAM3, JAM3, SOX1, PAX1, and Six-gene/GynTect had more balanced performance. Deeks' test did not show strong evidence of publication bias for most analyses, although borderline findings were observed in selected marker-endpoint analyses. GRADE-DTA certainty was low or very low across marker-endpoint analyses.</p><p><strong>Conclusions: </strong>DNA methylation markers showed heterogeneous diagnostic accuracy for detecting CIN2+ and CIN3+. Some markers demonstrated potentially useful sensitivity- or specificity-oriented profiles, but certainty of evidence was low or very low. Further standardized prospective validation is required before routine clinical implementation.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"14 1","pages":"e37"},"PeriodicalIF":2.8,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896416","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 the Impact of Virtual Clinics on Emergency Department and Primary Healthcare Visits in Saudi Arabia: A Cross-Sectional Study of 10,000 Patients.","authors":"Mohamed Almulhim, Yousef A Alhamaid, Qasem Almulihi, Mohannad Alghamdi, Mohammad Assiri, Saleh Saeed Al Jathnan Al Qahtani, Mohammad A Al Sultan, Mahmoud Essa Alwabari, Feras Ahmed Alsultan, Hussam Mohammed Alsultan, Ahmed Abdullah Alsultan, Yaser Mohammed Alsultan","doi":"10.22037/aaem.v14i1.2988","DOIUrl":"10.22037/aaem.v14i1.2988","url":null,"abstract":"<p><strong>Introduction: </strong>By reducing the need for certain in-demand services, the virtual clinics could increase overall healthcare accessibility and operational effectiveness. This study aimed to examine the effect of establishing these clinics on the frequency of emergency department (ED) and primary healthcare (PHC) visits across Saudi Arabia.</p><p><strong>Methods: </strong>A nationwide cross-sectional survey was carried out on 10,000 patients who had used virtual clinics in various parts of the country, between May 2024 and October 2025. A self-administered questionnaire was used in the study to collect information on the frequency and reasons for ED and PHC visits both before and after the introduction of virtual clinics. Fisher's exact tests, Pearson's chi-squared, and descriptive statistics were used in the data analysis process.</p><p><strong>Results: </strong>Among the participants, 44% used virtual clinics once, 23% twice, and 33% more than twice. The establishment of virtual clinics led to 20% decrease in ED visits and 18% decrease in PHC visits. Preferred services included general consultations (76%), prescription renewals (49%), and follow-up appointments (48%). Factors contributing to reduction in in-person visits were shorter wait times (45.18%), better accessibility (39.61%), and reduced costs (36.23%). Demographic factors such as age, gender, and income level significantly influenced virtual clinic utilization patterns (p < 0.001).</p><p><strong>Conclusion: </strong>Virtual clinics have raised operational efficiency while simultaneously enhancing the accessibility and quality of healthcare. The findings align with Saudi Arabia's Vision 2030 objectives on the digitization of the healthcare sector.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"14 1","pages":"e36"},"PeriodicalIF":2.8,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896492","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":"Operationalizing the 2024 International Health Regulation (IHR) Amendments for Disaster and Emergency Health; a Letter to the Editor.","authors":"Reza Habibisaravi","doi":"10.22037/aaem.v14i1.2991","DOIUrl":"https://doi.org/10.22037/aaem.v14i1.2991","url":null,"abstract":"<p><p>The 2024 IHR amendments offer a practical roadmap for disaster and emergency health, translating clearer international alert triggers into faster local surge activation and embedding fairness into the allocation of vaccines, oxygen, and supplies for those most at risk. Strengthened national focal points and standardized data flows help bridge the stubborn gap between public health surveillance and frontline prehospital care, so Emergency Medical Teams can deploy with fewer delays. Digital tools like AI-driven forecasting can sharpen surge planning, but only when anchored in transparent, human-reviewed safeguards. Turning promise into real capability means testing new alert workflows through joint exercises, updating cross-border mutual aid agreements, and investing in field infrastructure alongside robust data governance. Ultimately, these amendments will be judged by whether they shorten the time from signal to response and narrow access gaps for the vulnerable---making future responses not just faster, but measurably fairer.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"14 1","pages":"e35"},"PeriodicalIF":2.8,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896398","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":"Shock-Stratified Prognostic Performance of Lactate and Procalcitonin in Pediatric Sepsis In-Hospital Mortality; A Retrospective Cohort Study.","authors":"Thi Van Vo, Dien Tri Lu, Dien Minh Thai","doi":"10.22037/aaem.v14i1.3029","DOIUrl":"10.22037/aaem.v14i1.3029","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Admission lactate and procalcitonin (PCT) are routinely measured in pediatric sepsis; however, their prognostic performance may vary by clinical phenotype. This study aimed to evaluate the shock-stratified prognostic performance of admission lactate and PCT for predicting in-hospital mortality in children with sepsis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this retrospective cohort study (July 2022 - July 2025), children aged 2 months to 15 years evaluated for suspected sepsis were screened; 193 met eligibility criteria and were included in analyses. Septic shock was recorded at admission, and organ dysfunction was recorded at admission or within the first 24 hours. The Phoenix Sepsis Score was calculated in 143 patients with complete lactate and other required data, whereas the Pediatric Sequential Organ Failure Assessment (pSOFA) score was calculated for all 193 patients using data recorded within the first 24 hours. Admission lactate and PCT were summarized by survival status within shock and non-shock phenotypes. Multivariable logistic regression models adjusted for age and malnutrition assessed biomarker-mortality associations and biomarker × shock interactions. Discrimination was evaluated using shock-stratified receiver operating characteristic (ROC) curves and area under the curve (AUC), with DeLong tests comparing AUCs between phenotypes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 193 children, 93 (48.2%) had septic shock, 145 (75.1%) had organ dysfunction, and 79 (40.9%) died in hospital. The median Phoenix Sepsis Score was 2.0 (range, 0--12) among 143 patients, while the median pSOFA score was 4.0 (range: 0--21) among all 193 patients. Mortality was higher in shock than non-shock sepsis (66.7% vs 17.0%; odds ratio (OR): 9.77 (95% confidence interval (CI): 4.96-19.24)) and in those with organ dysfunction (53.1% vs 4.2%; OR = 26.03 (95% CI: 6.09-111.34)). Admission lactate was higher in non-survivors than survivors in both non-shock and shock groups (p&lt;0.05). In adjusted interaction models, each 1 mmol/L increase in lactate (OR = 1.50, 95% CI: 1.11--2.01; p = 0.0075) and each one-unit increase in natural-log--transformed PCT (ln(PCT)) (OR = 1.34, 95% CI: 1.01-1.79; p=0.0458) were associated with mortality in non-shock sepsis. The lactate × shock interaction (OR = 0.76, 95% CI: 0.55--1.05; p = 0.092) and ln(PCT) × shock interaction (OR = 0.74, 95% CI: 0.52--1.07; p = 0.114) were not statistically significant. Shock-stratified ROC curve analysis showed better discrimination in non-shock than shock for lactate (AUC: 0.76 (95% CI: 0.67-0.85) vs 0.62 (95% CI: 0.40-0.83); DeLong p=0.233) and modest discrimination for natural-log-transformed PCT [ln(PCT)] in both phenotypes (AUC: 0.65 (95% CI: 0.55-0.75) vs 0.61 (95% CI: 0.41-0.80); DeLong p=0.695).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Admission lactate showed moderate discrimination for in-hospital mortality in non-shock sepsis, whereas discrimination was lower in septic","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"14 1","pages":"e34"},"PeriodicalIF":2.8,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896460","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":"Dispatcher Performance and Prehospital Outcomes in Telephone-Assisted Airway Management following Foreign Body Obstruction: A Cross-Sectional Study.","authors":"Aida Jahangiri, Sina Valiee, Naser Kamyari, Salam Vatandost","doi":"10.22037/aaem.v14i1.3011","DOIUrl":"https://doi.org/10.22037/aaem.v14i1.3011","url":null,"abstract":"<p><strong>Introduction: </strong>Prehospital care plays a crucial role in early recognition and timely management of foreign body airway obstruction (FBAO). This study aimed to identify factors associated with dispatcher performance and prehospital outcomes in the telephone-assisted management of FBAO.</p><p><strong>Methods: </strong>This cross-sectional study was conducted through a review of recorded emergency telephone calls related to FBAO. Data were collected from the prehospital emergency medical services center over a one-year period, from March 20, 2024 to March 20, 2025. Demographic characteristics of dispatcher were obtained through self-reported questionnaires. Recorded calls were assessed using validated 13-item researcher-developed checklist based on the standardized telephone assistance algorithm for FBAO, categorized across three age groups (score range 0-1). Patient demographic characteristics, clinical characteristics, and prehospital outcomes, including recovery without dispatch of an operational team and dispatch of an operational team, were extracted from electronic medical records. Data were entered and analyzed using SPSS version 16. A p-value < 0.05 was considered statistically significant.</p><p><strong>Results: </strong>A total of 262 telephone assistance FBAO cases were included in the final analysis, of which 45.8% involved infants. The overall mean dispatcher performance score was 0.87 ± 0.10. Multivariable logistic regression analysis demonstrated that patient's age (adjusted odds ratio (AOR) = 1.60, 95% confidence interval (CI): 1.13-2.26, p = 0.008) and dispatcher's clinical experience (AOR = 1.44, 95% CI: 1.05-1.98, p = 0.023) were significant positive predictors of better performance of dispatcher. In contrast, contractual employment (AOR = 0.37, 95% CI: 0.21-0.68, p = 0.001), higher monthly overtime hours (AOR = 0.33, 95% CI: 0.16-0.68, p = 0.002), and non-participation in stress management workshops (AOR = 0.40, 95% CI: 0.23-0.68, p = 0.001) were negatively associated with dispatcher performance. Complete airway obstruction (AOR = 0.08, 95% CI: 0.03-0.17, p < 0.001), occurrence in an outdoor setting (AOR = 4.86, 95% CI: 1.60-16.40, p = 0.007), and involvement of non-edible foreign bodies (AOR = 0.16, 95% CI: 0.06-0.37, p < 0.001) were significant predictors of outcomes.</p><p><strong>Conclusion: </strong>The findings indicate that dispatcher performance in telephone-assisted management of FBAO was generally acceptable. Enhancing performance requires not only simulation-based training but also consideration of individual and occupational factors affecting dispatchers. Moreover, improving patient outcomes depends on dispatchers' awareness of patient-specific characteristics to ensure timely and context-appropriate interventions.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"14 1","pages":"e32"},"PeriodicalIF":2.8,"publicationDate":"2026-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13484915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787406","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":"Eye-Tracking Analysis of Attention Disruptions Under Realistic Interruptions During Trauma Management; A Cross-sectional Study in a Simulated Virtual Reality.","authors":"Navaz Emadi, Rita Mojtahedzadeh, Seyyed Farshad Allameh, Kamal Basiri, Aeen Mohammadi","doi":"10.22037/aaem.v14i1.3034","DOIUrl":"https://doi.org/10.22037/aaem.v14i1.3034","url":null,"abstract":"<p><strong>Introduction: </strong>Distractions and interruptions may interfere with concentration, working memory, and timely decision-making. This study aimed to analyze the visual attention patterns of medical interns during the management of a multiple-trauma patient in a realistic virtual reality (VR) emergency scenario using eye-tracking technology integrated into VR simulation.</p><p><strong>Methods: </strong>This cross-sectional simulation-based study was conducted among 15 medical interns at Tehran University of Medical Sciences. Participants were exposed to a 242-second high-fidelity VR trauma scenario representing a crowded ED with multiple environmental distractions and interruptions. Eye-tracking data were collected using the HTC Vive Pro Eye headset. The scenario was divided into four predefined temporal intervals. Areas of interest (AOIs) were defined and classified as relevant (main patient, key treatment team members, and essential equipment) or distractors (nonessential environmental and emotional stimuli). Main outcome measures included cumulative gaze time on relevant and distractor AOIs, gaze time outside defined AOIs, and the Relevant/Distractor ratio.</p><p><strong>Results: </strong>A total of 253,075 gaze samples were obtained, with a mean of 16,871.7 ± 2,097.0 samples per participant. The mean duration of valid eye-tracking data was 238.5 ± 12.3 seconds per participant, corresponding to approximately 98.6% of the total scenario time. Across all intervals, gaze was predominantly directed toward relevant AOIs, and this pattern became progressively stronger over time. The Relevant/Distractor ratio increased from 3.41 ± 1.58 in the initial interval to 27.60 ± 26.12 in the final interval, while attention to distractor AOIs decreased from 19.2% to 4.7%. Spatially, the head and face of the main injured patient, the emergency medicine resident, and the patient monitor consistently attracted the greatest attention.</p><p><strong>Conclusion: </strong>Medical interns progressively adopted a more structured and goal-directed visual attention strategy, increasingly prioritizing vital clinical information over distracting stimuli. VR-based eye tracking appears to be a feasible and informative tool for assessing attentional behavior and may support targeted educational interventions in trauma training.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"14 1","pages":"e33"},"PeriodicalIF":2.8,"publicationDate":"2026-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13484916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787512","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}