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Journal Editors: The Invisible Architects of Academia 期刊编辑:学术界的隐形建筑师
IF 1.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2025-09-26 DOI: 10.1111/1742-6723.70142
Viet Tran

Journal editors play a pivotal yet often unseen role in shaping the direction and integrity of academic discourse. Their responsibilities include coordinating peer review, ensuring ethical oversight and curating content that reflects both relevance and scholarly merit. In an era marked by misinformation and growing scepticism toward experts, editorial processes serve as a safeguard for public trust in scientific publishing. This reflective account draws on personal experience as a section editor for Emergency Medicine Australasia, highlighting the transition from trainee contributor to a steward of original research and reviews. Editorial servitude has offered valuable insights into academic publishing, improved writing skills and a deeper understanding of complex subject matters. Editors influence scholarly inquiry through thoughtful manuscript selection, reviewer engagement and constructive feedback. Although the path to editorial roles is rarely direct, it begins with opportunities to demonstrate capability. Far from passive arbiters, editors are the invisible architects of academia and custodians of academic credibility.

期刊编辑在塑造学术话语的方向和完整性方面发挥着关键但往往不为人知的作用。他们的职责包括协调同行评审,确保道德监督和策划反映相关性和学术价值的内容。在一个充斥着错误信息和对专家日益怀疑的时代,编辑过程是公众对科学出版信任的保障。这个反思的帐户借鉴了个人的经验,作为一个部分编辑急诊医学澳大利亚,突出从实习生贡献者到一个管家的原始研究和评论的过渡。编辑的苦役为学术出版提供了宝贵的见解,提高了写作技巧,加深了对复杂主题的理解。编辑通过深思熟虑的手稿选择,审稿人参与和建设性的反馈影响学术调查。尽管通往编辑角色的道路很少是直接的,但它始于展示能力的机会。编辑绝不是被动的仲裁者,而是学术界无形的建筑师和学术信誉的保管人。
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引用次数: 0
Invalid Results With a Point-Of-Care High Sensitivity Troponin Assay in the Emergency Department 急诊科即时高灵敏度肌钙蛋白测定无效结果
IF 1.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2025-09-23 DOI: 10.1111/1742-6723.70141
Simone Canovi, Rocco Pio D'Andrea, Nicola Macarone Palmieri, Rossana Colla
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引用次数: 0
Lignocaine Liberation: Reclaiming Patient Centred Care During Emergency Department Speculum Examinations 利多卡因解放:在急诊科窥镜检查中恢复以病人为中心的护理。
IF 1.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2025-09-16 DOI: 10.1111/1742-6723.70139
Haddijatou Hughes

This article examines the importance of analgesia during speculum exams in the emergency department (ED). As ED physicians, we can promote a comprehensive approach to pelvic examinations and advocate for peri-procedural analgesia for these patients. Emergency doctors should routinely inquire about women's needs and address them before the speculum exam. I discuss which populations may experience heightened pain and explore both non-pharmacological and pharmacological options for pain relief. There is a paucity of ED-based research addressing this issue, which urgently requires attention. Ensuring equitable access to analgesia is a fundamental clinical obligation.

本文探讨了在急诊科(ED)检查中镇痛的重要性。作为急诊科医生,我们可以推广骨盆检查的综合方法,并提倡对这些患者进行围手术期镇痛。急诊医生应定期询问妇女的需求,并在窥镜检查前解决这些问题。我讨论了哪些人群可能会经历疼痛加剧,并探讨了缓解疼痛的非药物和药物选择。针对这一问题的基于教育的研究很少,迫切需要引起重视。确保公平获得镇痛药是一项基本的临床义务。
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引用次数: 0
Computed Tomography Head Ordering Practices in Residential Aged Care Facility Residents Presenting to Emergency Department After an Unwitnessed Fall 计算机断层扫描头部排序的做法在住宅老年护理机构的居民出现急诊部跌倒后未被目击。
IF 1.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2025-09-16 DOI: 10.1111/1742-6723.70137
Elizabeth Chen, Clover Donohue, Amy Sweeny, Nemat Alsaba, Megan McGonagle, Gerben Keijzers

Objective

To determine CT head imaging rates, yield and emergent intervention rate (neurosurgery, cessation or reversal of anticoagulants) in residential aged care facility (RACF) residents presenting to ED with an unwitnessed fall. Secondary objectives included a description of shared decision-making discussions with patients or substitute decision makers regarding ED transfer and CT head imaging.

Methods

Retrospective cross-sectional study of residential aged care residents aged over 65 years presenting with unwitnessed falls at two university-affiliated tertiary EDs between 1 January and 30 June 2024. Dual independent data extraction of medical records assessed CT imaging use and yield, which was defined as new intracranial haemorrhage on the radiology report. Change of management and shared decision-making were defined by documentation in the medical record. Data analyses were descriptive, and associations were reported using the odds ratio with 95% confidence intervals.

Results

Of 398 patients, 235 (59%) underwent CTH imaging and intracranial haemorrhage was identified in 10 patients (4.3%). No patients underwent neurosurgery. Anticoagulation was ceased in four patients. Shared decision-making was documented for hospital transfer in 14.1% of patients, 13.8% of patients receiving CTH and 25.1% among patients who did not undergo imaging. Patients with signs of head injury, on anticoagulation or evidence of polytrauma were more likely to receive a CTH.

Conclusions

CT head imaging was common among RACF residents with unwitnessed falls despite low diagnostic yield and infrequent changes in management, with no neurosurgical intervention in our cohort. Limited documentation of SDM calls for stronger integration of meaningful patient-centred discussions to reduce avoidable transfers and imaging.

目的:确定住院老年护理机构(RACF)住院患者因未见跌倒而就诊于ED的CT头部显像率、产率和紧急干预率(神经外科手术、停用或逆转抗凝剂)。次要目标包括描述与患者或替代决策者关于ED转移和CT头部成像的共同决策讨论。方法:对2024年1月1日至6月30日在两所大学附属高等教育急诊科就诊的65岁以上住院老年人进行回顾性横断面研究。病历的双重独立数据提取评估了CT成像的使用和产出率,在放射学报告中定义为新发颅内出血。管理变更和共同决策由病历文件定义。数据分析是描述性的,使用95%置信区间的比值比报告相关性。结果:398例患者中,235例(59%)接受了CTH成像,10例(4.3%)发现颅内出血。没有患者接受神经外科手术。4例患者停止抗凝治疗。14.1%的患者、13.8%接受CTH的患者和25.1%未接受影像学检查的患者在医院转院时有共同决策记录。有头部损伤迹象、抗凝治疗或多发外伤证据的患者更有可能接受CTH。结论:CT头部成像在未见跌倒的RACF患者中很常见,尽管诊断率很低,治疗方法也很少改变,在我们的队列中没有神经外科干预。有限的SDM文献要求加强有意义的以患者为中心的讨论的整合,以减少可避免的转移和成像。
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引用次数: 0
Antibiotic Therapy for Pyelonephritis in the Emergency Department 急诊科肾盂肾炎的抗生素治疗
IF 1.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2025-09-11 DOI: 10.1111/1742-6723.70130
Jessica Yu, Christine Koolstra, De Villiers Smit, Biswadev Mitra

Objectives

Acute pyelonephritis (APN) is a common diagnosis among patients presenting to the Emergency Department (ED). It is treated by empiric antibiotics within the ED. With a rise in antimicrobial resistance globally, it is unknown whether patients are being managed with empiric antibiotics that are appropriate for the causative organisms of APN. The aim of this study was to describe the pathogens causing APN and to assess whether the current choice of empirical antibiotics is appropriate.

Methods

A single-centre retrospective review of patients with a discharge diagnosis of APN at an adult tertiary referral hospital in metropolitan Melbourne over a 5-year period (2018–2022) was conducted. Eligible cases were identified from ICD-10 discharge diagnoses. Demographics, cultured organisms and antibiotic regimens were extracted using explicit chart review.

Results

There were 557 patients included with APN with 569 urine samples cultured after initial assessment. The most common pathogen cultured was E. coli, identified in 232 (40.8%) culture results. There were 26 (4.7%; 95% CI: 3.1–6.6) patients managed in the ED with inappropriate antibiotics. This occurred most frequently when ampicillin or amoxicillin monotherapy was prescribed. Patients were discharged with inappropriate antibiotics in 76 (13.6%) cases. This occurred most commonly when no antibiotic was prescribed on discharge.

Conclusion

Most empiric antibiotic prescribing for APN was appropriate and sensitive against the cultured organism. E. Coli in urine samples was commonly resistant to amoxicillin, ampicillin or trimethoprim. Strict adherence to national clinical guidelines can further reduce the rates of inappropriate antibiotic prescriptions.

目的:急性肾盂肾炎(APN)是急诊科(ED)患者的常见诊断。在急诊科使用经验性抗生素进行治疗。随着全球抗菌素耐药性的上升,尚不清楚患者是否正在使用适用于APN致病微生物的经验性抗生素进行管理。本研究的目的是描述引起APN的病原体,并评估目前选择的经验性抗生素是否合适。方法:对墨尔本市区一家成人三级转诊医院5年(2018-2022年)出院诊断为APN的患者进行单中心回顾性分析。根据ICD-10出院诊断确定符合条件的病例。统计资料,培养的微生物和抗生素方案提取使用明确的图表回顾。结果:共纳入557例APN患者,经初步评估培养尿样569份。最常见的病原菌为大肠杆菌,共232例(40.8%)。有26例(4.7%;95% CI: 3.1-6.6)患者在急诊科使用不适当的抗生素。当处方氨苄西林或阿莫西林单药治疗时,这种情况最常发生。76例(13.6%)患者出院时抗生素使用不当。这种情况最常见于出院时未开抗生素的情况。结论:APN的经验性抗生素处方对培养菌的敏感性较高。尿样中的大肠杆菌对阿莫西林、氨苄西林或甲氧苄啶普遍耐药。严格遵守国家临床指南可进一步降低不适当抗生素处方的发生率。
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引用次数: 0
In-Flight Deterioration Occurs Early in Aeromedical Trauma Patients 航空医学创伤患者在飞行中病情恶化较早。
IF 1.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2025-09-11 DOI: 10.1111/1742-6723.70140
Benjamin Powell, Susanna Cramb

Reliably defining the risk of adverse in-flight events in aeromedical trauma patients could enable more informed pre-departure treatment and guide central asset allocation to achieve better system-level outcomes. Unfortunately, the current literature base specifically examining the in-flight period is sparse. Flight duration is often considered a proxy for the risk of in-flight deterioration; however, there is limited data to support this commonly held assumption. This paper examines the association between flight duration and the risk of in-flight deterioration in aeromedical trauma patients. A total of 2927 cases of aeromedical transport for acute trauma were retrospectively examined, and the time to first hypotension was recorded. Cases were categorised as either primary or inter-hospital transfer retrievals. Cases were also subclassified as being a primary Traumatic Brain Injury or not based on several criteria, including initial GCS. The median time to hypotension was 11.5 min overall, 10 min in primary retrieval cases, and 15 min in inter-hospital transfer cases (p = 0.049). Notably, after approximately 50 min, a significant plateau in cumulative risk was observed. Isolated TBI cases had a significantly higher overall rate of in-flight hypotension, at 39.5% compared to 9.2%. Overall, this paper supports the physiologically plausible assumption that longer aeromedical transfer times are associated with an increased risk of deterioration during flight. It also demonstrates that deterioration tends to occur early in flight, raising questions as to why this might occur.

可靠地确定航空医疗创伤患者的飞行中不良事件风险,可以使出发前的治疗更加知情,并指导中央资产配置,以实现更好的系统级结果。不幸的是,目前专门研究飞行期间的文献基础很少。飞行时间通常被认为是飞行中恶化风险的代表;然而,支持这一普遍假设的数据有限。本文探讨飞行时间与航空医学创伤患者飞行恶化风险之间的关系。回顾性分析2927例急性外伤空运患者首次出现低血压的时间。病例被分类为初级或医院间转院检索。根据包括初始GCS在内的几个标准,病例也被细分为原发性创伤性脑损伤或非创伤性脑损伤。到低血压的中位时间为总体11.5 min,首次恢复病例为10 min,院间转院病例为15 min (p = 0.049)。值得注意的是,在大约50分钟后,观察到累积风险的显著平台。单独的TBI病例在飞行中出现低血压的总体比率显著高于前者,为39.5%,而后者为9.2%。总的来说,本文支持生理学上合理的假设,即较长的航空医疗转移时间与飞行中恶化的风险增加有关。它还表明,退化往往发生在飞行的早期,这就提出了为什么会发生这种情况的问题。
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引用次数: 0
Authors' Reply to Merz et al. on eCPR in New Zealand 作者对Merz等人关于新西兰eCPR的答复
IF 1.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2025-09-10 DOI: 10.1111/1742-6723.70136
S. Wiebe, A. Boehm
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引用次数: 0
What Proportion of Emergency Department Headache Patients With Normal Neurology Have a Serious Secondary Headache Cause? A HEAD Study Report 神经功能正常的急诊科头痛患者继发严重头痛的比例是多少?校长研究报告
IF 1.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2025-09-10 DOI: 10.1111/1742-6723.70138
Anne Maree Kelly, Kevin H. Chu, Win Sen Kuan, Gerben Keijzers, Frances B. Kinnear, Alejandro Cardozo-Ocampo, the HEAD Study and HEAD Colombia Investigators

Objectives

To estimate the proportion of Emergency Department (ED) headache patients without neurological features who are diagnosed with a serious secondary headache cause.

Methods

Unplanned secondary analysis of HEAD Study/HEAD Colombia data. Patients without a known history of cerebral conditions and with a normal neurological assessment were included. The outcome of interest was the proportion of patients diagnosed with a serious secondary headache cause.

Results

One hundred ninety-one patients were diagnosed with a serious secondary headache cause (191/3951, 4.8%, 95% CI 4.2%–5.5%).

Conclusion

Absence of neurological features alone cannot be used to reliably exclude a serious secondary headache cause in ED patients.

目的评估急诊科(ED)无神经学特征的头痛患者诊断为严重继发性头痛的比例。方法对HEAD研究/HEAD哥伦比亚数据进行非计划的二次分析。患者没有已知的大脑病史和正常的神经系统评估。我们感兴趣的结果是诊断为严重继发性头痛原因的患者比例。结果191例患者诊断为严重继发性头痛原因(191/3951,4.8%,95% CI 4.2% ~ 5.5%)。结论单纯缺乏神经学特征不能可靠地排除ED患者严重继发性头痛的原因。
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引用次数: 0
Urgent Care Centre Eligible Presentations in a Remote Emergency Department 紧急护理中心在偏远急诊科的合格介绍
IF 1.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2025-09-09 DOI: 10.1111/1742-6723.70135
Jack Johnstone, Chris Perry, Ellice Rigby, Lisa Capps, Richard Johnson

Objective

This study aimed to identify presentations to the Alice Springs Emergency Department that could be managed in an Urgent Care Centre (UCC).

Methods

We reviewed 1 year of ED presentation data at Alice Springs Hospital (ASH) from August 2022 to August 2023 and used a sequence of exclusion criteria to identify patients most likely to be eligible for UCC management.

Results

Our model indicated that 35.0% of ED presentations at ASH during this period could have been managed in a UCC. Only 41.5% of these presentations (14.5% of total presentations) occurred during UCC operating hours.

Conclusions

According to this model, a significant proportion of ED presentations could potentially be managed in a UCC, although a large proportion of these occurred outside of UCC opening hours. The impact of the introduction of a UCC into a remote community on ED presentations, patient experience, patient outcomes and the broader system requires further study.

目的:本研究旨在确定爱丽斯泉急诊科可以在紧急护理中心(UCC)管理的报告。方法:我们回顾了Alice Springs医院(ASH)从2022年8月至2023年8月1年的ED表现数据,并使用一系列排除标准来确定最有可能符合UCC治疗条件的患者。结果我们的模型显示,在此期间,35.0%的ASH ED表现可以在UCC中得到控制。只有41.5%的报告(14.5%的报告)发生在UCC的工作时间。根据该模型,很大比例的ED演示可以在UCC中进行管理,尽管其中很大一部分发生在UCC开放时间之外。在偏远社区引入UCC对急诊科表现、患者体验、患者结果和更广泛的系统的影响需要进一步研究。
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引用次数: 0
The ‘Second Shift’ in Emergency Medicine: Strengths and Barriers of the Gendered Double Burden 急诊医学的“第二次转变”:性别双重负担的优势和障碍
IF 1.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2025-09-08 DOI: 10.1111/1742-6723.70133
Jennifer Jamieson, Zoe Ling, Krupa Mehta, Jocelyn Howell

The ‘double burden’ (or ‘second shift’) describes the workload of people in paid employment who are also responsible for unpaid domestic work. Globally, most of this work is shouldered by women and is often undervalued. For women working in Emergency Medicine, the double burden is likely to have impacts on career progression and leadership opportunities, as well as present challenges around competing demands of a rotating roster and domestic labour. With a higher and earlier attrition rate from emergency medicine, the loss of female clinicians has enormous implications for the EM workforce. The double burden has often been viewed as a challenge and a barrier to women; however, employing a strengths-based lens reveals that the experience of the double burden may lead to more empathetic and inclusive leadership models with greater innovation and gender equity within emergency department teams.

“双重负担”(或“第二班”)描述的是从事有偿工作的人同时承担无偿家务的工作量。在全球范围内,这些工作大多由妇女承担,往往被低估。对于从事急诊医学工作的妇女来说,这种双重负担可能会影响她们的职业发展和领导机会,以及目前在轮岗和家务劳动的竞争需求方面所面临的挑战。由于急诊医学人员的流失率更高、更早,女性临床医生的流失对急诊医疗人员有着巨大的影响。这种双重负担往往被视为对妇女的挑战和障碍;然而,采用基于优势的视角表明,双重负担的经验可能会导致在急诊科团队中更具同情心和包容性的领导模式,具有更大的创新和性别平等。
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引用次数: 0
期刊
Emergency Medicine Australasia
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