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Validation of the Turkish Version of the Professional Fulfillment Index. 土耳其版专业履行指数的验证。
IF 1.8 3区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2024-11-01 DOI: 10.5811/westjem.21199
Merve Eksioglu, Ayca Koca, Burcu Azapoglu Kaymak, Tuba Cimilli Ozturk, Atilla Halil Elhan

Introduction: Clinician burnout represents a significant occupational hazard among physicians, with a notably high prevalence among emergency physicians. The Stanford Professional Fulfillment Index (PFI) was developed to comprehensively assess various aspects of doctors' work experiences, including professional fulfillment. In this study we aimed to validate the Turkish version of the PFI (T-PFI), a 16-item instrument designed to measure physicians' professional fulfillment and burnout.

Methods: In this cross-sectional study, we validated the T-PFI in two phases. The initial phase involved translating and culturally adapting the original PFI into Turkish. We evaluated the content validity of the translated version using item and scale content validity indices (I-CVI and S-CVI, respectively). The validated T-PFI was then distributed among a broad cohort of emergency physicians via an online survey to further assess its reliability and validity. The assessment tools included Cronbach α, confirmatory factor analysis, and content validity indices.

Results: Of 1,434 physicians who were sent the survey, 425 fully completed it (29.6%). There was an almost equal distribution of 215 females and 210 males. Only 9.6% of the participants reported high levels of professional fulfillment, whereas a significant majority (79.1%) were susceptible to burnout. The Cronbach α values for the professional fulfillment and overall burnout scales were 0.87 and 0.90, respectively. The content validity was confirmed by I-CVI values exceeding 0.80 and an S-CVI/average relevance of 0.92. The confirmatory factor analysis demonstrated an acceptable model fit after adjustments.

Conclusion: The T-PFI is a reliable and valid tool for assessing professional fulfillment and burnout among emergency physicians in Turkey. Effective interventions to mitigate burnout are essential to improve physician well-being in Turkish healthcare settings.

临床医生职业倦怠是医生中一个重要的职业危害,在急诊医生中发病率尤其高。斯坦福职业实现指数(Stanford Professional Fulfillment Index, PFI)是为了综合评估医生工作经历的各个方面,包括职业实现。在本研究中,我们旨在验证土耳其版的PFI (T-PFI),这是一个16个项目的工具,旨在测量医生的职业成就感和职业倦怠。方法:在横断面研究中,我们分两个阶段验证了T-PFI。最初的阶段包括将原始的PFI翻译并在文化上改编成土耳其语。我们使用项目和量表内容效度指数(分别为I-CVI和S-CVI)来评估翻译版本的内容效度。然后通过在线调查将经过验证的T-PFI分发给大量急诊医生,以进一步评估其信度和效度。评估工具包括Cronbach α、验证性因子分析和内容效度指标。结果:在接受调查的1434名医生中,425名(29.6%)完全完成了调查。215名女性和210名男性的分布几乎相等。只有9.6%的参与者报告了高水平的职业成就感,而绝大多数(79.1%)容易倦怠。职业满足和职业倦怠量表的Cronbach α值分别为0.87和0.90。I-CVI值超过0.80,S-CVI/平均相关性为0.92,证实了内容效度。验证性因子分析表明,调整后的模型拟合是可接受的。结论:T-PFI是评估土耳其急诊医生职业成就感和职业倦怠的可靠和有效的工具。有效的干预措施,以减轻倦怠是必不可少的,以提高医生的福祉在土耳其医疗保健设置。
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引用次数: 0
A Review of the Clinical Presentation, Causes, and Diagnostic Evaluation of Increased Intracranial Pressure in the Emergency Department. 急诊科颅内压增高的临床表现、原因及诊断评价综述。
IF 1.8 3区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2024-11-01 DOI: 10.5811/westjem.18500
Cristiana Olaru, Sam Langberg, Nicole Streiff McCoin

Increased intracranial pressure (ICP) is encountered in numerous traumatic and non-traumatic medical situations, and it requires immediate recognition and attention. Clinically, ICP typically presents with a headache that is most severe in the morning, aggravated by Valsalva-like maneuvers, and associated with nausea or vomiting. Papilledema is a well-recognized sign of increased ICP; however, emergency physicians often find it difficult to visualize the optic disc using ophthalmoscopy or to accurately interpret digital fundus photographs when using a non-mydriatic retinal camera. Emergency ultrasound can evaluate the optic nerve sheath diameter (ONSD) and optic disc elevation to determine whether increased ICP is present, however, the studies have been small with different definitions and measurements of the ONSD. The ONSD threshold values for increased ICP have been reported anywhere from 4.8 to 6.3 millimeters. Neuroimaging is the next step in the evaluation of patients with papilledema or high clinical suspicion of increased ICP, as it can identify most structural causes or typical radiological patterns of increased ICP. Neuroradiographic signs of increased ICP can be helpful in suggesting idiopathic intracranial hypertension (IIH), especially when papilledema is absent. Patients with papilledema and normal neuroimaging may undergo lumbar puncture as part of their clinical workup. The cerebrospinal fluid (CSF) opening pressure remains one of the most important investigations to establish the diagnosis of IIH. A CSF evaluation is also required to exclude other etiologies of elevated ICP such as infectious, inflammatory, and neoplastic meningitis. Invasive ICP measurement remains the standard to measure and monitor this condition.

颅内压升高(ICP)在许多创伤性和非创伤性医疗情况下都会遇到,需要立即识别和注意。临床上,ICP典型表现为头痛,早晨最严重,缬氨酸钠样动作加重,并伴有恶心或呕吐。乳头水肿是公认的颅内压增高的征兆;然而,急诊医生经常发现使用检眼镜很难看到视盘,或者当使用无晶状体视网膜相机时,很难准确地解释数字眼底照片。急诊超声可以评估视神经鞘直径(ONSD)和视盘升高,以确定是否存在颅内压增高,然而,研究规模较小,对ONSD的定义和测量方法不同。据报道,ICP升高的ONSD阈值在4.8到6.3毫米之间。神经影像学是评估乳头水肿或临床高度怀疑颅内压增高患者的下一步,因为它可以确定大多数结构性原因或颅内压增高的典型影像学模式。颅内压增高的神经影像学征象有助于提示特发性颅内高压(IIH),特别是在没有乳头水肿的情况下。有乳头水肿和正常神经成像的患者可以进行腰椎穿刺作为临床检查的一部分。脑脊液(CSF)开口压力仍然是建立IIH诊断的最重要的调查之一。脑脊液评估也需要排除其他病因升高的颅内压,如感染性、炎症性和肿瘤性脑膜炎。有创ICP测量仍然是测量和监测这种情况的标准。
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引用次数: 0
Reframing Child Protection in Emergency Medicine. 重构急诊医学中的儿童保护。
IF 1.8 3区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2024-11-01 DOI: 10.5811/westjem.18481
Joseph P Shapiro, Genevieve Preer, Caroline J Kistin

Child maltreatment remains a concerning source of morbidity and mortality in the United States, where more than 600,000 children are victims of abuse each year, with well-described, long-term consequences for physical and mental health. However, the US child welfare system is characterized by systemic racism and inequity. Black and Native American children are more likely to be evaluated and reported for suspected abuse despite evidence that race does not independently change their risk of being abused. Once reported to child protective services (CPS), these children are more likely to be removed from their homes and less likely to be reunited with their families than White children. Much of the inequity in this system starts at the front door, where a growing body of research demonstrates that bias regularly infiltrates decision-making in the initial clinical evaluation and management of suspected abuse. Minority children presenting to emergency departments (ED) are more likely to receive diagnostic testing and are more likely to be referred to CPS. In this editorial, we argue for the application of an equity lens to child protection in the ED. We discuss how emergency physicians can balance efforts to protect children from abuse with the imperative to protect children and families from the harms of an inequitable child welfare system. Our discussion concludes with concrete recommendations for emergency clinicians to participate in active bias mitigation and thoughtfully navigate their responsibilities as mandated reporters.

在美国,虐待儿童仍然是一个令人担忧的发病率和死亡率的来源,每年有60多万儿童成为虐待的受害者,对身心健康造成了详细描述的长期后果。然而,美国的儿童福利制度存在着系统性的种族主义和不平等。黑人和印第安儿童更有可能因涉嫌虐待而接受评估和报告,尽管有证据表明种族并不能单独改变他们遭受虐待的风险。一旦报告给儿童保护服务(CPS),这些孩子比白人孩子更有可能被带离家园,更不可能与家人团聚。这一体系中的不公平现象大多从一开始就存在,越来越多的研究表明,在最初的临床评估和对疑似滥用行为的管理中,偏见经常渗透到决策过程中。到急诊科(ED)就诊的少数族裔儿童更有可能接受诊断测试,更有可能被转介到CPS。在这篇社论中,我们主张在ED中应用公平的视角来保护儿童。我们讨论了急诊医生如何在保护儿童免受虐待的努力与保护儿童和家庭免受不公平儿童福利制度伤害的必要性之间取得平衡。我们的讨论最后提出了具体的建议,建议急诊临床医生积极参与减轻偏见,并深思熟虑地把握他们作为强制报告者的责任。
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引用次数: 0
Diagnostic and Prognostic Value of SCUBE-1 in COVID-19 Patients. scbe -1在COVID-19患者中的诊断和预后价值。
IF 1.8 3区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2024-11-01 DOI: 10.5811/westjem.18586
Vildan Ozer, Ozgen Gonenc Cekic, Ozlem Bulbul, Davut Aydın, Eser Bulut, Firdevs Aksoy, Mehtap Pehlivanlar Kucuk, Suleyman Caner Karahan, Ebru Emel Sozen, Esra Ozkaya, Polat Kosucu, Yunus Karaca, Suleyman Turedi

Introduction: The workload of physicians increased due to the number of patients presenting with suspicion of coronavirus 2019 (COVID-19) and the prolonged wait times in the emergency department during the COVID-19 pandemic. Signal peptide-CUB-EGF domain-containing protein 1 (SCUBE-1) is a protein present in platelets and endothelial cells; it is activated by inflammation from COVID-19 and may be associated with COVID-19's known thrombotic risk. We aimed to determine whether SCUBE-1 levels are diagnostically correlated in suspected COVID-19 patients, and whether SCUBE-1 correlated with severity of disease and, therefore, might be useful to guide hospitalization/discharge decisions.

Methods: The suspected COVID-19 patients cared for at tertiary healthcare institutions for one year between May 2021-May 2022 were examined in this study. The subjects were both suspected COVID-19 patients not ultimately found to have COVID-19 and those who were diagnosed with COVID-19. By modifying the disease severity scoring systems present in COVID-19 guidelines in 2021, the COVID-19-positive patient group was classified as mild, moderate, severe, and critical, and compared using the SCUBE-1 levels. Moreover, SCUBE-1 levels were compared between the COVID-19 positive group and the COVID-19 negative group.

Results: A total of 507 patients were considered for the present study. After excluding 175 patients for incomplete data and alternate comorbid organ failure. we report on 332 patients (65.5%). Of these 332 patients, 80 (24.0%) were COVID-19 negative, and 252 (76.0%) were COVID-19 positive. Of 252 (100%) patients diagnosed with COVID-19, 74 (29.4%) were classified as mild, 95 (37.7%) moderate, 45 (17.8%) severe, and 38 (15.1%) critical. The SCUBE-1 levels were statistically different between COVID-19 positive (8.48 ± 7.42 nanograms per milliliter [ng/mL]) and COVID-19 negative (1.86 ± 0.92 ng/mL) patients (P < 0.001). In the COVID-19 positive group, SCUBE-1 levels increased with disease severity (mild = 3.20 ± 1.65 ng/mL, moderate = 4.78 ± 2.26 ng/mL, severe = 13.68 ± 3.95 ng/mL, and critical = 21.87 ± 5.39 ng/mL) (P < 0.001). The initial SCUBE-1 levels of discharged patients were significantly lower than those requiring hospitalization (discharged = 2.89 ng/mL [0.55-8.60 ng/mL]; ward admitted = 7.13 ng/mL [1.38-21.29 ng/mL], and ICU admitted = 21.19 ng/mL [10.58-37.86 ng/mL]) (P < 0.001).

Conclusion: The SCUBE-1 levels were found to be differentiated between patients with and without COVID-19 and to be correlated with the severity of illness.

导语:2019冠状病毒大流行期间,由于疑似2019冠状病毒(COVID-19)的患者数量增加,以及急诊室等待时间延长,医生的工作量增加。信号肽- cub - egf结构域蛋白1 (SCUBE-1)是一种存在于血小板和内皮细胞中的蛋白;它被COVID-19的炎症激活,并可能与COVID-19已知的血栓形成风险相关。我们的目的是确定SCUBE-1水平在疑似COVID-19患者中是否与诊断相关,以及SCUBE-1是否与疾病严重程度相关,因此可能有助于指导住院/出院决策。方法:对2021年5月至2022年5月在三级医疗机构就诊1年的疑似COVID-19患者进行调查。受试者都是最终未被发现患有COVID-19的疑似COVID-19患者和被诊断患有COVID-19的患者。通过修改2021年COVID-19指南中存在的疾病严重程度评分系统,将COVID-19阳性患者组分为轻度、中度、重度和危重,并使用SCUBE-1级别进行比较。比较新冠病毒阳性组与阴性组间SCUBE-1水平的差异。结果:本研究共纳入507例患者。在排除了175例数据不完整和其他合并症器官衰竭的患者后。我们报告了332例患者(65.5%)。其中阴性80例(24.0%),阳性252例(76.0%)。252例(100%)确诊为COVID-19的患者中,轻度74例(29.4%),中度95例(37.7%),重度45例(17.8%),危重38例(15.1%)。scbe -1水平在COVID-19阳性患者(8.48±7.42纳克/毫升[ng/mL])与COVID-19阴性患者(1.86±0.92纳克/毫升])之间差异有统计学意义(P P P)结论:scbe -1水平在COVID-19与非COVID-19患者之间存在差异,并与病情严重程度相关。
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引用次数: 0
Improving Patient Understanding of Emergency Department Discharge Instructions. 提高病人对急诊科出院须知的理解。
IF 1.8 3区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2024-11-01 DOI: 10.5811/westjem.18579
Sarah Russell, Nancy Jacobson, Ashley Pavlic

Introduction: Previous studies have shown that patients in the emergency department (ED) are frequently given incomplete discharge instructions that are written at least four grade levels above the recommended sixth-grade reading level, leading to poor understanding. Our aims in this study were to implement standardized discharge instructions containing six key components written at a more appropriate reading level for common emergency department (ED) diagnoses to improve patient understanding.

Methods: We conducted this study in a 20-bed ED at an urban Veteran's Administration hospital. Data was collected via in-person patient and clinician interviews. Patient interviews were conducted after patients received their discharge instructions. We compared patient responses to clinician responses and marked them as incorrect, partially correct, or correct with a score of 0, 0.5, or 1, respectively. The maximum possible score for each interview was six. Six key components of discharge instructions were asked about: diagnosis; new medications; at-home care; duration of illness; reasons to return; and follow-up. There were 25 patients in the pre-intervention group and 20 in the intervention group with the standardized set of instructions. We performed a Mann-Whitney U test on the total interview scores in the control and intervention groups and conducted a sub-analysis on the individual scores for each of the six key components.

Results: The patients in the intervention demonstrated a statistically significant increase in patient-clinician correlation when compared to the patients in the pre-intervention group overall (P < 0.05), and two of the six key components of the discharge instructions individually showed statistically significant increase in patient-clinician correlation when standardized discharge instructions were used.

Conclusion: Patients who received the standardized discharge instructions had improved understanding of their discharge instructions. Future opportunities extending off this pilot study include expanding the number of diagnoses for which standardized instructions are used and investigating patient-centered outcomes related to these instructions.

导读:先前的研究表明,急诊科(ED)的患者经常得到不完整的出院说明,这些说明的书写水平至少比推荐的六年级阅读水平高出四个等级,导致理解不佳。我们在这项研究中的目的是实施标准化的出院指南,其中包含六个关键部分,以更适合普通急诊科(ED)诊断的阅读水平编写,以提高患者的理解。方法:我们在一家城市退伍军人管理局医院的20个床位的急诊科进行了这项研究。通过对患者和临床医生的面对面访谈收集数据。在患者收到出院指示后进行患者访谈。我们将患者的反应与临床医生的反应进行比较,并分别以0分、0.5分或1分将其标记为不正确、部分正确或正确。每次面试的最高分是6分。出院说明的六个关键组成部分被问及:诊断;新的药物;家庭护理;患病时间;回归的理由;和随访。干预前组25例,标准化指导组20例。我们对对照组和干预组的总访谈得分进行了曼-惠特尼U测试,并对六个关键组成部分的每个得分进行了子分析。结果:与干预前组患者相比,干预组患者与临床医生的相关性总体上有统计学意义的提高(P)。结论:接受标准化出院指导的患者对出院指导的理解有所提高。扩展这一试点研究的未来机会包括扩大使用标准化指导的诊断数量,并调查与这些指导相关的以患者为中心的结果。
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引用次数: 0
Teaching the New Ways: Improving Resident Documentation for the New 2023 Coding Requirements. 教学新方法:改善2023年新编码要求的居民文件。
IF 1.8 3区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2024-11-01 DOI: 10.5811/westjem.21183
Nathan Zapolsky, Annemarie Cardell, Riddhi Desai, Stacey Frisch, Nicholas Jobeun, Daniel Novak, Michael Silver, Arlene S Chung
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引用次数: 0
Telesimulation Use in Emergency Medicine Residency Programs: National Survey of Residency Simulation Leaders. 远程模拟在急诊医学住院医师计划中的应用:全国住院医师模拟领导者调查。
IF 1.8 3区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2024-11-01 DOI: 10.5811/westjem.24863
Max Berger, Jack Buckanavage, Jaime Jordan, Steven Lai, Linda Regan

Introduction: Coronavirus 2019 (COVID-19) accelerated the need for virtual learning including telesimulation. Many emergency medicine (EM) programs halted in-person simulation and trialed telesimulation, but specifics on its utilization and plans for future use are unknown. Telesimulation has been defined as "a process by which telecommunication and simulation resources are utilized to provide education, training, and/or assessment to learners at an off-site location." Our objective in this study was to describe the patterns of telesimulation usage in EM residency programs during COVID-19-induced learning restrictions as well as its anticipated future utility.

Methods: We identified EM simulation leaders via the EMRA Match website, institutional websites, or personal contact with residency coordinators and directors, and invited them to participate by email. Participants completed a confidential, web-based survey consisting of multiple-choice items and one free-response question, developed by our study team with consideration of survey research best practices and Messick's validity framework. We collected data between January-February 2022. We calculated descriptive statistics for multiple-choice items and examined the free-response answers for common themes.

Results: We obtained contact information for simulation leaders at 139 EM residency programs. Survey response rate was 65% (91/139). During in-person restrictions, 62% (56/91) of programs used telesimulation. Assuming all restrictions lifted, 38% (34/90) of respondents planned to continue to use telesimulation, compared to 9% (8/91) using telesimulation before COVID-19. Most respondents planned to use telesimulation for medical knowledge (26/34, 76%) and communication/teamwork-focused cases (23/34, 68%). In response to the free-response question regarding experience with and plans for use, we identified three major themes: 1) telesimulation is a valuable alternative to in-person learning; 2) telesimulation is an option for learners unable to participate in person; and 3) telesimulation is challenging for procedural education.

Conclusion: Despite the relatively limited use of telesimulation in EM residencies prior to COVID-19, an increased number of programs have plans to continue incorporating telesimulation into their curricula. This plan for continued use opens opportunities for further innovation and scholarship within simulation education.

导语:2019冠状病毒病(COVID-19)加速了对包括远程模拟在内的虚拟学习的需求。许多急诊医学(EM)项目停止了现场模拟和远程模拟试验,但其使用的具体细节和未来使用的计划尚不清楚。远程模拟被定义为“利用电信和模拟资源在非现场位置向学习者提供教育、培训和/或评估的过程”。我们在本研究中的目的是描述在covid -19引起的学习限制期间EM住院医师计划中远程模拟的使用模式及其预期的未来效用。方法:我们通过EMRA Match网站、机构网站或与住院医师协调员和主任的个人联系确定EM模拟领导者,并通过电子邮件邀请他们参与。参与者完成了一份保密的、基于网络的调查,包括多项选择题和一个自由回答问题,由我们的研究团队根据调查研究的最佳实践和梅西克的有效性框架开发。我们收集了2022年1月至2月之间的数据。我们计算了多项选择题的描述性统计数据,并检查了常见主题的自由回答答案。结果:我们获得了139个EM住院医师项目的模拟负责人的联系信息。调查回复率为65%(91/139)。在现场限制期间,62%(56/91)的程序使用了远程模拟。假设所有限制都取消,38%(34/90)的受访者计划继续使用远程模拟,而在COVID-19之前使用远程模拟的受访者为9%(8/91)。大多数受访者计划在医学知识(26/ 34,76%)和以沟通/团队合作为重点的病例(23/ 34,68%)中使用远程模拟。在回答关于使用经验和使用计划的自由回答问题时,我们确定了三个主要主题:1)远程模拟是面对面学习的有价值的替代方案;2)远程模拟是学习者无法亲自参与的一种选择;3)模拟模拟对程序性教育提出了挑战。结论:尽管在2019冠状病毒病之前,远程模拟在EM住院医师中的使用相对有限,但越来越多的项目计划继续将远程模拟纳入其课程。这个继续使用的计划为模拟教育中的进一步创新和奖学金提供了机会。
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引用次数: 0
Barriers to Adoption of a Child-Abuse Clinical Decision Support System in Emergency Departments. 急诊科采用虐待儿童临床决策支持系统的障碍。
IF 1.8 3区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2024-11-01 DOI: 10.5811/westjem.18501
Alanna C Peterson, Donald M Yealy, Emily Heineman, Rachel P Berger

Introduction: Child abuse is a leading cause of morbidity and mortality in children. The rate of missed child abuse in general emergency departments (ED), where 85% of children are evaluated, is higher than in pediatric EDs. We sought to evaluate the impact of an electronic health record (EHR)-embedded child-abuse clinical decision support system (CA-CDSS) in the identification and evaluation of child maltreatment in a network of EDs three years after implementation.

Methods: We anonymously surveyed all 196 ED attending physicians and advanced practice practitioners (APP) in the University of Pittsburgh Medical Center network. The survey evaluated practitioner awareness of, attitudes toward, and changes in clinical practice prompted by the CA-CDSS. We also assessed practitioner recognition and evaluation of sentinel injuries.

Results: Of the 71 practitioners (36%) who responded to the survey, 75% felt the tool raised child abuse awareness, and 72% had a face-to-face discussion with the child's nurse after receiving a CA-CDSS alert. Among APPs, 72% consulted with the attending physician after receiving an alert. Many practitioners were unaware of at least one function of the CA-CDSS; 38% did not know who completed the child abuse screen (CAS); 54% were unaware that they could view the results of the CAS in the EHR, and 69% did not recognize the clinical decision support dashboard icon. Slightly over 20% of respondents felt that the CA-CDSS limited autonomy; and 4.5% disagreed with the recommendations in the physical abuse order set, which reflects American Academy of Pediatrics (AAP) guidelines. Greater than 90% of respondents correctly identified an intraoral injury and torso bruise in an infant as sentinel injuries requiring an evaluation for abuse.

Conclusion: A child-abuse clinical decision support system embedded in the electronic health record was associated with communication among practitioners and was overall perceived as improving child abuse awareness in our system. Practitioners correctly recognized injuries concerning for abuse. Barriers to improving identification and evaluation of abuse include gaps in knowledge about the CA-CDSS and the presence of practitioners who disagree with the AAP recommendations for physical abuse evaluation and/or felt that clinical decision support in general limited their clinical autonomy.

儿童虐待是儿童发病和死亡的主要原因。普通急诊科(ED)对85%的儿童进行了评估,但未发现虐待儿童的比率高于儿科急诊科。我们试图评估电子健康记录(EHR)嵌入式儿童虐待临床决策支持系统(CA-CDSS)在实施三年后在急诊室网络中识别和评估儿童虐待的影响。方法:我们匿名调查了匹兹堡大学医学中心网络中所有196名急诊科主治医师和高级执业医师(APP)。该调查评估了执业医师对CA-CDSS的认识、态度和临床实践的变化。我们还评估了从业人员对前哨损伤的认识和评估。结果:在回应调查的71名从业人员(36%)中,75%的人认为该工具提高了儿童虐待意识,72%的人在收到CA-CDSS警报后与儿童的护士进行了面对面的讨论。在app中,72%的人在收到警报后咨询了主治医生。许多从业人员不知道CA-CDSS的至少一项功能;38%的人不知道谁完成了虐待儿童筛查(CAS);54%的人不知道他们可以在电子病历中查看CAS的结果,69%的人不知道临床决策支持仪表板图标。略多于20%的受访者认为CA-CDSS限制了自主权;4.5%的人不同意身体虐待顺序集的建议,这反映了美国儿科学会(AAP)的指导方针。超过90%的答复者正确地将婴儿的口内损伤和躯干挫伤确定为需要对虐待进行评估的前哨损伤。结论:嵌入电子健康记录的虐待儿童临床决策支持系统与从业人员之间的沟通有关,总体上被认为提高了我们系统中对虐待儿童的认识。从业人员正确识别与虐待有关的伤害。改善对虐待的识别和评估的障碍包括对CA-CDSS的知识差距,以及不同意AAP对身体虐待评估的建议和/或认为临床决策支持通常限制了他们的临床自主权的从业人员的存在。
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引用次数: 0
External Validation of the RESCUE-IHCA Score as a Predictor for In-Hospital Cardiac Arrest Patients Receiving Extracorporeal Cardiopulmonary Resuscitation. RESCUE-IHCA评分作为院内心脏骤停患者接受体外心肺复苏预测因子的外部验证
IF 1.8 3区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2024-11-01 DOI: 10.5811/westjem.18601
Yi-Ju Ho, Pei-I Su, Chien-Yu Chi, Min-Shan Tsai, Yih-Sharng Chen, Chien-Hua Huang

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) improves the prognosis of in-hospital cardiac arrest (IHCA). The six-factor RESCUE-IHCA score (resuscitation using ECPR during IHCA) was developed to predict outcomes of post-IHCA ECPR-treated adult patients. Our goal was to validate the score in an Asian medical center with a high volume and experience of ECPR performance and to compare the differences in patient characteristics between the current study and the original cohort in a 2022 observational study.

Method: For this single-center, retrospective cohort study we enrolled 324 ECPR-treated adult IHCA patients. The primary outcome was in-hospital mortality. We used the area under the receiver operating curve (AUROC) to externally validate the RESCUE-IHCA score. The calibration of the model was tested by the decile calibration plot as well as Hosmer-Lemeshow goodness-of-fit with an associated P-value.

Results: Of the 324 participants, 231 (71%) died before hospital discharge. The discriminative performance of the RESCUE-IHCA score was comparable with the originally validated cohort, with an AUC of 0.63. A prolonged duration of cardiac arrest was associated with an increased risk of mortality (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.03, P = .006). An initial rhythm of ventricular tachycardia (OR 0.14, 95% CI 0.04-0.51, P = .003), ventricular fibrillation (OR 0.11, 95% CI 0.03-0.46, P = .003), and palpable pulse (OR 0.26, 95% CI 0.07-0.92, P = 0.04) were associated with a reduced mortality risk compared to asystole or pulseless electrical activity. In contrast to the original study, age (P = 0.28), resuscitation timing (P = 0.14), disease category (P = 0.18), and pre-existing renal insufficiency (P = 0.12) were not associated with in-hospital death.

Conclusion: In external validation, the RESCUE-IHCA score exhibited performance comparable to its original validation within the single-center population. Further investigation on hospital experience, time-of-day effect, and specific disease categories is warranted to improve the selection criteria for ECPR candidates during IHCA.

背景:体外心肺复苏(ECPR)可改善院内心脏骤停(IHCA)的预后。开发了六因素RESCUE-IHCA评分(IHCA期间使用ECPR复苏)来预测IHCA后ECPR治疗的成人患者的预后。我们的目标是在一家拥有大量ECPR表现经验的亚洲医疗中心验证评分,并比较当前研究与2022年观察性研究中原始队列之间患者特征的差异。方法:在这项单中心、回顾性队列研究中,我们招募了324例接受ecpr治疗的成年IHCA患者。主要终点是住院死亡率。我们使用受试者工作曲线下面积(AUROC)从外部验证RESCUE-IHCA评分。模型的校准通过十分位数校准图和Hosmer-Lemeshow拟合优度与相关p值进行检验。结果:在324名参与者中,231人(71%)在出院前死亡。RESCUE-IHCA评分的判别性能与最初验证的队列相当,AUC为0.63。心脏骤停持续时间延长与死亡风险增加相关(优势比[OR] 1.02, 95%可信区间[CI] 1.01-1.03, P = 0.006)。与无搏动或无脉性电活动相比,室性心动速达(OR 0.14, 95% CI 0.04-0.51, P = 0.003)、心室颤动(OR 0.11, 95% CI 0.03-0.46, P = 0.003)和可触脉(OR 0.26, 95% CI 0.07-0.92, P = 0.04)的初始节律与降低的死亡风险相关。与原始研究相比,年龄(P = 0.28)、复苏时间(P = 0.14)、疾病类别(P = 0.18)和既往肾功能不全(P = 0.12)与院内死亡无关。结论:在外部验证中,RESCUE-IHCA评分在单中心人群中表现出与其原始验证相当的性能。有必要对医院经验、时间效应和特定疾病类别进行进一步调查,以改进IHCA期间ECPR候选人的选择标准。
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引用次数: 0
Interfacility Patient Transfers During COVID-19 Pandemic: Mixed-Methods Study. COVID-19 大流行期间的医院间病人转运:混合方法研究。
IF 1.8 3区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2024-09-01 DOI: 10.5811/westjem.20929
Michael B Henry, Emily Funsten, Marisa A Michealson, Danielle Albright, Cameron S Crandall, David P Sklar, Naomi George, Margaret Greenwood-Ericksen

Introduction: The United States lacks a national interfacility patient transfer coordination system. During the coronavirus 2019 (COVID-19) pandemic, many hospitals were overwhelmed and faced difficulties transferring sick patients, leading some states and cities to form transfer centers intended to assist sending facilities. In this study we aimed to explore clinician experiences with newly implemented transfer coordination centers.

Methods: This mixed-methods study used a brief national survey along with in-depth interviews. The American College of Emergency Physicians Emergency Medicine Practice Research Network (EMPRN) administered the national survey in March 2021. From September-December 2021, semi-structured qualitative interviews were conducted with administrators and rural emergency clinicians in Arizona and New Mexico, two states that started transfer centers during COVID-19.

Results: Among 141 respondents (of 765, 18.4% response rate) to the national EMPRN survey, only 30% reported implementation or expansion of a transfer coordination center during COVID-19. Those with new transfer centers reported no change in difficulty of patient transfers during COVID-19 while those without had increased difficulty. The 17 qualitative interviews expanded upon this, revealing four major themes: 1) limited resources for facilitating transfers even before COVID-19; 2) increased number of and distance to transfer partners during the COVID-19 pandemic; 3) generally positive impacts of transfer centers on workflow, and 4) the potential for continued use of centers to facilitate transfers.

Conclusion: Transfer centers may have offset pandemic-related transfer challenges brought on by the COVID-19 pandemic. Clinicians who frequently need to transfer patients may particularly benefit from ongoing access to such transfer coordination services.

导言:美国缺乏全国性的医院间病人转运协调系统。在 2019 年冠状病毒(COVID-19)大流行期间,许多医院不堪重负,面临着转运病人的困难,因此一些州和城市成立了转运中心,旨在协助送往医院的病人。在这项研究中,我们旨在探讨临床医生对新实施的转运协调中心的体验:这项混合方法研究采用了简短的全国调查和深入访谈。美国急诊医师学会急诊医学实践研究网络(EMPRN)于 2021 年 3 月进行了全国调查。2021 年 9 月至 12 月,对亚利桑那州和新墨西哥州的管理人员和农村急诊临床医生进行了半结构化定性访谈,这两个州在 COVID-19 期间建立了转运中心:在全国 EMPRN 调查的 141 位受访者(共 765 位,回复率为 18.4%)中,只有 30% 的受访者表示在 COVID-19 期间实施或扩大了转运协调中心。有新转运中心的受访者表示,在 COVID-19 期间,病人转运的难度没有变化,而没有转运中心的受访者则表示难度有所增加。17 个定性访谈对此进行了扩展,揭示了四大主题:1)即使在 COVID-19 之前,用于促进转运的资源也有限;2)COVID-19 大流行期间,转运合作伙伴的数量和距离增加;3)转运中心对工作流程的总体积极影响,以及 4)继续使用转运中心促进转运的潜力:转运中心可能抵消了 COVID-19 大流行带来的与大流行相关的转运挑战。经常需要转运病人的临床医生可能会从持续使用此类转运协调服务中获益匪浅。
{"title":"Interfacility Patient Transfers During COVID-19 Pandemic: Mixed-Methods Study.","authors":"Michael B Henry, Emily Funsten, Marisa A Michealson, Danielle Albright, Cameron S Crandall, David P Sklar, Naomi George, Margaret Greenwood-Ericksen","doi":"10.5811/westjem.20929","DOIUrl":"https://doi.org/10.5811/westjem.20929","url":null,"abstract":"<p><strong>Introduction: </strong>The United States lacks a national interfacility patient transfer coordination system. During the coronavirus 2019 (COVID-19) pandemic, many hospitals were overwhelmed and faced difficulties transferring sick patients, leading some states and cities to form transfer centers intended to assist sending facilities. In this study we aimed to explore clinician experiences with newly implemented transfer coordination centers.</p><p><strong>Methods: </strong>This mixed-methods study used a brief national survey along with in-depth interviews. The American College of Emergency Physicians Emergency Medicine Practice Research Network (EMPRN) administered the national survey in March 2021. From September-December 2021, semi-structured qualitative interviews were conducted with administrators and rural emergency clinicians in Arizona and New Mexico, two states that started transfer centers during COVID-19.</p><p><strong>Results: </strong>Among 141 respondents (of 765, 18.4% response rate) to the national EMPRN survey, only 30% reported implementation or expansion of a transfer coordination center during COVID-19. Those with new transfer centers reported no change in difficulty of patient transfers during COVID-19 while those without had increased difficulty. The 17 qualitative interviews expanded upon this, revealing four major themes: 1) limited resources for facilitating transfers even before COVID-19; 2) increased number of and distance to transfer partners during the COVID-19 pandemic; 3) generally positive impacts of transfer centers on workflow, and 4) the potential for continued use of centers to facilitate transfers.</p><p><strong>Conclusion: </strong>Transfer centers may have offset pandemic-related transfer challenges brought on by the COVID-19 pandemic. Clinicians who frequently need to transfer patients may particularly benefit from ongoing access to such transfer coordination services.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 5","pages":"758-766"},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Western Journal of Emergency Medicine
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