首页 > 最新文献

medRxiv - Emergency Medicine最新文献

英文 中文
Diagnostic performance of serum CA-125 for overall and complicated acute appendicitis: a systematic review and meta-analysis 血清 CA-125 对总体急性阑尾炎和复杂急性阑尾炎的诊断性能:系统综述和荟萃分析
Pub Date : 2023-12-17 DOI: 10.1101/2023.12.16.23300068
Javier Arredondo Montero, Blanca Paola Pérez Riveros, Oscar Emilio Bueso Asfura
Background This study aimed to analyze the diagnostic performance of serum CA-125 in acute appendicitis (AA).
背景 本研究旨在分析血清 CA-125 在急性阑尾炎(AA)中的诊断性能。
{"title":"Diagnostic performance of serum CA-125 for overall and complicated acute appendicitis: a systematic review and meta-analysis","authors":"Javier Arredondo Montero, Blanca Paola Pérez Riveros, Oscar Emilio Bueso Asfura","doi":"10.1101/2023.12.16.23300068","DOIUrl":"https://doi.org/10.1101/2023.12.16.23300068","url":null,"abstract":"<strong>Background</strong> This study aimed to analyze the diagnostic performance of serum CA-125 in acute appendicitis (AA).","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138820058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Variation in ambulance pre-alert process and practice: Cross-sectional survey of ambulance clinicians 救护车预先警报程序和做法的差异:对救护车临床医生的横断面调查
Pub Date : 2023-12-15 DOI: 10.1101/2023.12.14.23299969
Joanne Coster, Fiona Sampson, Rachel O’Hara, Jaqui Long, Fiona Bell, Steve Goodacre
Background Ambulance clinicians use pre-alerts calls to alert emergency departments (EDs) about the arrival of critically ill patients. We explored ambulance clinician’s views and experiences of pre-alert practice and processes using a national online survey.
背景 救护车临床医生使用预先警报电话提醒急诊科(ED)危重病人的到来。我们通过一项全国性在线调查,了解了救护车临床医生对预先警报做法和流程的看法和经验。
{"title":"Variation in ambulance pre-alert process and practice: Cross-sectional survey of ambulance clinicians","authors":"Joanne Coster, Fiona Sampson, Rachel O’Hara, Jaqui Long, Fiona Bell, Steve Goodacre","doi":"10.1101/2023.12.14.23299969","DOIUrl":"https://doi.org/10.1101/2023.12.14.23299969","url":null,"abstract":"<strong>Background</strong> Ambulance clinicians use pre-alerts calls to alert emergency departments (EDs) about the arrival of critically ill patients. We explored ambulance clinician’s views and experiences of pre-alert practice and processes using a national online survey.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"34 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138714682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
What influences ambulance clinician decisions to pre-alert Emergency Departments: a qualitative exploration of decision-making in three UK Ambulance Services 是什么影响了救护车临床医生向急诊科发出预先警报的决定:对英国三家救护车服务机构决策的定性研究
Pub Date : 2023-12-15 DOI: 10.1101/2023.12.14.23299973
Rachel O’Hara, Fiona Sampson, Jaqui Long, Joanne Coster, Richard Pilbery
Background Ambulance clinicians use pre-alerts to inform receiving hospitals of the imminent arrival of a time-critical patient considered to require immediate attention, enabling the receiving Emergency Department or other clinical area to prepare. Pre-alerts are key to ensuring immediate access to appropriate care, but unnecessary pre-alerts can divert resources from other patients and fuel ‘pre-alert fatigue’ amongst ED staff. This research aims to provide a better understanding of pre-alert decision-making practice.
背景 救护车临床医生使用预先警报通知接收医院有一名时间紧迫的病人即将到达,需要立即救治,以便接收医院的急诊科或其他临床区域做好准备。预先警报是确保立即获得适当护理的关键,但不必要的预先警报会占用其他病人的资源,并加剧急诊科工作人员的 "预先警报疲劳"。这项研究旨在更好地了解预警前的决策实践。
{"title":"What influences ambulance clinician decisions to pre-alert Emergency Departments: a qualitative exploration of decision-making in three UK Ambulance Services","authors":"Rachel O’Hara, Fiona Sampson, Jaqui Long, Joanne Coster, Richard Pilbery","doi":"10.1101/2023.12.14.23299973","DOIUrl":"https://doi.org/10.1101/2023.12.14.23299973","url":null,"abstract":"<strong>Background</strong> Ambulance clinicians use pre-alerts to inform receiving hospitals of the imminent arrival of a time-critical patient considered to require immediate attention, enabling the receiving Emergency Department or other clinical area to prepare. Pre-alerts are key to ensuring immediate access to appropriate care, but unnecessary pre-alerts can divert resources from other patients and fuel ‘pre-alert fatigue’ amongst ED staff. This research aims to provide a better understanding of pre-alert decision-making practice.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"239 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138714679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Time of surgery for aneurysmal subarachnoid hemorrhage in patients ≥70 years ≥70岁患者接受动脉瘤性蛛网膜下腔出血手术的时间
Pub Date : 2023-12-15 DOI: 10.1101/2023.12.12.23299889
Hengrui Zhang, Bangyue Wang, Ruyi Wang, Chao Peng, Changkai Hou, Yan Zhao, Linchun Huan, Yanfen Chai, Xinyu Yang, Jianjun Yu
Objective To establish a time-to-surgery threshold for elderly aneurysmal subarachnoid hemorrhage patients before the risk of mortality increases.
目的 在死亡风险增加之前,为老年动脉瘤性蛛网膜下腔出血患者确定手术时间阈值。
{"title":"Time of surgery for aneurysmal subarachnoid hemorrhage in patients ≥70 years","authors":"Hengrui Zhang, Bangyue Wang, Ruyi Wang, Chao Peng, Changkai Hou, Yan Zhao, Linchun Huan, Yanfen Chai, Xinyu Yang, Jianjun Yu","doi":"10.1101/2023.12.12.23299889","DOIUrl":"https://doi.org/10.1101/2023.12.12.23299889","url":null,"abstract":"<strong>Objective</strong> To establish a time-to-surgery threshold for elderly aneurysmal subarachnoid hemorrhage patients before the risk of mortality increases.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138714885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
What factors predict ambulance pre-alerts to the emergency department? Analysis of routine data from 3 UK ambulance services. 哪些因素可预测救护车向急诊科发出的预先警报?对英国 3 家救护车服务机构的常规数据进行分析。
Pub Date : 2023-12-08 DOI: 10.1101/2023.12.07.23299650
Fiona C Sampson, Richard Pilbery, Esther Herbert, Steve Goodacre, Fiona Bell, Rob Spaight, Andy Rosser, Peter Webster, Mark Millins, Andy Pountney, Joanne Coster, Jacqui Long, Rachel O'Hara, Alexis Foster, Jamie Miles, Janette Turner, Aimee Boyd
ObjectiveAmbulance clinicians use pre-alert calls to advise emergency departments (EDs) of the arrival of patients requiring immediate review or intervention. Consistency of pre-alert practice is important in ensuring appropriate EDs response. We used routine data to describe pre-alert practice and explore factors affecting variation in practice.MethodsWe undertook an observational study using a linked dataset incorporating 12 months' ambulance patient records, ambulance clinician data and emergency call data for three UK ambulance services. We used LASSO regression to identify candidate variables for multivariate logistic regression models to predict variation in pre-alert use, analysing clinician factors (role, experience, qualification, time of pre-alert during shift), patient factors (NEWS2 score, clinical working impression, age, sex) and hospital factors (receiving ED, ED handover delay status). ResultsFrom the dataset of 1,363,274 patients conveyed to ED, 142,795 (10.5%) were pre-alerted, of whom only a third were for conditions with clear pre-alert pathways (e.g. sepsis, STEMI, major trauma). Casemix (illness acuity score, clinical diagnostic impression) was the strongest predictor of pre-alert use but male patient gender, clinician role, receiving hospital, and hospital turnaround delay at receiving hospitals were also statistically significant predictors, after adjusting for casemix. There was no evidence of higher pre-alert rates in the final hour of shift.ConclusionsPre-alert decisions are determined by factors other than illness acuity and clinical diagnostic impression. Research is required to determine whether our findings are reproducible elsewhere and why non-clinical factors (e.g. patient gender) may influence pre-alert practice.
目的救护车临床医生使用预先警报电话通知急诊科(ED)需要立即检查或干预的病人到达。预先警报做法的一致性对于确保急诊科做出适当反应非常重要。我们使用常规数据来描述预报警实践,并探索影响实践差异的因素。方法我们使用一个链接数据集开展了一项观察性研究,该数据集包含英国三家救护车服务机构 12 个月的救护车患者记录、救护车临床医生数据和紧急呼叫数据。我们使用 LASSO 回归来确定多变量逻辑回归模型的候选变量,以预测预警报使用的变化,分析了临床医生因素(角色、经验、资质、当班期间预警报的时间)、患者因素(NEWS2 评分、临床工作印象、年龄、性别)和医院因素(接收 ED、ED 移交延迟状态)。结果在 1,363,274 名转送至急诊室的患者数据集中,有 142,795 名患者(10.5%)接受了预警报,其中只有三分之一的患者的病情有明确的预警报路径(如败血症、STEMI、重大创伤)。病例组合(疾病敏锐度评分、临床诊断印象)是使用预警报的最强预测因素,但在对病例组合进行调整后,男性患者性别、临床医生角色、接诊医院和接诊医院周转延迟也是具有统计学意义的预测因素。结论 除病情严重程度和临床诊断印象外,预先警报的决定还取决于其他因素。需要进行研究,以确定我们的研究结果是否可在其他地方复制,以及非临床因素(如患者性别)为何会影响预警报做法。
{"title":"What factors predict ambulance pre-alerts to the emergency department? Analysis of routine data from 3 UK ambulance services.","authors":"Fiona C Sampson, Richard Pilbery, Esther Herbert, Steve Goodacre, Fiona Bell, Rob Spaight, Andy Rosser, Peter Webster, Mark Millins, Andy Pountney, Joanne Coster, Jacqui Long, Rachel O'Hara, Alexis Foster, Jamie Miles, Janette Turner, Aimee Boyd","doi":"10.1101/2023.12.07.23299650","DOIUrl":"https://doi.org/10.1101/2023.12.07.23299650","url":null,"abstract":"Objective\u0000Ambulance clinicians use pre-alert calls to advise emergency departments (EDs) of the arrival of patients requiring immediate review or intervention. Consistency of pre-alert practice is important in ensuring appropriate EDs response. We used routine data to describe pre-alert practice and explore factors affecting variation in practice.\u0000Methods\u0000We undertook an observational study using a linked dataset incorporating 12 months' ambulance patient records, ambulance clinician data and emergency call data for three UK ambulance services. We used LASSO regression to identify candidate variables for multivariate logistic regression models to predict variation in pre-alert use, analysing clinician factors (role, experience, qualification, time of pre-alert during shift), patient factors (NEWS2 score, clinical working impression, age, sex) and hospital factors (receiving ED, ED handover delay status). Results\u0000From the dataset of 1,363,274 patients conveyed to ED, 142,795 (10.5%) were pre-alerted, of whom only a third were for conditions with clear pre-alert pathways (e.g. sepsis, STEMI, major trauma). Casemix (illness acuity score, clinical diagnostic impression) was the strongest predictor of pre-alert use but male patient gender, clinician role, receiving hospital, and hospital turnaround delay at receiving hospitals were also statistically significant predictors, after adjusting for casemix. There was no evidence of higher pre-alert rates in the final hour of shift.\u0000Conclusions\u0000Pre-alert decisions are determined by factors other than illness acuity and clinical diagnostic impression. Research is required to determine whether our findings are reproducible elsewhere and why non-clinical factors (e.g. patient gender) may influence pre-alert practice.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138559621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Development and Evaluation of a Digital Scribe: Conversation Summarization Pipeline for Emergency Department Counseling Sessions towards Reducing Documentation Burden 开发和评估数字抄写员:急诊科咨询会议的对话总结管道,减轻文档记录负担
Pub Date : 2023-12-07 DOI: 10.1101/2023.12.06.23299573
Emre Sezgin, Joseph Sirrianni, Kelly Kranz
Objective: We present a proof-of-concept digital scribe system as an ED clinical conversation summarization pipeline and report its performance. Materials and Methods: We use four pre-trained large language models to establish the digital scribe system: T5-small, T5-base, PEGASUS-PubMed, and BART-Large-CNN via zero-shot and fine-tuning approaches. Our dataset includes 100 referral conversations among ED clinicians and medical records. We report the ROUGE-1, ROUGE-2, and ROUGE-L to compare model performance. In addition, we annotated transcriptions to assess the quality of generated summaries. Results: The fine-tuned BART-Large-CNN model demonstrates greater performance in summarization tasks with the highest ROUGE scores (F1ROUGE-1=0.49, F1ROUGE-2=0.23, F1ROUGE-L=0.35) scores. In contrast, PEGASUS-PubMed lags notably (F1ROUGE-1=0.28, F1ROUGE-2=0.11, F1ROUGE-L=0.22). BART-Large-CNN's performance decreases by more than 50% with the zero-shot approach. Annotations show that BART-Large-CNN performs 71.4% recall in identifying key information and a 67.7% accuracy rate. Discussion: The BART-Large-CNN model demonstrates a high level of understanding of clinical dialogue structure, indicated by its performance with and without fine-tuning. Despite some instances of high recall, there is variability in the model's performance, particularly in achieving consistent correctness, suggesting room for refinement. The model's recall ability varies across different information categories. Conclusion: The study provides evidence towards the potential of AI-assisted tools in reducing clinical documentation burden. Future work is suggested on expanding the research scope with larger language models, and comparative analysis to measure documentation efforts and time.
目的:我们提出了一个概念验证数字抄写系统,作为急诊室临床对话总结管道,并报告其性能。材料与方法:我们使用四种预先训练好的大型语言模型来建立数字抄写系统:T5-small、T5-base、PEGASUS-PubMed 和 BART-Large-CNN。我们的数据集包括 100 个急诊室临床医生之间的转诊对话和医疗记录。我们报告了 ROUGE-1、ROUGE-2 和 ROUGE-L,以比较模型性能。此外,我们还对转录内容进行了注释,以评估生成摘要的质量。结果经过微调的 BART-Large-CNN 模型在摘要任务中表现出更高的性能,其 ROUGE 分数最高(F1ROUGE-1=0.49,F1ROUGE-2=0.23,F1ROUGE-L=0.35)。相比之下,PEGASUS-PubMed 则明显落后(F1ROUGE-1=0.28,F1ROUGE-2=0.11,F1ROUGE-L=0.22)。采用零镜头方法后,BART-Large-CNN 的性能下降了 50% 以上。注释显示,BART-Large-CNN 在识别关键信息方面的召回率为 71.4%,准确率为 67.7%。讨论BART-Large-CNN 模型在微调和不微调的情况下都表现出了对临床对话结构的高度理解。尽管存在召回率高的情况,但该模型的性能仍存在差异,特别是在实现一致的正确性方面,这表明该模型仍有改进的余地。在不同的信息类别中,模型的召回能力也各不相同。结论本研究为人工智能辅助工具在减轻临床文档负担方面的潜力提供了证据。建议在今后的工作中扩大研究范围,采用更大型的语言模型,并进行比较分析,以衡量记录工作和时间。
{"title":"Development and Evaluation of a Digital Scribe: Conversation Summarization Pipeline for Emergency Department Counseling Sessions towards Reducing Documentation Burden","authors":"Emre Sezgin, Joseph Sirrianni, Kelly Kranz","doi":"10.1101/2023.12.06.23299573","DOIUrl":"https://doi.org/10.1101/2023.12.06.23299573","url":null,"abstract":"Objective: We present a proof-of-concept digital scribe system as an ED clinical conversation summarization pipeline and report its performance. Materials and Methods: We use four pre-trained large language models to establish the digital scribe system: T5-small, T5-base, PEGASUS-PubMed, and BART-Large-CNN via zero-shot and fine-tuning approaches. Our dataset includes 100 referral conversations among ED clinicians and medical records. We report the ROUGE-1, ROUGE-2, and ROUGE-L to compare model performance. In addition, we annotated transcriptions to assess the quality of generated summaries. Results: The fine-tuned BART-Large-CNN model demonstrates greater performance in summarization tasks with the highest ROUGE scores (F1ROUGE-1=0.49, F1ROUGE-2=0.23, F1ROUGE-L=0.35) scores. In contrast, PEGASUS-PubMed lags notably (F1ROUGE-1=0.28, F1ROUGE-2=0.11, F1ROUGE-L=0.22). BART-Large-CNN's performance decreases by more than 50% with the zero-shot approach. Annotations show that BART-Large-CNN performs 71.4% recall in identifying key information and a 67.7% accuracy rate. Discussion: The BART-Large-CNN model demonstrates a high level of understanding of clinical dialogue structure, indicated by its performance with and without fine-tuning. Despite some instances of high recall, there is variability in the model's performance, particularly in achieving consistent correctness, suggesting room for refinement. The model's recall ability varies across different information categories. Conclusion: The study provides evidence towards the potential of AI-assisted tools in reducing clinical documentation burden. Future work is suggested on expanding the research scope with larger language models, and comparative analysis to measure documentation efforts and time.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138554095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Normobaric Hyperoxia Combined with Endovascular Treatment Based on Temporal Gradient: A dose-escalation study 常压高氧与基于时间梯度的血管内治疗相结合:剂量递增研究
Pub Date : 2023-12-07 DOI: 10.1101/2023.12.05.23299563
Weili Li, Sifei Wang, Lan Liu, Jiaohao Chen, Jing Lan, Jiayue Ding, Zhiying Chen, Shuhua Yuan, Zhifeng Qi, Ming Wei, Xunming Ji
BACKGROUND: Normobaric hyperoxia (NBO) has neuroprotective effects in acute ischemic stroke (AIS). Thus, we aimed to identify the optimal NBO treatment duration combined with endovascular treatment (EVT).METHODS: Patients with acute stroke who had an indication for EVT at Tianjin Huanhu Hospital were included and randomly assigned to four groups (1:1 ratio) based on NBO therapy duration: 1) Sham-NBO group (oxygen 1 L/min continuously for 4 h); 2) NBO-2h group (10 L/min continuously for 2 h); 3) NBO-4h group (10 L/min continuously for 4 h); and 4) NBO-6h group (10 L/min continuously for 6 h). The primary outcome was cerebral infarction volume at 72 h after randomization. The primary safety outcome was the 90-d mortality rate.RESULTS: A total of 100 patients were included (Sham-NBO group, n=25; NBO-2h group, n=25; NBO-4h group, n=25; and NBO-6h group, n=25). The 72-h cerebral infarct volumes were 39.4 ± 34.3 ml, 30.6 ± 30.1ml, 19.7 ± 15.4 ml, and 22.6 ± 22.4 ml, respectively (P=0.013). The NBO-4h and NBO-6h groups exhibited significant differences compared to the Sham-NBO group (adjusted P values: 0.011 and 0.027, respectively). No significant differences were found between the NBO-4h and NBO-6h groups. The National Institute of Health Stroke Scale (NIHSS) scores at 24 h, 72 h, and 7 d, and the changes in NIHSS scores from baseline to 24 h were significantly different in the NBO-4h and NBO-6h groups compared with the Sham-NBO group (P<0.05). No significant differences were observed between the NBO-4h and NBO-6h groups in the NIHSS assessments. No significant differences were noted among groups in the 90-d mortality rate, symptomatic intracranial haemorrhage, early neurological deterioration, and severe adverse events.CONCLUSIONS:The effectiveness of NBO therapy was associated with oxygen administration duration. In patients with AIS who undergone EVT, NBO treatment for 4-6 h may yield better outcomes than other oxygen therapy regimens or low flow oxygen therapy.
背景:常压高氧(NBO)对急性缺血性卒中(AIS)具有神经保护作用。方法:纳入天津环湖医院有 EVT 适应症的急性脑卒中患者,根据 NBO 治疗时间随机分配到四组(1:1 比例):1)Sham-NBO组(氧气1升/分钟,持续4小时);2)NBO-2h组(10升/分钟,持续2小时);3)NBO-4h组(10升/分钟,持续4小时);4)NBO-6h组(10升/分钟,持续6小时)。主要结果是随机分组后 72 小时的脑梗塞体积。结果:共纳入 100 名患者(Sham-NBO 组,n=25;NBO-2h 组,n=25;NBO-4h 组,n=25;NBO-6h 组,n=25)。72小时脑梗死体积分别为(39.4 ± 34.3)毫升、(30.6 ± 30.1)毫升、(19.7 ± 15.4)毫升和(22.6 ± 22.4)毫升(P=0.013)。NBO-4h 组和 NBO-6h 组与 Sham-NBO 组相比差异显著(调整后 P 值分别为 0.011 和 0.027)。NBO-4h 组和 NBO-6h 组之间无明显差异。与 Sham-NBO 组相比,NBO-4h 组和 NBO-6h 组在 24 h、72 h 和 7 d 的美国国立卫生研究院卒中量表(NIHSS)评分以及从基线到 24 h 的 NIHSS 评分变化均有显著差异(P<0.05)。在 NIHSS 评估中,NBO-4h 组和 NBO-6h 组之间未观察到明显差异。结论:NBO疗法的有效性与给氧时间长短有关。对于接受EVT的AIS患者,4-6小时的NBO治疗可能比其他氧疗方案或低流量氧疗产生更好的疗效。
{"title":"Normobaric Hyperoxia Combined with Endovascular Treatment Based on Temporal Gradient: A dose-escalation study","authors":"Weili Li, Sifei Wang, Lan Liu, Jiaohao Chen, Jing Lan, Jiayue Ding, Zhiying Chen, Shuhua Yuan, Zhifeng Qi, Ming Wei, Xunming Ji","doi":"10.1101/2023.12.05.23299563","DOIUrl":"https://doi.org/10.1101/2023.12.05.23299563","url":null,"abstract":"BACKGROUND: Normobaric hyperoxia (NBO) has neuroprotective effects in acute ischemic stroke (AIS). Thus, we aimed to identify the optimal NBO treatment duration combined with endovascular treatment (EVT).\u0000METHODS: Patients with acute stroke who had an indication for EVT at Tianjin Huanhu Hospital were included and randomly assigned to four groups (1:1 ratio) based on NBO therapy duration: 1) Sham-NBO group (oxygen 1 L/min continuously for 4 h); 2) NBO-2h group (10 L/min continuously for 2 h); 3) NBO-4h group (10 L/min continuously for 4 h); and 4) NBO-6h group (10 L/min continuously for 6 h). The primary outcome was cerebral infarction volume at 72 h after randomization. The primary safety outcome was the 90-d mortality rate.\u0000RESULTS: A total of 100 patients were included (Sham-NBO group, n=25; NBO-2h group, n=25; NBO-4h group, n=25; and NBO-6h group, n=25). The 72-h cerebral infarct volumes were 39.4 ± 34.3 ml, 30.6 ± 30.1ml, 19.7 ± 15.4 ml, and 22.6 ± 22.4 ml, respectively (P=0.013). The NBO-4h and NBO-6h groups exhibited significant differences compared to the Sham-NBO group (adjusted P values: 0.011 and 0.027, respectively). No significant differences were found between the NBO-4h and NBO-6h groups. The National Institute of Health Stroke Scale (NIHSS) scores at 24 h, 72 h, and 7 d, and the changes in NIHSS scores from baseline to 24 h were significantly different in the NBO-4h and NBO-6h groups compared with the Sham-NBO group (P&lt;0.05). No significant differences were observed between the NBO-4h and NBO-6h groups in the NIHSS assessments. No significant differences were noted among groups in the 90-d mortality rate, symptomatic intracranial haemorrhage, early neurological deterioration, and severe adverse events.\u0000CONCLUSIONS:The effectiveness of NBO therapy was associated with oxygen administration duration. In patients with AIS who undergone EVT, NBO treatment for 4-6 h may yield better outcomes than other oxygen therapy regimens or low flow oxygen therapy.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138552775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
ChatGPT Provides Inconsistent Risk-Stratification of Patients With Atraumatic Chest Pain ChatGPT为非创伤性胸痛患者提供了不一致的风险分层
Pub Date : 2023-11-30 DOI: 10.1101/2023.11.29.23299214
Thomas F. Heston, Lawrence M. Lewis
BACKGROUND ChatGPT is a large language model with promising healthcare applications. However, its ability to analyze complex clinical data and provide consistent results is poorly known. This study evaluated ChatGPT-4’s risk stratification of simulated patients with acute nontraumatic chest pain compared to validated tools.
ChatGPT是一种大型语言模型,具有很好的医疗保健应用程序。然而,其分析复杂临床数据并提供一致结果的能力尚不为人所知。本研究评估了ChatGPT-4对模拟急性非创伤性胸痛患者的风险分层,并与验证工具进行了比较。
{"title":"ChatGPT Provides Inconsistent Risk-Stratification of Patients With Atraumatic Chest Pain","authors":"Thomas F. Heston, Lawrence M. Lewis","doi":"10.1101/2023.11.29.23299214","DOIUrl":"https://doi.org/10.1101/2023.11.29.23299214","url":null,"abstract":"<strong>BACKGROUND</strong> ChatGPT is a large language model with promising healthcare applications. However, its ability to analyze complex clinical data and provide consistent results is poorly known. This study evaluated ChatGPT-4’s risk stratification of simulated patients with acute nontraumatic chest pain compared to validated tools.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"39 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138523152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protecting Emergency Medical Services (EMS) Staff from Aggression and Violence in Conflict Encounters (PEACE1): A survey of Wales Adults attitudes in 2022 保护紧急医疗服务(EMS)工作人员免受冲突中的侵略和暴力(PEACE1): 2022年威尔士成年人态度调查
Pub Date : 2023-11-30 DOI: 10.1101/2023.11.30.23299241
Nigel Rees, Daniel Todd, Francesca Fiorentino, Peter O’Meara, Lauren Williams, Julia Williams, Claire Hawkes
Background Emergency Medical Services (EMS) staff frequently encounter violence and aggression (V&A) directed towards them, which negatively affects their wellbeing and provision of services. This is an international problem and employers and others are tackling it through policy, education, legislation, and public information campaigns. The aim of this study was to explore the Welsh public’s views of V&A directed at EMS staff and their awareness of policy changes and the reach of media campaigns associated with recent policy changes.
背景:紧急医疗服务(EMS)工作人员经常遭遇针对他们的暴力和侵略,这对他们的福祉和提供服务产生了负面影响。这是一个国际问题,雇主和其他人正在通过政策、教育、立法和公共信息运动来解决这个问题。本研究的目的是探讨威尔士公众对EMS员工的看法,以及他们对政策变化的认识,以及与最近政策变化相关的媒体活动的影响。
{"title":"Protecting Emergency Medical Services (EMS) Staff from Aggression and Violence in Conflict Encounters (PEACE1): A survey of Wales Adults attitudes in 2022","authors":"Nigel Rees, Daniel Todd, Francesca Fiorentino, Peter O’Meara, Lauren Williams, Julia Williams, Claire Hawkes","doi":"10.1101/2023.11.30.23299241","DOIUrl":"https://doi.org/10.1101/2023.11.30.23299241","url":null,"abstract":"<strong>Background</strong> Emergency Medical Services (EMS) staff frequently encounter violence and aggression (V&amp;A) directed towards them, which negatively affects their wellbeing and provision of services. This is an international problem and employers and others are tackling it through policy, education, legislation, and public information campaigns. The aim of this study was to explore the Welsh public’s views of V&amp;A directed at EMS staff and their awareness of policy changes and the reach of media campaigns associated with recent policy changes.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138523154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Psychological impact of COVID-19 on frontline healthcare workers during the early months of the pandemic and responses to reduce the burden, helping to prepare for Disease X: A systematic review COVID-19在大流行的最初几个月对一线医护人员的心理影响以及减轻负担的应对措施,有助于为X疾病做准备:系统综述
Pub Date : 2023-11-28 DOI: 10.1101/2023.11.28.23299078
Jarryd S. Ludski
Objective The COVID-19 pandemic placed enormous strain on healthcare workers (HCW) and systems. With currently over 766 million cases, a high risk of workplace-acquired infection and a constantly evolving disease trajectory, COVID-19 placed an incredible burden on frontline HCWs. Studies from previous pandemics highlight significant psychological distress in these workers, yet mental health remained a secondary consideration in many hospitals pandemic response. This review explores the psychological impact of COVID-19 on frontline HCWs during the early stages of the pandemic and describes responses implemented by health services to reduce this impact. Additionally, it aims to provide a framework for future evidence-based programs that support the wellbeing of frontline HCWs throughout the ongoing pandemic and into the future, helping to prepare for Disease X.
目的2019冠状病毒病(COVID-19)大流行给医护人员和卫生系统带来了巨大压力。目前病例超过7.66亿例,工作场所获得性感染的风险很高,疾病轨迹不断演变,COVID-19给一线医护人员带来了难以置信的负担。以往大流行的研究强调了这些工作人员的严重心理困扰,但在许多医院的大流行应对中,精神健康仍然是次要考虑因素。本综述探讨了COVID-19在大流行早期阶段对一线医护人员的心理影响,并描述了卫生服务机构为减少这种影响而采取的应对措施。此外,它还旨在为未来的循证规划提供一个框架,在当前大流行期间和未来支持一线医护人员的福祉,帮助为X病做好准备。
{"title":"Psychological impact of COVID-19 on frontline healthcare workers during the early months of the pandemic and responses to reduce the burden, helping to prepare for Disease X: A systematic review","authors":"Jarryd S. Ludski","doi":"10.1101/2023.11.28.23299078","DOIUrl":"https://doi.org/10.1101/2023.11.28.23299078","url":null,"abstract":"<strong>Objective</strong> The COVID-19 pandemic placed enormous strain on healthcare workers (HCW) and systems. With currently over 766 million cases, a high risk of workplace-acquired infection and a constantly evolving disease trajectory, COVID-19 placed an incredible burden on frontline HCWs. Studies from previous pandemics highlight significant psychological distress in these workers, yet mental health remained a secondary consideration in many hospitals pandemic response. This review explores the psychological impact of COVID-19 on frontline HCWs during the early stages of the pandemic and describes responses implemented by health services to reduce this impact. Additionally, it aims to provide a framework for future evidence-based programs that support the wellbeing of frontline HCWs throughout the ongoing pandemic and into the future, helping to prepare for Disease X.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138523155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
medRxiv - Emergency Medicine
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1