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What assessment, intervention and diagnostics should women with early pregnancy bleeding receive in the emergency department and when? A scoping review and synthesis of evidence. 孕早期出血妇女应在急诊科接受哪些评估、干预和诊断?范围审查和证据综述。
IF 2.1 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2024-10-14 DOI: 10.1016/j.auec.2024.09.006
Baylie Trostian, Andrea McCloughen, Ramon Z Shaban, Kate Curtis

Background: Vaginal bleeding is a frequent complication in early pregnancy, care that women receive, or lack thereof, can have immediate and long-term consequences. There is a lack of cogent, synthesised evidence on the assessment, interventions, and diagnostics for the management of early pregnancy bleeding in the emergency department (ED). This paper reports the results of a scoping review that identified that examined the literature to clarify concepts and generate a synthesis of the evidence for the assessment, interventions, diagnostics and management of early pregnancy bleeding in the ED.

Methods: Five databases were searched. Practice guidelines and statements were sourced from professional organisations, and online repositories. Three types of data were included: practice guidelines, reviews, and primary research. Data were extracted and collated, and findings were synthesised into a clinical guideline.

Results: A total 122 (of 3602) papers from database searching, and six (of 46) practice guidelines were included. Seventy-seven publications reported on assessment including performing vital observations. Thirty-six reported on interventions including administration of analgesia, and 114 reported on diagnostics, which most (n = 93) recommended use of ultrasound. Few (12 %) of practice statements and guidelines recommended care not based in current evidence. The study yielded an evidence-based practice guideline to be used for initial management of early pregnancy bleeding.

Conclusions: The practice guideline generated by this examination and synthesis of the evidence offers comprehensive, evidence informed recommendations for the initial management of early pregnancy bleeding. Continued research and knowledge translation for initial management of early pregnancy bleeding is needed to reduce variation in emergency care and improve outcomes for women.

背景:阴道出血是妊娠早期的常见并发症,妇女接受的护理或缺乏护理都会造成直接或长期的后果。在急诊科(ED)处理早孕出血的评估、干预和诊断方面,缺乏有说服力的综合证据。本文报告了一项范围界定综述的结果,该综述对文献进行了梳理,以澄清概念,并对急诊科早孕出血的评估、干预、诊断和管理方面的证据进行综合:方法:检索了五个数据库。实践指南和声明来自专业组织和在线资料库。包括三类数据:实践指南、综述和初步研究。对数据进行提取和整理,并将结果汇总为临床指南:通过数据库搜索,共收录了 122 篇论文(共 3602 篇)和 6 份实践指南(共 46 份)。有 77 篇文献报告了评估情况,包括进行生命体征观察。36篇报告了包括实施镇痛在内的干预措施,114篇报告了诊断方法,其中大多数(93篇)建议使用超声波。极少数(12%)的实践声明和指南推荐的护理方法没有以现有证据为基础。这项研究产生了一份以证据为基础的实践指南,可用于孕早期出血的初步处理:通过对证据的研究和综合,为孕早期出血的初期处理提供了全面的、以证据为依据的建议。需要继续对早期妊娠出血的初期处理进行研究和知识转化,以减少急救护理中的差异,改善妇女的预后。
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引用次数: 0
Nonstandard cardiopulmonary resuscitation and basic life support: A scoping review of techniques applicable to wheelchair users. 非标准心肺复苏术和基本生命支持:适用于轮椅使用者的技术范围综述。
IF 2.1 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2024-10-04 DOI: 10.1016/j.auec.2024.09.005
Elisha Deegan, Peter Lewis, Laynie H Pullin, Nathan J Wilson

Aim: To explore evidence that informs new or non-standard methods for delivery of cardiopulmonary resuscitation (CPR) and basic life support (BLS) that may be used by carers of wheelchair users and assist in the development of an educational intervention.

Material and methods: A scoping review was conducted. Keywords used included cardiac arrest, cardiopulmonary, resuscitation, "basic life support", and special circumstances. In total, 3581 papers were retrieved and 72 full text articles were reviewed with 14 papers meeting the inclusion criteria.

Results: Nine intervention studies, three systematic reviews and two expert opinion papers were included and divided into four broad categories pertaining to how they differed from standard CPR guidelines. The four categories were nontraditional compression techniques, CPR not delivered in a flat position, CPR not delivered on a hard surface and CPR not delivered at floor level.

Conclusion: The scoping review has identified techniques for delivery of CPR and BLS that may be beneficial to wheelchair users. Further research is required to determine applicability and effectiveness.

目的:探究轮椅使用者护理者可能使用的新的或非标准的心肺复苏(CPR)和基本生命支持(BLS)方法的相关证据,并协助制定教育干预措施:材料和方法:进行了一次范围界定审查。使用的关键词包括心脏骤停、心肺复苏、复苏术、"基本生命支持 "和特殊情况。共检索到 3581 篇论文,审查了 72 篇全文,其中 14 篇符合纳入标准:结果:共纳入 9 篇干预研究、3 篇系统综述和 2 篇专家意见论文,并根据其与标准心肺复苏指南的不同之处分为四大类。这四大类分别是非传统按压技术、非平躺进行心肺复苏、非在坚硬表面进行心肺复苏以及非在地面进行心肺复苏:范围界定审查确定了可能对轮椅使用者有益的心肺复苏和复苏生命支持技术。需要进一步研究以确定其适用性和有效性。
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引用次数: 0
Strengthening emergency department response to chemical, biological, radiological, and nuclear disasters: A scoping review. 加强急诊科应对化学、生物、放射和核灾难的能力:范围审查。
IF 2.1 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2024-10-01 DOI: 10.1016/j.auec.2024.09.003
Jamie Ranse, Benjamin Mackie, Julia Crilly, David Heslop, Bridget Wilson, Marion Mitchell, Sarah Weber, Nathan Watkins, Joseph Sharpe, Michael Handy, Attila Hertelendy, Jane Currie, Karen Hammad

Introduction: Natural hazards resulting in disasters are increasing globally, impacting communities and disrupting industries. In addition to planning for these natural hazard disasters, emergency departments (EDs) should prepare for chemical, biological, radiological, and nuclear (CBRN) incidents that result in surges of patient presentations. Chemical, biological, radiological, and nuclear incidents differ in preparedness to natural hazards, requiring an understanding of patient management and health system-related challenges.

Methods: This scoping review used the Arksey and O'Malley five-step framework. Manuscripts were retrieved from four databases and search engines using keywords relating to impacts on the ED from real world CBRN event(s). Analysis focused on the characteristics of CBRN event, ED impact, and lessons learnt against four surge capacity domains that including staff, stuff, space, and systems.

Results: A total of 44 paper were included in this review. Most of the incidents were chemical in nature (n = 36/44, 81.8 %). The majority of CBRN incidents were accidental (n = 34/44, 77.3 %). Between 1 and 1470 people (Mdn=56, IQR: 18-228) presented to an ED from each event. Most patients were discharged from the ED, but this was variably reported. Some key lessons related to secondary exposure to ED staff, repurposing spaces, and coordination of CBRN incidents.

Conclusion: With the increasing number of CBRN incidents, strategies to strengthen EDs and limit the impact from a surge in patient presentations are paramount. An understanding of local CBRN risk to inform a top-hazards approach to CBRN preparedness, and the implementation of pre-emptive CBRN clinical pathways is recommended. Additionally, strategies should be implemented to protect staff from the risk of secondary exposure to a CBRN event. These strategies may include adequate education, training, and personal protective equipment for staff.

导言:在全球范围内,自然灾害导致的灾难日益增多,对社区造成了影响并扰乱了产业。除了为这些自然灾害制定计划外,急诊科(ED)还应为导致患者激增的化学、生物、放射和核(CBRN)事件做好准备。化学、生物、放射和核事故与自然灾害的准备工作不同,需要了解患者管理和医疗系统相关的挑战:本次范围界定审查采用了 Arksey 和 O'Malley 的五步框架。使用与真实世界 CBRN 事件对急诊室的影响相关的关键词,从四个数据库和搜索引擎中检索了相关稿件。分析的重点是 CBRN 事件的特征、急诊室受到的影响以及从人员、物资、空间和系统等四个激增能力领域吸取的经验教训:结果:共有 44 篇论文被纳入本综述。大多数事件属于化学事件(n = 36/44,81.8%)。大多数化学、生物、辐射和核事故是意外事故(n = 34/44,77.3%)。每次事件都有 1 到 1470 人(Mdn=56,IQR:18-228)被送往急诊室。大多数患者已从急诊室出院,但报告的情况各不相同。一些重要的经验教训与急诊室工作人员的二次接触、空间的重新利用以及化学、生物、辐射和核事件的协调有关:结论:随着化学、生物、辐射和核事件的不断增加,加强急诊室并限制患者激增造成的影响的策略至关重要。建议了解当地的化学、生物、辐射和核风险,为化学、生物、辐射和核防备工作的最高危害方法提供信息,并实施先发制人的化学、生物、辐射和核临床路径。此外,还应该实施一些战略,保护工作人员免受化学、生物、辐射和核事件的二次暴露风险。这些策略可包括对员工进行充分的教育、培训和个人防护设备。
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引用次数: 0
Emergency management of orbital compartment syndrome: Lateral canthotomy and cantholysis case series. 眶隔综合征的紧急处理:外侧泪囊切开术和泪囊溶解术病例系列。
IF 2.1 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2024-09-27 DOI: 10.1016/j.auec.2024.09.004
Rebecca Ilona Peisah, Kevin Ostrowski

Background: Orbital compartment syndrome (OCS) is considered a time critical condition that requires urgent surgical decompression to preserve vision. This study aims to evaluate the current clinical criteria for performing a lateral canthotomy and cantholysis (LCC) in the emergency management of suspected traumatic OCS.

Methods: A retrospective audit of patients with suspected traumatic OCS presenting to an adult major trauma centre between January 1, 2017, and August 1, 2022, was performed.

Results: 20 patients with traumatic OCS treated with a LCC were identified. Five patients satisfied the definitive clinical criteria for LCC. The remaining 15 patients received LCC based on secondary clinical findings, or computed tomography (CT) findings suggestive of OCS. 17 patients received non-contrast CT scanning prior to LCC. Of the nine patients noted to regain baseline or close to baseline vision, only one was decompressed within two hours of injury.

Conclusion: Despite OCS being a clinical diagnosis, the signs and symptoms associated with OCS are difficult to elicit on presentation. Seeking imaging should not delay time to decompression when clinical diagnostic criteria are present. However, imaging may have a role in determining the need for orbital decompression where the absolute indications for LCC cannot be adequately assessed.

背景:眼眶隔室综合征(OCS)被认为是一种需要紧急手术减压以保护视力的危重症。本研究旨在评估在紧急处理疑似外伤性眼眶隔室综合征时实施外侧角膜切开术和角膜溶解术(LCC)的现行临床标准:方法:对2017年1月1日至2022年8月1日期间到成人主要创伤中心就诊的疑似外伤性OCS患者进行回顾性审核。结果:确定了20名接受LCC治疗的外伤性OCS患者。5名患者符合LCC的明确临床标准。其余 15 名患者根据继发性临床发现或计算机断层扫描(CT)结果提示 OCS,接受了 LCC 治疗。17 名患者在 LCC 之前接受了非对比 CT 扫描。在九名恢复基线或接近基线视力的患者中,只有一人在受伤后两小时内进行了减压:结论:尽管OCS是一种临床诊断,但与OCS相关的体征和症状在就诊时很难表现出来。在具备临床诊断标准的情况下,寻求影像学检查不应延误减压时间。不过,在无法充分评估 LCC 的绝对适应症时,影像学检查可能有助于确定是否需要进行眼眶减压。
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引用次数: 0
A scoping review study of patients with a primary immune deficiency who have presented to the paediatric emergency department with a fever 对因发烧到儿科急诊室就诊的原发性免疫缺陷患者进行范围界定研究。
IF 2.1 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2024-09-25 DOI: 10.1016/j.auec.2024.09.001
Samantha Ryan , Elizabeth Forster , Bronwyn Griffin

Aim

To identify, analyse, and synthesise existing research on the characteristics and risk factors associated with primary immune deficiencies (PIDs), with focus on understanding how factors impede patient outcomes.

Background

There is currently limited research regarding the management of this cohort when they present to an emergency department with the presentation urgency often being overlooked.

Method

Three databases, google scholar, and citations were searched for relevant studies under the criteria. Included papers were analysed and reported following the PRISMA guideline, and then critically appraised using the Mixed Method Appraisal Tool.

Results

After a review of 625 titles and abstracts, 20 studies met the inclusion criteria. The majority being mixed method (n = 8) and case studies (n = 8). All chosen studies reported some form of management of a child with a PID, and most made recommendations for improvement.

Conclusions

Further research is needed to facilitate an understanding of how to enhance emergency management, to increase positive outcomes. Relevance to practice: There is a critical need for improved management strategies for children with a PID presenting to ED with fever. Creating protocols, increasing staff knowledge, and implementing patient specific interventions are essential in improving outcomes and reducing serious complications in this high-risk paediatric population.
目的:确定、分析和综合与原发性免疫缺陷症(PID)相关的特征和风险因素的现有研究,重点了解这些因素如何阻碍患者的预后:背景:目前,对急诊科就诊的原发性免疫缺陷症患者的管理研究十分有限,其就诊的紧迫性往往被忽视:方法:在三个数据库、谷歌学术和引文中搜索符合标准的相关研究。按照 PRISMA 指南对纳入的论文进行分析和报告,然后使用混合方法评估工具进行批判性评估:在对 625 篇标题和摘要进行审查后,有 20 项研究符合纳入标准。其中大部分为混合方法研究(8 项)和病例研究(8 项)。所有被选中的研究都报告了对患有 PID 的儿童进行某种形式的管理,大多数研究都提出了改进建议:结论:需要进一步开展研究,以促进对如何加强应急管理的理解,从而提高积极效果:对于因发烧而到急诊室就诊的 PID 患儿,亟需改进管理策略。制定方案、增加医务人员的知识、实施针对患者的干预措施对于改善这一高风险儿科人群的治疗效果和减少严重并发症至关重要。
{"title":"A scoping review study of patients with a primary immune deficiency who have presented to the paediatric emergency department with a fever","authors":"Samantha Ryan ,&nbsp;Elizabeth Forster ,&nbsp;Bronwyn Griffin","doi":"10.1016/j.auec.2024.09.001","DOIUrl":"10.1016/j.auec.2024.09.001","url":null,"abstract":"<div><h3>Aim</h3><div>To identify, analyse, and synthesise existing research on the characteristics and risk factors associated with primary immune deficiencies (PIDs), with focus on understanding how factors impede patient outcomes.</div></div><div><h3>Background</h3><div>There is currently limited research regarding the management of this cohort when they present to an emergency department with the presentation urgency often being overlooked.</div></div><div><h3>Method</h3><div>Three databases, google scholar, and citations were searched for relevant studies under the criteria. Included papers were analysed and reported following the PRISMA guideline, and then critically appraised using the Mixed Method Appraisal Tool.</div></div><div><h3>Results</h3><div>After a review of 625 titles and abstracts, 20 studies met the inclusion criteria. The majority being mixed method (n = 8) and case studies (n = 8). All chosen studies reported some form of management of a child with a PID, and most made recommendations for improvement.</div></div><div><h3>Conclusions</h3><div>Further research is needed to facilitate an understanding of how to enhance emergency management, to increase positive outcomes. Relevance to practice: There is a critical need for improved management strategies for children with a PID presenting to ED with fever. Creating protocols, increasing staff knowledge, and implementing patient specific interventions are essential in improving outcomes and reducing serious complications in this high-risk paediatric population.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 4","pages":"Pages 282-289"},"PeriodicalIF":2.1,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
X-ray imaging of multiple adjacent regions in paediatric patients: Potential utility for diagnosis and patient management. 儿科患者多个邻近区域的 X 射线成像:诊断和患者管理的潜在实用性。
IF 1.8 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2024-09-12 DOI: 10.1016/j.auec.2024.09.002
Dania Abu Awwad,Noor Akl,Franziska Jerjen,Ernest Ekpo
BACKGROUNDIn emergency presentations, it is not uncommon for patients to present with imaging requests of multiple body regions to detect concurrent injury. While current literature explores diagnostic efficacy of adjacent imaging for forearm fractures, there is limited research on its effectiveness across all extremities. This paper explores the diagnostic yield of X-ray adjacent imaging of the upper and lower limb in paediatric patients.METHODSA retrospective audit was performed using information available on radiology request forms from paediatric patients (age <18 years) that had multiple X-rays of adjacent body regions over six months at two hospitals. The main or first X-ray was referred to as initial imaging, while all subsequent X-rays of adjacent regions was considered secondary imaging. Clinical history and radiologists' findings were collected, categorised, and analysed using Chi square.RESULTSThere were 661 X-rays performed across 277 patients. Initial imaging was significantly more likely to detect injuries or abnormalities (35 %) than X-rays of adjacent regions (1.6 %), with 94 % of all abnormalities detected on initial imaging overall (χ2(3) = 241.247, p < 0.001). X-ray request forms with no clinical symptoms were significantly more likely to have no findings detected (χ2(3) = 53.493, p < 0.001).CONCLUSIONX-ray imaging of a body region adjacent to an injury has low diagnostic yield, suggesting the need for interventions to reduce unnecessary adjacent X-ray imaging. Clinical history information was often limited and concurrent injuries were low.
背景在急诊病例中,患者要求对身体多个区域进行成像以检测并发损伤的情况并不少见。虽然目前的文献探讨了前臂骨折邻近成像的诊断效果,但对其在所有四肢的有效性研究有限。方法利用两家医院的儿科患者(年龄小于 18 岁)的放射科申请表上的信息进行了回顾性审核,这些患者在 6 个月内接受了多个身体邻近区域的 X 光检查。主要或首次 X 光检查被称为初次成像,而随后所有相邻区域的 X 光检查则被视为二次成像。结果277名患者共接受了661次X光检查。初次成像发现损伤或异常的几率(35%)明显高于邻近区域的 X 光(1.6%),初次成像发现的异常占所有异常的 94%(χ2(3) = 241.247,P < 0.001)。无临床症状的 X 光申请表未发现异常的几率明显更高(χ2(3) = 53.493,p < 0.001)。临床病史信息通常有限,并发损伤较少。
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引用次数: 0
Establishing enablers and barriers to implementing the HIRAID® emergency nursing framework in rural emergency departments 确定在农村急诊科实施 HIRAID® 急诊护理框架的有利因素和障碍。
IF 2.1 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2024-08-31 DOI: 10.1016/j.auec.2024.08.002
Belinda Kennedy , Kate Curtis , Sarah Kourouche , Louise Casey , Dorothy Hughes , Vivienne Chapman , Margaret Fry

Background

Rural Australia has large geographic distances between emergency departments with variability of services and medical support. Emergency nurses must be appropriately skilled to assess and manage unpredictable and diverse presentations. HIRAID® is an evidence-based framework to support emergency nurses in assessment and care delivery. To inform implementation, the study aimed to identify the enablers and barriers to introducing HIRAID® in practice.

Methods

This embedded mixed methods study was conducted in 11 rural, regional emergency departments in Southern New South Wales, Australia. Respondents completed a 22-item survey, indicating their level of agreement on statements related to practice change, free text responses were optional. Quantitative data were analysed using descriptive statistics and qualitative data using content analysis. Results were identified as barriers or enablers, then integrated and mapped to the Theoretical Domains Framework.

Results

The survey was completed by 102 (54 %) nurses. Two enablers and four barriers to implementation were identified and mapped to 10 Theoretical Domains Framework domains. Key barriers were workplace limitations, such as time and resources, and knowledge of the HIRAID® intervention.

Conclusion

Barriers varied between facilities related to adequate support to implement and the impact on patient care. The results will inform a strategy to implement HIRAID®.
背景:澳大利亚农村地区的急诊室之间相距甚远,服务和医疗支持也不尽相同。急诊护士必须具备适当的技能,以评估和处理不可预测的各种情况。HIRAID® 是一个以证据为基础的框架,用于支持急诊护士进行评估和提供护理。为了为实施提供信息,本研究旨在确定在实践中引入 HIRAID® 的有利因素和障碍:这项嵌入式混合方法研究在澳大利亚新南威尔士州南部的 11 个农村地区急诊科进行。受访者填写了一份包含 22 个项目的调查表,表明他们对与实践变革相关的陈述的同意程度,自由文本回答为可选项。定量数据采用描述性统计进行分析,定性数据采用内容分析进行分析。调查结果被确定为障碍或促进因素,然后与理论领域框架进行整合和映射:102 名护士(54%)完成了调查。结果:102 名护士(54%)完成了调查,确定了实施过程中的两个促进因素和四个障碍,并将其与理论领域框架的 10 个领域进行了映射。主要障碍是工作场所的限制,如时间和资源,以及对 HIRAID® 干预措施的了解:结论:不同机构在实施过程中遇到的障碍各不相同,这些障碍涉及到对实施的充分支持以及对患者护理的影响。这些结果将为 HIRAID® 的实施策略提供参考。
{"title":"Establishing enablers and barriers to implementing the HIRAID® emergency nursing framework in rural emergency departments","authors":"Belinda Kennedy ,&nbsp;Kate Curtis ,&nbsp;Sarah Kourouche ,&nbsp;Louise Casey ,&nbsp;Dorothy Hughes ,&nbsp;Vivienne Chapman ,&nbsp;Margaret Fry","doi":"10.1016/j.auec.2024.08.002","DOIUrl":"10.1016/j.auec.2024.08.002","url":null,"abstract":"<div><h3>Background</h3><div>Rural Australia has large geographic distances between emergency departments with variability of services and medical support. Emergency nurses must be appropriately skilled to assess and manage unpredictable and diverse presentations. HIRAID® is an evidence-based framework to support emergency nurses in assessment and care delivery. To inform implementation, the study aimed to identify the enablers and barriers to introducing HIRAID® in practice.</div></div><div><h3>Methods</h3><div>This embedded mixed methods study was conducted in 11 rural, regional emergency departments in Southern New South Wales, Australia. Respondents completed a 22-item survey, indicating their level of agreement on statements related to practice change, free text responses were optional. Quantitative data were analysed using descriptive statistics and qualitative data using content analysis. Results were identified as barriers or enablers, then integrated and mapped to the Theoretical Domains Framework.</div></div><div><h3>Results</h3><div>The survey was completed by 102 (54 %) nurses. Two enablers and four barriers to implementation were identified and mapped to 10 Theoretical Domains Framework domains. Key barriers were workplace limitations, such as time and resources, and knowledge of the HIRAID® intervention.</div></div><div><h3>Conclusion</h3><div>Barriers varied between facilities related to adequate support to implement and the impact on patient care. The results will inform a strategy to implement HIRAID®.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 4","pages":"Pages 290-298"},"PeriodicalIF":2.1,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
Adherence to low back pain clinical guidelines in Australian hospital emergency departments: A public and private comparison 澳大利亚医院急诊科对腰背痛临床指南的遵守情况:公立和私立医院的比较。
IF 2.1 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2024-07-26 DOI: 10.1016/j.auec.2024.07.001
Claire L. Samanna , Paul Buntine , Daniel L. Belavy , Ron V. Sultana , Clint T. Miller , Vasilios (Bill) Nimorakiotakis , Patrick J. Owen
Managing LBP via clinical practice guidelines in healthcare settings is recommended, yet burgeoning evidence suggests adherence is suboptimal in emergency department settings. Whether adherence differs between public and private settings is unknown. A retrospective audit of two Australian emergency departments matched 86 private patients to 86 public patients by age ( ± 5 years), sex (male/female) and LBP duration (first time/history of LBP). Patient charts were reviewed according to the Australian clinical guidelines for the management of LBP. Guidelines were considered individually and via a collective guideline adherence score (GAS). Management GAS was lower in private patients compared to public patients (d [95 %CI]: −0.67 [−0.98, −0.36], P < 0.001). Public patients were more likely to have documentation of guideline-based advice (OR [95 %CI]: 4.4 [2.4, 8.4], P < 0.001) and less likely to be sent for imaging (OR [95 %CI]: 5.0 [2.6, 9.4], P < 0.001). Private patients were more likely to have documented screening for psychosocial risk factors (OR [95 %CI]: 21.8 [9.1, 52.1], P < 0.001) and more likely to receive guideline-based medication prescriptions at patient discharge (OR [95 %CI]: 2.2 [1.2, 4.2], P = 0.013). Differences exist in public and private hospital emergency department guideline adherence. Exploring barriers and facilitators underpinning these differences will assist in guiding future implementation science approaches.
人们建议在医疗机构中通过临床实践指南来管理腰背痛,但大量证据表明,在急诊科环境中遵守指南的情况并不理想。公立医院和私立医院在遵守指南方面是否存在差异尚不清楚。对澳大利亚两家急诊科进行的一项回顾性审计将86名私立医院患者和86名公立医院患者按年龄(±5岁)、性别(男/女)和枸杞痛持续时间(首次/有枸杞痛病史)进行了配对。根据澳大利亚枸杞痛治疗临床指南对患者病历进行了审查。对指南进行了单独考量,并通过指南遵守情况集体评分(GAS)进行考量。与公立医院患者相比,私立医院患者的管理 GAS 较低(d [95 %CI]:-0.67 [-0.98, -0.36],P.
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引用次数: 0
Paramedic clinical practice guideline development in Australia and New Zealand: A qualitative descriptive analysis 澳大利亚和新西兰辅助医务人员临床实践指南的制定:定性描述分析。
IF 2.1 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2024-07-12 DOI: 10.1016/j.auec.2024.06.003
Sonja Maria , Marc Colbeck , Matt Wilkinson-Stokes , Adam Moon , Michelle Thomson , Joel Ballard , Lachlan Parker , Fraser Watson , James Oswald

Background

This collaborative study by The Australasian College of Paramedicine's Clinical Practice Guidelines (CPG) Working Group aimed to examine CPG development practices in Australian and New Zealand ambulance services.

Methods

Employing a qualitative descriptive design, the research utilised thematic analysis to extract insights from interviews with eleven experts actively involved in CPG development. The study embraced a nominalist and constructivist approach, recognising the intricate connection between individual experiences and the realities of CPG development in the paramedic field.

Results

Key findings revealed significant heterogeneity in CPG development practices, emphasising a lack of formal training and a substantial reliance on existing guidelines. The study highlighted challenges in project management flexibility, limited research capacity, and inconsistencies in external consultations and resource utilisation.

Conclusion

The study recommends adopting project management frameworks, investing in training, and utilising evidence evaluation methodologies like GRADE. It emphasises the need for multidisciplinary teams and formal expertise in evidence synthesis, advocating for targeted training programs. Funding challenges highlight the importance of dedicated budgets and collaborative efforts for resource allocation. Knowledge translation and implementation issues underscore the significance of training programs for evidence evaluation and knowledge translation in overcoming these challenges.
背景:澳大利亚辅助医疗学院临床实践指南(CPG)工作组开展的这项合作研究旨在考察澳大利亚和新西兰救护车服务部门的 CPG 制定实践:这项由澳大利亚辅助医疗学院临床实践指南(CPG)工作组开展的合作研究旨在考察澳大利亚和新西兰救护车服务部门的 CPG 开发实践:研究采用了定性描述设计,利用主题分析法从与 11 名积极参与 CPG 开发的专家的访谈中提取见解。研究采用了一种唯名论和建构主义方法,承认个人经验与辅助医疗领域 CPG 开发的现实之间存在着错综复杂的联系:主要研究结果表明,在 CPG 开发实践中存在很大的差异,强调了缺乏正规培训和对现有指南的严重依赖。研究强调了项目管理灵活性方面的挑战、有限的研究能力以及外部咨询和资源利用方面的不一致:研究建议采用项目管理框架,投资于培训,并利用 GRADE 等证据评估方法。研究强调,在证据综合方面需要多学科团队和正规的专业知识,提倡开展有针对性的培训计划。资金方面的挑战凸显了专项预算和资源分配合作的重要性。知识转化和实施问题强调了证据评估和知识转化培训计划在克服这些挑战方面的重要性。
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引用次数: 0
Use of diagnostic tests in elderly patients consulting the emergency department. Analysis of the emergency department and elder needs cohort (EDEN-8) 在急诊科就诊的老年患者中使用诊断测试。急诊科和老年人需求队列(EDEN-8)分析。
IF 2.1 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2024-07-04 DOI: 10.1016/j.auec.2024.06.004
Javier Jacob , Elena Fuentes , Juan González del Castillo , Inmaculada Bajo-Fernández , Aitor Alquezar-Arbé , Eric Jorge García-Lamberechts , Sira Aguiló , Cesáreo Fernández-Alonso , Guillermo Burillo-Putze , Pascual Piñera , Pere Llorens , Sònia Jimenez , Adriana Gil-Rodrigo , Jorge Sánchez Tembleque-Sánchez , Maria Pilar López-Diez , Marta Iglesias-Vela , Rafael Antonio Pérez-Costa , Marién López-Pardo , Rebeca González-González , Marina Carrión-Fernández , Òscar Miró

Objective

Analyse the association between the use of diagnostic tests and the characteristics of older patients 65 years of age or more who consult the emergency department (ED).

Methods

We performed an analysis of the EDEN cohort that includes patients who consulted 52 Spanish EDs. The association of age, sex, and ageing characteristics with the use of diagnostic tests (blood tests, electrocardiogram (ECG), microbiological cultures, X-ray, computed tomography, ultrasound, invasive techniques) was studied. The association was analysed by calculating the adjusted odds ratios (aOR) and their 95 % confidence intervals (CI) using a logistic regression model.

Results

A total of 25,557 patients were analysed. There was an increase in the use of diagnostic tests based on age, with an aOR for blood test of 1.805 (95 %CI 1.671 – 1.950), ECG 1.793 (95 %CI 1.664 – 1.932) and X-ray 1.707 (95 %CI 1.583 – 1.840) in the group of 85 years or more. The use of diagnostic tests is lower in the female population. Most ageing characteristics (cognitive impairment, previous falls, polypharmacy, dependence, and comorbidity) were independently associated with increased use of diagnostic tests.

Conclusions

Age, and the characteristics of ageing itself are generally associated with a greater use of diagnostic tests in the ED.
目的分析诊断测试的使用与急诊科(ED)就诊的 65 岁及以上老年患者特征之间的关联:我们对包括 52 家西班牙急诊室就诊患者在内的 EDEN 队列进行了分析。我们研究了年龄、性别和老龄化特征与使用诊断测试(血液测试、心电图、微生物培养、X 光、计算机断层扫描、超声波、侵入性技术)之间的关联。通过使用逻辑回归模型计算调整后的几率比(aOR)及其 95 % 的置信区间(CI)来分析两者之间的关联:结果:共对 25 557 名患者进行了分析。年龄越大,诊断检测的使用率越高,85 岁及以上人群的血液检测 aOR 为 1.805(95 %CI 1.671 - 1.950),心电图 aOR 为 1.793(95 %CI 1.664 - 1.932),X 光 aOR 为 1.707(95 %CI 1.583 - 1.840)。女性使用诊断测试的比例较低。大多数老龄化特征(认知障碍、既往跌倒、多种药物治疗、依赖性和合并症)与诊断检测使用率的增加有独立关联:结论:年龄和老龄化本身的特征通常与急诊室诊断检测的使用增加有关。
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Australasian Emergency Care
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