Academic Emergency Medicine最新文献

Background: The "minority tax", also known as the "diversity tax" refers to the additional burden placed on minoritized individuals in advancing diversity, equity, and inclusion (DEI). Although DEI efforts have evolved over time, evidence on its emotional, professional, and institutional impacts in academic emergency medicine (EM) is limited. We examined the various impacts of the minority tax in this population.

Methods: We conducted a qualitative study using a descriptive phenomenological framework to explore the lived experiences of 21 academic EM faculty leaders engaged in DEI work. Participants were purposively sampled across U.S. regions. Semi-structured interviews were conducted (March-May 2023), transcribed, and analyzed using thematic analysis informed by both inductive and deductive coding strategies. We explored personal and professional impacts of DEI engagement, experiences with the minority tax, and strategies for mitigation.

Results: Participants described their DEI roles as a "double-edged sword," balancing meaningful engagement with substantial emotional and professional costs. Sixteen of 21 participants identified direct experiences with the minority tax, including expectations to serve as cultural representatives, provide uncompensated labor, and experiences of institutional marginalization. Despite these challenges, many participants found personal fulfillment in their work and emphasized mentorship as both a key source of support and a driver of career advancement. Suggested strategies for addressing the minority tax included stronger institutional support, appropriate compensation for DEI contributions, and equitable distribution of DEI responsibilities across all faculty, regardless of identity.

Conclusions: The minority tax in academic emergency medicine presents a complex challenge that carries significant emotional and professional costs even as DEI work can provide personal meaning and career advancement. Addressing this burden requires systemic changes, including recognition of DEI efforts in career progression and shared responsibility across all faculty demographics.

Background: Community consultation (CC) is crucial for exception from informed consent (EFIC) trials. Digital marketing platforms offer a novel and efficient way to gather community input through surveys. This study aimed to determine if the demographics of digital CC survey respondents align with those of their targeted communities.

Methods: We deployed an EFIC CC digital survey for Pedi-PART, a multicenter study on paramedic airway management in critically ill children. A seven-item survey, developed to gauge community perspectives on emergency care research and the trial, was disseminated through a digital marketing platform (Qualtrics Inc.). The survey targeted adults aged 18-65 residing within the geographic service areas of 10 participating EMS agencies. We determined community demographic data from the 2022 American Community Survey (ACS) for the dominant county in each service area. We compared survey respondent demographics (age, sex, race, ethnicity, household income, education) with those of the corresponding communities.

Results: We received 6630 completed surveys (528 to 913 per community). The proportion of individuals over 35 years old was similar between survey and community populations (67.1% vs. 66.5%). Survey respondents were more likely to be female (60.0% vs. 50.9%) and report household incomes < $100,000 (77.5% vs. 60.2%). Survey respondents were less likely to be Black, American Indian, Pacific Islander, or other race (33.9% vs. 52.1%), Hispanic ethnicity (15.3% vs. 34.9%), or have at least a high school education (23.2% vs. 34.9%). Demographic differences between survey respondents and communities varied across the 10 communities.

Conclusions: Demographic differences may exist between digital survey respondents and their targeted communities. Study teams should account for these factors when utilizing such platforms for EFIC CC.

Introduction: Emergency medical services (EMS) providers are often first responders to agitated older adults, providing critical clinical care and transport. However, significant knowledge gaps persist in our understanding of agitation management for older adults in the prehospital setting.

Aims: To describe the barriers and facilitators to the management of agitation in older adults and the reduction of restraint use by EMS providers.

Methods: In-depth semi-structured qualitative interviews (n = 30) took place with EMS providers employed in Alberta, Canada. The theoretical domains framework (TDF) served as a guiding structure for the development of the interview guide. Framework analysis was used to analyze the qualitative data: a line-by-line thematic analysis was used to identify codes/themes, which were then mapped onto the TDF, and behavior change wheel.

Results: Six major thematic categories were identified. EMS providers reported inadequate training and support, especially for managing agitation in older adult populations. Restraints are used as a safety measure for patient and provider safety, and as a last resort once other agitation management strategies have been exhausted. EMS providers report a complex decision-making matrix of balancing the risks, benefits, and ethical considerations of restraint use, which is often collaborative and integrates EMS protocols. Common barriers to effective agitation management in EMS, as well as non-restraint agitation management techniques are also discussed.

Conclusion: The present study is the first in-depth exploration of EMS provider experiences regarding the management of agitation and chemical and physical restraints in older adults.

Background: Syncope places a significant burden on emergency departments (EDs), often prompting extensive testing to exclude life-threatening conditions. However, the diagnostic utility of troponin, B-type natriuretic peptide (BNP), transthoracic echocardiography (TTE), and outpatient cardiac monitoring remains unclear.

Methods: This systematic review assessed the diagnostic accuracy of these tests in adults presenting with syncope. The research question was: In ED patients with syncope, does TTE, cardiac biomarkers (troponin, BNP), or outpatient arrhythmia monitoring, compared with no testing, improve outcomes within 30 days? Primary outcomes included adverse events (death, arrhythmias, structural/ischemic heart disease, and select non-cardiac causes such as pulmonary embolism or aortic dissection) for biomarkers and diagnostic yield for TTE and monitoring. Sensitivity, specificity, and likelihood ratios (LR+ and LR-) were calculated for biomarkers, while diagnostic yield with 95% CI was reported for TTE and monitoring. Risk of bias was assessed using JBI and QUADAS-2.

Results: The database searches identified 1759 citations. After applying inclusion and exclusion criteria, 41 studies (21,557 patients) were included. Significant heterogeneity among the included trials (all with I² > 90%) precluded meta-analysis. For BNP, LR+ ranged 1.4-47 and LR- 0.06-0.4; for troponin, LR+ 1.9-11.2 and LR- 0.2-0.9. TTE diagnostic yield was 0%-29% overall and 8%-28% in high-risk groups. Outpatient monitoring yielded 1%-59% overall and 12%-42% in high-risk patients.

Conclusion: In ED patients with syncope, the diagnostic accuracy and yield of cardiac biomarkers, TTE, and outpatient monitoring show substantial variability, largely due to differences in patient populations, outcome measures, and study methodologies. Based on the existing evidence, these modalities in isolation cannot be recommended for routine use in syncope evaluation. Among these tests, the diagnostic yield of TTE and outpatient monitoring is greater in patients with cardiac risk factors and could potentially contribute to a more accurate diagnosis.