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Prospective validity evidence for the abbreviated emergency medicine Copenhagen Burnout Inventory. 急诊医学哥本哈根倦怠调查表缩写本的前瞻性有效性证据。
IF 3.4 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-08-01 Epub Date: 2024-03-17 DOI: 10.1111/acem.14892
Earl J Reisdorff, Mary M Johnston, Michelle D Lall, Dave W Lu, Karl Y Bilimoria, Melissa A Barton

Background: Prior research has provided retrospective validity evidence for an abbreviated Copenhagen Burnout Inventory (CBI) to measure burnout among emergency medicine (EM) residents. We sought to provide additional validity and reliability evidence for the two-factor, six-item abbreviated CBI.

Methods: This cross-sectional study used data from the abbreviated CBI that was administered following the 2022 American Board of Emergency Medicine In-training Examination. Confirmatory factor analysis (CFA) was performed and the prevalence of burnout among EM residents was determined.

Results: Of the 8918 eligible residents, 7465 (83.7%) completed the abbreviated CBI. CFA confirmed the previously developed model of two factors using six items answered with a 1- to 5-point Likert scale. The internal factor was derived from personal and work-related burnout and the external factor was related to caring for patients. The reliability was determined using Cronbach's alpha (0.87). The overall prevalence of burnout was 49.4%; the lowest prevalence was at the EM1 level (43.1%) and the highest was at the EM2 level (53.8%).

Conclusions: CFA of the abbreviated CBI demonstrated good reliability and model fit. The two-factor, six-item survey instrument identified an increase in the prevalence of burnout among EM residents that coincided with working in the COVID-19 environment. The abbreviated CBI has sufficient reliability and validity evidence to encourage its broader use.

背景:先前的研究为哥本哈根倦怠量表(CBI)测量急诊医学(EM)住院医生的倦怠感提供了回顾性的有效性证据。我们试图为这一双因素、六项目的简略哥本哈根倦怠量表提供更多的有效性和可靠性证据:这项横断面研究使用了 2022 年美国急诊医学委员会在岗培训考试后进行的缩写 CBI 数据。结果:在8918名符合条件的住院医师中,74%的住院医师有职业倦怠:在 8918 名符合条件的住院医师中,有 7465 人(83.7%)完成了简略 CBI。CFA证实了之前开发的两个因子模型,该模型由6个项目组成,采用1-5点李克特量表。内部因子来自个人和工作相关的职业倦怠,外部因子则与护理病人有关。信度采用 Cronbach's alpha(0.87)进行测定。职业倦怠的总体发生率为 49.4%;发生率最低的是 EM1 级(43.1%),最高的是 EM2 级(53.8%):结论:缩写 CBI 的 CFA 显示了良好的可靠性和模型拟合度。双因素、六项目调查工具发现,在COVID-19环境中工作的急诊科住院医师倦怠感增加。缩写 CBI 有足够的可靠性和有效性证据来鼓励更广泛地使用。
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引用次数: 0
Asymptomatic bacteriuria or symptomatic urinary tract infection? That is the question. 无症状菌尿还是有症状的尿路感染?这就是问题所在。
IF 3.4 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-08-01 Epub Date: 2024-06-17 DOI: 10.1111/acem.14966
Alejandro Smithson
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引用次数: 0
Eligibility for anticoagulation initiation in atrial fibrillation: Agreement between emergency physician and medical record review. 心房颤动患者开始抗凝治疗的资格:急诊医生与病历审查之间的一致性。
IF 3.4 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-08-01 Epub Date: 2024-03-08 DOI: 10.1111/acem.14889
Darshana Seeburruth, X Catherine Tong, Christopher Kirwan, Sophie Ramsden, Aqsa Kibria, Jaimie Carter, Johnny Huang, Robyn McArthur, Natasha Clayton, Kerstin de Wit
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引用次数: 0
Academic emergency medicine: Common practice or underdeveloped? 学术急诊医学:常见做法还是发展不足?
IF 3.4 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-08-01 Epub Date: 2024-06-23 DOI: 10.1111/acem.14975
Alexander T Janke, Robert W Neumar
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引用次数: 0
Estimating the size and scope of the academic emergency physician workforce. 估计学术急诊医生队伍的规模和范围。
IF 3.4 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-08-01 Epub Date: 2024-05-20 DOI: 10.1111/acem.14931
Cameron J Gettel, Carlos A Camargo, Christopher L Bennett, D Mark Courtney, Amy H Kaji, Gregory J Fermann, Fiona E Gallahue, Lewis S Nelson, Carleigh F Hebbard, Craig Rothenberg, Ali S Raja, Arjun K Venkatesh

Background: Academic emergency medicine (EM) is foundational to the EM specialty through the development of new knowledge and clinical training of resident physicians. Despite recent increased attention to the future of the EM workforce, no evaluations have specifically characterized the U.S. academic EM workforce. We sought to estimate the national proportion of emergency physicians (EPs) identified as academic and the proportion of emergency department (ED) visits that take place at academic sites.

Methods: We performed a cross-sectional analysis of EPs and EDs using data from the American Hospital Association, the Centers for Medicare & Medicaid Services, and Doximity's Residency Navigator. EPs were identified as "academic" if they were affiliated with at least one facility determined to be academic, defined as EDs officially designated by the Accreditation Council for Graduate Medical Education (ACGME) as clinical training sites at accredited EM residency programs. Our primary outcomes were to estimate the national proportion of EPs identified as academic and the proportion of ED visits performed at academic sites.

Results: Our analytic sample included 26,937 EPs practicing clinically across 4920 EDs and providing care during 130,471,386 ED visits. Among EPs, 11,720 (43.5%) were identified as academic, and among EDs, 635 (12.9%) were identified as academic sites, including 585 adult/general sites, 45 pediatric-specific sites, and 10 sites affiliated with the Department of Veterans Affairs. In 2021, academic EDs provided care for 42,794,106 ED visits or 32.8% of all ED visits nationally.

Conclusions: Approximately four in 10 EPs practice in at least one clinical training site affiliated with an ACGME-accredited EM residency program, and approximately one in three ED visits nationally occur in these academic EDs. We encourage further work using alternative definitions of an academic EPs and EDs, along with longitudinal research to identify trends in the workforce's composition.

背景:急诊医学(EM)学术通过开发新知识和对住院医生进行临床培训,为急诊医学专业奠定了基础。尽管最近人们越来越关注急诊医学人才队伍的未来,但却没有对美国学术急诊医学人才队伍的具体特点进行评估。我们试图估算全国被认定为学术型的急诊医生(EPs)的比例,以及在学术型医院急诊科(ED)就诊的比例:我们利用美国医院协会、医疗保险与医疗补助服务中心以及 Doximity 的住院医生导航仪提供的数据,对急诊医生和急诊室进行了横向分析。如果急诊科至少隶属于一家被认定为学术性的医疗机构,则被认定为 "学术性 "急诊科,学术性急诊科的定义是由美国毕业后医学教育认证委员会(ACGME)正式指定的急诊科,是经认可的急诊科住院医师培训项目的临床培训基地。我们的主要结果是估算全国被认定为学术性急诊科的比例以及在学术性急诊科就诊的比例:我们的分析样本包括在 4920 家急诊室从事临床工作的 26,937 名急诊医生,他们在 130,471,386 次急诊就诊中提供了医疗服务。在急救医生中,有 11720 人(43.5%)被认定为学术型;在急诊室中,有 635 人(12.9%)被认定为学术型,其中包括 585 个成人/普通急诊室、45 个儿科急诊室和 10 个隶属于退伍军人事务部的急诊室。2021 年,学术性急诊室为 42,794,106 人次的急诊就诊提供了医疗服务,占全国急诊就诊总人次的 32.8%:大约每10名急诊医生中就有4名在至少一个隶属于ACGME认证的急诊科住院医师培训项目的临床培训基地工作,全国大约每3次急诊就有1次发生在这些学术性急诊中。我们鼓励进一步研究学术性急诊科医生和急诊室的其他定义,并开展纵向研究,以确定医生队伍构成的趋势。
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引用次数: 0
Response to: "Asymptomatic bacteriuria or symptomatic urinary tract infection? That is the question". 回应"无症状菌尿还是无症状尿路感染?这是一个问题"。
IF 3.4 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-08-01 Epub Date: 2024-06-17 DOI: 10.1111/acem.14967
Brett Biebelberg, Iain E Kehoe, Michael R Filbin, Thomas Heldt, Andrew T Reisner
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引用次数: 0
Interventions to improve emergency department throughput and care delivery indicators: A systematic review and meta-analysis. 改善急诊科吞吐量和护理服务指标的干预措施:系统回顾和荟萃分析。
IF 3.4 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-08-01 Epub Date: 2024-06-03 DOI: 10.1111/acem.14946
Elias Youssef, Roshanak Benabbas, Brittany Choe, Donald Doukas, Hope A Taitt, Rajesh Verma, Shahriar Zehtabchi

Background: Emergency department (ED) crowding has repercussions on acute care, contributing to prolonged wait times, length of stay, and left without being seen (LWBS). These indicators are regarded as systemic shortcomings, reflecting a failure to provide equitable and accessible acute care. The objective was to evaluate the effectiveness of interventions aimed at improving ED care delivery indicators.

Methods: This was a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing ED interventions aimed at reducing key metrics of time to provider (TTP), time to disposition (TTD), and LWBS. We excluded disease-specific trials (e.g., stroke). We used Cochrane's revised tool to assess the risk of bias and Grading of Recommendations, Assessment, Development, and Evaluations to rate the quality of evidence. The meta-analysis was performed using a random-effects model and Cochrane Q test for heterogeneity. Data were summarized as means (±SD) for continuous variables and risk ratios (RR) with 95% confidence intervals (CIs).

Results: We searched MEDLINE, EMBASE, and other major databases. A total of 1850 references were scanned and 20 RCTs were selected for inclusion. The trials reported at least one of the three outcomes of TTD, TTP, or LWBS. Most interventions focused on triage liaison physician and point-of-care (POC) testing. Others included upfront expedited workup (ordering tests before full evaluation by a provider), scribes, triage kiosks, and sending notifications to consultants or residents. POC testing decreased TTD by an average of 5-96 min (high heterogeneity) but slightly increased TTP by a mean difference of 2 min (95% CI 0.6-4 min). Utilizing a triage liaison physician reduced TTD by 28 min (95% CI 19-37 min; moderate-quality evidence) and was more effective in reducing LWBS than routine triage (RR 0.76, 95% CI 0.66-0.88; moderate quality).

Conclusions: Operational strategies such as POC testing and triage liaison physicians could mitigate the impact of ED crowding and appear to be effective. The current evidence supports these strategies when tailored to the appropriate practice environment.

背景:急诊科(ED)拥挤对急症护理产生了影响,导致等待时间延长、住院时间延长和未就诊(LWBS)。这些指标被视为系统性缺陷,反映出未能提供公平、便捷的急诊护理。我们的目标是评估旨在改善急诊室护理服务指标的干预措施的有效性:这是一项对随机对照试验(RCT)进行的系统性回顾和荟萃分析,这些试验评估了急诊室干预措施,旨在缩短患者就诊时间(TTP)、处置时间(TTD)和LWBS等关键指标。我们排除了针对特定疾病(如中风)的试验。我们使用 Cochrane 的修订工具来评估偏倚风险,并使用《建议、评估、发展和评价分级》来评定证据质量。荟萃分析采用随机效应模型和异质性 Cochrane Q 检验。数据总结为连续变量的平均值(±SD)和风险比(RR)及 95% 置信区间(CI):我们检索了 MEDLINE、EMBASE 和其他主要数据库。共扫描了 1850 篇参考文献,筛选出 20 项 RCT 纳入其中。这些试验至少报告了 TTD、TTP 或 LWBS 三项结果中的一项。大多数干预措施侧重于分诊联络医生和护理点(POC)检测。其他干预措施包括前期快速检查(在医疗服务提供者进行全面评估前开具检查单)、抄写员、分诊信息亭以及向顾问或住院医师发送通知。POC 检测平均减少了 5-96 分钟的 TTD(异质性高),但略微增加了 2 分钟的 TTP(95% CI 0.6-4 分钟)。与常规分诊相比,使用分诊联络医生可将 TTD 缩短 28 分钟(95% CI 19-37 分钟;中等质量证据),并更有效地减少 LWBS(RR 0.76,95% CI 0.66-0.88;中等质量):POC检测和分诊联络医生等操作策略可减轻急诊室拥挤的影响,而且似乎是有效的。目前的证据表明,这些策略适合于适当的实践环境。
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引用次数: 0
Reporting of sex and gender demographics among research studies. 研究报告中的性和性别人口统计报告。
IF 3.4 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-08-01 Epub Date: 2024-02-17 DOI: 10.1111/acem.14866
Michael Gottlieb, Rachel Chang, Miranda Viars, Alexandra Mannix
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引用次数: 0
Eligibility of emergency department patients for public benefit programs. 急诊科病人享受公共福利计划的资格。
IF 3.4 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-08-01 Epub Date: 2024-03-25 DOI: 10.1111/acem.14870
Joseph Harrison, Grace McDermott, Erica L Dixon, Michael Mehta, Aliza Haider, Charles Rareshide, Lauren Southwick, Anish K Agarwal, Raina M Merchant, Austin S Kilaru
{"title":"Eligibility of emergency department patients for public benefit programs.","authors":"Joseph Harrison, Grace McDermott, Erica L Dixon, Michael Mehta, Aliza Haider, Charles Rareshide, Lauren Southwick, Anish K Agarwal, Raina M Merchant, Austin S Kilaru","doi":"10.1111/acem.14870","DOIUrl":"10.1111/acem.14870","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"820-823"},"PeriodicalIF":3.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140287941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
Enhancing emergency department charting: Using Generative Pre-trained Transformer-4 (GPT-4) to identify laceration repairs. 加强急诊科图表制作:使用生成预训练变换器-4 (GPT-4) 识别裂伤修复。
IF 3.4 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-07-31 DOI: 10.1111/acem.14995
Jaskaran Karan Bains, Christopher Y K Williams, Drake Johnson, Hope Schwartz, Naina Sabbineni, Atul J Butte, Aaron E Kornblith
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引用次数: 0
期刊
Academic Emergency Medicine
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