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Operating characteristics of diagnostic tests for syphilis. 梅毒诊断测试的操作特点。
IF 3.4 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-10-01 Epub Date: 2024-09-06 DOI: 10.1111/acem.15008
Fatima Johari, Michelle Ordoveza Cho
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引用次数: 0
Response to Letter to Editor. 回应致编辑的信。
IF 3.4 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-10-01 Epub Date: 2024-08-06 DOI: 10.1111/acem.14982
Ryan C Gibbons, Thomas G Costantino
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引用次数: 0
T32 programs in emergency medicine: A report from the ACEP-SAEM Federal Research Funding Workgroup. 急诊医学 T32 计划:ACEP-SAEM 联邦研究资助工作组的报告。
IF 3.4 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-10-01 Epub Date: 2024-08-16 DOI: 10.1111/acem.15002
Patrick J Maher, Richard Rothman, Robert Neumar, Jeremy Brown, Willard Sharp, Charles Cairns, Gabor D Kelen, Amy Kaji, Jody A Vogel, Lynne D Richardson

Advancing care in Emergency Medicine (EM) requires the development of well-trained researchers, but our specialty has lower amounts of research funding compared to similar medical fields. Increasing the number of pathways available for research training supports the growth of new investigators. To address the need for more EM researchers, the Society of Academic Emergency Medicine and the American College of Emergency Physicians convened a Federal Research Funding Workgroup. Here, we report the workgroup recommendations regarding the creation of Research Training Fellowships using the T32 grant structure sponsored by the National Institutes of Health. After reviewing the history of NIH-grant supported research fellowships in EM, we outline the rationale and describe the core components of T32-supported research fellowships, including program design, fellow evaluation, and recruitment considerations.

推动急诊医学(EM)的发展需要培养训练有素的研究人员,但与同类医学领域相比,我们专业的研究经费较少。增加研究培训的途径有助于新研究人员的成长。为了满足对更多急诊科研究人员的需求,急诊医学学术学会和美国急诊医师学会召集了一个联邦研究资助工作组。在此,我们报告了工作组关于利用美国国立卫生研究院赞助的 T32 基金结构设立研究培训奖学金的建议。在回顾了美国国立卫生研究院资助的急诊科研究培训奖学金的历史后,我们概述了 T32 资助的研究培训奖学金的基本原理,并介绍了其核心组成部分,包括项目设计、研究人员评估和招聘注意事项。
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引用次数: 0
Does code status clarification for elderly patients being admitted from the emergency department make a difference? 对急诊科收治的老年患者进行代码状态澄清是否会产生影响?
IF 3.4 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-10-01 Epub Date: 2024-05-06 DOI: 10.1111/acem.14936
Carl Pafford, Amber R Comer, Daniel Slubowski, Laurae Rettig, Benton R Hunter
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引用次数: 0
Is more better? A multilevel analysis of percutaneous coronary intervention hospital openings and closures on patient volumes. 越多越好吗?经皮冠状动脉介入治疗医院开设和关闭对患者数量的多层次分析。
IF 3.4 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-10-01 Epub Date: 2024-05-16 DOI: 10.1111/acem.14926
Renee Y Hsia, Rita F Redberg, Yu-Chu Shen

Background: It is unknown how changes in the percutaneous coronary intervention (PCI) "built environment" have impacted PCI volumes at the community, hospital, and patient levels. This study sought to determine how PCI hospital openings and closures effect community- and hospital-level PCI volumes as well as the likelihood of receiving PCI at a low-volume hospital.

Methods: We conducted a retrospective cohort study of 3,966,025 Medicare Fee-For-Service patients in 37,451 zip codes and 2564 U.S. hospitals who underwent PCI from 2006 to 2017. We conducted community-, hospital-, and patient-level analyses using ordinary least squares regressions with fixed effects to determine changes in PCI volumes after PCI hospital openings or closures.

Results: Between 2006 and 2017, a total of 17% and 7% of patients lived in communities that experienced PCI hospital openings and closures, respectively. Openings were associated with a 10% increase in community PCI volume, a 2% increase in the share of elective PCI, and a doubling in the likelihood of receiving PCI at a low-volume hospital. In communities with low baseline PCI capacity, openings were associated with a 12% increase in community PCI volume, and in high-capacity communities, an 8% increase. PCI closures were associated with a 9% decrease in community PCI volume in high-capacity communities but no measurable change in low-capacity communities.

Conclusions: PCI service expansion is associated with increased PCI at low-volume hospitals and a greater number of elective procedures. Increased governmental oversight may be necessary to ensure that openings and closures of these specialized services yield the desired benefits.

背景:经皮冠状动脉介入治疗(PCI)"建筑环境 "的变化如何影响社区、医院和患者层面的 PCI 量,目前尚不清楚。本研究旨在确定 PCI 医院的开设和关闭如何影响社区和医院层面的 PCI 量,以及在低量医院接受 PCI 的可能性:我们对2006年至2017年期间接受PCI治疗的37451个邮政编码和2564家美国医院的3966025名联邦医疗保险付费服务患者进行了回顾性队列研究。我们使用带固定效应的普通最小二乘法回归进行了社区、医院和患者层面的分析,以确定PCI医院开设或关闭后PCI量的变化:2006年至2017年期间,分别有17%和7%的患者所居住的社区经历了PCI医院的开设和关闭。开业与社区PCI量增加10%、择期PCI比例增加2%以及在低容量医院接受PCI的可能性增加一倍有关。在基线 PCI 容量较低的社区,开放与社区 PCI 容量增加 12% 相关,而在高容量社区,则与增加 8% 相关。在PCI容量大的社区,关闭PCI与社区PCI量减少9%有关,但在PCI容量小的社区则没有明显变化:PCI服务的扩展与低容量医院的PCI增加和选择性手术数量增加有关。可能需要加强政府监督,以确保这些专业服务的开放和关闭能产生预期效益。
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引用次数: 0
Delirium detection in the emergency department: A diagnostic accuracy meta-analysis of history, physical examination, laboratory tests, and screening instruments. 急诊科谵妄检测:病史、体格检查、实验室检测和筛查工具的诊断准确性荟萃分析。
IF 3.4 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-10-01 Epub Date: 2024-05-16 DOI: 10.1111/acem.14935
Christopher R Carpenter, Sangil Lee, Maura Kennedy, Glenn Arendts, Linda Schnitker, Debra Eagles, Simon Mooijaart, Susan Fowler, Michelle Doering, Michael A LaMantia, Jin H Han, Shan W Liu

Introduction: Geriatric emergency department (ED) guidelines emphasize timely identification of delirium. This article updates previous diagnostic accuracy systematic reviews of history, physical examination, laboratory testing, and ED screening instruments for the diagnosis of delirium as well as test-treatment thresholds for ED delirium screening.

Methods: We conducted a systematic review to quantify the diagnostic accuracy of approaches to identify delirium. Studies were included if they described adults aged 60 or older evaluated in the ED setting with an index test for delirium compared with an acceptable criterion standard for delirium. Data were extracted and studies were reviewed for risk of bias. When appropriate, we conducted a meta-analysis and estimated delirium screening thresholds.

Results: Full-text review was performed on 55 studies and 27 were included in the current analysis. No studies were identified exploring the accuracy of findings on history or laboratory analysis. While two studies reported clinicians accurately rule in delirium, clinician gestalt is inadequate to rule out delirium. We report meta-analysis on three studies that quantified the accuracy of the 4 A's Test (4AT) to rule in (pooled positive likelihood ratio [LR+] 7.5, 95% confidence interval [CI] 2.7-20.7) and rule out (pooled negative likelihood ratio [LR-] 0.18, 95% CI 0.09-0.34) delirium. We also conducted meta-analysis of two studies that quantified the accuracy of the Abbreviated Mental Test-4 (AMT-4) and found that the pooled LR+ (4.3, 95% CI 2.4-7.8) was lower than that observed for the 4AT, but the pooled LR- (0.22, 95% CI 0.05-1) was similar. Based on one study the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is the superior instrument to rule in delirium. The calculated test threshold is 2% and the treatment threshold is 11%.

Conclusions: The quantitative accuracy of history and physical examination to identify ED delirium is virtually unexplored. The 4AT has the largest quantity of ED-based research. Other screening instruments may more accurately rule in or rule out delirium. If the goal is to rule in delirium then the CAM-ICU or brief CAM or modified CAM for the ED are superior instruments, although the accuracy of these screening tools are based on single-center studies. To rule out delirium, the Delirium Triage Screen is superior based on one single-center study.

导言:老年急诊科(ED)指南强调及时识别谵妄。本文更新了以往对病史、体格检查、实验室检测和急诊科谵妄诊断筛查工具的诊断准确性系统综述,以及急诊科谵妄筛查的检测-治疗阈值:我们进行了一项系统综述,以量化识别谵妄方法的诊断准确性。如果研究描述了在急诊室环境中使用谵妄指数测试与可接受的谵妄标准比较来评估 60 岁或以上成人的情况,则纳入该研究。我们提取了数据,并对研究进行了偏倚风险审查。在适当的情况下,我们进行了荟萃分析,并估算了谵妄筛查阈值:我们对 55 项研究进行了全文审阅,其中 27 项纳入了本次分析。没有发现探讨病史或实验室分析结果准确性的研究。虽然有两项研究报告称临床医生能准确排除谵妄,但临床医生的态势并不足以排除谵妄。我们报告了三项研究的荟萃分析,这些研究量化了 4 A's Test (4AT) 判断谵妄的准确性(汇总阳性似然比 [LR+] 7.5,95% 置信区间 [CI] 2.7-20.7)和排除谵妄的准确性(汇总阴性似然比 [LR-] 0.18,95% 置信区间 [CI] 0.09-0.34)。我们还对两项研究进行了荟萃分析,这两项研究量化了简略智力测验-4(AMT-4)的准确性,发现汇总的 LR+(4.3,95% CI 2.4-7.8)低于 4AT 的准确性,但汇总的 LR-(0.22,95% CI 0.05-1)与 4AT 相似。根据一项研究,重症监护室意识模糊评估方法(CAM-ICU)是排除谵妄的最佳工具。计算得出的测试阈值为 2%,治疗阈值为 11%:结论:病史和体格检查在确定急诊室谵妄方面的定量准确性几乎尚未得到探讨。4AT 在基于急诊室的研究中数量最多。其他筛查工具可能会更准确地排除谵妄。如果目标是排除谵妄,那么CAM-ICU、简短CAM或针对急诊室的改良CAM都是较好的工具,尽管这些筛查工具的准确性都是基于单中心研究。若要排除谵妄,根据一项单中心研究,谵妄分流筛查更胜一筹。
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引用次数: 0
Forget me not. 别忘了我
IF 3.4 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-10-01 Epub Date: 2024-09-01 DOI: 10.1111/acem.15007
Folafoluwa O Odetola
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引用次数: 0
Impact of a simplified cannulation procedure pack on peripheral intravenous catheter-associated Staphylococcus aureus bacteremia: An interrupted time series analysis. 简化插管程序包对外周静脉导管相关金黄色葡萄球菌菌血症的影响:间断时间序列分析。
IF 3.4 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-10-01 Epub Date: 2024-06-10 DOI: 10.1111/acem.14942
Diana Egerton-Warburton, Aaron Badwal, Suzanne Bumpstead, Catherine Martin, Samuel Penfold, Robert Meek, Lisa Kuhn
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引用次数: 0
Low-dose ketamine as an adjunct to morphine: A randomized controlled trial among patients with and without current opioid use. 小剂量氯胺酮作为吗啡的辅助药物:在目前使用和未使用阿片类药物的患者中进行的随机对照试验。
IF 3.4 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-10-01 Epub Date: 2024-07-16 DOI: 10.1111/acem.14983
Stine Fjendbo Galili, Bodil Hammer Bech, Hans Kirkegaard, Jette Ahrensberg, Lone Nikolajsen

Background: Pain is a common complaint among patients presenting to the emergency department (ED), yet pain treatment is frequently suboptimal. The aim of this study was to determine the effectiveness of low-dose ketamine (LDK) as an adjunct to morphine versus morphine alone for treatment of acute pain among ED patients with and without current opioid use.

Methods: Adult patients presenting with acute pain of ≥5 on a numeric rating scale (0-10) who were deemed by their treating ED physician to require intravenous opioids were randomized to receive either 0.1 mg/kg ketamine (treatment group) or isotonic saline (placebo) as an adjunct to morphine. Patients with and without current opioid use were randomized separately. Pain was measured at baseline (T0) and 10, 20, 30, 45, 60, and 120 min after randomization. The primary outcome was pain reduction from T0 to T10. Secondary outcomes included pain intensity over 120 min, need of rescue opioids, side effects, and patient and provider satisfaction.

Results: A total of 116 patients were included from May 2022 to August 2023. Median (IQR) age was 51 (36.5-67) years; 58% were male and 36% had current opioid use. Pain reduction from T0 to T10 was greater in the LDK group (4 [IQR 3-6]) compared to the placebo group (1 [IQR 0-2]; p = 0.001). Pain intensity was lower in the LDK group at T10, T20, and T30, compared to the placebo group. There was a higher risk of nausea, vomiting, and dissociation in the LDK group during the first 10 min.

Conclusions: LDK may be effective as an adjunct analgesic to morphine for short-term pain relief in treatment of acute pain in the ED for both patients with and without current opioid use.

背景:疼痛是急诊科(ED)患者的常见主诉,但疼痛治疗效果往往不尽如人意。本研究旨在确定低剂量氯胺酮(LDK)作为吗啡的辅助药物与单独使用吗啡治疗目前使用或未使用阿片类药物的急诊科患者急性疼痛的效果:对急诊科医生认为需要静脉注射阿片类药物的急性疼痛评分≥5分(0-10分)的成人患者进行随机分组,接受0.1毫克/千克氯胺酮(治疗组)或等渗盐水(安慰剂)作为吗啡的辅助治疗。正在使用和未使用阿片类药物的患者被分别随机分组。疼痛测量时间为基线(T0)和随机分组后的 10、20、30、45、60 和 120 分钟。主要结果是从 T0 到 T10 的疼痛减轻情况。次要结果包括 120 分钟内的疼痛强度、阿片类药物救援需求、副作用以及患者和提供者的满意度:结果:从 2022 年 5 月到 2023 年 8 月,共纳入 116 名患者。中位(IQR)年龄为 51(36.5-67)岁;58% 为男性,36% 目前使用阿片类药物。与安慰剂组(1 [IQR 0-2];p = 0.001)相比,LDK 组从 T0 到 T10 的疼痛减轻幅度更大(4 [IQR 3-6])。与安慰剂组相比,LDK 组在 T10、T20 和 T30 的疼痛强度较低。在最初的 10 分钟内,LDK 组出现恶心、呕吐和分离的风险较高:LDK可作为吗啡的辅助镇痛药,在急诊室治疗急性疼痛时有效缓解疼痛,适用于目前使用或未使用阿片类药物的患者。
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引用次数: 0
Response to: "Evaluating the efficacy of prehospital transfusion: A critical analysis". 回应"评估院前输血的疗效:批判性分析"。
IF 3.4 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-09-26 DOI: 10.1111/acem.15025
David W Schoenfeld, Carlo L Rosen, Tim Harris, Stephen H Thomas
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引用次数: 0
期刊
Academic Emergency Medicine
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