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The ECG: old test, new possibilities. 心电图:旧的测试,新的可能性。
IF 2.4 Pub Date : 2024-12-01 DOI: 10.1007/s43678-024-00822-0
Zhenghong Liu, Marcus Eng Hock Ong
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引用次数: 0
Describing resident physician productivity in a Canadian academic emergency department. 描述加拿大学术急诊科住院医生的工作效率。
IF 2.4 Pub Date : 2024-12-01 Epub Date: 2024-09-27 DOI: 10.1007/s43678-024-00781-6
Julien Turk, Scott Odorizzi, Sebastian Dewhirst, Jessica Maher, Jeffrey M Landreville

Purpose: This cohort study aimed to investigate resident physician productivity in an academic emergency department (ED) and assess the impact of longitudinal coaching relationships known as clinical coaching teams and co-learners (medical students) on resident productivity.

Methods: Data from patient visits to two academic EDs in Ottawa, Canada between April 2022 and March 2023 were analyzed. The attending physician schedule, learner arrangements, and patient ED treatment team information were collected. The presence or absence of clinical coaching teams was also recorded. Mean productivity, measured as patients per hour, was calculated for different shifts and learner arrangements. Linear regression and paired t tests were performed for analysis across ambulatory and non-ambulatory settings, with a focus on productivity differences across residents' training programs and level of training.

Results: A total of 142,386 ED visits were included in the analysis across 8161 attending physician shifts. Resident productivity increased with each year of training, with Royal College of Physicians and Surgeons of Canada emergency medicine residents being the most productive by year 5. There was no significant difference in productivity between residents on clinical coaching team shifts compared to non-clinical coaching team shifts. Productivity decreased slightly when residents worked with medical students as co-learners. There was no significant relationship between the difference in productivity on shifts with and without a medical student and year of training.

Conclusions: This study is the first of its kind to describe resident physician productivity in a Canadian emergency department. The results of this study demonstrate that resident physician productivity improves with seniority, and that co-learners and clinical coaching teams do not significantly impact productivity. This information will be useful to program directors and residents to help set realistic expectations around productivity and to ED physician leads in planning service delivery for patients in the context of a training program.

目的:这项队列研究旨在调查学术急诊科(ED)住院医师的工作效率,并评估被称为临床指导团队和共同学习者(医学生)的纵向指导关系对住院医师工作效率的影响:分析了 2022 年 4 月至 2023 年 3 月期间加拿大渥太华两家学术性急诊科的患者就诊数据。收集了主治医生的日程安排、学习者的安排以及患者急诊室治疗团队的信息。此外,还记录了临床指导团队的存在与否。计算了不同班次和学习者安排下的平均生产率(以每小时病人数计算)。对门诊和非门诊环境进行线性回归和配对 t 检验分析,重点关注住院医师培训项目和培训水平之间的生产率差异:在 8161 个主治医生班次中,共有 142386 次急诊就诊被纳入分析范围。住院医师的工作效率随着培训年限的增加而提高,加拿大皇家内外科医生学院急诊科住院医师的工作效率在第 5 年时最高。与非临床指导小组轮班的住院医师相比,临床指导小组轮班的住院医师在工作效率上没有明显差异。当住院医师与医科学生共同学习时,工作效率略有下降。有医科学生和无医科学生轮班时的工作效率差异与培训年限无明显关系:这项研究是首次对加拿大急诊科住院医生的工作效率进行描述。研究结果表明,住院医师的工作效率随着年资的增加而提高,共同学习者和临床指导团队对工作效率的影响不大。这些信息对项目主任和住院医师很有帮助,有助于他们围绕工作效率设定切合实际的期望值,并帮助住院医师在培训项目中规划为患者提供的服务。
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引用次数: 0
Diagnostic accuracy of point-of-care ultrasound (PoCUS) for the diagnosis of hip effusion in the pediatric emergency department. 儿科急诊室诊断髋关节积液的护理点超声波(PoCUS)诊断准确性。
IF 2.4 Pub Date : 2024-12-01 Epub Date: 2024-10-01 DOI: 10.1007/s43678-024-00788-z
Hadas Katz-Dana, Rudica Stackievicz, Elad Dana, Nir Friedman, Gali Lackner, Ehud Rosenbloom, Ayelet Shles

Purpose: A new limp or refusal to weight-bear are common symptoms in children presenting to the pediatric emergency department (ED). This poses a diagnostic challenge, particularly among toddlers and nonverbal patients. Point-of-care ultrasound (PoCUS) used by pediatric emergency medicine physicians may detect hip effusion, which dramatically aids diagnostic workup and management. There is limited literature regarding the accuracy of hip PoCUS conducted by pediatric emergency medicine physicians. This study aims to assess the diagnostic performance of pediatric emergency medicine physician-performed PoCUS in identifying hip effusion.

Methods: This prospective study was conducted in a single-center pediatric ED. Children presenting with limb pain or new limp were evaluated by pediatric emergency medicine physicians who also performed hip PoCUS and categorized findings as either "effusion" or "no effusion" based on standard sonographic definitions. Patients also underwent radiology department ultrasound reviewed by a pediatric radiologist. Diagnostic test characteristics with corresponding 95% confidence intervals (CI) were calculated using radiology department ultrasound findings as the reference standard.

Results: A total of 95 patients were enrolled by 8 pediatric emergency medicine physicians. Excellent agreement was observed between PoCUS performed by pediatric emergency medicine physicians and radiology department ultrasound for the presence or absence of hip effusion (kappa = 0.81 [95% CI 0.70-0.93]). Hip effusion was identified by PoCUS in 44 out of 49 effusion-positive patients, with a sensitivity of 89.8% (95% CI 77.7-96.6%), specificity of 91.3% (95% CI 79.2%-97.5%), positive likelihood ratio of 10.33 (95% CI 4.03-26.47), and negative likelihood ratio of 0.11 (95% CI 0.05-0.26).

Conclusion: PoCUS performed by pediatric emergency medicine physicians has reasonably high sensitivity and specificity for diagnosing hip effusion among pediatric patients presenting to the pediatric ED with a limp or leg pain. This practice may potentially expedite both diagnosis and treatment within this patient population.

目的:新出现的跛行或拒绝负重是儿科急诊室(ED)就诊儿童的常见症状。这给诊断带来了挑战,尤其是在幼儿和不善言语的患者中。儿科急诊医生使用的护理点超声波(PoCUS)可检测到髋关节积液,这大大有助于诊断工作和治疗。有关儿科急诊医生进行髋关节 PoCUS 的准确性的文献有限。本研究旨在评估儿科急诊医生进行的 PoCUS 在识别髋关节积液方面的诊断性能:这项前瞻性研究在一家单中心儿科急诊室进行。方法:这项前瞻性研究在一家单中心儿科急诊室进行,由儿科急诊内科医生对出现肢体疼痛或新出现跛行的儿童进行评估,他们也进行了髋关节 PoCUS 检查,并根据标准超声波定义将检查结果分为 "渗出 "或 "无渗出"。患者还接受了放射科超声检查,并由儿科放射科医生进行了复查。以放射科超声波检查结果为参考标准,计算诊断测试特征及相应的 95% 置信区间 (CI):结果:8 位儿科急诊医生共收治了 95 名患者。由儿科急诊医生进行的 PoCUS 与放射科超声检查在是否存在髋关节积液方面的结果非常一致(kappa = 0.81 [95% CI 0.70-0.93])。49例积液阳性患者中有44例通过PoCUS发现了髋关节积液,敏感性为89.8%(95% CI 77.7-96.6%),特异性为91.3%(95% CI 79.2%-97.5%),阳性似然比为10.33(95% CI 4.03-26.47),阴性似然比为0.11(95% CI 0.05-0.26):由儿科急诊医生实施的PoCUS对诊断因跛行或腿痛而就诊于儿科急诊室的儿科患者的髋关节积液具有相当高的敏感性和特异性。这种做法有可能加快对这类患者的诊断和治疗。
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引用次数: 0
Just the facts: evaluation and management of epistaxis. 实事求是:鼻衄的评估和处理。
IF 2.4 Pub Date : 2024-11-15 DOI: 10.1007/s43678-024-00820-2
Brit Long, Morgan Langille, Hans Rosenberg, Paul Atkinson
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引用次数: 0
Evaluating the safety of procedural sedation in emergency department settings among the pediatric population: a systematic review and meta-analysis of randomized controlled trials. 评估急诊科在儿科人群中使用程序镇静剂的安全性:随机对照试验的系统回顾和荟萃分析。
IF 2.4 Pub Date : 2024-11-10 DOI: 10.1007/s43678-024-00809-x
Muhammad Taha Khan, Ammar Ishaq, Samia Rohail, Samia Aziz Sulaiman, Fatima Ali Raza, Haris Habib, Aman Goyal

Objective: Our meta-analysis aimed to evaluate the safety of procedural sedation and analgesia in pediatric emergency department (ED) settings by investigating the incidence of cardiac, respiratory, gastrointestinal, and neurological adverse events associated with different sedation medications.

Methods: In accordance with PRISMA guidelines, a comprehensive database search for randomized controlled trials was performed across ten databases from January 2005 to June 2024. Our inclusion criteria included randomized controlled trials involving children under 18 years old undergoing pediatric sedation and analgesia in the ED. Data on medication types, dosages, administration routes, and adverse events were extracted and analyzed. Primary endpoints included cardiac, respiratory, gastrointestinal, and neurological adverse events.

Results: Seventeen studies met the inclusion criteria, a total of 2,302 procedural sedations. The most common adverse events were vomiting, agitation, and hypoxia, which occurred in 104.9 [95% CI = 76.9-132.9], 37.5 [95% CI = 20.6-54.4], 38.3 [95% CI = 23.9-52.6] of each 1000 sedations, respectively. Other adverse events included apnea, hypotension, and the need for bag-valve mask ventilation, which occurred in 8.6 [95% CI: 3.5-13.6], 9.3 [95% CI: -1.4 to 20.1], and 13.5 [95% CI: 3.2-23.8] of each 1,000 sedations, respectively. Severe adverse events were rare, with no reported instances of intubation and only one case of laryngospasm. Subgroup analyses revealed varying incidence rates of adverse events across different sedation protocols, with ketamine and its combinations showing higher rates of specific respiratory complications.

Conclusions: Procedural sedation in pediatric EDs is generally safe, with a low incidence of adverse events, such as vomiting, agitation, and hypoxia. Life-threatening respiratory adverse events are extremely rare. Our findings thus support the careful selection and monitoring of sedation protocols to minimize risks.

目的我们的荟萃分析旨在通过调查与不同镇静药物相关的心脏、呼吸、胃肠道和神经系统不良事件的发生率,评估儿科急诊室(ED)手术镇静和镇痛的安全性:根据 PRISMA 指南,我们对 2005 年 1 月至 2024 年 6 月期间的 10 个数据库进行了随机对照试验的全面数据库检索。我们的纳入标准包括涉及在急诊室接受儿科镇静和镇痛治疗的 18 岁以下儿童的随机对照试验。我们提取并分析了有关药物类型、剂量、给药途径和不良事件的数据。主要终点包括心脏、呼吸、胃肠道和神经系统不良事件:17项研究符合纳入标准,共进行了2302次手术镇静。最常见的不良事件是呕吐、躁动和缺氧,在每1000次镇静中分别发生104.9次[95% CI = 76.9-132.9]、37.5次[95% CI = 20.6-54.4]、38.3次[95% CI = 23.9-52.6]。其他不良事件包括呼吸暂停、低血压和需要进行袋阀面罩通气,在每1000例镇静剂中分别发生8.6例[95% CI:3.5-13.6]、9.3例[95% CI:-1.4-20.1]和13.5例[95% CI:3.2-23.8]。严重不良事件很少发生,没有插管的报道,只有一例喉痉挛。亚组分析显示,不同镇静方案的不良事件发生率不同,氯胺酮及其复合制剂的特定呼吸系统并发症发生率较高:结论:在儿科急诊室进行手术镇静总体上是安全的,呕吐、躁动和缺氧等不良事件的发生率较低。危及生命的呼吸系统不良事件极为罕见。因此,我们的研究结果支持谨慎选择和监控镇静方案,以最大限度地降低风险。
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引用次数: 0
What's luck got to do with it? Taking an institutional approach to gender inequity in academic EM leadership. 这与运气有什么关系?从制度上解决少數族裔学术领导层中的性别不平等问题。
IF 2.4 Pub Date : 2024-11-01 DOI: 10.1007/s43678-024-00800-6
Gillian Sheppard, Keerat Grewal, Teresa M Chan
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引用次数: 0
Just the Facts: Assessing and managing soft tissue knee injuries in the Emergency Department. 就事论事:在急诊科评估和处理膝关节软组织损伤。
IF 2.4 Pub Date : 2024-11-01 Epub Date: 2024-08-10 DOI: 10.1007/s43678-024-00761-w
Benjamin Gompels, Luke McCarron, Luka Jovanovic, Thomas Molloy, Vazeer Ahmed, Martin Gargan, Mike Barrett
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引用次数: 0
Ready to launch: a cross-sectional study of field trauma triage and air-ambulance policies across Canada. 蓄势待发:对加拿大各地现场创伤分流和空中救护政策的横断面研究。
IF 2.4 Pub Date : 2024-11-01 Epub Date: 2024-09-30 DOI: 10.1007/s43678-024-00779-0
Kwasi Nkansah-Junior, Rawaan S Elsawi, Ian R Drennan, Melissa McGowan, Brodie Nolan

Purpose: This study aimed to understand current prehospital trauma air-ambulance policies and triage guidelines across Canada. The research question centered on understanding the guidelines used by provinces and territories and identifying potential regional variations in air-ambulance triage.

Methods: We conducted a cross-sectional survey from November 2022 to May 2023, involving trauma leaders from Canada's 13 provinces and territories. Participants were identified via the Trauma Association of Canada and professional networks. The survey, developed with expert input and pilot tested for clarity, focused on prehospital trauma-triage guidelines, level of adoption of Center for Disease Control and Prevention (CDC) triage guidelines, and auto-launch air-ambulance policies. Data were collected using an 18-item electronic survey. Potential response bias was considered, and confidentiality was maintained. A cross-sectional qualitative analysis was used to evaluate the guidelines' adoption and variations, with responses compared across regions.

Results: The analysis revealed a nationwide adoption (11 of 11 respondents) of the CDC guidelines, indicating a standardized approach to patient transportation. Notably, many provinces and territories (5 of 11) endorse auto-launch protocols for air ambulances in specific scenarios. These policies offer advantages in geographically vast regions weighed against the cost of over-triage and inefficient resource allocation. Each province and territory tailors its approach based on factors such as geographic areas served, and available resources.

Conclusion: This study provides a snapshot of the current state of prehospital trauma-triage guidelines in Canada. With some differences in nomenclature, Canadian provinces and territories widely apply the CDC guidelines to serve their populations. There is some regional variation on how transport is initiated within their borders. The findings underscore the delicate balance required for optimizing air-ambulance policies, considering factors such as timely access, resource allocation, and the local application of guidelines.

目的:本研究旨在了解加拿大各地现行的院前创伤空中救护政策和分流指南。研究问题的核心是了解各省和地区使用的指南,并确定空中救护分流方面可能存在的地区差异:我们在 2022 年 11 月至 2023 年 5 月期间进行了一项横向调查,涉及加拿大 13 个省和地区的创伤领导者。参与者是通过加拿大创伤协会和专业网络确定的。调查内容主要涉及院前创伤分诊指南、采用疾病控制和预防中心(CDC)分诊指南的程度以及自动启动空中救护政策。数据收集采用了 18 项电子调查。调查中考虑了可能存在的回答偏差,并对数据进行了保密。采用横断面定性分析来评估指南的采用和变化情况,并对不同地区的答复进行比较:分析结果显示,全国范围内均采用了疾病预防控制中心指南(11 个受访者中有 11 个采用了该指南),这表明患者转运采用了标准化方法。值得注意的是,许多省和地区(11 个受访者中的 5 个)都赞同在特定情况下采用空中救护车自动发射协议。这些政策在地域广阔的地区具有优势,但同时也要权衡过度分流和资源分配效率低下的代价。每个省和地区都会根据所服务的地理区域和可用资源等因素调整其方法:本研究简要介绍了加拿大院前创伤分诊指南的现状。加拿大各省和地区广泛采用疾病预防控制中心的指南为其居民服务,但在术语上存在一些差异。至于在其境内如何启动转运,则存在一些地区差异。研究结果强调了优化空中救护政策所需的微妙平衡,要考虑到及时到达、资源分配和当地应用指南等因素。
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引用次数: 0
This is a call to action for all leaders in Emergency Medicine: men and women. 这是对急诊医学界所有男女领导者的行动号召。
IF 2.4 Pub Date : 2024-11-01 DOI: 10.1007/s43678-024-00794-1
Lauren Lacroix, Lisa Calder
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引用次数: 0
Effectiveness of caregiver educational materials for paediatric community-acquired pneumonia in the emergency department: a qualitative study. 急诊科儿科社区获得性肺炎护理人员教育材料的有效性:一项定性研究。
IF 2.4 Pub Date : 2024-11-01 Epub Date: 2024-10-03 DOI: 10.1007/s43678-024-00777-2
Lara Murphy, Nelson Huang, Sujane Kandasamy, Gita Wahi, Jeffrey M Pernica

Objectives: The objective of this study was to better understand caregiver perspectives on educational materials relating to paediatric community-acquired pneumonia and antibiotic stewardship in the emergency department setting.

Methods: This was a phenomenologically informed qualitative study. Caregivers of young children in Hamilton, Ontario were presented with four educational materials (animated video, physician led lecture-style video, caregiver led testimony-style video, and a printed brochure) providing information relating to treatment strategies for community-acquired pneumonia. Caregivers were then asked open-ended questions about how they felt about the effectiveness of the media used. The principles of conventional content analysis guided the coding and synthesis of the transcribed interviews.

Results: Eleven caregivers were interviewed. Most caregivers preferred the animated video and brochure to the lecture-style physician video and caregiver testimonial video. Common themes for effective educational materials included visually attention-grabbing graphics, accessible language, and formats they could reference following their visit (e.g. brochure).

Conclusions: The busy nature of the emergency department setting can impede effective communication between clinicians and parents. Employing educational materials may allow for more informed parent-provider communication on care decision making. Caregivers in our study prioritized the simplest information formats for education around community-acquired pneumonia and antimicrobial stewardship which could be referenced following discharge. This was best accomplished by short, animated videos and brochures. Results from this study can inform development of future educational materials used in paediatric emergency department settings to optimize caregiver education and corresponding care plan adherence.

研究目的本研究旨在更好地了解护理人员对急诊科环境中与儿科社区获得性肺炎和抗生素管理相关的教育材料的看法:这是一项基于现象学的定性研究。研究人员向安大略省汉密尔顿市的幼儿看护者展示了四种教育材料(动画视频、医生主导的演讲式视频、看护者主导的证词式视频和印刷小册子),这些材料提供了与社区获得性肺炎治疗策略相关的信息。然后向护理人员提出开放式问题,询问他们对所使用媒体的有效性有何看法。在传统内容分析原则的指导下,对转录的访谈内容进行编码和综合:共采访了 11 位护理人员。大多数护理人员更喜欢动画视频和小册子,而不是演讲式的医生视频和护理人员感言视频。有效教育材料的共同主题包括吸引视觉注意力的图片、易懂的语言以及就诊后可参考的格式(如小册子):结论:急诊科环境的繁忙会阻碍临床医生与家长之间的有效沟通。采用教育材料可使家长与医疗服务提供者就护理决策进行更明智的沟通。在我们的研究中,护理人员优先考虑采用最简单的信息形式,围绕社区获得性肺炎和抗菌药物管理进行教育,以便在出院后参考。简短的动画视频和小册子是实现这一目标的最佳方式。这项研究的结果可为今后儿科急诊室教育材料的开发提供参考,从而优化护理人员的教育和相应护理计划的执行。
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引用次数: 0
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