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Roze E, Nilles C, Louapre C, Soumet-Leman B, Renaud MC, Dechartres A, Atkinson-Clement C. A podcast to teach medical humanities at medical school: a text-mining study of students' lived experience. MEDICAL EDUCATION ONLINE 2024; 29:2367823. [PMID: 38905106 PMCID: PMC11195461 DOI: 10.1080/10872981.2024.2367823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 06/10/2024] [Indexed: 06/23/2024]
Abstract
The teaching of medical humanities is increasingly being integrated into medical school curricula. We developed a podcast called Le Serment d'Augusta (Augusta's Oath), consisting of six episodes tackling hot topics in the modern world of healthcare related to the patient-doctor relationship, professionalism, and ethics. This podcast aimed to provide scientific content in an entertaining way, while promoting debate among medical students. The Le Serment d'Augusta podcast was proposed as one of the various optional modules included in the second- to fifth-year curriculum at the School of Medicine of Sorbonne University (Paris). We asked students to report their lived experience of listening to the podcast. We then used a text-mining approach focusing on two main aspects: i) students' perspective of the use of this educational podcast to learn about medical humanities; ii) self-reported change in their perception of and knowledge about core elements of healthcare after listening to the podcast. 478 students were included. Students were grateful for the opportunity to participate in this teaching module. They greatly enjoyed this kind of learning tool and reported that it gave them autonomy in learning. They appreciated the content as well as the format, highlighting that the topics were related to the very essence of medical practice and that the numerous testimonies were of great added value. Listening to the podcast resulted in knowledge acquisition and significant change of perspective. These findings further support the use of podcasts in medical education, especially to teach medical humanities, and their implementation in the curriculum.
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Affiliation(s)
- Emmanuel Roze
- DMU Neurosciences, Pitié-Salpêtrière Hospital, Paris, France
- Faculty of Medicine of Sorbonne University, INSERM, CNRS, Paris Brain Institute, Paris, France
| | - Christelle Nilles
- DMU Neurosciences, Pitié-Salpêtrière Hospital, Paris, France
- Neurology department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Céline Louapre
- DMU Neurosciences, Pitié-Salpêtrière Hospital, Paris, France
- Faculty of Medicine of Sorbonne University, INSERM, CNRS, Paris Brain Institute, Paris, France
| | | | - Marie-Christine Renaud
- Faculty of Medicine of Sorbonne University, INSERM, CNRS, Paris Brain Institute, Paris, France
| | - Agnès Dechartres
- Département de Santé Publique, Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Cyril Atkinson-Clement
- Faculty of Medicine of Sorbonne University, INSERM, CNRS, Paris Brain Institute, Paris, France
- Precision Imaging, School of Medicine, University of Nottingham, Nottingham, UK
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Madyavanhu N, Shekede MD, Kusangaya S, Pfukenyi DM, Chikerema S, Gwitira I. Bovine anaplasmosis in Zimbabwe: spatio-temporal distribution and environmental drivers. Vet Q 2024; 44:1-16. [PMID: 38279663 PMCID: PMC10823892 DOI: 10.1080/01652176.2024.2306210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 01/10/2024] [Indexed: 01/28/2024] Open
Abstract
Understanding the spatial and temporal distribution of Bovine anaplasmosis is crucial for identifying areas of high prevalence for targeted disease control. This research was aimed at modelling and mapping the B. anaplasmosis potential distribution, and identify hotspots as well as significant variables explaining the occurrence of the disease. The Getis Ord Gi* statistic for Hotspot analysis was used as well as MaxEnt ecological niche modelling. The effects of time, land-use, and agro-ecological regions on B. anaplasmosis occurrence were tested using Analysis of Variance (ANOVA). Results showed that several districts in Zimbabwe are suitable for the occurence of the disease for example Binga, Seke, Buhera, Kwekwe, Gweru, Mhondoro, Chegutu, Sanyati, and in the North: Mbire, Muzarabani, Mt Darwin, Shamva, Bindura, Zvimba and Makonde. Morbidity and mortality hotspots were detected in Gokwe-south, Kwekwe, and Chirumhanzu districts. Binga, Gokwe-south, Gutu, Hurungwe, Mazoe, Nkayi, Shamva, and Kwekwe districts also experienced high disease incidences. Temperature seasonality, precipitation seasonality, mean diurnal range, and isothermality were the most important variables in explaining 93% of B. anaplasmosis distribution. Unlike land-use and agro-ecological regions, time (months) had a significant effect on B. anaplasmosis occurrence with July and September having significantly (p < 0.05) higher cases and deaths than the rest of the months. The results of this study provide insights into the management strategies and control of B. anaplasmosis in Zimbabwe. It is thus concluded that geo-spatial techniques, combined with ecological niche modelling can provide useful insights into disease prevalence and distribution and hence can contribute to effective management and control of B. anaplasmosis in Zimbabwe.
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Affiliation(s)
- Natasher Madyavanhu
- Department of Geography Geospatial Sciences and Earth Observation, Faculty of Science, University of Zimbabwe, Harare, Zimbabwe
| | - Munyaradzi Davis Shekede
- Department of Geography Geospatial Sciences and Earth Observation, Faculty of Science, University of Zimbabwe, Harare, Zimbabwe
- Department of Geospatial Sciences and Earth Observation, Zimbabwe National Geospatial and Space Agency, Harare, Zimbabwe
| | - Samuel Kusangaya
- Department of Geography Geospatial Sciences and Earth Observation, Faculty of Science, University of Zimbabwe, Harare, Zimbabwe
| | - Davies Mubika Pfukenyi
- Department of Veterinary Sciences, Faculty of Animal and Veterinary Sciences, Botswana University of Agriculture and Natural Resources, Gaborone, Botswana
| | - Sylvester Chikerema
- Department of Clinical Veterinary Studies, University of Zimbabwe, Harare, Zimbabwe
| | - Isaiah Gwitira
- Department of Geography Geospatial Sciences and Earth Observation, Faculty of Science, University of Zimbabwe, Harare, Zimbabwe
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Ussher JM, Carpenter M, Power R, Ryan S, Allison K, Hart B, Hawkey A, Perz J. "I've had constant fears that I'll get cancer": the construction and experience of medical intervention on intersex bodies to reduce cancer risk. Int J Qual Stud Health Well-being 2024; 19:2356924. [PMID: 38796859 PMCID: PMC11134048 DOI: 10.1080/17482631.2024.2356924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 05/14/2024] [Indexed: 05/29/2024] Open
Abstract
PURPOSE This paper examines the subjective experience of medical interventions on intersex bodies to reduce cancer risk. METHODS Twenty-five individuals with intersex variations took part in semi-structured interviews, analysed through thematic discourse analysis. RESULTS Intersex bodies were positioned as inherently sick and in need of modification, with cancer risk legitimating surgical and hormonal intervention. This resulted in embodied shame, with negative impacts on fertility and sexual wellbeing. However, many participants resisted discourses of bio-pathologisation and embraced intersex status. Some medical interventions, such as HRT, were perceived to have increased the risk of cancer. Absence of informed consent, and lack of information about intersex status and the consequences of medical intervention, was positioned as a human rights violation. This was compounded by ongoing medical mismanagement, including health care professional lack of understanding of intersex variations, and the objectification or stigmatization of intersex people within healthcare. The consequence was non-disclosure of intersex status in health contexts and lack of trust in health care professionals. CONCLUSIONS The legitimacy of poorly-evidenced cancer risk discourses to justify medical intervention on intersex bodies needs to be challenged. Healthcare practitioners need to be provided with education and training about cultural safety practices for working with intersex people.
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Affiliation(s)
- Jane M. Ussher
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, Australia
| | - Morgan Carpenter
- Intersex Human Rights Australia, Sydney, Australia
- Faculty of Medicine and Health, Sydney Health Ethics, Sydney, Australia
| | - Rosalie Power
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, Australia
| | - Samantha Ryan
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, Australia
| | - Kimberley Allison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, Australia
| | - Bonnie Hart
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
| | - Alexandra Hawkey
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, Australia
| | - Janette Perz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, Australia
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Kalanlar B, Akkaya G. Nursing student's experiences of Role-Play Scenario-Based Disaster Triage (START) training: A qualitative research. NURSE EDUCATION TODAY 2024; 141:106307. [PMID: 39002414 DOI: 10.1016/j.nedt.2024.106307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 06/06/2024] [Accepted: 07/09/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Disasters can overwhelm healthcare systems, making effective triage a crucial skill for nurses. Role-Play Scenario-Based Disaster Triage Training offers a promising approach to prepare nursing students for these situations. Understanding students' experiences with this training method can inform its development and effectiveness in fostering disaster preparedness. However, little is known about this training experience of nursing students. In particular, by examining the challenges faced by students, the emotional distress they experience and their achievements, it will provide guidance for the development of education programs in a more comprehensive and student-oriented manner. AIM The aim of this study is to elucidate the experiences of nursing students regarding Role-Play Scenario-Based Disaster Triage Training. DESIGN AND METHODS A qualitative approach was employed to comprehend participating students' experiences. Face-to-face and online semi-structured interviews were conducted with 17 students using an interview guide, and the interactions were recorded for subsequent analysis. Thematic analysis was employed to develop themes. RESULTS The study results emphasize the challenges experienced by students during triage training, their gains and the support they need to cope with the challenges they experience. Data were organized around four main themes: "Challenges of the triage process" with subthemes such as "Thinking of the actual earthquake moment" and "Ethical dilemmas"; "Emotional turmoil" with subthemes including "Anxiety" and "Fear and Helplessness"; "Achievements" with subthemes such as "Increase in knowledge and skills" and "The importance of the nurse"; and "Suggestions" with subthemes including "Continuous education" and "Mandatory course". CONCLUSIONS The findings of the study provide new insights into the experiences of nursing students during the disaster triage process. The results may contribute to the improvement of future training programs by identifying the challenges and needs faced by nursing students after disaster triage education.
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Affiliation(s)
- Bilge Kalanlar
- Department of Public Health Nursing, Hacettepe University Faculty of Nursing Ankara, Turkey.
| | - Gülnur Akkaya
- Department of Nursing, Health Science Faculty Çanakkale Onsekiz Mart University, Turkey
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Joseph T, Jean Paul A, Francis A, Joseph O. Suspicion diagnostic of Hirschsprung's disease in an adult intraoperatively: A case report. Trauma Case Rep 2024; 53:101088. [PMID: 39183808 PMCID: PMC11342209 DOI: 10.1016/j.tcr.2024.101088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2024] [Indexed: 08/27/2024] Open
Abstract
Background Hirschsprung disease, a developmental disorder affecting the neuronal ganglion cells in distal colon, is the leading cause of intestinal obstruction in newborns, predominantly males, although the diagnosis can be made lately in rare cases. We describe an adult Hirschsprung disease case found intraoperatively. Case description He is a 20-year-old male patient with past medical history of epilepsy, psychomotor delay and recently a perineal perforating injury, admitted in the emergency room with initial diagnosis of peritonitis by perforated viscus with Frankel grad B spinal cord injury. Among his initial signs and symptoms were abdominal distension, rebound tenderness, decreased bowel sounds and diffuse pain. Laboratory tests revealed increased Hb, decreased white cells count and increased creatinine level. Initial management included: fluid resuscitation, analgesics, antibiotics and laxatives. After becoming hemodynamically unstable, the patient was introduced to the operating room where a highly dilated rectum with areas of necrosis at the base was discovered after access to the abdominal cavity. While doing the intervention, the patient experienced 3 cardiac arrests following by successful ressucitation and blood transfusion; leading to the decision to delay the definitive closure using the Bottega technique. The surgical course was unfavorable as the patient died around 4 hour post-surgery. Conclusion Hirschsprung disease in adult, due to its rarity and its overlapping features with many other conditions that can affect the GI system, can be misdiagnosed or discovered lately. A thorough evaluation by an appropriate specialist is essential for adequate diagnosis and management.
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Lingawi S, Hutton J, Khalili M, Dainty KN, Grunau B, Shadgan B, Christenson J, Kuo C. Wearable devices for out-of-hospital cardiac arrest: A population survey on the willingness to adhere. J Am Coll Emerg Physicians Open 2024; 5:e13268. [PMID: 39193083 PMCID: PMC11345495 DOI: 10.1002/emp2.13268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/19/2024] [Accepted: 07/18/2024] [Indexed: 08/29/2024] Open
Abstract
Objectives When an out-of-hospital cardiac arrest (OHCA) occurs, the first step in the chain of survival is detection. However, 75% of OHCAs are unwitnessed, representing the largest barrier to activating the chain of survival. Wearable devices have the potential to be "artificial bystanders," detecting OHCA and alerting 9-1-1. We sought to understand factors impacting users' willingness for continuous use of a wearable device through an online survey to inform future use of these systems for automated OHCA detection. Methods Data were collected from October 2022 to June 2023 through voluntary response sampling. The survey investigated user convenience and perception of urgency to understand design preferences and willingness to adhere to continuous wearable use across different hypothetical risk levels. Associations between categorical variables and willingness were evaluated through nonparametric tests. Logistic models were fit to evaluate the association between continuous variables and willingness at different hypothetical risk levels. Results The survey was completed by 359 participants. Participants preferred hand-based devices (wristbands: 87%, watches: 86%, rings: 62%) and prioritized comfort (94%), cost (83%), and size (72%). Participants were more willing to adhere at higher levels of hypothetical risk. At the baseline risk of 0.1%, older individuals with prior wearable use were most willing to adhere to continuous wearable use. Conclusion Individuals were willing to continuously wear wearable devices for OHCA detection, especially at increased hypothetical risk of OHCA. Optimizing willingness is not just a matter of adjusting for user preferences, but also increasing perception of urgency through awareness and education about OHCA.
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Affiliation(s)
- Saud Lingawi
- School of Biomedical EngineeringUniversity of British ColumbiaBritish ColumbiaCanada
- Centre for Aging SMARTBritish ColumbiaCanada
- British Columbia Resuscitation Research CollaborativeBritish ColumbiaCanada
| | - Jacob Hutton
- British Columbia Resuscitation Research CollaborativeBritish ColumbiaCanada
- Department of Emergency MedicineUniversity of British Columbia and St. Paul's HospitalBritish ColumbiaCanada
- British Columbia Emergency Health ServicesBritish ColumbiaCanada
- Centre for Advancing Health OutcomesBritish ColumbiaCanada
| | - Mahsa Khalili
- Centre for Aging SMARTBritish ColumbiaCanada
- British Columbia Resuscitation Research CollaborativeBritish ColumbiaCanada
- Department of Emergency MedicineUniversity of British Columbia and St. Paul's HospitalBritish ColumbiaCanada
- Centre for Advancing Health OutcomesBritish ColumbiaCanada
| | - Katie N. Dainty
- North York General HospitalOntarioCanada
- Institute of Health PolicyManagement and EvaluationUniversity of TorontoOntarioCanada
| | - Brian Grunau
- British Columbia Resuscitation Research CollaborativeBritish ColumbiaCanada
- Department of Emergency MedicineUniversity of British Columbia and St. Paul's HospitalBritish ColumbiaCanada
- British Columbia Emergency Health ServicesBritish ColumbiaCanada
- Centre for Advancing Health OutcomesBritish ColumbiaCanada
| | - Babak Shadgan
- School of Biomedical EngineeringUniversity of British ColumbiaBritish ColumbiaCanada
- British Columbia Resuscitation Research CollaborativeBritish ColumbiaCanada
- Department of OrthopaedicsUniversity of British ColumbiaBritish ColumbiaCanada
- International Collaboration on Repair DiscoveriesBritish ColumbiaCanada
| | - Jim Christenson
- British Columbia Resuscitation Research CollaborativeBritish ColumbiaCanada
- Department of Emergency MedicineUniversity of British Columbia and St. Paul's HospitalBritish ColumbiaCanada
- Centre for Advancing Health OutcomesBritish ColumbiaCanada
| | - Calvin Kuo
- School of Biomedical EngineeringUniversity of British ColumbiaBritish ColumbiaCanada
- Centre for Aging SMARTBritish ColumbiaCanada
- British Columbia Resuscitation Research CollaborativeBritish ColumbiaCanada
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Fechner R, Verhagen A, Alcock M, Norton J, Stubbs PW, Harrison LE, Pate JW. The Effectiveness of Pain Science Education on Caregiver and Children's Knowledge, Beliefs, Attitudes, and Behaviors-A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2024; 25:104578. [PMID: 38796130 DOI: 10.1016/j.jpain.2024.104578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/01/2024] [Accepted: 05/18/2024] [Indexed: 05/28/2024]
Abstract
Pain science education (PSE) can be used as part of treatment and prevention for chronic pain in children. We assessed the effectiveness of PSE on knowledge, beliefs, attitudes, and behaviors in children and the people that care for children. We set a minimum criterion for education to address pain biology knowledge. We included studies aimed at both treatment and prevention of chronic pain. We conducted searches using 5 databases. We assessed the risk of bias using the Cochrane Risk of Bias 2 tool. Data were pooled using a random-effects meta-analysis or assessed using a narrative synthesis. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation. We screened 14,505 records and included 7 studies involving 351 caregivers and 1,285 children. Four studies were included in meta-analyses. We found low-certainty evidence that PSE has a large beneficial effect on caregiver knowledge and beliefs compared with alternative education (standardized mean difference = 1.14 [95% confidence interval: .88-1.42]; I2 = 0%). We found no difference in functional disability in children with chronic pain after PSE (Functional Disability Inventory score mean difference = .73 [95% confidence interval: -.81 to 2.27; I = 0%]). Narrative syntheses showed low-certainty evidence for improved knowledge and beliefs in children with preventative and treatment effects. Overall, we found few studies, and along with high risk of bias, this significantly contributed to the low certainty of findings. The effect of learning pain science for both preventative and treatment effects in children, carers, and the child/carer dyad remains mostly unknown. This review was prospectively registered with The international Prospective register of systematic reviews (CRD42022344382) on July 22, 2022. PERSPECTIVE: This review examines the effect of PSE on pain-related knowledge, beliefs, attitudes, and behaviors in children and the people that care for children (0-18). The findings contribute to knowledge about pain treatments and health promotion for caregivers and their children with and without chronic pain.
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Affiliation(s)
- Rebecca Fechner
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia; QIPPPS Queensland Interdisciplinary Paediatric Persistent Pain Service, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia.
| | - Arianne Verhagen
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Mark Alcock
- QIPPPS Queensland Interdisciplinary Paediatric Persistent Pain Service, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Jennifer Norton
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Peter W Stubbs
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Lauren E Harrison
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Joshua W Pate
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Choi J, Hur DG, Tennakoon L, Spain DA, Staudenmayer K. The burden of readmissions after rib fractures among older adults. Surgery 2024; 176:955-960. [PMID: 38880698 DOI: 10.1016/j.surg.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 05/06/2024] [Accepted: 05/13/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND The index hospitalization morbidity and mortality of rib fractures among older adults (aged ≥65 years) is well-known, yet the burden and risks for readmissions after rib fractures in this vulnerable population remain understudied. We aimed to characterize the burdens and etiologies associated with 3-month readmissions among older adults who suffer rib fractures. We hypothesized that readmissions would be common and associated with modifiable etiologies. METHODS This survey-weighted retrospective study using the 2017 and 2019 National Readmissions Database evaluated adults aged ≥65 years hospitalized with multiple rib fractures and without major extrathoracic injuries. The main outcome was the proportion of patients experiencing all-cause 3-month readmissions. We assessed the 5 leading principal readmission diagnoses overall and delineated them by index hospitalization discharge disposition (home or facility). Sensitivity analysis using clinical classification categories characterized readmissions that could reasonably represent rib fracture-related sequelae. RESULTS In 2017, 25,092 patients met the inclusion criteria, with 20% (N = 4,894) experiencing 3-month readmissions. Six percent of patients did not survive their readmission. The 5 leading principal readmission diagnoses were sepsis (many associated with secondary diagnoses of pneumonia [41%] or urinary tract infections [41%]), hypertensive heart/kidney disease, hemothorax, pneumonia, and respiratory failure. In 2019, a comparable 3-month readmission rate of 23% and identical 5 leading diagnoses were found. Principal readmission diagnosis of hemothorax was associated with the shortest time to readmission (median [interquartile range]:9 [5-23] days). Among patients discharged home after index hospitalization, pleural effusion-possibly representing mischaracterized hemothorax-was among the leading principal readmission diagnoses. Some patients readmitted with a principal diagnosis of hemothorax or pleural effusion had these diagnoses at index hospitalization; a lower proportion of these patients underwent pleural fluid intervention during index hospitalization compared with readmission. On sensitivity analysis, 30% of 3-month readmissions were associated with principal diagnoses suggesting rib fracture-related sequelae. CONCLUSION Readmissions are not infrequent among older adults who suffer rib fractures, even in the absence of major extrathoracic injuries. Future studies should better characterize how specific complications associated with readmissions, such as pneumonia, urinary tract infections, and delayed hemothoraces, could be mitigated.
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Affiliation(s)
- Jeff Choi
- Department of Surgery, Stanford University, California; Department of Biomedical Data Science, School of Medicine, Stanford University, California.
| | - Dong Gi Hur
- School of Medicine, Stanford University, California
| | | | - David A Spain
- Department of Surgery, Stanford University, California. https://in.linkedin.com/DavidASpain
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Alzahrani A. LexArabic: A receptive vocabulary size test to estimate Arabic proficiency. Behav Res Methods 2024; 56:5529-5556. [PMID: 37964176 DOI: 10.3758/s13428-023-02286-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 11/16/2023]
Abstract
Arabic is understudied in second-language research (L2) and lacks rapid and adequate tools for measuring proficiency. Drawing inspiration from LexTALE and its extensions, this study created and validated a quick receptive vocabulary size test to estimate L2 Arabic proficiency. In Experiment 1, the initial version of LexArabic was designed and evaluated with 192 L1 and L2 speakers. Item analysis using point-biserial correlations and item response theory (IRT) was conducted to refine the test, resulting in a final version with 90 items (60 words, 30 nonwords). Experiment 2 assessed LexArabic reliability, validity, and accuracy using a new group of 260 L1 and L2 speakers. The validity of LexArabic was evaluated through objective tasks (a general Arabic proficiency test, L1 to L2 translation task, L2 to L1 translation task) as well as subjective tasks (self-rated proficiency). Results showed that LexArabic demonstrated good reliability (α > 90), validity (correlation with two objective tasks and one subjective task), as well as accuracy (AUC value = .88). The introduction of LexArabic has the potential to facilitate experimental research on both L1 and L2 Arabic speakers and contributes to the development of standardized L2 proficiency assessment across languages.
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Affiliation(s)
- Alaa Alzahrani
- Department of English, King Saud University, Riyadh, Saudi Arabia.
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De Mond J, Ghio M, Ritondale J, Butts C, McGrew P. Focused assessment with sonography for trauma exam for diagnosis of pericardial effusion in penetrating thoracic trauma - A retrospective review from a level 1 trauma center. Am J Surg 2024; 235:115788. [PMID: 38839437 DOI: 10.1016/j.amjsurg.2024.115788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/25/2024] [Accepted: 05/29/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION Point of care ultrasound has long been used in the trauma setting for rapid assessment and diagnosis of critically ill patients. Its utility for diagnosis of pericardial effusion in the setting of penetrating thoracic trauma has more recently been a topic of consideration, given the rapid decompensation that these patients can experience. OBJECTIVES This study aims to identify the diagnostic accuracy of point of care ultrasound in the diagnosis of pericardial effusion among patients with penetrating thoracic trauma. METHODS Retrospective review of 2099 patients brought to the trauma bay between the years 2016 and 2021 were analyzed for diagnosis of pericardial effusion. Patients who were diagnosed with a pericardial effusion were investigated for point of care ultrasound findings. Descriptive statistics were performed to identify sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS Prevalence was calculated to be 26.7 cases of pericardial effusion per 1000 patients presenting with penetrating thoracic trauma. Incidence was estimated to be 3.8 cases of pericardial effusion per 1000 person-years. Calculation of diagnostic capabilities of ED POCUS revealed a sensitivity of 96.36 %, a specificity of 100 %, PPV of 100 %, and NPV of 99.90 %. CONCLUSIONS Point of Care cardiac ultrasonography is a reliable tool for the rapid diagnosis of pericardial effusion in penetrating thoracic trauma patients. Patients with ultrasound suggestive of this condition should receive rapid surgical management to prevent decompensation.
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Affiliation(s)
- Jeffrey De Mond
- Tulane University School of Medicine, Department of Trauma and Acute Care Surgery, New Orleans, LA, USA
| | - Michael Ghio
- Tulane University School of Medicine, Department of Trauma and Acute Care Surgery, New Orleans, LA, USA
| | - Joseph Ritondale
- Tulane University School of Medicine, Department of Trauma and Acute Care Surgery, New Orleans, LA, USA
| | - Christine Butts
- Tulane University School of Medicine, Department of Trauma and Acute Care Surgery, New Orleans, LA, USA
| | - Patrick McGrew
- Tulane University School of Medicine, Department of Trauma and Acute Care Surgery, New Orleans, LA, USA.
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Chambers O, Eckhardt D, Jackson TE, Vincent A, Zapata I, Simon B. Development of a Novel, Reusable Task Trainer for Foreign Body Removal and Abscess Incision and Drainage. J Physician Assist Educ 2024; 35:237-242. [PMID: 38684090 DOI: 10.1097/jpa.0000000000000580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
INTRODUCTION Cutaneous abscess incision and drainage and foreign body removal are 2 common procedures in a variety of outpatient settings. The goal of this project was to create a novel, clean, reusable task trainer that could more accurately reproduce all the steps necessary to perform cutaneous abscess drainage or foreign body removal including ultrasound to identify the abscess cavity or foreign body. METHODS The novel task trainer was constructed using silicone for both the base and the top skin. Toothpaste mixed with saline was used for the abscess material as this produced an ultrasound image that mimicked purulent material. A piece of a metal paper clip was imbedded in the top skin to mimic a cutaneous foreign body. Physician assistant (PA) students given a didactic lecture then used the novel task trainer as part of a clinical skills course. RESULTS After the activity, the PA students were asked to voluntarily complete a brief preretrospective/postretrospective survey comprised 8 questions that addressed their self-perceived knowledge and skills using a 5-point Likert scale. Survey data from an initial cohort of PA students at one university show effectiveness of the models when used with the associated curriculum. DISCUSSION This study demonstrates the feasibility of constructing a practical, low-cost, non-animal-based task trainer for the purpose of training incision and drainage of cutaneous abscesses and removal of cutaneous foreign bodies. This novel task trainer allows for ultrasound skill development and provides realistic imaging experience.
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Affiliation(s)
- Orrin Chambers
- Orrin Chambers, OMS IV, is a principal investigator, Rocky Vista University, Englewood, Colorado
- David Eckhardt, MS, PA-C, is a faculty advisor, Department of Physician Assistant Studies, Rocky Vista University, Englewood, Colorado
- Thomas E. Jackson, III, BA, is a research associate, Office of Simulation in Medicine and Surgery, Rocky Vista University, Englewood, Colorado
- Apolline Vincent, OMS II, is a research associate, Rocky Vista University, Englewood, Colorado
- Isain Zapata, PhD, is a statistician, Department of Biomedical Sciences, Rocky Vista University, Englewood, Colorado
- Bradley Simon, MD, FACEP, is a faculty advisor, Office of Simulation in Medicine and Surgery, Rocky Vista University, Englewood, Colorado
| | - David Eckhardt
- Orrin Chambers, OMS IV, is a principal investigator, Rocky Vista University, Englewood, Colorado
- David Eckhardt, MS, PA-C, is a faculty advisor, Department of Physician Assistant Studies, Rocky Vista University, Englewood, Colorado
- Thomas E. Jackson, III, BA, is a research associate, Office of Simulation in Medicine and Surgery, Rocky Vista University, Englewood, Colorado
- Apolline Vincent, OMS II, is a research associate, Rocky Vista University, Englewood, Colorado
- Isain Zapata, PhD, is a statistician, Department of Biomedical Sciences, Rocky Vista University, Englewood, Colorado
- Bradley Simon, MD, FACEP, is a faculty advisor, Office of Simulation in Medicine and Surgery, Rocky Vista University, Englewood, Colorado
| | - Thomas E Jackson
- Orrin Chambers, OMS IV, is a principal investigator, Rocky Vista University, Englewood, Colorado
- David Eckhardt, MS, PA-C, is a faculty advisor, Department of Physician Assistant Studies, Rocky Vista University, Englewood, Colorado
- Thomas E. Jackson, III, BA, is a research associate, Office of Simulation in Medicine and Surgery, Rocky Vista University, Englewood, Colorado
- Apolline Vincent, OMS II, is a research associate, Rocky Vista University, Englewood, Colorado
- Isain Zapata, PhD, is a statistician, Department of Biomedical Sciences, Rocky Vista University, Englewood, Colorado
- Bradley Simon, MD, FACEP, is a faculty advisor, Office of Simulation in Medicine and Surgery, Rocky Vista University, Englewood, Colorado
| | - Apolline Vincent
- Orrin Chambers, OMS IV, is a principal investigator, Rocky Vista University, Englewood, Colorado
- David Eckhardt, MS, PA-C, is a faculty advisor, Department of Physician Assistant Studies, Rocky Vista University, Englewood, Colorado
- Thomas E. Jackson, III, BA, is a research associate, Office of Simulation in Medicine and Surgery, Rocky Vista University, Englewood, Colorado
- Apolline Vincent, OMS II, is a research associate, Rocky Vista University, Englewood, Colorado
- Isain Zapata, PhD, is a statistician, Department of Biomedical Sciences, Rocky Vista University, Englewood, Colorado
- Bradley Simon, MD, FACEP, is a faculty advisor, Office of Simulation in Medicine and Surgery, Rocky Vista University, Englewood, Colorado
| | - Isain Zapata
- Orrin Chambers, OMS IV, is a principal investigator, Rocky Vista University, Englewood, Colorado
- David Eckhardt, MS, PA-C, is a faculty advisor, Department of Physician Assistant Studies, Rocky Vista University, Englewood, Colorado
- Thomas E. Jackson, III, BA, is a research associate, Office of Simulation in Medicine and Surgery, Rocky Vista University, Englewood, Colorado
- Apolline Vincent, OMS II, is a research associate, Rocky Vista University, Englewood, Colorado
- Isain Zapata, PhD, is a statistician, Department of Biomedical Sciences, Rocky Vista University, Englewood, Colorado
- Bradley Simon, MD, FACEP, is a faculty advisor, Office of Simulation in Medicine and Surgery, Rocky Vista University, Englewood, Colorado
| | - Bradley Simon
- Orrin Chambers, OMS IV, is a principal investigator, Rocky Vista University, Englewood, Colorado
- David Eckhardt, MS, PA-C, is a faculty advisor, Department of Physician Assistant Studies, Rocky Vista University, Englewood, Colorado
- Thomas E. Jackson, III, BA, is a research associate, Office of Simulation in Medicine and Surgery, Rocky Vista University, Englewood, Colorado
- Apolline Vincent, OMS II, is a research associate, Rocky Vista University, Englewood, Colorado
- Isain Zapata, PhD, is a statistician, Department of Biomedical Sciences, Rocky Vista University, Englewood, Colorado
- Bradley Simon, MD, FACEP, is a faculty advisor, Office of Simulation in Medicine and Surgery, Rocky Vista University, Englewood, Colorado
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12
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Gouveri E, Gkouveri A, Popovic DS, Papazoglou D, Papanas N. Intentional Insulin Overdose and Depression in Subjects with and Without Diabetes Mellitus: A Commentary. Diabetes Ther 2024; 15:1845-1854. [PMID: 39046697 PMCID: PMC11330432 DOI: 10.1007/s13300-024-01623-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 07/09/2024] [Indexed: 07/25/2024] Open
Abstract
Insulin is an essential medication for people with type 1 diabetes mellitus and for some people with type 2 diabetes. Interestingly, insulin abuse has been reported as a mode of suicide, not only among people with diabetes, but also among their relatives, and among medical and paramedical personnel who have access to insulin. The aim of the present commentary was to raise awareness of potential depression-related intentional insulin overdose and its complications, as well as of the diagnosis and treatment of this entity. Insulin overdose may lead to severe and prolonged hypoglycemia, hypoglycemic coma, and death. Moreover, hypokalemia, hypomagnesemia, hypophosphatemia, and elevated liver enzymes are common. Insulin overdose should be suspected among people with diabetes in case of unexplained prolonged hypoglycemia and among people without diabetes who exhibit hypoglycemia and may have access to diabetic medications. The ratio of insulin to C-peptide helps distinguish exogenous insulin administration from endogenous secretion. The cornerstone of therapy is prompt administration of concentrated glucose infusions for days with simultaneous oral intake, when possible, and intense glucose monitoring to prevent hypoglycemia. Moreover, monitoring of serum electrolyte levels is recommended. Finally, psychiatric evaluation aiming at early identification of depression and suicidality is of paramount importance.
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Affiliation(s)
- Evanthia Gouveri
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, 68100, Alexandroupolis, Greece
| | | | - Djordje S Popovic
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Vojvodina, Novi Sad, Serbia
- Medical Faculty, University of Novi Sad, Novi Sad, Serbia
| | - Dimitrios Papazoglou
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, 68100, Alexandroupolis, Greece
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, 68100, Alexandroupolis, Greece.
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13
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Monteiro S, Acai A, Kahlke R, Chan TM, Sukhera J. Shifting paradigms: A collective and structural strategy for addressing healthcare inequity. J Eval Clin Pract 2024; 30:887-893. [PMID: 38853452 DOI: 10.1111/jep.14013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/04/2024] [Accepted: 04/28/2024] [Indexed: 06/11/2024]
Abstract
Healthcare inequity is a persistent systemic problem, yet many solutions have historically focused on "debiasing" individuals. Individualistic strategies fit within a competency-based medical education and assessment paradigm, whereby professional values of social accountability, patient safety, and healthcare equity are linked to an individual clinician's competence. Unfortunately, efforts to realise the conceptual linkages between medical education curricula and goals to improve healthcare equity fail to address the institutional values, policies, and practices that enable structural racism. In this article, we explore alternative approaches that target collective and structural causes of health inequity. We first describe the structural basis of healthcare inequity by identifying the ways in which institutional culture, power and privilege erode patient-centred care and contribute to epistemic injustice. We then outline some reasons that stereotypes, which are a culturally supported foundation for discrimination, bias and racism in healthcare, cannot be modified effectively through individualistic strategies or education curricula. Finally, we propose a model that centres shared values for leadership by individuals and institutions with consistency in goal setting, knowledge translation, and talent development. Figure 1 summarises the key recommendations. We have provided cases to supplement this work and facilitate discussion about the model's application to practice.
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Affiliation(s)
- Sandra Monteiro
- Division of Education and Innovation, Department of Medicine, McMaster Education Research, Innovation and Theory (MERIT) Program, McMaster University, Ontario, Hamilton, Canada
| | - Anita Acai
- Department of Psychiatry and Behavioural Neurosciences, McMaster Education Research, Innovation and Theory (MERIT) Program, McMaster University, Ontario, Hamilton, Canada
- St. Joseph's Education Research Centre (SERC), St. Joseph's Healthcare Hamilton, Ontario, Hamilton, Canada
| | - Renate Kahlke
- Division of Education and Innovation, Department of Medicine, McMaster Education Research, Innovation and Theory (MERIT) Program, McMaster University, Hamilton, Ontario, Canada
| | - Teresa M Chan
- Division of Emergency/Division of Education & Innovation, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Faculty of Health Sciences, Office of Continuing Professional Development, McMaster University, Ontario, Hamilton, Canada
| | - Javeed Sukhera
- Hartford Hospital/Institute of Living, Hartford, Connecticut, USA
- Department of Psychiatry, Yale University School of Medicine, Connecticut, New Haven, USA
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14
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Yamada H, Ohara T, Abe Y, Iwano H, Onishi T, Katabami K, Takigiku K, Tada A, Tanigushi H, Mihara H, Yamamoto T, Maeda K, Wada Y. Guidance for performance, utilization, and education of cardiac and lung point-of-care ultrasonography from the Japanese Society of Echocardiography. J Echocardiogr 2024; 22:113-151. [PMID: 38722468 DOI: 10.1007/s12574-024-00649-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 08/24/2024]
Abstract
In recent years, bedside ultrasound examinations have been used in many clinical departments and are called point-of-care ultrasound (POCUS). Regarding POCUS in the cardiac field, a protocol called focus (focused) cardiac ultrasound (FoCUS) has been developed in Europe and the United States, is being used clinically, and an educational syllabus has been created. According to them, FoCUS is defined as a point-of-care cardiac ultrasound examination using standardized limited sections and protocols. FoCUS is primarily intended to be performed by non-cardiologists, and in order to avoid making mistakes in judgment, it is important to be familiar with its limitations and it is necessary to understand pathological conditions that can only be diagnosed using conventional comprehensive echocardiography. The Japanese Society of Echocardiography has edited this clinical guideline because we believe that FoCUS should be used effectively and appropriately in Japan, and that appropriate education is essential to popularize FoCUS in Japan. Furthermore, lung POCUS has recently come into clinical use. Lung POCUS is useful for the diagnosis and follow-up of heart failure when used in conjunction with FoCUS, and is especially useful in primary care where chest X-rays are not available. The working group that created this manual agreed that it is desirable to educate patients about lung POCUS in conjunction with FoCUS, so we decided to include the basic techniques of lung POCUS and how to use them in this manuscript.
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Affiliation(s)
- Hirotsugu Yamada
- Community Medicine for Cardiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.
| | - Takahiro Ohara
- Division of Geriatric and Community Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Yukio Abe
- Cardiovascular Medicine, Cardiovascular Center, Osaka City General Hospital, Osaka, Japan
| | - Hiroyuki Iwano
- Division of Cardiology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Tetsuari Onishi
- Cardiovascular Medicine, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Japan
| | - Kenichi Katabami
- Department of Emergency Medicine, Hokkaido University Hospital, Sapporo, Japan
| | | | - Akira Tada
- Department of Internal Medicine, National Health Insurance Kuniyoshi/Hasekebara Clinic, Nara, Japan
| | - Hayato Tanigushi
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan
| | | | - Takeshi Yamamoto
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Nippon, Japan
| | - Ken Maeda
- Department of Nursing, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Yasuaki Wada
- Cardiovascular Medicine, Nagoya City University East Medical Center, Nagoya, Japan
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15
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Yücel Özden KB, Sarıca Çevik H, Asenova R, Ungan M. Guardians of health under fire: Understanding and combating violence against doctors. Aten Primaria 2024; 56:102944. [PMID: 38678853 PMCID: PMC11066614 DOI: 10.1016/j.aprim.2024.102944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 05/01/2024] Open
Abstract
Violence against physicians is not a newly emerged but an increasingly serious problem. Various studies have reported a prevalence of up to 90%. If not prevented, it not only causes physical and mental harm to physicians who are dedicated to serving humanity but also affects the entire healthcare system and, consequently, the whole community with its direct and indirect effects. Some interventions have a positive outcome when effectively managed. However, for these interventions to be permanent and effective, they need to be multidisciplinary, legally backed and adopted as public policy. In this article, the prevalence of violence against physicians in the literature, its causes, practices worldwide, and suggestions for solving this problem are compiled.
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Affiliation(s)
| | - Hüsna Sarıca Çevik
- Ankara University School of Medicine, Department of Family Medicine, Ankara, Turkey.
| | - Radost Asenova
- Medical University of Plovdiv, Department of Urology and General Medicine, Plovdiv, Bulgaria
| | - Mehmet Ungan
- Ankara University School of Medicine, Department of Family Medicine, Ankara, Turkey
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16
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Marshall S, Ryan E, Rivera J, Reynolds L, Atti S. GLP-1 Receptor Agonist Exposures Are Increasingly Common and Generally Associated with Mild Symptoms: A Single Poison Center Experience. J Med Toxicol 2024; 20:278-285. [PMID: 38861153 PMCID: PMC11288212 DOI: 10.1007/s13181-024-01008-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 06/12/2024] Open
Abstract
INTRODUCTION Glucagon-like peptide-1 receptor agonist use has increased over the last decade for glycemic control in type 2 diabetes mellitus, cardiovascular risk reduction, and weight loss. Clinical trials indicate that gastrointestinal adverse effects are commonly experienced and severe hypoglycemia is rare; however, there is little data regarding glucagon-like peptide-1 receptor agonist in overdose. METHODS We performed a retrospective chart review evaluating and characterizing glucagon-like peptide-1 receptor agonist exposures reported to a single poison center between 2006 and 2023. Patient demographics, circumstances of exposure, clinical effects, and outcomes were abstracted from charts. Descriptive statistics were utilized to summarize demographic information and clinical factor data. RESULTS A total of 152 charts met inclusion criteria. Therapeutic errors accounted for 91% of exposures. Most patients (67%) reported no symptoms, although not all patients were followed to a definitive outcome. Nausea, vomiting, generalized weakness, and abdominal pain were the predominant symptoms reported. Most patients (62%) were monitored and closely followed in the home setting. Hypoglycemia was rare but occurred in the setting of a single agent glucagon-like peptide-1 receptor agonist exposure in two patients. Two additional patients who developed hypoglycemia involved co-administration of insulin. 21% of the exposures were related to errors on initial use of the pen. CONCLUSION Exposures to glucagon-like peptide-1 receptor agonist have increased substantially over the years. Effects from an exposure tended to be mild and primarily involve gastrointestinal symptoms. Hypoglycemia was rare. Therapeutic and administration errors were common. Education on pen administration may help to reduce errors.
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Affiliation(s)
- Stacy Marshall
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States.
- Alabama Poison Information Center, Children's of Alabama, Birmingham, Alabama, United States.
| | - Erin Ryan
- Department of Pharmacy Practice, University of Illinois Chicago, Chicago, Illinois, United States
| | - Jessica Rivera
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Alabama Poison Information Center, Children's of Alabama, Birmingham, Alabama, United States
| | - Lindy Reynolds
- School of Public Health, University of Alabama at Birmingham, 203 General Service Building 521 19th Street South, Birmingham, AL, 35233, United States
| | - Suhkshant Atti
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Alabama Poison Information Center, Children's of Alabama, Birmingham, Alabama, United States
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Martín-Miguel MV, Delgado-Martín MV, Barreiro-Arceiz C, Goicoechea-Castaño A, Rodríguez-Pastoriza S, González-Formoso C, Fernández-Pérez M, García-Cendón C, Roca J, Clavería A. BODYFAT: a new calculator to determine the risk of being overweight validated in Spanish children between 11 and 17 years of age. Eur J Pediatr 2024; 183:3885-3895. [PMID: 38896274 PMCID: PMC11322224 DOI: 10.1007/s00431-024-05596-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/27/2024] [Accepted: 05/02/2024] [Indexed: 06/21/2024]
Abstract
The assessment of body fat of children in primary care requires consideration of the dynamic changes in height, weight, lean mass, and fat mass during childhood growth. To achieve this, we aim to develop a predictive equation based on anthropometric values, with optimal diagnostic utility. This is a cross-sectional observational study, involving schoolgoers aged 11-17 years in the Vigo metropolitan area. Out of 10,747 individuals, 577 were randomly recruited. VARIABLES age, sex, ethnicity/country of origin, weight, height, 8 skinfolds, 3 diameters, 7 perimeters, and 85% percentile of body fat mass as the gold standard. Generalized additive regression was selected by cross-validation and compared using receiver operating characteristic curves (ROC curves). Sensitivity, specificity, positive and negative predictive values, true positive and true negative values, false positive and false negative values, accuracy, and positive and negative likelihood ratios were calculated. Two models were identified. The optimal model includes sex, weight, height, leg perimeter, and arm perimeter, with sensitivity of 0.93 (0.83-1.00), specificity of 0.91 (0.83-0.96), accuracy of 0.91 (0.84-0.96), and area under the curve (AUC) of 0.957 (0.928-0.986). The second model includes sex, age, and body mass index, with sensitivity of 0.93 (0.81-1.00), specificity of 0.90 (0.80-0.97), accuracy of 0.90 (0.82-0.96), and an AUC of 0.944 (0.903-0.984). CONCLUSION Two predictive models, with the 85th percentile of fat mass as the gold standard, built with basic anthropometric measures, show very high diagnostic utility parameters. Their calculation is facilitated by a complementary online calculator. WHAT IS KNOWN • In routine clinical practice, mainly in primary care, BMI is used to determine overweight and obesity. This index has its weaknesses in the assessment of children. WHAT IS NEW • We provide a calculator whose validated algorithm, through the determination of fat mass by impedanciometry, makes it possible to determine the risk of overweight and obesity in the community setting, through anthropometric measurements, providing a new practical, accessible and reliable model that improves the classification of overweight and obesity in children with respect to that obtained by determining BMI.
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Affiliation(s)
- María Victoria Martín-Miguel
- Vigo Family and Community Medicine and Nursing Teaching Unit, Health Area of Vigo, SERGAS, Vigo, Spain
- I-Saúde Group, South Galicia Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur), SERGAS-UVIGO, Vigo, Spain
- Research Netwpork in Chronicity, Primary Care and Health Promotion (Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud/RICAPPS), Vigo, Spain
| | - María Victoria Delgado-Martín
- Moaña Health Center, SERGAS, Vigo Area, Vigo, Spain.
- I-Saúde Group, South Galicia Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur), SERGAS-UVIGO, Vigo, Spain.
- Research Netwpork in Chronicity, Primary Care and Health Promotion (Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud/RICAPPS), Vigo, Spain.
| | | | - Ana Goicoechea-Castaño
- Sárdoma Health Center, SERGAS, Vigo Area, Vigo, Spain
- I-Saúde Group, South Galicia Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Sara Rodríguez-Pastoriza
- I-Saúde Group, South Galicia Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Clara González-Formoso
- I-Saúde Group, South Galicia Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur), SERGAS-UVIGO, Vigo, Spain
- Ponteareas Health Center, SERGAS, Vigo Area, Vigo, Spain
- Research Netwpork in Chronicity, Primary Care and Health Promotion (Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud/RICAPPS), Vigo, Spain
| | - Martín Fernández-Pérez
- I-Saúde Group, South Galicia Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Clara García-Cendón
- I-Saúde Group, South Galicia Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur), SERGAS-UVIGO, Vigo, Spain
- Val Miñor Health Center, SERGAS, Vigo Area, Vigo, Spain
| | - Javier Roca
- Galician Research and Mathematical Technology Center (Centro de Investigación e Tecnoloxía Matemática de Galicia/CITMAga) & Department of Statistics and Operations Research, University of Vigo, Vigo, Spain
- Research Netwpork in Chronicity, Primary Care and Health Promotion (Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud/RICAPPS), Vigo, Spain
| | - Ana Clavería
- I-Saúde Group, South Galicia Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur), SERGAS-UVIGO, Vigo, Spain
- Research Netwpork in Chronicity, Primary Care and Health Promotion (Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud/RICAPPS), Vigo, Spain
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18
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Biggs O, Taljaard L, Van Hoving DJ, Rugunanan M. The utilisation of emergency point-of-care ultrasound in a tertiary hospital emergency department in East London, South Africa. Afr J Emerg Med 2024; 14:135-140. [PMID: 38948012 PMCID: PMC11214390 DOI: 10.1016/j.afjem.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 05/16/2024] [Accepted: 05/19/2024] [Indexed: 07/02/2024] Open
Abstract
Introduction Emergency departments are the primary entry point for emergencies in the public healthcare system. Resource constraints burden a large proportion of the public hospital emergency departments, which includes limited access to radiological services. Emergency point-of-care ultrasound provides a tool capable of bridging this gap. The Eastern Cape is yet to describe the utilisation of emergency point-of-care ultrasound in any of its emergency departments. Methods Frere Hospital initiated a clinical audit to assess the utilisation of emergency point-of-care ultrasound in its emergency department in 2022. This study was a retrospective review of the audit between 01 November 2022 until 28 February 2023. Data from the handwritten register regarding patient's presenting complaints and provisional diagnoses was also captured during the study period to draw comparisons between burden of disease and use of emergency point-of-care ultrasound. Results A total of 9501 patients attended Frere Hospital's emergency department over the study period with 492 emergency point-of-care ultrasounds performed (overall utilisation rate 5.2 %). The five credentialed emergency point-of-care ultrasound providers performed the majority (n = 360, 73.2 %) of the applications, compared to 132 (26.8 %) performed by the seven non-credentialed providers. The extended focused abdominal sonography in trauma (eFAST) was the most frequently performed application (n = 140, 28.5 %). Conclusion Emergency point-of-care ultrasound is underutilised in Frere Hospital's emergency department. The varied casemix requires upskilling of clinicians in emergency point-of-care ultrasound to suit the burden of disease experienced in the department. Ongoing emergency point-of-care ultrasound training, credentialing and research is important to ensure appropriate and quality emergency point-of-care ultrasound utilisation.
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Affiliation(s)
- Oscar Biggs
- Frere Hospital Department of Emergency Medicine, East London, South Africa
| | - Luan Taljaard
- Frere Hospital Department of Emergency Medicine, East London, South Africa
| | | | - Meeren Rugunanan
- Frere Hospital Department of Emergency Medicine, East London, South Africa
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Hammami MB, Qasim A, Thakur R, Vegivinti CTR, Patton CD, Vikash S, Kumar A. Rasburicase-induced hemolytic anemia and methemoglobinemia: a systematic review of current reports. Ann Hematol 2024; 103:3399-3411. [PMID: 37468669 DOI: 10.1007/s00277-023-05364-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/09/2023] [Indexed: 07/21/2023]
Abstract
Since the FDA's approval of rasburicase use for treatment of tumor lysis syndrome (TLS), multiple cases of rasburicase-induced methemoglobinemia and hemolytic anemia have been reported among patients with G6PD deficiency. This study aims to provide a systematic review of cases reporting such adverse reactions to rasburicase. A literature review of published cases in PubMed, Embase, Cochrane, and Web of Science was conducted. Descriptive studies reporting cases of rasburicase-induced methemoglobinemia and/or hemolytic anemia in English were analyzed and summarized in this study. Forty-three cases, including a case from our institution, were included in this study. Most cases (60.5%) received rasburicase for TLS treatment. Almost all patients (93.8%) were tested for G6PD after rasburicase administration. The median time to symptom onset was 24 h. The median methemoglobin level was 10%, peaking after a median of 24 h. The median hemoglobin nadir was 6.1 g/dL, and most patients (n = 32) required blood transfusion. Out of 39 cases with reported outcomes, 35 patients (89.7%) recovered, while four patients (three females and one male) died. The median time to recovery was 4.5 days while the median time to death was 8 days. Screening for G6PD deficiency among high-risk patients is important but not practical in acutely severe settings. When prior screening for G6PD deficiency is not feasible, close monitoring for methemoglobinemia and hemolytic anemia is recommended. Exchange transfusion is increasingly reported as a potentially successful therapeutic modality. Ascorbic acid may provide limited benefits. Methylene blue should be avoided as it may exacerbate hemolysis among these patients.
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Affiliation(s)
- M Bakri Hammami
- Department of Medicine, Albert Einstein College of Medicine/Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY, USA.
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Asma Qasim
- Department of Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Rahul Thakur
- Department of Medicine, Albert Einstein College of Medicine/Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY, USA
| | - Charan Thej Reddy Vegivinti
- Department of Medicine, Albert Einstein College of Medicine/Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY, USA
- Department of Oncology, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Sindhu Vikash
- Department of Medicine, Albert Einstein College of Medicine/Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY, USA
| | - Abhishek Kumar
- Department of Hematology and Medical Oncology, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, NY, USA
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Smith LE, Martin AF, Brooks SK, Davies R, Stein MV, Amlôt R, Marteau TM, Rubin GJ. Measuring and increasing rates of self-isolation in the context of COVID-19: a systematic review with narrative synthesis. Public Health 2024; 234:224-235. [PMID: 38972797 DOI: 10.1016/j.puhe.2024.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/24/2024] [Accepted: 05/24/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVES This study aimed to investigate (1) definitions of self-isolation used during the COVID-19 pandemic; (2) measures used to quantify adherence and their reliability, validity, and acceptability; (3) rates of self-isolation adherence; and (4) factors associated with adherence. STUDY DESIGN This was a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Synthesis Without Meta-analysis (PRISMA) guidelines (PROSPERO record CRD42022377820). METHODS MEDLINE, PsycINFO, Embase, Web of Science, PsyArXiv, medRxiv, and grey literature sources were searched (1 January 2020 to 13 December 2022) using terms related to COVID-19, isolation, and adherence. Studies were included if they contained original, quantitative data of self-isolation adherence during the COVID-19 pandemic. We extracted definitions of self-isolation, measures used to quantify adherence, adherence rates, and factors associated with adherence. RESULTS We included 45 studies. Self-isolation was inconsistently defined. Four studies did not use self-report measures. Of 41 studies using self-report, one reported reliability; another gave indirect evidence for the lack of validity of the measure. Rates of adherence to self-isolation for studies with only some concerns of bias were 51%-86% for COVID-19 cases, 78%-94% for contacts, and 16% for people with COVID-19-like symptoms. There was little evidence that self-isolation adherence was associated with sociodemographic or psychological factors. CONCLUSIONS There was no consensus in defining, operationalising, or measuring self-isolation, resulting in significant risk of bias in included studies. Future definitions of self-isolation should state behaviours to be enacted and duration. People recommended to self-isolate should be given support. Public health campaigns should aim to increase perceived effectiveness of self-isolation and promote accurate information about susceptibility to infection.
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Affiliation(s)
- L E Smith
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, United Kingdom; NIHR Health Protection Research Unit in Emergency Preparedness and Response, United Kingdom; UK Health Security Agency, Behavioural Science and Insights Unit, United Kingdom.
| | - A F Martin
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, United Kingdom; NIHR Health Protection Research Unit in Emergency Preparedness and Response, United Kingdom
| | - S K Brooks
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, United Kingdom; NIHR Health Protection Research Unit in Emergency Preparedness and Response, United Kingdom
| | - R Davies
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, United Kingdom; NIHR Health Protection Research Unit in Emergency Preparedness and Response, United Kingdom
| | - M V Stein
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, United Kingdom; Department of Psychology, King's College London, United Kingdom
| | - R Amlôt
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, United Kingdom; UK Health Security Agency, Behavioural Science and Insights Unit, United Kingdom
| | - T M Marteau
- University of Cambridge, Department of Public Health and Primary Care, United Kingdom
| | - G J Rubin
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, United Kingdom; NIHR Health Protection Research Unit in Emergency Preparedness and Response, United Kingdom
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21
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Ionescu L, Morariu PC, Dascălu CG, Iov DE, Oancea AF, Chiriac CP, Sîrbu O, Timofte DV, Rezuş C, Șorodoc L, Şorodoc V, Baroi GL, Tanase DM, Floria M. Accidental hypothermia in the largest emergency hospital in North-Eastern Romania. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2024; 62:295-306. [PMID: 38470364 DOI: 10.2478/rjim-2024-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Accidental hypothermia (AH) presents a significant mortality risk, even in individuals with good health. Early recognition of the parameters associated with negative prognosis could save more lives. METHODS This was a pilot, retrospective observational study, conducted in the largest Emergency Hospital in North Eastern Romania, which included all patients with AH (defined as body temperature below 35°C), hospitalized and treated in our hospital between 2019 and 2022. RESULTS A total of 104 patients with AH were included in our study, 90 of whom had data collected and statistically analyzed. The clinical, biological, and therapeutic parameters associated with negative outcomes were represented by a reduced GCS score (p=0.024), diminished systolic and diastolic blood pressure (p=0.007 respectively, 0.013), decreased bicarbonate (p=0.043) and hemoglobin levels (p=0.002), the presence of coagulation disorders (p=0.007), as well as the need for administration of inotropic or vasopressor medications (p=0.04). CONCLUSION In this pilot, retrospective, observational study, the negative outcomes observed in patients with AH hospitalized in the largest Emergency Hospital in North-Eastern Romania were associated with several clinical, biochemical, and therapeutic factors, which are easy to identify in clinical practice. Recognizing the significance of these associated factors empowers healthcare practitioners to intervene at an early stage to save more lives.
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Affiliation(s)
- Lidia Ionescu
- 1University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
- 2Surgery Clinic, "Sfântul Spiridon" Emergency Hospital, 700111 Iasi, Romania
| | - Paula Cristina Morariu
- 1University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
- 3Medical Clinic, "Sfântul Spiridon" Emergency Hospital 700111 Iasi, Romania
| | - Cristina Gena Dascălu
- 1University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
- 4Department of Medical Informatics and Biostatistics; University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
| | - Diana Elena Iov
- 1University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
- 3Medical Clinic, "Sfântul Spiridon" Emergency Hospital 700111 Iasi, Romania
| | - Alexandru Florinel Oancea
- 1University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
- 5Cardiology Clinic, "Sfântul Spiridon" Emergency Hospital, 700111 Iasi, Romania
| | - Cristina Petronela Chiriac
- 1University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
- 3Medical Clinic, "Sfântul Spiridon" Emergency Hospital 700111 Iasi, Romania
| | - Oana Sîrbu
- 1University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
- 3Medical Clinic, "Sfântul Spiridon" Emergency Hospital 700111 Iasi, Romania
| | - Daniel Vasile Timofte
- 1University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
- 2Surgery Clinic, "Sfântul Spiridon" Emergency Hospital, 700111 Iasi, Romania
| | - Ciprian Rezuş
- 1University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
- 3Medical Clinic, "Sfântul Spiridon" Emergency Hospital 700111 Iasi, Romania
| | - Laurenţiu Șorodoc
- 1University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
- 3Medical Clinic, "Sfântul Spiridon" Emergency Hospital 700111 Iasi, Romania
| | - Victoriţa Şorodoc
- 1University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
- 3Medical Clinic, "Sfântul Spiridon" Emergency Hospital 700111 Iasi, Romania
| | - Genoveva Livia Baroi
- 1University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
- 2Surgery Clinic, "Sfântul Spiridon" Emergency Hospital, 700111 Iasi, Romania
| | - Daniela Maria Tanase
- 1University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
- 3Medical Clinic, "Sfântul Spiridon" Emergency Hospital 700111 Iasi, Romania
| | - Mariana Floria
- 1University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
- 3Medical Clinic, "Sfântul Spiridon" Emergency Hospital 700111 Iasi, Romania
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22
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Zhang Y, Stayt L, Sutherland S, Greenway K. How clinicians make decisions for patient management plans in telehealth. J Adv Nurs 2024; 80:3516-3532. [PMID: 38380577 DOI: 10.1111/jan.16104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Abstract
AIM This systematic integrative literature review explores how clinicians make decisions for patient management plans in telehealth. BACKGROUND Telehealth is a modality of care that has gained popularity due to the development of digital technology and the COVID-19 pandemic. It is recognized that telehealth, compared to traditional clinical settings, carries a higher risk to patients due to its virtual characteristics. Even though the landscape of healthcare service is increasingly moving towards virtual systems, the decision-making process in telehealth remains not fully understood. DESIGN A systematic integrative review. DATA SOURCES Databases include CINAHL, APA PsycInfo, Academic Search Complete, PubMed, Web of Science and Google Scholar. REVIEW METHODS This systematic integrative review method was informed by Whittemore and Knafl (2005). The databases were initially searched with keywords in November 2022 and then repeated in October 2023. Thematic synthesis was conducted to analyse and synthesize the data. RESULTS The search identified 382 articles. After screening, only 10 articles met the eligibility criteria and were included. Five studies were qualitative, one quantitative and four were mixed methods. Five main themes relevant to decision-making processes in telehealth were identified: characteristics of decision-making in telehealth, patient factor, clinician factor, CDSS factor and external influencing factor. CONCLUSIONS The decision-making process in telehealth is a complicated cognitive process influenced by multi-faceted components, including patient factors, clinician factors, external influencing factors and technological factors. IMPACT Telehealth carries higher risk and uncertainty than face-to-face encounters. CDSS, rather than bringing unification and clarity, seems to bring more divergence and ambiguity. Some of the clinical reasoning processes in telehealth remain unknown and need to be verbalized and made transparent, to prepare junior clinicians with skills to minimize risks associated with telehealth. PATIENT OR PUBLIC CONTRIBUTION Not applicable.
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Affiliation(s)
- Yuhan Zhang
- Oxford University Hospital NHS Foundation Trust, Oxford, UK
- Oxford Brookes University, Oxford, UK
| | - Louise Stayt
- Oxford University Hospital NHS Foundation Trust, Oxford, UK
- Oxford Brookes University, Oxford, UK
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Wilkinson-Stokes M, Tew M, Yap CYL, Crellin D, Gerdtz M. The Economic Impact of Community Paramedics Within Emergency Medical Services: A Systematic Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:665-684. [PMID: 39017994 PMCID: PMC11339145 DOI: 10.1007/s40258-024-00902-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND AND OBJECTIVE Globally, emergency medical services (EMSs) report that their demand is dominated by non-emergency (such as urgent and primary care) requests. Appropriately managing these is a major challenge for EMSs, with one mechanism employed being specialist community paramedics. This review guides policy by evaluating the economic impact of specialist community paramedic models from a healthcare system perspective. METHODS A multidisciplinary team (health economics, emergency care, paramedicine, nursing) was formed, and a protocol registered on PROSPERO (CRD42023397840) and published open access. Eligible studies included experimental and analytical observational study designs of economic evaluation outcomes of patients requesting EMSs via an emergency telephone line ('000', '111', '999', '911' or equivalent) responded to by specialist community paramedics, compared to patients attended by usual care (i.e. standard paramedics). A three-stage systematic search was performed, including Peer Review of Electronic Search Strategies (PRESS) and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Two independent reviewers extracted and verified 51 unique characteristics from 11 studies, costs were inflated and converted, and outcomes were synthesised with comparisons by model, population, education and reliability of findings. RESULTS Eleven studies (n = 7136 intervention group) met the criteria. These included one cost-utility analysis (measuring both costs and consequences), four costing studies (measuring cost only) and six cohort studies (measuring consequences only). Quality was measured using Joanna Briggs Institute tools, and was moderate for ten studies, and low for one. Models included autonomous paramedics (six studies, n = 4132 intervention), physician oversight (three studies, n = 932 intervention) and/or special populations (five studies, n = 3004 intervention). Twenty-one outcomes were reported. Models unanimously reduced emergency department (ED) transportation by 14-78% (higher quality studies reduced emergency department transportation by 50-54%, n = 2639 intervention, p < 0.001), and costs were reduced by AU$338-1227 per attendance in four studies (n = 2962). One study performed an economic evaluation (n = 1549), finding both that the costs were reduced by AU$454 per attendance (although not statistically significant), and consequently that the intervention dominated with a > 95% chance of the model being cost effective at the UK incremental cost-effectiveness ratio threshold. CONCLUSIONS Community paramedic roles within EMSs reduced ED transportation by approximately half. However, the rate was highly variable owing to structural (such as local policies) and stochastic (such as the patient's medical condition) factors. As models unanimously reduced ED transportation-a major contributor to costs-they in turn lead to net healthcare system savings, provided there is sufficient demand to outweigh model costs and generate net savings. However, all models shift costs from EDs to EMSs, and therefore appropriate redistribution of benefits may be necessary to incentivise EMS investment. Policymakers for EMSs could consider negotiating with their health department, local ED or insurers to introduce a rebate for successful community paramedic non-ED-transportations. Following this, geographical areas with suitable non-emergency demand could be identified, and community paramedic models introduced and tested with a prospective economic evaluation or, where this is not feasible, with sufficient data collection to enable a post hoc analysis.
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Affiliation(s)
- Matt Wilkinson-Stokes
- Department of Nursing, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Michelle Tew
- Melbourne Health Economics, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Celene Y L Yap
- Department of Nursing, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Di Crellin
- Department of Nursing, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Marie Gerdtz
- Department of Nursing, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, 3010, Australia
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Chen YH, Handly N, Chang DC, Chen YW. Racial difference in receiving computed tomography for head injury patients in emergency departments. Am J Emerg Med 2024; 83:54-58. [PMID: 38964277 DOI: 10.1016/j.ajem.2024.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/19/2024] [Accepted: 06/17/2024] [Indexed: 07/06/2024] Open
Abstract
STUDY OBJECTIVE Prior studies have suggested potential racial differences in receiving imaging tests in emergency departments (EDs), but the results remain inconclusive. In addition, most prior studies may only have limited racial groups for minority patients. This study aimed to investigate racial differences in head computed tomography (CT) administration rates in EDs among patients with head injuries. METHODS Patients with head injuries who visited EDs were examined. The primary outcome was patients receiving head CT during ED visits, and the primary exposure was patient race/ethnicity, including Asian, Hispanic, Non-Hispanic Black (Black), and Non-Hispanic White (White). Multivariable logistic regression analyses were performed using the National Hospital Ambulatory Medical Care Survey database, adjusting for patients and hospital characteristics. RESULTS Among 6130 patients, 51.9% received a head CT scan. Asian head injury patients were more likely to receive head CT than White patients (59.1% versus 54.0%, difference 5.1%, p < 0.001). This difference persisted in adjusted results (odds ratio, 1.52; 95% CI, 1.06-2.16, p = 0.022). In contrast, Black and Hispanic patients have no significant difference in receiving head CT than White patients after the adjustment. CONCLUSIONS Asian head injury patients were more likely to receive head CT than White patients. This difference may be attributed to the limited English proficiency among Asian individuals and the fact that there is a wide variety of different languages spoken by Asian patients. Future studies should examine rates of receiving other diagnostic imaging modalities among different racial groups and possible interventions to address this difference.
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Affiliation(s)
- Yuan-Hsin Chen
- Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States of America
| | - Neal Handly
- Department of Emergency Medicine, Contra Costa Regional Medical Center, Martinez, CA, United States of America; Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, PA, United States of America
| | - David C Chang
- Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States of America
| | - Ya-Wen Chen
- Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States of America.
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25
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Klunder JH, Heymans MW, van der Heide I, Verheij RA, Maarsingh OR, van Hout HP, Joling KJ. Predicting unplanned admissions to hospital in older adults using routinely recorded general practice data: development and validation of a prediction model. Br J Gen Pract 2024; 74:e628-e636. [PMID: 38724188 PMCID: PMC11349354 DOI: 10.3399/bjgp.2023.0350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 02/26/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Unplanned admissions to hospital represent a hazardous event for older people. Timely identification of high-risk individuals using a prediction tool may facilitate preventive interventions. AIM To develop and validate an easy-to-use prediction model for unplanned admissions to hospital in community-dwelling older adults using readily available data to allow rapid bedside assessment by GPs. DESIGN AND SETTING This was a retrospective study using the general practice electronic health records of 243 324 community-dwelling adults aged ≥65 years linked with national administrative data to predict unplanned admissions to hospital within 6 months. METHOD The dataset was geographically split into a development (n = 142 791/243 324, 58.7%) and validation (n = 100 533/243 324, 41.3%) sample to predict unplanned admissions to hospital within 6 months. The performance of three different models was evaluated with increasingly smaller selections of candidate predictors (optimal, readily available, and easy-to-use models). Logistic regression was used with backward selection for model development. The models were validated internally and externally. Predictive performance was assessed by area under the curve (AUC) and calibration plots. RESULTS In both samples, 7.6% (development cohort: n = 10 839/142 791, validation cohort: n = 7675/100 533) had ≥1 unplanned hospital admission within 6 months. The discriminative ability of the three models was comparable and remained stable after geographic validation. The easy-to-use model included age, sex, prior admissions to hospital, pulmonary emphysema, heart failure, and polypharmacy. Its discriminative ability after validation was AUC 0.72 (95% confidence interval = 0.71 to 0.72). Calibration plots showed good calibration. CONCLUSION The models showed satisfactory predictive ability. Reducing the number of predictors and geographic validation did not have an impact on predictive performance, demonstrating the robustness of the model. An easy-to-use tool has been developed in this study that may assist GPs in decision making and with targeted preventive interventions.
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Affiliation(s)
- Jet H Klunder
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam; Aging and Later Life, Amsterdam Public Health Research Institute, Amsterdam
| | - Martijn W Heymans
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit; Methodology, Amsterdam Public Health, Public Health Research Institute, Amsterdam
| | - Iris van der Heide
- Netherlands Institute for Health Services Research (NIVEL); Department of Languages, Literature and Communication, Faculty of Humanities, Utrecht University, Utrecht
| | - Robert A Verheij
- NIVEL, Utrecht; Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg
| | - Otto R Maarsingh
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam; Aging and Later Life, Amsterdam Public Health Research Institute, Amsterdam
| | - Hein Pj van Hout
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam; Aging and Later Life, Amsterdam Public Health Research Institute, Amsterdam
| | - Karlijn J Joling
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam; Aging and Later Life, Amsterdam Public Health Research Institute, Amsterdam
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26
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Bodnar RJ. Endogenous opiates and behavior: 2023. Peptides 2024; 179:171268. [PMID: 38943841 DOI: 10.1016/j.peptides.2024.171268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 07/01/2024]
Abstract
This paper is the forty-sixth consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2023 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug and alcohol abuse (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Psychology Doctoral Sub-Program, Queens College and the Graduate Center, City University of New York, USA.
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Jeffers KL, Cohen J, Chin E, Thompson N, Tekmal S, Lombardo R, Barlow J, Billstrom A, Aden J, Myers M. Point of Care Ultrasounds Obtained by Novice Physician Assistant Residents (POCUS ON PAR). Mil Med 2024; 189:e2242-e2247. [PMID: 38743577 DOI: 10.1093/milmed/usae219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/19/2024] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION The integration of Point of Care Ultrasound (POCUS) into the care of trauma patients, specifically the E-FAST, has improved the accuracy of initial diagnoses and improved time to surgical intervention in critically ill patients. Physician assistants (PAs) are critically important members of any military trauma resuscitation team and are often team leaders in a pre-hospital setting. They may receive training in ultrasound but there are little data to support their use or evaluate their effectiveness in using POCUS. We designed a study to evaluate the image quality of an E-FAST Exam performed by Emergency Medicine Physician Assistant (EMPA) Fellows and Emergency Medicine (EM) Interns following identical training. Our hypothesis is that image quality obtained by EMPAs will be non-inferior to those images obtained by EM Interns. MATERIALS AND METHODS This is a prospective single-blinded study comparing the image quality of E-FAST exams performed by first year EM interns and first year EMPA fellows. All participants completed standard POCUS training prior to enrollment in the study. A total of 8 EMPAs and 8 EM first year residents completed 10 recorded E-FAST exams to be used as study images. Participants also viewed a 15-question slide show containing images of positive (6) and negative (9) E-FAST exams and recorded their interpretations. Images were reviewed by expert reviewers who were blinded to which images were collected by which group. An image quality score was recorded for each view as well as an overall image quality score. Image quality was rated on a 1 to 5 image quality scale. RESULTS For overall image quality, the mean score for EMPAs was 3.6 ± 0.5 and for EM residents was 3.2 ± 0.5 with statistical significance favoring better image quality from the EMPAs. The time to completion for the EFAST exam for EMPAs was 4.8 ± 1.3 minutes and for interns it was 3.4 ± 1.4 minutes (P value = 0.02). There was no difference in image interpretation quiz scores between the groups (mean score 92% among interns and 95% among PAs). CONCLUSIONS POCUS is an imaging modality which is very portable and relatively inexpensive which makes it ideal for military medicine. PAs are essential members of military trauma teams, and often run an initial trauma resuscitation. Being able to correctly identify patients who have free fluid early in the course of treatment allows for more correct evacuation criteria to ensure the sickest patients get to care the fastest. Although there are limited data to support POCUS use by non-physicians, our data support a growing body of evidence that it is not the profession or baseline medical education that determines an individual's ability to use and incorporate ultrasound into bedside and clinical practice. Our study shows that with training and experience PAs or other members of the military health care team can use the EFAST to better care for trauma patients.
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Affiliation(s)
| | - Jared Cohen
- Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Eric Chin
- Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | | | | | - Robyn Lombardo
- Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Jessica Barlow
- Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Amie Billstrom
- Marquette University College of Health Sciences Physician Assistant Studies, Milwaukee, WI 53233, USA
| | - James Aden
- Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Melissa Myers
- Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
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Ng IKS, Lim SL, Teo KSH, Goh WGW, Thong C, Lee J. Referring wisely: knowing when and how to make subspecialty consultations in hospital medicine. Postgrad Med J 2024:qgae106. [PMID: 39197106 DOI: 10.1093/postmj/qgae106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 07/29/2024] [Accepted: 08/06/2024] [Indexed: 08/30/2024]
Abstract
Subspecialty consultations are becoming highly prevalent in hospital medicine, due to an ageing population with multimorbid conditions and increasingly complex care needs, as well as medicolegal fears that lead to widespread defensive medical practices. Although timely subspecialty consultations in the appropriate clinical context have been found to improve clinical outcomes, there remains a significant proportion of specialty referrals in hospital medicine which are inappropriate, excessive, or do not add value to patient care. In this article, we sought to provide an overview of the common problems pertaining to excessive quantity and suboptimal quality of inpatient subspecialty consultations made in real-world practice and highlight their implications for healthcare financing and patient care. In addition, we discuss the underlying contributing factors that predispose to inappropriate use of the specialist referral system. Finally, we offer a practical, multitiered approach to help rationalize subspecialty consultations, through (i) a systematic model ('WISE' template) for individual referral-making, (ii) development of standardized healthcare institutional referral guidelines with routine clinical audits for quality control, (iii) adopting an integrated generalist care model, and (iv) incorporating training on effective referral-making in medical education.
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Affiliation(s)
- Isaac K S Ng
- Internal Medicine Residency Program, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - Shir Lynn Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
- Department of Cardiology, National University Heart Center, 5 Lower Kent Ridge Road, Singapore 119074, Singapore
- Pre-hospital Emergency Research Center, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Kevin S H Teo
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
- Division of Neurology, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore
| | - Wilson G W Goh
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
- Division of Infectious Diseases, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore
| | - Christopher Thong
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore
| | - Joanne Lee
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 7, Singapore 119228, Singapore
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Vohra V, Dirks A, Bonito G, James T, Carroll DK. A 19-year longitudinal assessment of gyromitrin-containing (Gyromitra spp.) mushroom poisonings in Michigan. Toxicon 2024; 247:107825. [PMID: 38908526 DOI: 10.1016/j.toxicon.2024.107825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 06/24/2024]
Abstract
Mushroom poisonings are common in the United States. Gyromitrin (acetaldehyde N-methyl-N-formylhydrazone) is a clinically significant mycotoxin primarily associated with the lorchel (i.e. the false morel) Gyromitra esculenta. Resemblance between 'true and false morels' has resulted in misidentification of Gyromitra spp. as edible and sought after Morchella spp., resulting in toxicity. Despite literature evidence outlining toxic sequalae, Gyromitra spp. mushrooms are commonly consumed and prepared for culinary purposes. Classic clinical teachings emphasize significant neurotoxicity, including seizures, associated with ingestion of gyromitrin-containing mushrooms, stemming from gyromitrin's terminal metabolite monomethylhydrazine. We performed a longitudinal descriptive review of the clinical toxicity associated with ingestion of mushroom species known or suspected to contain gyromitrin in cases reported to the Michigan Poison & Drug Information Center between January 1, 2002, to December 31, 2020. Our 19-year descriptive case series of gyromitrin-containing mushroom ingestions reported to our Center demonstrated a preponderance of gastrointestinal signs and symptoms, including hepatotoxicity. Of 118 identified cases, 108 (91.5%) of the reported ingestions involved Gyromitra esculenta. The most frequent clinical findings associated with symptomatic ingestions (n = 83) were the aforementioned gastrointestinal symptoms (n = 62; 74.7%). Neurological symptoms were less frequent (n = 22, 26.5%) while hepatotoxicity occurred in fewer patients (n = 14; 16.9%). Of symptomatic patients, most were treated with symptomatic and supportive care (n = 58; 70%). Pyridoxine was used in a total of seven patients (n = 7; 8.4%) with either hepatotoxicity or neurotoxicity. Medical outcomes ranged from minor to major, with no reported deaths. Patient presentations (i.e. GI vs. neurotoxic symptoms) following ingestion of gyromitrin-containing mushrooms may be highly variable and multifactorial, owing to differences in dose ingested, geographical distribution, genetic variability of both patient and mushroom species, and species-specific differences in toxin composition. Future research warrants species-level identification of ingested gyromitrin-containing mushrooms and investigating the contribution of genetic polymorphisms to differences in clinical toxidromes.
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Affiliation(s)
- V Vohra
- Michigan Poison & Drug Information Center, Department of Emergency Medicine, Wayne State University School of Medicine, 550 East Canfield St., Detroit, MI, USA.
| | - A Dirks
- University of Michigan, Ecology and Evolutionary Biology, 4038 Biological Sciences Building, Ann Arbor, MI, USA.
| | - G Bonito
- Michigan State University, College of Agriculture & Natural Resources, Department of Plant, Soil, and Microbial Sciences, 1066 Bogue Street, East Lansing, MI, USA.
| | - T James
- University of Michigan, Ecology and Evolutionary Biology, 4038 Biological Sciences Building, Ann Arbor, MI, USA.
| | - D K Carroll
- Detroit Medical Center, Department of Emergency Medicine, 4201 St. Antoine St., Detroit, MI, USA.
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Trivedi SV, Batta R, Henao-Romero N, Mondal P, Wilson T, Stempien J. A comparison of self-triage tools to nurse driven triage in the emergency department. PLoS One 2024; 19:e0297321. [PMID: 39196994 DOI: 10.1371/journal.pone.0297321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 08/09/2024] [Indexed: 08/30/2024] Open
Abstract
INTRODUCTION Canadian patients presenting to the emergency department (ED) typically undergo a triage process where they are assessed by a specially trained nurse and assigned a Canadian Triage and Acuity Scale (CTAS) score, indicating their level of acuity and urgency of assessment. We sought to assess the ability of patients to self-triage themselves through use of one of two of our proprietary self-triage tools, and how this would compare with the standard nurse-driven triage process. METHODS We enrolled a convenience sample of ambulatory ED patients aged 17 years or older who presented with chief complaints of chest pain, abdominal pain, breathing problems, or musculoskeletal pain. Participants completed one, or both, of an algorithm generated self-triage (AGST) survey, or visual acuity scale (VAS) based self-triage tool which subsequently generated a CTAS score. Our primary outcome was to assess the accuracy of these tools to the CTAS score generated through the nurse-driven triage process. RESULTS A total of 223 patients were included in our analysis. Of these, 32 (14.3%) presented with chest pain, 25 (11.2%) with shortness of breath, 75 (33.6%) with abdominal pain, and 91 (40.8%) with musculoskeletal pain. Of the total number of patients, 142 (47.2%) completed the AGST tool, 159 (52.8%) completed the VAS tool and 78 (25.9%) completed both tools. When compared to the nurse-driven triage standard, both the AGST and VAS tools had poor levels of agreement for each of the four presenting complaints. CONCLUSIONS Self-triage through use of an AGST or VAS tool is inaccurate compared to the established standard of nurse-driven triage. Although existing literature exists which suggests that self-triage tools developed for specific subsets of complaints may be feasible, our results would suggest that adopting the self-triage approach on a broader scale for all-comers to the ED does not appear to be a viable option to enhance the current triage process. Further study is required to show if self-triage can be used in the ED to optimize the triage process.
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Affiliation(s)
- Sachin V Trivedi
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Rachit Batta
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nicolas Henao-Romero
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Prosanta Mondal
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan Canada
| | - Tracy Wilson
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - James Stempien
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Tang KB, Simpson MD, Burns MM. Evolving trends of pharmaceutical poisonings associated with QRS complex prolongation. Clin Toxicol (Phila) 2024:1-9. [PMID: 39194962 DOI: 10.1080/15563650.2024.2390138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/23/2024] [Accepted: 08/03/2024] [Indexed: 08/29/2024]
Abstract
INTRODUCTION Tricyclic antidepressants often cause drug-induced QRS complex prolongation in overdose but are now less commonly prescribed. We sought to determine, among a contemporary cohort of patients, the pharmaceuticals independently associated with QRS complex prolongation in acute overdose. METHODS We performed secondary analysis of data from the Toxicology Investigators Consortium (ToxIC) Core Registry. We included adult patients presenting from January 2016 through March 2023 with acute or acute-on-chronic pharmaceutical exposures. The primary outcome was QRS complex prolongation >0.12 s. Secondary outcomes included cardiac arrest, death, ventricular dysrhythmia, intensive care unit admission, initiation of vasopressors, and treatment with sodium bicarbonate. We used a multivariable logistic regression model with QRS complex prolongation as the outcome and individual pharmaceuticals of interest as independent variables. We assessed yearly trends of the contribution of relevant pharmaceuticals to QRS complex prolongation since 2016. RESULTS Of 11,945 patients in the total cohort (median age 37 years, 6,652 [55.7%] female), 366 (3.1%) developed QRS complex prolongation. Of 9,417 patients included in the model, 290 (3.1%) developed QRS complex prolongation. Amitriptyline, nortriptyline, doxepin, imipramine, noxiptiline, bupropion, flecainide, carvedilol, propranolol, diphenhydramine, and lamotrigine poisonings were independent predictors of QRS complex prolongation. Flecainide poisoning conferred the greatest odds of QRS complex prolongation (OR 574.1; 95% CI: 88.3-12,747). The contribution of tricyclic antidepressants to QRS complex prolongation decreased from 38.8% to 17.6% of all patients with QRS complex prolongation from 2016 to 2022. In 2022, the proportion of QRS complex prolongation from diphenhydramine (20.6%) surpassed that of tricyclic antidepressants. DISCUSSION This study provides insights into contemporary pharmaceutical poisoning associated with QRS complex prolongation. Tricyclic antidepressants remain clinically relevant exposures but are no longer the most common cause of drug-induced QRS complex prolongation. CONCLUSIONS Bupropion, diphenhydramine, and antidysrhythmics are increasingly common causes of QRS complex prolongation, each associated with numerous severe outcomes in poisoning. Greater safety measures to protect patients from cardiovascular toxicity from these pharmaceuticals are warranted.
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Affiliation(s)
- Katherine B Tang
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michael D Simpson
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michele M Burns
- Harvard Medical Toxicology, Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
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Ramsay S, Dahinten VS, Ranger M, Babul S, Saewyc E. Follow-up visits after pediatric concussion and the factors associated with early follow-up: a population-based study in British Columbia. Brain Inj 2024:1-7. [PMID: 39193878 DOI: 10.1080/02699052.2024.2395382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 08/15/2024] [Accepted: 08/18/2024] [Indexed: 08/29/2024]
Abstract
OBJECTIVES To explore the rates and timing of a first follow-up visit for children and adolescents with a concussive injury and to identify factors associated with follow-up timing. METHODS A descriptive, correlational design drawing on linked, population-based administrative data of concussed children and adolescents (ages 5-18 years) from the province of British Columbia (BC), Canada. Data were accessed through Population Data BC. Descriptive statistics and binary logistic regression were used to analyze the data. RESULTS From January 1, 2016 to December 31, 2017, we retrieved 22,601 cases of concussion, of which 19% had an early follow-up visit (N = 4,294), 4.9% had later follow-up (N = 1,107), and 76.1% had no follow-up (N = 17,200). The factors of older age, living in a rural area, higher socioeconomic status, and seeing a specialist physician at an initial concussion diagnosis were more likely to have an early follow-up visit. CONCLUSION Early follow-up is important for recovery, but most children and adolescents with a concussion do not receive follow-up in BC.
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Affiliation(s)
- Scott Ramsay
- School of Nursing, University of British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, University of British Columbia, Vancouver, Canada
- BC Children's Hospital, Provincial Health Services Authority, Vancouver, Canada
| | - V Susan Dahinten
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Manon Ranger
- School of Nursing, University of British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, University of British Columbia, Vancouver, Canada
| | - Shelina Babul
- BC Children's Hospital Research Institute, University of British Columbia, Vancouver, Canada
- BC Children's Hospital, Provincial Health Services Authority, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Elizabeth Saewyc
- School of Nursing, University of British Columbia, Vancouver, Canada
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José Alejandro GA, Juan M, Luis CB, Fátima Pamela SM, Ivonne B, Diana Laura PT, Ashly M. Envenomation by the Indian ornamental tarantula (Poecilotheria regalis): A case report on treatment with Latrodectus mactans antivenom. Toxicon 2024; 247:107842. [PMID: 38960287 DOI: 10.1016/j.toxicon.2024.107842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/05/2024] [Accepted: 06/28/2024] [Indexed: 07/05/2024]
Abstract
Poecilotheria spiders are considered theraphosids of underestimated clinical importance, with bites from these species inducing symptoms such as severe pain and intense muscle cramps. However, there is no specific treatment for the envenomation caused by these species, which, while native to India and Sri Lanka, are widely distributed worldwide. The present study reports the case of a 31-year-old man bitten by a Poecilotheria regalis specimen. The patient's clinical presentation was similar to Latrodectus envenomation, and patient was treated with an L. mactans antivenom. Most of patient's symptoms improved (fasciculations, pain, erythema, and local swelling), except muscle cramps. A toxicological study conducted on mice did not show that L. mactans antivenom has a neutralizing effect on the toxicity of P. regalis. The present report discusses the envenoming process of Poecilotheria species and the possible neutralizing effect exerted by L. mactans antivenom.
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Affiliation(s)
- García-Arredondo José Alejandro
- Departamento de Investigación Química y Farmacológica de Productos Naturales, Facultad de Química, Universidad Autónoma de Querétaro, Centro Universitario S/N, 76010, Querétaro, Querétaro, Mexico.
| | - Mosqueda Juan
- Laboratorio de Inmunología y Vacunas, Facultad de Ciencias Naturales, Universidad Autónoma de Querétaro, Querétaro, 76230, Querétaro, Mexico; Aracnario, Facultad de Ciencias Naturales, Universidad Autónoma de Querétaro, Querétaro, Av. De Las Ciencias S/N, 76230, Juriquilla, Mexico
| | - Cuéllar-Balleza Luis
- Aracnario, Facultad de Ciencias Naturales, Universidad Autónoma de Querétaro, Querétaro, Av. De Las Ciencias S/N, 76230, Juriquilla, Mexico
| | - Sánchez-Morales Fátima Pamela
- Hospital General Regional No. 2 El Marqués, Instituto Mexicano Del Seguro Social, Circuito Universidades KM 1 S/N, 76269, El Marqués, Querétaro, Mexico
| | - Buitrón Ivonne
- Posgrado en Ciencias Químico Biológicas, Facultad de Química, Universidad Autónoma de Querétaro, Centro Universitario S/N, 76010, Querétaro, Querétaro, Mexico
| | - Pescador-Tovar Diana Laura
- Posgrado en Ciencias Químico Biológicas, Facultad de Química, Universidad Autónoma de Querétaro, Centro Universitario S/N, 76010, Querétaro, Querétaro, Mexico
| | - Mohan Ashly
- Posgrado en Ciencias Químico Biológicas, Facultad de Química, Universidad Autónoma de Querétaro, Centro Universitario S/N, 76010, Querétaro, Querétaro, Mexico
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Abdulaziz KE, Taljaard M, Dowlatshahi D, Stiell IG, Wells GA, Sivilotti MLA, Émond M, Sharma M, Stotts G, Lee J, Worster A, Morris J, Cheung KW, Jin AY, Sahlas DJ, Murray HE, MacKey A, Verreault S, Camden MC, Yip S, Teal P, Gladstone DJ, Boulos MI, Chagnon N, Shouldice E, Atzema CL, Slaoui T, Teitlebaum J, Perry JJ. Derivation of a clinical prediction score for the diagnosis of clinically significant symptomatic carotid artery disease. CAN J EMERG MED 2024:10.1007/s43678-024-00759-4. [PMID: 39190092 DOI: 10.1007/s43678-024-00759-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 07/29/2024] [Indexed: 08/28/2024]
Abstract
OBJECTIVES Emergent vascular imaging identifies a subset of patients requiring immediate specialized care (i.e. carotid stenosis > 50%, dissection or free-floating thrombus). However, most TIA patients do not have these findings, so it is inefficient to image all TIA patients in crowded emergency departments (ED). Our objectives were to derive and internally validate a clinical prediction score for clinically significant carotid artery disease in TIA patients. METHODS This was a planned secondary analysis of a prospective cohort study from 14 Canadian EDs. Among 11555 consecutive adult ED patients with TIA/minor stroke symptoms over 12 years, 9882 had vascular imaging and were included in the analysis. Our main outcome was clinically significant carotid artery disease, defined as extracranial internal carotid stenosis ≥ 50%, dissection, or thrombus in the internal carotid artery, with contralateral symptoms. RESULTS Of 9882 patients, 888 (9.0%) had clinically significant carotid artery disease. Logistic regression was used to derive a 13-variable reduced model. We simplified the model into a score (Symcard [Symptomatic carotid artery disease] Score), with suggested cut-points for high, medium, and low-risk stratification. A substantial portion (38%) of patients were classified as low-risk, 33.8% as medium risk, and 28.2% as high risk. At the low-risk cut-point, sensitivity was 92.9%, specificity 41.1%, and diagnostic yield 1.7%. CONCLUSIONS This simple score can predict carotid artery disease in TIA patients using readily available information. It identifies low-risk patients who can defer vascular imaging to an outpatient or specialty clinic setting. Medium-risk patients may undergo imaging immediately or with slight delay, depending on local resources. High-risk patients should undergo urgent vascular imaging.
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Affiliation(s)
- Kasim E Abdulaziz
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Better Outcomes Registry & Network (BORN) Ontario, Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada.
- Epidemiology Program, F6, The Ottawa Hospital, Civic Campus, Ottawa, ON, Canada.
| | - Monica Taljaard
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Dar Dowlatshahi
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine (Neurology), University of Ottawa, Ottawa, ON, Canada
| | - Ian G Stiell
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - George A Wells
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | | | - Marcel Émond
- CHU de Québec, Hôpital de L'Enfant-Jésus, Québec City, QC, Canada
- Division of Emergency Medicine, Université Laval, Québec City, QC, Canada
| | - Mukul Sharma
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
| | - Grant Stotts
- Department of Medicine (Neurology), University of Ottawa, Ottawa, ON, Canada
| | - Jacques Lee
- Schwartz\Reisman Emergency Medicine Institute, Mount Sinai Hospital, Toronto, ON, Canada
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Judy Morris
- Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Ka Wai Cheung
- University of British Columbia, Vancouver, BC, Canada
| | - Albert Y Jin
- Division of Neurology, Queen's University, Kingston, ON, Canada
| | - Demetrios J Sahlas
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
| | - Heather E Murray
- CHU de Québec, Hôpital de L'Enfant-Jésus, Québec City, QC, Canada
| | - Ariane MacKey
- Division of Emergency Medicine, Université Laval, Québec City, QC, Canada
- Division of Neurology, Laval University, Quebec City, QC, Canada
| | - Steve Verreault
- Division of Emergency Medicine, Université Laval, Québec City, QC, Canada
- Division of Neurology, Laval University, Quebec City, QC, Canada
| | - Marie-Christine Camden
- Division of Emergency Medicine, Université Laval, Québec City, QC, Canada
- Division of Neurology, Laval University, Quebec City, QC, Canada
| | - Samuel Yip
- Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Philip Teal
- Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - David J Gladstone
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mark I Boulos
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nicolas Chagnon
- Department of Emergency Medicine, Montfort Hospital and University of Ottawa, Ottawa, ON, Canada
| | | | - Clare L Atzema
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Tarik Slaoui
- University of British Columbia, Vancouver, BC, Canada
| | | | - Jeffrey J Perry
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
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Tu H, Su J, Gong K, Li Z, Yu X, Xu X, Shi Y, Sheng J. A dynamic model to predict early occurrence of acute kidney injury in ICU hospitalized cirrhotic patients: a MIMIC database analysis. BMC Gastroenterol 2024; 24:290. [PMID: 39192202 DOI: 10.1186/s12876-024-03369-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 08/13/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND This study aimed to develop a tool for predicting the early occurrence of acute kidney injury (AKI) in ICU hospitalized cirrhotic patients. METHODS Eligible patients with cirrhosis were identified from the Medical Information Mart for Intensive Care database. Demographic data, laboratory examinations, and interventions were obtained. After splitting the population into training and validation cohorts, the least absolute shrinkage and selection operator regression model was used to select factors and construct the dynamic online nomogram. Calibration and discrimination were used to assess nomogram performance, and clinical utility was evaluated by decision curve analysis (DCA). RESULTS A total of 1254 patients were included in the analysis, and 745 developed AKI. The mean arterial pressure, white blood cell count, total bilirubin level, Glasgow Coma Score, creatinine, heart rate, platelet count and albumin level were identified as predictors of AKI. The developed model had a good ability to differentiate AKI from non-AKI, with AUCs of 0.797 and 0.750 in the training and validation cohorts, respectively. Moreover, the nomogram model showed good calibration. DCA showed that the nomogram had a superior overall net benefit within wide and practical ranges of threshold probabilities. CONCLUSIONS The dynamic online nomogram can be an easy-to-use tool for predicting the early occurrence of AKI in critically ill patients with cirrhosis.
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Affiliation(s)
- Huilan Tu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, National Medical Center for Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Junwei Su
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, National Medical Center for Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Kai Gong
- Department of Infectious Diseases, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Zhiwei Li
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xia Yu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, National Medical Center for Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Xianbin Xu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, National Medical Center for Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Yu Shi
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, National Medical Center for Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, 310003, China.
| | - Jifang Sheng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, National Medical Center for Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, 310003, China.
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O'Malley L, Kellett U, Forster EM. Australian rural emergency nurses' care of paediatric patients: A qualitative study. J Pediatr Nurs 2024; 79:42-51. [PMID: 39190968 DOI: 10.1016/j.pedn.2024.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 08/14/2024] [Accepted: 08/14/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Rural emergency nurses (RENs) are expected to provide care to paediatric patients presenting to their facilities however, as generalist nurses, they experience challenges and feelings that are unique to the rural context. DESIGN AND METHODS An exploratory qualitative study of 13 RENs via semi structured interviews of perceptions and experiences of caring for paediatrics and self-determination of autonomous practice, motivations and connectedness in care was the approach used. FINDINGS Inductive thematic analysis of data identified four themes with sub-themes identified within each theme. The four themes were: Caring for Children, Professional Roles, Professional Care and Connection and Professional Development. CONCLUSION RENs describe feeling fear, stress and anxiety when caring for sick children, particularly when known to the patient and family in their community yet will self-determine autonomous practice and use gatekeeping in certain situations of paediatric care. RENs are motivated to increase their paediatric knowledge and skills, seeking paediatric education opportunities but face barriers in attendance such as travel and costs. RENs rely on connectedness with other rural nurses, seeking paediatric nursing guidance or telehealth support, particularly when performing multiple roles or in the absence of a doctor in the ED. PRACTICE IMPLICATIONS Provision of opportunities for RENs to lead education in paediatric nursing, that is contextually appropriate and co-designed with paediatric experts is preferred. This would yield greater REN engagement and participation in paediatric education for knowledge and skill proficiency, would increase rural nurse professional development and reduce feelings of fear and anxiety when caring for paediatrics.
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Affiliation(s)
- Lee O'Malley
- School of Nursing and Midwifery, Griffith University, Queensland, Australia.
| | - Ursula Kellett
- School of Nursing and Midwifery, Griffith University, Queensland, Australia.
| | - Elizabeth M Forster
- School of Nursing and Midwifery, Griffith University, Queensland, Australia.
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Myrskykari H, Nordquist H. Paramedics' experiences and observations: work-related emotions and well-being resources during the initial months of the COVID-19 pandemic-a qualitative study. BMC Emerg Med 2024; 24:152. [PMID: 39183333 PMCID: PMC11346295 DOI: 10.1186/s12873-024-01072-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 08/13/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND As first responders, paramedics are an extremely important part of the care chain. COVID-19 significantly impacted their working circumstances. We examined, according to the experiences and observations of paramedics, (1) what kinds of emotions the Emergency Medical Service (EMS) personnel experienced in their new working circumstances, and (2) what work-related factors became resources for the well-being of EMS personnel during the initial months of the COVID-19 pandemic. METHODS This qualitative study utilized reflective essay material written by experienced, advanced-level Finnish paramedics (n = 30). The essays used in this study were written during the fall of 2020 and reflected the period when Finland had declared a state of emergency (on 17.3.2020) and the Emergency Powers Act was implemented. The data was analyzed using an inductive thematic analysis. RESULTS The emotions experienced by the EMS personnel in their new working circumstances formed three themes: (1) New concerns arose that were constantly present; (2) Surviving without proper guidance; and (3) Rapidly approaching breaking point. Three themes were formed from work-related factors that were identified as resources for the well-being of the EMS personnel. These were: (1) A high level of organizational efficiency was achieved; (2) Adaptable EMS operations; and (3) Encouraging atmosphere. CONCLUSIONS Crisis management practices should be more attentive to personnel needs, ensuring that managerial and psychological support is readily available in crisis situations. Preparedness that ensures effective organizational adaptation also supports personnel well-being during sudden changes in working circumstances.
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Affiliation(s)
- Henna Myrskykari
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.
- Emergency Medical Services, University of Turku and Turku University Hospital, Turku, Finland.
| | - Hilla Nordquist
- Department of Healthcare and Emergency Care, South-Eastern Finland University of Applied Sciences, Kotka, Finland
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Thiebaud PC, Philippon AL, Plaisance P, Chauvin A, Houze-Cerfon CH, Truchot J. Designing simulation-based curriculum content for emergency medicine residents in France: a Delphi method. BMC MEDICAL EDUCATION 2024; 24:924. [PMID: 39187828 PMCID: PMC11348525 DOI: 10.1186/s12909-024-05901-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 08/13/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND The value of simulation in emergency medicine is indisputable because it allows training and acquisition of many technical and non-technical skills (TS and NTS). In France, there are no curriculum regarding the use of simulation as a teaching tool during emergency medicine residency. The aim of this study was to design the content of a national simulation-based curriculum for emergency medicine residency programs. METHODS The Delphi method was conducted between March and June 2022. The questionnaire was divided into three sections: TS, NTS and clinical situations as starting points (SSPs). A panel of emergency physicians' experts on simulation education was established. An online survey was conducted in which they were asked to score, on a four-point Likert scale, the suitability of skills and SSPs to be taught through simulation courses during the emergency medicine residency. The questionnaire was revised between each round following comments or suggestions for additional items from the experts. RESULTS Sixty-six experts completed the Delphi process. The initial questionnaire included 64 TS, 37 NTS and 103 SSPs. The experts' comments led to the addition of 12 TS, 24 NTS and 6 SSPs. Consensus was obtained after three rounds. The experts selected 24 TS and 20 NTS to be taught as a priority through simulation during the emergency medicine residency, and 15 SSPs to be used in priority. CONCLUSION With a Delphi method, French experts in simulation-based emergency medicine education have selected 24 technical and 20 non-technical skills to be taught as a priority with simulation-based training to emergency medicine residents.
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Affiliation(s)
- Pierre-Clément Thiebaud
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, UMR-S 1136, AP-HP, Hôpital Saint-Antoine, Service d'Accueil des Urgences, Paris, France.
| | - Anne-Laure Philippon
- Sorbonne Université, GRC 14, BIOFAST, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Patrick Plaisance
- AP-HP.Université Paris Cité, Hôpital Lariboisière, Fédération des Urgences, Paris, France
- Université Paris Cité, Paris, France
| | - Anthony Chauvin
- AP-HP.Université Paris Cité, Hôpital Lariboisière, Fédération des Urgences, Paris, France
- Université Paris Cité, INSERM U942 MASCOT, Paris, France
| | - Charles-Henri Houze-Cerfon
- Centre hospitalier universitaire de Toulouse, Pôle médecine d'urgences, Bâtiment Urgences Réanimation Médecines (URM), Place du Docteur Baylac - TSA 40031, 31059, Toulouse Cedex 9, France
- Institut Toulousain de Simulation en Santé, Bâtiment U2000, Place du Docteur Baylac - TSA 40031 - 31059, Toulouse Cedex 9, France
| | - Jennifer Truchot
- Université Paris Cité, AP-HP, Hôpital Cochin, Service d'Accueil des Urgences, Paris, France
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Kim DJ, Sheppard G, Lewis D, Buchanan IM, Jelic T, Thavanathan R, Myslik F, Lalande E, Bell CR, Chenkin J, Heslop CL, Olszynski P, Atkinson P, Burwash-Brennan T. POCUS literature primer: key papers on cardiac and lung POCUS. CAN J EMERG MED 2024:10.1007/s43678-024-00755-8. [PMID: 39183217 DOI: 10.1007/s43678-024-00755-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 07/26/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVE Although point of care ultrasound (POCUS) use has become prevalent in medicine, clinicians may not be familiar with the evidence supporting its utility in patient care. The objective of this study is to identify the top five most influential papers published on the use of cardiac POCUS and lung POCUS in adult patients. METHODS A 14-member expert panel from the Canadian Association of Emergency Physicians (CAEP) Emergency Ultrasound Committee and the Canadian Ultrasound Fellowship Collaborative used a modified Delphi process. Panel members are ultrasound fellowship trained or equivalent, are engaged in POCUS scholarship, and are leaders in POCUS locally and nationally in Canada. The modified Delphi process consisted of three rounds of sequential surveys and discussion to achieve consensus on the top five most influential papers on cardiac POCUS and lung POCUS. RESULTS A total of 66 relevant papers on cardiac POCUS and 68 relevant papers on lung POCUS were nominated by the panel. There was 100% participation by the panel members in all three rounds of the modified Delphi process. At the end of this process, we identified the top five most influential papers on cardiac POCUS and lung POCUS. Papers include studies supporting the use of POCUS for accurately assessing left ventricular systolic function, diagnosing pericardial effusion, clarifying its test characteristics for pulmonary embolism, identifying pulmonary edema and pneumonia, as well as consensus statements on the use of cardiac and lung POCUS in clinical practice. CONCLUSION We have created a list of the top five influential papers on cardiac POCUS and lung POCUS as an evidence-based resource for trainees, clinicians, and researchers. This will help trainees and clinicians better understand how to use POCUS when scanning the heart and lungs, and it will also help researchers better understand where to direct their scholarly efforts with future research.
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Affiliation(s)
- Daniel J Kim
- Department of Emergency Medicine, University of British Columbia and Vancouver General Hospital, Vancouver, BC, Canada.
| | - Gillian Sheppard
- Discipline of Emergency Medicine, Memorial University of Newfoundland, St. John's, NF, Canada
| | - David Lewis
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - Ian M Buchanan
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Tomislav Jelic
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Rajiv Thavanathan
- Ottawa Hospital Research Institute and Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Frank Myslik
- Division of Emergency Medicine, Department of Medicine, Western University, London, ON, Canada
| | - Elizabeth Lalande
- Department of Emergency Medicine, Université Laval, Quebec City, QC, Canada
| | - Colin R Bell
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Jordan Chenkin
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Claire L Heslop
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Paul Olszynski
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Paul Atkinson
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - Talia Burwash-Brennan
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, QC, Canada
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Tallon JM, Sibley A. ATV associated injuries: any changes after 20 years? CAN J EMERG MED 2024:10.1007/s43678-024-00750-z. [PMID: 39186239 DOI: 10.1007/s43678-024-00750-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 07/01/2024] [Indexed: 08/27/2024]
Affiliation(s)
- John M Tallon
- Department of Emergency Medicine, Columbia Faculty of Medicine, University of British, Vancouver, BC, Canada.
- Gordon and Leslie Diamond Health Care Centre, Vancouver, BC, Canada.
| | - Aaron Sibley
- University of Prince Edward Island, Charlottetown, PEI, Canada
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
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Zahoor M, Farhat SM, Khan S, Ahmed T. Daidzin improves neurobehavioral outcome in rat model of traumatic brain injury. Behav Brain Res 2024; 472:115158. [PMID: 39047874 DOI: 10.1016/j.bbr.2024.115158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 07/13/2024] [Accepted: 07/21/2024] [Indexed: 07/27/2024]
Abstract
Traumatic brain injury (TBI) is associated with the etiology of multiple neurological disorders, including neurodegeneration, leading to various cognitive deficits. Daidzin (obtained from kudzu root and soybean leaves) is known for its neuroprotective effects through multiple mechanisms. This study aimed to investigate the pharmacological effects of Daidzin on sensory, and biochemical parameters, cognitive functions, anxiety, and depressive-like behaviors in the TBI rat model. Rats were divided into four groups (Control, TBI, TBI + Ibuprofen (30 mg/kg), and TBI + Daidzin (5 mg/kg)). Rats were subjected to TBI by dropping a 200 g rod from a height of 26 cm, resulting in an impact force of 0.51 J on the exposed crania. Ibuprofen (30 mg/kg) was used as a positive control reference/standard drug and Daidzin (5 mg/kg) as the test drug. Neurological severity score (NSS) assessment was done to determine the intactness of sensory and motor responses. Brain tissue edema and acetylcholine levels were determined in the cortex and hippocampus. Cognitive functions such as hippocampus-dependent memory, novel object recognition, exploration, depressive and anxiety-like behaviors were measured. Treatment with Daidzin improved NSS, reduced hippocampal and cortical edema, and improved levels of acetylcholine in TBI-induced rats. Furthermore, Daidzin treatment improved hippocampus-dependent memory, exploration behavior, and novel object recognition while reducing depressive and anxiety-like behavior. Our study revealed that Daidzin has a therapeutic potential comparable to Ibuprofen and can offer neuroprotection and enhanced cognitive and behavioral outcomes in rats after TBI.
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Affiliation(s)
- Maryam Zahoor
- Neurobiology Laboratory, Department of Biomedicine, Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology, Sector H-12, Islamabad 44000, Pakistan
| | - Syeda Mehpara Farhat
- Department of Biological Sciences, National University of Medical Sciences, Rawalpindi 46000, Pakistan
| | - Salman Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Touqeer Ahmed
- Neurobiology Laboratory, Department of Biomedicine, Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology, Sector H-12, Islamabad 44000, Pakistan.
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Ghosh SM, Kung JY, Crockford D, Harpur L, Tanguay R, Dyer D, Lang E, Ayas T, Feng G, VandenBerg SD. Systematic review protocol to determine the most effective pharmacological and non-pharmacological interventions for the management of acute methamphetamine toxicity. BMJ Open 2024; 14:e083089. [PMID: 39181555 PMCID: PMC11344523 DOI: 10.1136/bmjopen-2023-083089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 08/09/2024] [Indexed: 08/27/2024] Open
Abstract
INTRODUCTION This study describes the protocol for a systematic review. The systematic review will address experiences of managing methamphetamine intoxication, specifically violence and agitation related to intoxication, in the emergency department (ED). METHODS AND ANALYSIS This study uses the Grading of Recommendations Assessment, Development and Evaluation system to guide the methods in this section. The primary objective of the review is to identify experimental studies assessing the effectiveness of both pharmacological and non-pharmacological strategies to manage acute methamphetamine intoxication in patients presenting violently in the ED. Our secondary objectives will be to assess the impact of specific strategies on the time it takes to achieve de-escalation and/or sedation, the length of stay in the ED, frequency of admission, mortality and provider satisfaction with the intervention. ETHICS AND DISSEMINATION Ethics approval has been obtained from the Conjoint Health Research Ethics Board REB21-1387. Results will be published in a peer-reviewed journal and presented at healthcare conferences in Canada. TRIAL REGISTRATION NUMBER The protocol is registered through the International Prospective Register of Systematic Reviews (identification number: CRD42020157938) and will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extensions for systematic review protocols.
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Affiliation(s)
- Sumantra Monty Ghosh
- Department of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada
- Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Janice Y Kung
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | | | - Lisa Harpur
- Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Robert Tanguay
- Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Dianne Dyer
- Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Eddy Lang
- Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tim Ayas
- Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Gregory Feng
- Epidemiology, University of Toronto, Toronto, Ontario, Canada
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Peters GA, Cash RE, Goldberg SA, Gao J, Escudero T, Kolb LM, Camargo CA. Factors Associated With Potentially Unnecessary Transfers for Children With Asthma: A Retrospective Cohort Study. Pediatr Emerg Care 2024:00006565-990000000-00511. [PMID: 39173192 DOI: 10.1097/pec.0000000000003263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
OBJECTIVE Our objective was to identify the hospital- and community-related factors associated with the hospital-level rate of potentially unnecessary interfacility transfers (IFTs) for pediatric patients with asthma exacerbations. METHODS We analyzed California Emergency Department (ED) data from 2016 to 2019 to capture ED visits where a pediatric patient (age, 2-17 years) presented with an asthma exacerbation and was transferred to another ED or acute care hospital. The primary outcome was hospital-level rate of potentially unnecessary IFTs, defined as a visit where length of stay after transfer was <24 hours and no advanced services (eg, critical care) were used. Hospital- and community-related characteristics included urbanicity, teaching hospital status, availability of pediatric resources in the sending facility and patient's community, pediatric patient volume, and Social Vulnerability Index. We described and compared hospitals in the top quartile of potentially unnecessary IFT rate versus all others and used a multivariable modified Poisson model to identify factors associated with potentially unnecessary IFT. RESULTS A total of 325 sending hospitals were included, with a median 573 pediatric asthma visits (interquartile range, 183-1309) per hospital annually. Nearly half of the hospitals (145/325, 45%) sent a potentially unnecessary IFT. Most (90%) hospitals were urban, 9% were teaching hospitals, 5% had >500 beds, and 22% had a pediatric ED on-site. Factors associated with higher adjusted prevalence of potentially unnecessary IFT included availability of pediatric telehealth (prevalence ratio [PR], 1.5; 95% confidence interval [CI], 1.2-2.0), increased pediatric volume (eg, <1800 vs ≥10,000 visits: PR, 2.6; 95% CI, 1.4-4.7), and higher community Social Vulnerability Index (PR, 1.5; 95% CI, 1.1-1.9). CONCLUSIONS Several hospital- and community-related factors were associated with potentially unnecessary IFTs among pediatric patients presenting to the ED with asthma exacerbations. These findings provide insight into disparities in potentially unnecessary IFT across communities and can guide the development of future interventions.
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Affiliation(s)
| | | | | | - Jingya Gao
- Department of Emergency Medicine, Massachusetts General Hospital
| | | | - Lily M Kolb
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY and
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Weinstein SA. Hypersensitivity vs. uncommonly severe local envenoming by the red-back spider, Latrodectus hasselti Thorell, 1870 (Araneae: Theridiidae). Toxicon 2024:108077. [PMID: 39182727 DOI: 10.1016/j.toxicon.2024.108077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Revised: 08/17/2024] [Accepted: 08/20/2024] [Indexed: 08/27/2024]
Affiliation(s)
- Scott A Weinstein
- Young Adult Institute and Premier HealthCare, 220 East 42(nd) St, 8(th) Floor, New York, NY 10017 USA.
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Saberi E, Hutchinson M, Hurley J. Rising to the challenge: The motivation to champion routine intimate partner violence screening in rural emergency departments. Aust J Rural Health 2024. [PMID: 39180152 DOI: 10.1111/ajr.13176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 07/13/2024] [Accepted: 07/24/2024] [Indexed: 08/26/2024] Open
Abstract
OBJECTIVE To understand the motivations of champions who worked to bring about system and practice change that supported routine screening for intimate partner violence (IPV) in two rural emergency departments (EDs). INTRODUCTION Practice changes are required to achieve routine and effective identification and response to IPV. Nurses play a significant role in affecting such practice change. This paper identifies the motivations of champions in the ED setting who successfully brought about such change. SETTING The EDs of two Level 5 tertiary hospitals within a rural Local Health District (LHD) of New South Wales, Australia. PARTICIPANTS Twenty-three individuals who identified as champions and worked to introduce routine IPV screening in two rural hospital EDs. DESIGN Qualitative longitudinal semi-structured interviews employing a process of constant comparison and an interpretive framework to analyse data thematically. Interviews were carried out between June and August 2017 and again between July and August 2019. RESULTS Over the period of the study, routine screening was established, and screening rates steadily increased from a low baseline to a significantly higher rate. Three aspects of champion motivation emerged from the analysis: formation of an identity as a champion, making a difference to a significant social justice issue and providing quality and community-relevant care. CONCLUSIONS This study is the first study to report on champions and their motivation as they supported IPV practice change in the ED. The findings highlight the capacity for innovation in rural health services, with important implications for other settings looking to translate similar programs. Understanding motivating factors may assist in improved utilisation and support for champions. This is vital if champions are to bring about required practice change within their service and ensure the needs of individuals experiencing IPV are effectively met.
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Affiliation(s)
- Elham Saberi
- Faculty of Health, Southern Cross University, Lismore, New South Wales, Australia
| | - Marie Hutchinson
- Southern Cross University, Coffs Harbour Campus, Coffs Harbour, New South Wales, Australia
- Adjunct, University of Southern Queensland, Toowoomba Queensland, Australia
| | - John Hurley
- Southern Cross University, Coffs Harbour Campus, Coffs Harbour, New South Wales, Australia
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Hu J, Du Y, Zhou Y, Wang H. High sensitivity troponins and mortality in the population with metabolic dysfunction-associated steatotic liver disease. Sci Rep 2024; 14:19541. [PMID: 39174636 PMCID: PMC11341865 DOI: 10.1038/s41598-024-70645-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 08/20/2024] [Indexed: 08/24/2024] Open
Abstract
Given the global high prevalence of MASLD and its poor CVD prognosis, it is essential to perform risk stratification for MASLD patients. The specific impact of High Sensitivity Troponins (hs-cTn ) on mortality in MASLD patients remains unexplored. The NHANES databases from 1999 to 2004, which include data on high-sensitivity cardiac troponin (hs-cTn) levels and comorbidities, were linked with the most recent mortality dataset. Myocardial injury was determined using the 99th upper reference limits (URL) for hs-cTn. Our study included 3460 MASLD patients. The mean follow-up duration was 192 months, during which 1074 (23%) MASLD participants died from all-cause mortality, and 363 (7.3%) died from CVD mortality. Our findings indicate that MASLD patients with elevated levels of hs-cTnT (> 99th URL) exhibit increased risks of all-cause mortality [adjusted hazard ratio (aHR) = 1.93] and CVD mortality (aHR = 2.4). Similar results were observed for hs-cTnI, where the aHRs for all-cause mortality and CVD mortality were 2.03 and 2.97, respectively. Furthermore, we identified a nonlinear dose-response relationship between hs-cTn levels and the risk of mortality (P for nonlinearity < 0.001). Our findings suggest that hs-cTn can predict mortality risk in MASLD, aiding clinicians in risk-stratifying this population. Therefore, we recommend considering hs-cTn detection in individuals with MASLD to effectively assess their future mortality risk.
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Affiliation(s)
- Jingjing Hu
- Department of Emergency Medicine, Hangzhou Third People's Hospital, Hangzhou, China
| | - Yuteng Du
- Department of Emergency Medicine, Hangzhou Third People's Hospital, Hangzhou, China
- Department of Allergy and Clinical Immunology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yidan Zhou
- Department of Emergency Medicine, Hangzhou Third People's Hospital, Hangzhou, China.
| | - Huiying Wang
- Department of Allergy and Clinical Immunology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Lai EK, Slavik E, Ganim B, Perry LA, Treuting C, Dee T, Osborne M, Presley C, Towbin AJ. Implementing a Photodocumentation Program. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01236-1. [PMID: 39174733 DOI: 10.1007/s10278-024-01236-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 08/08/2024] [Accepted: 08/12/2024] [Indexed: 08/24/2024]
Abstract
The widespread availability of smart devices has facilitated the use of medical photography, yet photodocumentation workflows are seldom implemented in healthcare organizations due to integration challenges with electronic health records (EHR) and standard clinical workflows. This manuscript details the implementation of a comprehensive photodocumentation workflow across all phases of care at a large healthcare organization, emphasizing efficiency and patient safety. From November 2018 to December 2023, healthcare workers at our institution uploaded nearly 32,000 photodocuments spanning 54 medical specialties. The photodocumentation process requires as few as 11 mouse clicks and keystrokes within the EHR and on smart devices. Automation played a crucial role in driving workflow efficiency and patient safety. For example, body part rules were used to automate the application of a sensitive label to photos of the face, chest, external genitalia, and buttocks. This automation was successful, with over 50% of the uploaded photodocuments being labeled as sensitive. Our implementation highlights the potential for standardizing photodocumentation workflows, thereby enhancing clinical documentation, improving patient care, and ensuring the secure handling of sensitive images.
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Affiliation(s)
- Eric K Lai
- Department of Radiology, Tufts University School of Medicine, Boston, USA
| | - Evan Slavik
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, USA
- Information Services, Cincinnati Children's Hospital, Cincinnati, USA
| | - Bessie Ganim
- Information Services, Cincinnati Children's Hospital, Cincinnati, USA
| | - Laurie A Perry
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, USA
| | - Caitlin Treuting
- Division of Dermatology, Cincinnati Children's Hospital, Cincinnati, USA
| | - Troy Dee
- Information Services, Cincinnati Children's Hospital, Cincinnati, USA
| | - Melissa Osborne
- Information Services, Cincinnati Children's Hospital, Cincinnati, USA
| | - Cieara Presley
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, USA
- Information Services, Cincinnati Children's Hospital, Cincinnati, USA
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, USA.
- Department of Radiology, College of Medicine, University of Cincinnati, Cincinnati, USA.
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Helmy MA, Hasanin A, Milad LM, Mostafa M, Hamimy WI, Muhareb RS, Raafat H. Ability of parasternal intercostal muscle thickening fraction to predict reintubation in surgical patients with sepsis. BMC Anesthesiol 2024; 24:294. [PMID: 39174907 PMCID: PMC11340156 DOI: 10.1186/s12871-024-02666-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 07/31/2024] [Indexed: 08/24/2024] Open
Abstract
OBJECTIVES We aimed to evaluate the ability of the parasternal intercostal (PIC) thickening fraction during spontaneous breathing trial (SBT) to predict the need for reintubation within 48 h after extubation in surgical patients with sepsis. METHODS This prospective observational study included adult patients with sepsis who were mechanically ventilated and indicated for SBT. Ultrasound measurements of the PIC thickening fraction and diaphragmatic excursion (DE) were recorded 15 min after the start of the SBT. After extubation, the patients were followed up for 48 h for the need for reintubation. The study outcomes were the ability of the PIC thickening fraction (primary outcome) and DE to predict reintubation within 48 h of extubation using area under receiver characteristic curve (AUC) analysis. The accuracy of the model including the findings of right PIC thickening fraction and right DE was also assessed using the current study cut-off values. Multivariate analysis was performed to identify independent risk factors for reintubation. RESULTS We analyzed data from 49 patients who underwent successful SBT, and 10/49 (20%) required reintubation. The AUCs (95% confidence interval [CI]) for the ability of right and left side PIC thickening fraction to predict reintubation were 0.97 (0.88-1.00) and 0.96 (0.86-1.00), respectively; at a cutoff value of 6.5-8.3%, the PIC thickening fraction had a negative predictive value of 100%. The AUCs for the PIC thickening fraction and DE were comparable; and both measures were independent risk factors for reintubation. The AUC (95% CI) of the model including the right PIC thickening fraction > 6.5% and right DE ≤ 18 mm to predict reintubation was 0.99 (0.92-1.00), with a positive predictive value of 100% when both sonographic findings are positive and negative predictive value of 100% when both sonographic findings are negative. CONCLUSIONS Among surgical patients with sepsis, PIC thickening fraction evaluated during the SBT is an independent risk factor for reintubation. The PIC thickening fraction has an excellent predictive value for reintubation. A PIC thickening fraction of ≤ 6.5-8.3% can exclude reintubation, with a negative predictive value of 100%. Furthermore, a combination of high PIC and low DE can also indicate a high risk of reintubation. However, larger studies that include different populations are required to replicate our findings and validate the cutoff values.
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Affiliation(s)
- Mina Adolf Helmy
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Hasanin
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Lydia Magdy Milad
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Maha Mostafa
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Walid I Hamimy
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rimon S Muhareb
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Heba Raafat
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
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49
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Marino MR, Trunfio TA, Ponsiglione AM, Amato F, Improta G. Investigation of emergency department abandonment rates using machine learning algorithms in a single centre study. Sci Rep 2024; 14:19513. [PMID: 39174595 PMCID: PMC11341825 DOI: 10.1038/s41598-024-70545-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 08/19/2024] [Indexed: 08/24/2024] Open
Abstract
A critical problem that Emergency Departments (EDs) must address is overcrowding, as it causes extended waiting times and increased patient dissatisfaction, both of which are immediately linked to a greater number of patients who leave the ED early, without any evaluation by a healthcare provider (Leave Without Being Seen, LWBS). This has an impact on the hospital in terms of missing income from lost opportunities to offer treatment and, in general, of negative outcomes from the ED process. Consequently, healthcare managers must be able to forecast and control patients who leave the ED without being evaluated in advance. This study is a retrospective analysis of patients registered at the ED of the "San Giovanni di Dio e Ruggi d'Aragona" University Hospital of Salerno (Italy) during the years 2014-2021. The goal was firstly to analyze factors that lead to patients abandoning the ED without being examined, taking into account the features related to patient characteristics such as age, gender, arrival mode, triage color, day of week of arrival, time of arrival, waiting time for take-over and year. These factors were used as process measures to perform a correlation analysis with the LWBS status. Then, Machine Learning (ML) techniques are exploited to develop and compare several LWBS prediction algorithms, with the purpose of providing a useful support model for the administration and management of EDs in the healthcare institutions. During the examined period, 688,870 patients were registered and 39188 (5.68%) left without being seen. Of the total LWBS patients, 59.6% were male and 40.4% were female. Moreover, from the statistical analysis emerged that the parameter that most influence the abandonment rate is the waiting time for take-over. The final ML classification model achieved an Area Under the Curve (AUC) of 0.97, indicating high performance in estimating LWBS for the years considered in this study. Various patient and ED process characteristics are related to patients who LWBS. The possibility of predicting LWBS rates in advance could be a valid tool quickly identifying and addressing "bottlenecks" in the hospital organization, thereby improving efficiency.
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Affiliation(s)
| | - Teresa Angela Trunfio
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
| | - Alfonso Maria Ponsiglione
- Department of Electrical Engineering and Information Technologies, University of Naples "Federico II", Naples, Italy
| | - Francesco Amato
- Department of Electrical Engineering and Information Technologies, University of Naples "Federico II", Naples, Italy
| | - Giovanni Improta
- Department of Public Health, University of Naples "Federico II", Naples, Italy
- Interdepartmental Center for Research in Healthcare Management and Innovation in Healthcare (CIRMIS), University of Naples "Federico II", Naples, Italy
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50
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Kneafsey R, Moore A, Palmer S, Szczepura A, Hooper G, Leech C, Turner C, Khan A, Pawar B, Rodrigues Amorim Adegboye A. Tailored leadership training in emergency medicine: qualitative exploration of the impact of the EMLeaders programme on consultants and trainees in England. Emerg Med J 2024; 41:543-550. [PMID: 39009425 PMCID: PMC11347192 DOI: 10.1136/emermed-2023-213868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 07/01/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Emergency medicine (EM) consultants are expected to provide leadership to facilitate optimal clinical results, effective teamwork and learning. To foster leadership skills, the Emergency Medicine Leadership Programme (EMLeaders) was launched in 2018 by the Royal College of Emergency Medicine (RCEM), Health Education England and National Health Service England. A mixed-methods evaluation of EMLeaders was commissioned to assess the impact at the strategic, team and individual levels. This paper reports the qualitative evaluation component. METHODS Qualitative data collected from 2021 to 2022 were drawn from an online survey of RCEM members in England, which included four open questions about leadership training. At the end of the survey, participants were asked to share contact details if willing to undertake an in-depth qualitative interview. Interviews explored perceptions of the programme and impact of curriculum design and delivery. Data were analysed thematically against the Kirkpatrick framework, providing in-depth understanding. RESULTS There were 417 survey respondents, of whom 177 had participated in EMLeaders. Semistructured interviews were completed with 13 EM consultants, 13 trainees and 1 specialty and associate specialist doctor. EMLeaders was highly valued by EM consultants and trainees, particularly group interaction, expert facilitation and face-to-face practical scenario work. Consultant data yielded the themes: we believe in it; EM relevance is key; on a leadership journey; shaping better leaders; and a broken system. Challenges were identified in building engagement within a pressured workplace system and embedding workplace role modelling. Trainees identified behavioural shift in themselves following the programme but wanted more face-to-face discussions with senior colleagues. Key trainee themes included value in being together, storytelling in leadership, headspace for the leadership lens and survival in a state of collapse. CONCLUSION The development of leadership skills in EM is considered important. The EMLeaders programme can support leadership learning but further embedding is needed.
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Affiliation(s)
- Rosie Kneafsey
- Research Centre for Healthcare and Communities, Coventry University, Coventry, UK
| | - Amanda Moore
- Department of Primary Care and Population Health, University College London, London, UK
| | - Shea Palmer
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Ala Szczepura
- Research Centre for Healthcare and Communities, Coventry University, Coventry, UK
| | - Gareth Hooper
- Research Centre for Healthcare and Communities, Coventry University, Coventry, UK
| | - Caroline Leech
- Emergency Department, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Chris Turner
- Emergency Department, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Aanika Khan
- Royal Borough of Kensington and Chelsea, London, UK
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