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Murayama A. A Nine-Year Investigation of Industry Research and Nonresearch Payments to Emergency Physicians in the United States Between 2014 and 2022. J Emerg Med 2024; 66:e293-e303. [PMID: 38290882 DOI: 10.1016/j.jemermed.2023.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/19/2023] [Accepted: 10/22/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Financial relationships between physicians and the health care industry are common in the United States. Yet, there are limited data on payments to emergency physicians since the 2014 launch of the Open Payments Database. OBJECTIVES To analyze the trends and characteristics of industry payments to U.S. emergency physicians from 2014 to 2022. METHODS This retrospective study used the Open Payments Database to examine all general and research payments to all active emergency physicians. Descriptive statistics and generalized estimating equations were employed. RESULTS Between 2014 and 2022, 50.1% (33,021) of emergency physicians received $640.1 million in payments. Of these, 50.1% received general payments, and 1.2% received research payments. General payments constituted 18.7% ($119.7 million) of the overall industry payments. Median general and research payments were $149 ($49-$401) and $72,083 ($13,903-$370,142), respectively. Compared with other specialties, fewer emergency physicians received general payments, and the amounts were lower. The top 1% of emergency physicians received 80.5% of the general payments. No significant trends in payment amounts were observed from 2014 to 2019, but there was a significant decrease in both types of payments in 2020 due to the COVID-19 pandemic. CONCLUSIONS The majority of emergency physicians received payments from the health care industry, although these payments were typically minimal compared with other specialties. Payment trends remained consistent from 2014 to 2019, with a notable decrease in 2020 due to the pandemic.
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Affiliation(s)
- Anju Murayama
- School of Medicine, Tohoku University, Sendai City, Miyagi, Japan
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Alam F, LeBlanc VR, Baxter A, Tarshis J, Piquette D, Gu Y, Filipowska C, Krywenky A, Kester-Greene N, Cardinal P, Andrews M, Chartier F, Burrows C, Houzé-Cerfon CH, Burns JK, Kaustov L, Au S, Lam S, DeSousa S, Boet S. Age and its impact on crisis management performance and learning after simulation-based education by acute care physicians: a multicentre prospective cohort study. Br J Anaesth 2024; 132:383-391. [PMID: 38087740 DOI: 10.1016/j.bja.2023.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Physiological changes associated with ageing could negatively impact the crisis resource management skills of acute care physicians. This study was designed to determine whether physician age impacts crisis resource management skills, and crisis resource management skills learning and retention using full-body manikin simulation training in acute care physicians. METHODS Acute care physicians at two Canadian universities participated in three 8-min simulated crisis (pulseless electrical activity) scenarios. An initial crisis scenario (pre-test) was followed by debriefing with a trained facilitator and a second crisis scenario (immediate post-test). Participants returned for a third crisis scenario 3-6 months later (retention post-test). RESULTS For the 48 participants included in the final analysis, age negatively correlated with baseline Global Rating Scale (GRS; r=-0.30, P<0.05) and technical checklist scores (r=-0.44, P<0.01). However, only years in practice and prior simulation experience, but not age, were significant in a subsequent stepwise regression analysis. Learning from simulation-based education was shown with a mean difference in scores from pre-test to immediate post-test of 2.28 for GRS score (P<0.001) and 1.69 for technical checklist correct score (P<0.001); learning was retained for 3-6 months. Only prior simulation experience was significantly correlated with a decreased change in learning (r=-0.30, P<0.05). CONCLUSIONS A reduced amount of prior simulation training and increased years in practice, but not age on its own, were significant predictors of low baseline crisis resource management performance. Simulation-based education leads to crisis resource management learning that is well retained for 3-6 months, regardless of age or years in practice.
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Affiliation(s)
- Fahad Alam
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Anesthesiology & Pain Medicine University of Toronto, Toronto, ON, Canada.
| | - Vicki R LeBlanc
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada; University of Ottawa Simulation & Skills Centre, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Alan Baxter
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Jordan Tarshis
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Anesthesiology & Pain Medicine University of Toronto, Toronto, ON, Canada
| | - Dominique Piquette
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Yuqi Gu
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Caroline Filipowska
- Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ashley Krywenky
- Department of Emergency Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Nicole Kester-Greene
- Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Pierre Cardinal
- Department of Critical Care Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Meghan Andrews
- Department of Anesthesiology and Pain Medicine, Montfort Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Francois Chartier
- Le Centre Hospitalier Affilié Universitaire Régional (CHAUR), Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS MCQ), Trois-Rivière, QC, Canada
| | - Claire Burrows
- Department of Anaesthesia, Western Health, Melbourne, VIC, Australia; Western Health Anaesthesia and Critical Care Simulation, Melbourne, VIC, Australia
| | - Charles-Henri Houzé-Cerfon
- Department of Emergency Medicine, Toulouse University Hospital, Toulouse, France; Toulouse Institute of Simulation Healthcare, Toulouse University Hospital, Toulouse, France
| | - Joseph K Burns
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Lilia Kaustov
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Shelly Au
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sandy Lam
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Susan DeSousa
- Sunnybrook Canadian Simulation Centre, Toronto, ON, Canada
| | - Sylvain Boet
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada; Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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Akeely YY, Al Otaibi MM, Alesa SA, Bokhari NN, Alghamdi TA, Alahmari MS, AlRasheed NK. Organ Donation in the Emergency Department: Awareness and Opportunities. Cureus 2023; 15:e49746. [PMID: 38161899 PMCID: PMC10757646 DOI: 10.7759/cureus.49746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Background The only cure for end-organ failure is transplantation. Unfortunately, there are fewer organ donors than patients. Currently, the majority of organ donations come from live or brain-dead donors. In order to expand the pool of potential organ donors, the emergency department should be utilized effectively. Objectives The primary goal of this research is to determine emergency physicians' knowledge, awareness, and attitude about organ donation. Methodology A cross-sectional study was conducted through different hospitals in Saudi Arabia. It includes 106 physicians in the adult emergency departments. Results The majority (84.9%) of the participants never reported any case in the emergency department as a potential case for organ donation. In addition, 54.8% of the participants report having little to no knowledge of the ethical issues of organ donation. Furthermore, 66.1% of respondents claim to have little to no knowledge of the goals and duties of the SCOT (Saudi Center for Organ Transplantation). It was interesting to see that 96.2% of the participants reported that their organizations do not have any policies or procedures in place regarding organ donations. Regarding education, 99 (93.4%) physicians did not participate in any organ donation course, training, or teaching program about organ donation. At the same time, 67 (63.2%) physicians concurred that participation in a training program is essential. Moreover, 68 (64.2%) physicians believed that organ donation should be a part of every end-of-life case. In order to improve the donation process in the emergency department, 88 (83%) physicians would want a well-established program with defined policies and procedures. Conclusion According to our findings, the emergency physician has inadequate expertise and information on organ donation rules and procedures, which has resulted in a missed opportunity to recruit more potential donors. We recommend instituting clear policy and procedures and educating the physicians and all emergency medicine staff to have better outcome.
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Affiliation(s)
- Yahia Y Akeely
- Emergency Department, Security Forces Hospital, Riyadh, SAU
| | | | - Saleh A Alesa
- Emergency Department, Security Forces Hospital, Riyadh, SAU
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Freeman P. Measuring emergency physician productivity and work patterns. Emerg Med Australas 2023; 35:687-690. [PMID: 37454364 DOI: 10.1111/1742-6723.14208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 07/18/2023]
Abstract
I propose a methodology to compare individual emergency physician (EP) work patterns. This is intended to generate discussion within the specialty. A work pattern graph shows individual EP productivity and, assuming the EPs case selection is similar, can be used to compare group activity. Using a simple mathematical model, an averaged calculation can be made of the number of patients needed to be seen by each treating clinician during a standard shift.
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Affiliation(s)
- Peter Freeman
- Department of Emergency Medicine, Rotorua Hospital, Rotorua, New Zealand
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5
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Kilgore AE, Shufflebarger EF, Thompson MA, Zahid M, Gullett JP, Pigott DC, Burleson SL. Can Emergency Physicians Diagnose Cirrhosis by Ultrasound: A Prospective Single-Arm Educational Intervention. Cureus 2023; 15:e38012. [PMID: 37228520 PMCID: PMC10208003 DOI: 10.7759/cureus.38012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
Background and purpose Liver cirrhosis is common, and timely diagnosis of decompensated cirrhosis may impact acute care and resuscitation. Point-of-care ultrasound is a core competency of US emergency medicine training and is increasingly available in many acute care settings, including those where usual diagnostic modalities of cirrhosis may not be available. Only a few works of literature exist that evaluate the ultrasound diagnosis of cirrhosis and decompensated cirrhosis by emergency physicians (EPs). We aim to evaluate whether EPs can diagnose cirrhosis by ultrasound after a brief educational intervention and determine the accuracy of EP-interpreted ultrasound compared to the radiology-interpreted ultrasound as a gold standard. Methods This single-center prospective single-arm educational intervention evaluated the accuracy of EPs diagnosing cirrhosis and decompensated cirrhosis on ultrasound before and after a short educational intervention. Responses were paired across the three assessments, and paired sample t-tests were performed. Sensitivity, specificity, and likelihood ratios were calculated using attending radiology-interpreted ultrasounds as the gold standard. Results EPs scored a mean of 16% higher on a delayed knowledge assessment one month after the educational intervention than on the pre-intervention assessment. EP-interpreted ultrasound revealed a sensitivity of 0.90, specificity of 0.71, positive likelihood ratio of 3.08, and negative likelihood ratio of 0.14 compared to radiology-interpreted ultrasound. The sensitivity of our cohort was 0.98 for decompensated cirrhosis. Conclusions After a brief educational intervention, EPs can significantly increase their sensitivity and specificity in diagnosing cirrhosis using ultrasound. EPs were particularly sensitive in their diagnosis of decompensated cirrhosis.
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Affiliation(s)
- Ashton E Kilgore
- Emergency Medicine, University of Alabama at Birmingham, Birmingham, USA
| | | | - Maxwell A Thompson
- Emergency Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Mohd Zahid
- Radiology, University of Alabama at Birmingham, Birmingham, USA
| | - John P Gullett
- Emergency Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - David C Pigott
- Emergency Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Samuel L Burleson
- Emergency Medicine, University of Alabama at Birmingham, Birmingham, USA
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Reisdorff EJ, Masselink LE, Gallahue FE, Suter RE, Chappell BP, Evans DD, Salsberg E, Marco CA. Factors associated with emergency physician income. J Am Coll Emerg Physicians Open 2023; 4:e12949. [PMID: 37064163 PMCID: PMC10090942 DOI: 10.1002/emp2.12949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 04/18/2023] Open
Abstract
Objective Income fairness is important, but there are limited data that describe income equity among emergency physicians. Understanding the magnitude of and factors associated with income differences may be helpful in eliminating disparities. This study analyzed the associations of demographic factors, training, practice setting, and board certification with emergency physician income. Methods We distributed a survey to professional members of the American College of Emergency Physicians. The survey included questions on annual income, educational background, practice characteristics, gender, age, race, ethnicity, international medical graduate status, type of medical degree (MD vs DO), completion of a subspecialty fellowship, job characteristics, and board certification. Respondents also reported annual income. We used linear regression to determine the respondent characteristics associated with reported annual income. Results From 45,961 members we received 3407 responses (7.4%); 2350 contained complete data for regression analysis. The mean reported annual income was $315,306 (95% confidence interval [CI], $310,649 to $319,964). The mean age of the respondents was 47.4 years, 37.4% were women, 3.2% were races underrepresented in medicine (Black, American Indian, or Alaskan Native), and 4.8% were Hispanic or Latino. On linear regression, female gender was associated with lower reported annual income; difference -$43,565, 95% CI, -$52,217 to -$34,913. Physician age, degree (MD vs DO), underrepresented racial minority status, and underrepresented ethnic minority status were not associated with annual income. Fellowship training was associated with lower income; Accreditation Council for Graduate Medical Education (ACGME) program difference -$30,048; 95% CI, -$48,183 to -$11,912, non-ACGME-program difference -$27,640, 95% CI, -$40,970 to -$14,257. Working at a for-profit institution was associated with higher income; difference $12,290, 95% CI, $3693 to $20,888. Board certification was associated with higher income; difference, $43,267, 95% CI, $30,767 to $55,767. Conclusions This study identified income disparities associated with gender, practice setting, fellowship completion, and American Board of Emergency Medicine or American Osteopathic Board of Emergency Medicine certification.
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Affiliation(s)
| | - Leah E. Masselink
- George Washington University Fitzhugh Mullan Institute for Health Workforce EquityWashingtonDCUSA
| | - Fiona E. Gallahue
- Department of Emergency MedicineThe University of WashingtonSeattleWashingtonUSA
| | - Robert E. Suter
- Department of Emergency MedicineUniversity of Texas SouthwesternDallasTexasUSA
- Department of Military MedicineUniformed Services University of the Health SciencesBethesdaMarylandUSA
| | - Brad P. Chappell
- Department of Emergency MedicineUniversity of California, Harbor‐UCLA Medical CenterLos AngelesCaliforniaUSA
| | - Dian D. Evans
- Emory University Nell Hodgson Woodruff School of NursingAtlantaGeorgiaUSA
| | - Ed Salsberg
- George Washington University Fitzhugh Mullan Institute for Health Workforce EquityWashingtonDCUSA
| | - Catherine A. Marco
- Department of Emergency MedicinePenn State Health, Hershey Medical CenterHersheyPennsylvaniaUSA
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Chang MW, Kung CT, Yu SF, Wang HT, Lin CL. Exploring the Critical Driving Forces and Strategy Adoption Paths of Professional Competency Development for Various Emergency Physicians Based on the Hybrid MCDM Approach. Healthcare (Basel) 2023; 11:healthcare11040471. [PMID: 36833005 PMCID: PMC9957007 DOI: 10.3390/healthcare11040471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 02/09/2023] Open
Abstract
The implementation of competency-based medical education (CBME) focuses on learners' competency outcomes and performance during their training. Competencies should meet the local demands of the healthcare system and achieve the desired patient-centered outcomes. Continuous professional education for all physicians also emphasizes competency-based training to provide high-quality patient care. In the CBME assessment, trainees are evaluated on applying their knowledge and skills to unpredictable clinical situations. A priority of the training program is essential in building competency development. However, no research has focused on exploring strategies for physician competency development. In this study, we investigate the professional competency state, determine the driving force, and provide emergency physicians' competency development strategies. We use the Decision Making Trial and Evaluation Laboratory (DEMATEL) method to identify the professional competency state and investigate the relationship among the aspects and criteria. Furthermore, the study uses the PCA (principal component analysis) method to reduce the number of components and then identify the weights of the aspects and components using the ANP (analytic network process) approach. Therefore, we can establish the prioritization of competency development of emergency physicians (EPs) with the VIKOR (Vlse kriterijumska Optimizacija I Kompromisno Resenje) approach. Our research demonstrates the priority of competency development of EPs is PL (professional literacy), CS (care services), PK (personal knowledge), and PS (professional skills). The dominant aspect is PL, and the aspect being dominated is PS. The PL affects CS, PK, and PS. Then, the CS affects PK and PS. Ultimately, the PK affects the PS. In conclusion, the strategies to improve the professional competency development of EPs should begin with the improvement from the aspect of PL. After PL, the following aspects that should be improved are CS, PK, and PS. Therefore, this study can help establish competency development strategies for different stakeholders and redefine emergency physicians' competency to reach the desired CBME outcomes by improving advantages and disadvantages.
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Affiliation(s)
- Meng-Wei Chang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- Chang Gung Medical Education Research Centre (CG-MERC), Taoyuan 333, Taiwan
- Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung 802, Taiwan
| | - Chia-Te Kung
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Shan-Fu Yu
- Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung 802, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan
| | - Hui-Ting Wang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- Chang Gung Medical Education Research Centre (CG-MERC), Taoyuan 333, Taiwan
- Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung 802, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chia-Li Lin
- Department of International Business, Ming Chuan University, Taipei 111, Taiwan
- Correspondence:
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Xu H, Peng L, Wang Z, Liu X. Effects of psychological capital and social support availability on anxiety and depression among Chinese emergency physicians: Testing moderated mediation model. Front Psychol 2022; 13:991239. [PMID: 36571060 PMCID: PMC9768176 DOI: 10.3389/fpsyg.2022.991239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Anxiety often precedes depression, and the pathway from anxiety to depression may be affected by multiple exposures. Our research aims to explore the mediating effect of the social support availability (SSA) between anxiety and depression and how it is moderated by psychological capital. Methods A cross-sectional study was conducted among Chinese emergency physicians at the top-level general hospitals in eastern China. Data were collected via the questionnaire including anxiety and depression subscales of Symptom Checklist-90, Psychological Capital Questionnaire as well as Social Support Rating Scale. The PROCESS v3.4 macro was employed to assess the mediating role of SSA and a moderating role of psychological capital. Results A total of 536 valid samples were filtered. Anxiety, depression, SSA, and psychological capital were significant correlated. Anxiety was positively associated with depression (β = 0.82, p < 0.001), and the SSA mediated the relationship between anxiety and depression (indirect effect = 0.013, 95%BootCI [0.005, 0.023]). Psychological capital (specifically, self-efficacy, hope and resilience) further played a moderating role in the relationship between SSA and depression (β = 0.06, p < 0.01). Conclusion The mental health of emergency physicians should be concerned. In order to decrease anxiety and depression, SSA and psychological capital should be increased as the interventions for emergency physicians.
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Affiliation(s)
- Haibo Xu
- Center for Mental Health Education and Research, Xuzhou Medical University, Xuzhou, China
- School of Management, Xuzhou Medical University, Xuzhou, China
| | - Lixin Peng
- School of Management, Xuzhou Medical University, Xuzhou, China
| | - Zhen Wang
- School of Management, Xuzhou Medical University, Xuzhou, China
| | - Xin Liu
- Center for Mental Health Education and Research, Xuzhou Medical University, Xuzhou, China
- School of Management, Xuzhou Medical University, Xuzhou, China
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Gómez-Urquiza JL, Requena-Palomares I, Gorjón-Peramato E, Gómez-Salgado J, Cañadas-De la Fuente GA, Albendín-García L. Emergency and critical care professionals' opinion on escape room as a health sciences evaluation game: A cross-sectional descriptive study. Medicine (Baltimore) 2022; 101:e29432. [PMID: 35758377 PMCID: PMC9276226 DOI: 10.1097/md.0000000000029432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 04/20/2022] [Indexed: 11/26/2022] Open
Abstract
New teaching and evaluation methods are growing in health sciences. The escape room is a game that is showing benefits for assessing knowledge and important competencies in healthcare professionals. The aim of this study is to analyse the opinion of emergency and critical care professionals on the use of escape rooms as an evaluation game.A quantitative, descriptive, cross-sectional study was conducted using an ad-hoc questionnaire with a Likert-type scale. The study included emergency and critical care professionals who participated in the escape room "The Frustrated Emergency and Critical Care Professional," that took place during an emergency and critical care national congress. Data collection was carried out in June 2019.The sample was composed of n = 50 emergency and critical care professionals, 52% of whom were physicians and 48% were nurses. Professionals believe that this is a good teaching game for evaluation and useful for strengthen knowledge (4.7 points), as well as to improve teamwork and the ability to work under pressure (4.9).The escape room is a useful evaluation game in the context of emergency and critical care units that also allows training the teamwork and working under pressure competencies.
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Affiliation(s)
- Jose L. Gómez-Urquiza
- Nursing Department, Faculty of Health Sciences, University of Granada, Granada, Spain
| | | | | | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health. Faculty of Labour Sciences, University of Huelva, Huelva, Spain
- Safety and Health Posgraduate Programme. University Espíritu Santo, Guayaquil, Ecuador
| | | | - Luis Albendín-García
- Nursing Department, Faculty of Health Sciences, University of Granada, Granada, Spain
- La Chana Health Center, Andalusian Health Service, Junta de Andalucia, Granada, Spain
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Güllüpınar B, Sağlam C, Ünlüer EE, Ayvat P, Öztürk K, Gül M, Tandon S. Effectiveness of pericapsular nerve group block with ultrasonography in patients diagnosed with hip fracture in the emergency department. ULUS TRAVMA ACIL CER 2022; 28:832-838. [PMID: 35652877 PMCID: PMC10443010 DOI: 10.14744/tjtes.2022.67817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/02/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hip fractures (HF) are among the most common fractures present in the emergency department and are very painful. Pericapsular nerve group block (PENG) is a new regional anesthesia technique developed for analgesia in total hip arthroplas-ties. We aimed to determine the effectiveness of PENG block used to reduce pain in patients with HF in the emergency department. METHODS This single-center, randomized, and prospective study was carried out in the emergency department. The patients in-cluded in the study were selected according to the suitability of the personnel who will perform the procedure. The sealed envelope system was used for randomization. RESULTS Statistical analysis was performed with 39 patients (18 patients in the PENG group, 21 patients in the control group). Thir-teen (33.3%) of the patients were female and 26 (66.7%) were male. The mean age was 75.3. At rest post-procedure, the mean Numeric Rating Scale (NRS) scores of the patients at the 30th min, 2nd, 6th, and 24th h were 1.78±1.83, 0.00±0.00, 0.00±0.00, and 1.28±1.41 in the PENG group. On the other hand, it was 3.38±1.86, 0.05±0.22, 2.86±2.37, and 4.95±1.47 in the control group, respectively. The mean NRS scores of the patients at 15° elevation of the leg at the 30th min, 2nd, 6th, and 24th h were 3.06±1.80, 0.06±0.24, 0.22±0.43, and 2.44±1.50 in the PENG group and it was 5.24±1.81, 1.05±0.92, 4.29±2.35, and 7.14±1.24 in the control group, respectively. CONCLUSION PENG block can reduce pain and the need for systemic analgesics as a practical option in patients with HF.
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Affiliation(s)
- Birdal Güllüpınar
- Department of Emergency Medicine, İzmir Bozyaka Training and Resarch Hospital, İzmir-Turkey
| | - Caner Sağlam
- Department of Emergency Medicine, İzmir Bozyaka Training and Resarch Hospital, İzmir-Turkey
| | - Erden Erol Ünlüer
- Department of Emergency Medicine, İzmir Bozyaka Training and Resarch Hospital, İzmir-Turkey
| | - Pınar Ayvat
- Department of Anesthesiology and Reanimation, İzmir Democracy University Faculty of Medicine, İzmir-Turkey
| | - Kemal Öztürk
- Department of Emergency Medicine, Aksaray University Faculty of Medicine, Aksaray-Turkey
| | - Mehmet Gül
- Department of Emergency Medicine, Aksaray University Faculty of Medicine, Aksaray-Turkey
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Soh M, Hifumi T, Otani N, Maki K, Hayashi M, Miyazaki M, Kobayashi K, Ageishi R, Hatakeyama J, Kurihara T, Ishimatsu S. Trends in endotracheal intubation for patients with COVID-19 by emergency physicians. Glob Health Med 2022; 4:116-121. [PMID: 35586767 PMCID: PMC9066466 DOI: 10.35772/ghm.2021.01114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/15/2021] [Accepted: 01/07/2022] [Indexed: 06/15/2023]
Abstract
Emergency physicians perform endotracheal intubations for patients with COVID-19. However, the trends in the intubation for COVID-19 patients in terms of success rate, complications, personal protective equipment (PPE) information, barrier enclosure use, and its transition have not been established. We conducted a retrospective study of COVID-19 cases that required tracheal intubation at four hospitals in the Tokyo metropolitan area between January 2020 and August 2021. The overall intubation success rate, operator experience, and infection control methods were investigated. We then compared the early and late phases of the pandemic for a period of 8 months each. A total of 211 cases met the inclusion criteria, and 133 were eligible for analysis. The intubation success rate increased from 85% to 94% from early to late phase, although the percentage of intubations performed by emergency medicine residents increased significantly in the late phase (p = 0.03). The percentage of light PPE use significantly increased from 65% to 91% from early to late phase (p < 0.01), whereas the percentage of barrier enclosure use significantly decreased from 26% to 0% (p < 0.01). Furthermore, the infection prevention methods during intubation became more simplified from early to late phase.
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Affiliation(s)
- Mitsuhito Soh
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Norio Otani
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Kenro Maki
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Munehiro Hayashi
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Momoyo Miyazaki
- Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Kentaro Kobayashi
- Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Ryo Ageishi
- Department of Emergency Medicine and Critical Care, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Junji Hatakeyama
- Department of Emergency Medicine and Critical Care, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Tomohiro Kurihara
- Department of Emergency Medicine and Critical Care, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Shinichi Ishimatsu
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
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12
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Karakoyun OF, Kozaci N, Avci M, Uzunay H. Accuracy of emergency physicians' interpretation of computed tomography for urgent-emergent diagnoses in nontraumatic cases. Turk J Emerg Med 2022; 22:89-95. [PMID: 35529030 PMCID: PMC9069923 DOI: 10.4103/2452-2473.342804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/15/2021] [Accepted: 11/15/2021] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE The aim of this study is to evaluate the accuracy levels of the emergency physicians (EPs) managing the patient in the interpretation of the urgent-emergent pathological findings in thoracic and abdominal computed tomography (CT) scans. METHODS The EPs interpreted the CT scans of patients who visited the emergency department because of nontraumatic causes. Then, a radiology instructor made final assessments of these CT scans. Based on the interpretation of the radiology instructor, the false-positive rate, false-negative rate, sensitivity, specificity, positive predictive value, negative predictive value, and kappa coefficient (κ) of the EPs' interpretations of the CT scans were calculated. RESULTS A total of 268 thoracics and 185 abdominal CT scans were assessed in our study. The overall sensitivity and specificity of the EPs' interpretation of the thoracic CT scans were 90% and 89%, respectively, whereas the abdominal CT interpretation was 88% and 86%, respectively. There was excellent concordance between the EPs and the radiology instructor with regard to the diagnoses of pneumothorax, pulmonary embolism, pleural effusion, parenchymal pathology, and masses (κ: 0.90, κ: 0.87, κ: 0.71, κ: 0.79, and κ: 0.91, respectively) and to the diagnoses of intraabdominal free fluid, intraabdominal free gas, aortic pathology, splenic pathology, gallbladder pathology, mesenteric artery embolism, appendicitis, gynecological pathology, and renal pathology (κ: 1, κ: 0.92, κ: 0.96, κ: 0.88, κ: 0.80, κ: 0.79, κ: 0.89, κ: 0.88, and κ: 0.82, respectively). CONCLUSION The EPs are successful in the interpretation of the urgent-emergent pathological findings in thoracic and abdominal CT scans.
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Affiliation(s)
- Omer Faruk Karakoyun
- Department of Emergency Medicine, Mugla Sıtkı Kocman University Education and Research Hospital, Mugla, Turkey
| | - Nalan Kozaci
- Department of Emergency Medicine, Alanya Education and Research Hospital, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Mustafa Avci
- Department of Emergency Medicine, Antalya Education and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Huseyin Uzunay
- Department of Emergency Medicine, Kas State Hospital, Antalya, Turkey
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13
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Dong H, Zhang Q, Zhang Z, Zhu C. Association of sleep disturbance with shift work, occupational stress, and musculoskeletal pain in Chinese public hospital emergency workers: A multicentre cross-sectional study. Chronobiol Int 2022; 39:886-894. [PMID: 35253574 DOI: 10.1080/07420528.2022.2048662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Poor sleep, which is reportedly prevalent among healthcare professionals, could lead to various detrimental consequences. This study aimed to investigate the sleep quality of individuals working in emergency departments of public hospitals in China and explore the potential factors influencing sleep disturbance. A self-administered questionnaire was completed by 7688 emergency workers from 147 public hospitals in Shandong, China. Log-binomial regression analysis was performed to explore the relationship of sleep disturbance with possible influencing factors, including individual and work characteristics, occupational stress, shift work, and musculoskeletal pain. The participants' mean Pittsburgh Sleep Quality Index score was 9.6 ± 4.8, with 5341 (69.5%, 68.2-70.7%) of them experiencing sleep disturbance. The sleep quality was poorer in doctors (10.2 ± 5.1, 71.0%, 69.0-73.0%) than in nurses (9.2 ± 4.5, 68.6%, 67.0-70.1%), and poorer in those working in secondary (9.9 ± 4.5, 70.2%, 68.0-72.3%) and tertiary (12.2 ± 4.9, 77.5%, 75.3-79.7%) hospitals than in primary hospitals (8.0 ± 4.1, 64.6%, 62.6-66.6%). High prevalence of sleep disturbance was significantly associated with shift work, occupational stress, musculoskeletal pain, fewer breaks in a work shift, and less exercise during leisure time, after adjusting for confounding variables. Sleep disturbance occurred in emergency workers in the following order: two-shift rotation > three-shift rotation > permanent night shift > permanent day shift. Emergency workers in public hospitals in China had poor sleep quality and commonly experienced musculoskeletal pain. Urgent and comprehensive measures are needed to combat these issues.
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Affiliation(s)
- Hongyun Dong
- Medical Matters Department, Shouguang People's Hospital, Shouguang, Weifang Shandong Province China
| | - Qiong Zhang
- Oncology Department, Shouguang People's Hospital, Shouguang, Weifang, Shandong Province, China
| | - Zhenkun Zhang
- Oncology Department, Shouguang People's Hospital, Shouguang, Weifang, Shandong Province, China
| | - Chunji Zhu
- Neurology Department, Shouguang People's Hospital, Shouguang, Weifang, Shandong Province, China
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14
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Puchongmart C, Nakornchai T, Rittayamai N, Monsomboon A, Prapruetkit N, Limsuwat C, Ruangsomboon O, Chakorn T. Number of attempts required by emergency physicians to achieve competency in diaphragmatic ultrasound imaging. J Clin Ultrasound 2022; 50:256-262. [PMID: 34972254 DOI: 10.1002/jcu.23133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/24/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE This research aimed to determine the number of attempts that emergency physicians need to become proficient in undertaking diaphragmatic ultrasound imaging. METHODS A prospective observational study was conducted at the emergency department (ED) of a tertiary-care university hospital. Sixteen emergency physicians were each required to obtain a set of images of the right hemidiaphragm of five dyspneic patients using both diaphragmatic excursion and thickness techniques. The images were subsequently reviewed by a specialist using American College of Emergency Physician guidelines. If the evaluations of a physician did not reach the expected standard, the physician was to be given feedback and requested to collect images from another five patients. The process was to be repeated until such time as the images obtained by the physician were deemed to be up to standard. RESULTS Eighty patients, twelve emergency medicine residents, and four attending physicians were enrolled. Following a didactic session on diaphragmatic ultrasound imaging and its interpretation, practicing on five patients proved sufficient to achieve an adequate level of competency in conducting diaphragmatic ultrasound examinations. CONCLUSION Practicing on five patients is sufficient for emergency physicians to achieve an adequate level of competency in conducting right-sided diaphragmatic ultrasound examinations.
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Affiliation(s)
- Chanokporn Puchongmart
- Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tanyaporn Nakornchai
- Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nuttapol Rittayamai
- Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Apichaya Monsomboon
- Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nattakarn Prapruetkit
- Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chok Limsuwat
- Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Onlak Ruangsomboon
- Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tipa Chakorn
- Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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15
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Akbas S, Castellucci C, Nehls F, Müller SM, Spahn DR, Kaserer A. [Prehospital Pain Management: Overview and Potential Improvements]. Praxis (Bern 1994) 2022; 111:157-162. [PMID: 35232256 DOI: 10.1024/1661-8157/a003810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Prehospital Pain Management: Overview and Potential Improvements Abstract. Pain is a frequent issue in the prehospital setting. Rapid and adequate analgesia has a positive effect on the physiological and psychological condition of patients. However, up to 43 % of patients still suffer insufficient analgesia. Several studies have identified some factors that contribute to this problem; these factors can be patient- and intervention-specific or dependent on the staff on duty. In order to improve prehospital analgesia in the future, structural and organizational changes as well as the implementation of new methods and therapies are essential.
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Affiliation(s)
- Samira Akbas
- Institut für Anästhesiologie, Universität Zürich und Universitätsspital Zürich, Zürich
| | - Clara Castellucci
- Institut für Anästhesiologie, Universität Zürich und Universitätsspital Zürich, Zürich
| | - Franziska Nehls
- Institut für Anästhesiologie, Kantonsspital Winterthur, Winterthur
| | - Stefan Matthias Müller
- Schutz & Rettung Zürich, Institut für Anästhesiologie und Intensivmedizin, Stadtspital Triemli, Zürich
| | - Donat R Spahn
- Institut für Anästhesiologie, Universität Zürich und Universitätsspital Zürich, Zürich
| | - Alexander Kaserer
- Institut für Anästhesiologie, Universität Zürich und Universitätsspital Zürich, Zürich
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16
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Prachanukool T, Sanguanwit P, Thodamrong F, Suttapanit K. The 28-Day Mortality Outcome of the Complete Hour-1 Sepsis Bundle in the Emergency Department. Shock 2021; 56:969-974. [PMID: 34779799 PMCID: PMC8579988 DOI: 10.1097/shk.0000000000001815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/06/2021] [Accepted: 05/11/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The Surviving Sepsis Campaign published the Hour-1 Sepsis Bundle in 2018. The first-hour management of patients with sepsis in the emergency department (ED) is important, as suggested in the Hour-1 Sepsis Bundle. The objectives of the present study were to evaluate 28-day mortality and delayed septic shock with use of a complete and incomplete Hour-1 Sepsis Bundle in the ED. METHODS This prospective cohort study included adult patients with sepsis from March to July 2019. We followed the sepsis protocol used in the ED of a tertiary care hospital. RESULTS We enrolled 593 patients, with 55.9% in the complete Hour-1 Sepsis Bundle group. The 28-day mortality was 3.9% overall and no significant difference between the complete and incomplete Hour-1 Sepsis Bundle groups (3.6% vs. 4.2%, P = 0.707). Complete Hour-1 Sepsis Bundle treatment was not associated with 28-day mortality (adjusted OR = 2.04, 95% confidence interval [CI] = 0.72-5.74, P = 0.176) or delayed septic shock (adjusted OR = 0.74, 95% CI = 0.30-1.78, P = 0.499). Completion of each bundle did not affect outcomes of 28-day mortality and delayed septic shock. CONCLUSIONS The complete Hour-1 Sepsis Bundle treatment in the ED was not significantly associated with 28-day mortality and delayed septic shock. TRIAL REGISTRATION The trial was registered in the Thai Clinical Trial Registry, TCTR 20200526013.
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Affiliation(s)
- Thidathit Prachanukool
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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17
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Sir Ö, Hesselink G, Schoon Y, Olde Rikkert MGM. Dutch emergency physicians insufficiently educated in geriatric emergency medicine: results of a nationwide survey. Age Ageing 2021; 50:1997-2003. [PMID: 34673884 PMCID: PMC8581378 DOI: 10.1093/ageing/afab175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Indexed: 11/16/2022] Open
Abstract
Background Emergency physicians (EPs) provide care to older adults with complex health problems. Treating these patients is challenging for many EPs, which might originate from modest geriatric education. Objective Our aim was to assess EPs’ self-perceived needs regarding geriatric emergency medicine (GEM) education, factors determining these needs and the utilization of this education. Our secondary aim was to assess emergency department (ED) managers’ view and support for GEM education. Methods All EPs and ED managers in the Netherlands received a survey by e-mail. The questionnaires focused on EPs’ needs in GEM education, EPs’ utilization of GEM education and managerial support for GEM education. We used descriptive statistics to analyse needs, utilization of- and support for GEM education. Regression analyses were used to identify factors associated with EPs’ need for GEM education. Results EPs reported to need better training in diagnosing, treating and communicating with older adults. Seventy percent of EPs reported no GEM education program in their hospital, and 83% reported no utilization of GEM education outside their hospital. EPs working in EDs with a possibility for geriatric consultation, and EPs aware of actual GEM education programs, had lower educational needs. Of responding managers, 86.2% reported the care for older adults as an important topic; lack of finances and time were obstacles to provide GEM education for EPs. Conclusion EPs in the Netherlands feel insufficiently educated to treat older adults. ED managers largely recognize this educational challenge. This nationwide survey underlines the need to prioritize GEM education for EPs.
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Affiliation(s)
- Özcan Sir
- Radboud University Medical Center, Department of Emergency Medicine, Nijmegen, The Netherlands
| | - Gijs Hesselink
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Health Care, Nijmegen, The Netherlands
| | - Yvonne Schoon
- Radboud University Medical Center, Department of Geriatrics, Nijmegen, The Netherlands
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Wray TC, Johnson M, Cluff S, Nguyen FT, Tawil I, Braude D, Hanna W, Azevedo K, Venkataramani R, Dettmer TS, Marinaro J. Transesophageal Echocardiography Performed by Intensivist and Emergency Physicians-A 5-Year, Single-Center Experience. J Intensive Care Med 2021; 37:917-924. [PMID: 34541951 DOI: 10.1177/08850666211042522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: Data on the use of transesophageal echocardiography (TEE) by intensivist physicians (IP) and emergency physicians (EP) are limited. This study aims to characterize the use of TEE by IPs and EPs in critically ill patients at a single center in the United States. Materials and Methods: Retrospective chart review of all critical care TEEs performed from January 1, 2016 to January 31, 2021. The personnel performing the exams, location of the exams, characteristics of exams, complications, and outcome of the patients were reviewed. Results: A total of 396 examinations was reviewed. TEE was performed by IPs (92%) and EPs (9%). The location of TEE included: intensive care unit (87%), emergency department (11%), and prehospital (2%) settings. The most common indications for TEE were: hemodynamic instability/shock (44%), cardiac arrest (23%), and extracorporeal membrane oxygenation (ECMO) facilitation, adjustment, or weaning (21%). The most common diagnosis based on TEE were: normal TEE (25%), left ventricular dysfunction (19%), and vasodilatory shock (15%). A management change resulted from 89% of exams performed. Complications occurred in 2% of critical care TEEs. Conclusion: TEE can be successfully performed by IPs and EPs on critically ill patients in multiple clinical settings. TEE frequently informed management changes with few complications.
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Affiliation(s)
- Trenton C Wray
- 12289University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Molly Johnson
- 12289University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Shelby Cluff
- 12288University of New Mexico, Albuquerque, NM, USA
| | | | - Isaac Tawil
- 12289University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Darren Braude
- 12289University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Wendy Hanna
- 12289University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Keith Azevedo
- 12289University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | | | - Todd S Dettmer
- 12289University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Jonathan Marinaro
- 12289University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Payot C, Fehlmann CA, Suppan L, Niquille M, Lardi C, Sarasin FP, Larribau R. Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest. Int J Environ Res Public Health 2021; 18:ijerph18168323. [PMID: 34444071 PMCID: PMC8391446 DOI: 10.3390/ijerph18168323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 11/16/2022]
Abstract
The objective of this study was to identify the key elements used by prehospital emergency physicians (EP) to decide whether or not to attempt advanced life support (ALS) in asystolic out-of-hospital cardiac arrest (OHCA). From 1 January 2009 to 1 January 2017, all adult victims of asystolic OHCA in Geneva, Switzerland, were retrospectively included. Patients with signs of “obvious death” or with a Do-Not-Attempt-Resuscitation order were excluded. Patients were categorized as having received ALS if this was mentioned in the medical record, or, failing that, if at least one dose of adrenaline had been administered during cardiopulmonary resuscitation (CPR). Prognostic factors known at the time of EP’s decision were included in a multivariable logistic regression model. Included were 784 patients. Factors favourably influencing the decision to provide ALS were witnessed OHCA (OR = 2.14, 95% CI: 1.43–3.20) and bystander CPR (OR = 4.10, 95% CI: 2.28–7.39). Traumatic aetiology (OR = 0.04, 95% CI: 0.02–0.08), age > 80 years (OR = 0.14, 95% CI: 0.09–0.24) and a Charlson comorbidity index greater than 5 (OR = 0.12, 95% CI: 0.06–0.27) were the factors most strongly associated with the decision not to attempt ALS. Factors influencing the EP’s decision to attempt ALS in asystolic OHCA are the relatively young age of the patients, few comorbidities, presumed medical aetiology, witnessed OHCA and bystander CPR.
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Affiliation(s)
- Charles Payot
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (C.P.); (C.A.F.); (L.S.); (M.N.); (F.P.S.)
| | - Christophe A. Fehlmann
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (C.P.); (C.A.F.); (L.S.); (M.N.); (F.P.S.)
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- Emergency Medicine, Research Group, Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada
| | - Laurent Suppan
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (C.P.); (C.A.F.); (L.S.); (M.N.); (F.P.S.)
| | - Marc Niquille
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (C.P.); (C.A.F.); (L.S.); (M.N.); (F.P.S.)
| | - Christelle Lardi
- University Center of Legal Medicine (CURML), Geneva University Hospitals, 1211 Geneva, Switzerland;
| | - François P. Sarasin
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (C.P.); (C.A.F.); (L.S.); (M.N.); (F.P.S.)
| | - Robert Larribau
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (C.P.); (C.A.F.); (L.S.); (M.N.); (F.P.S.)
- Correspondence: ; Tel.: +41-79-553-9400
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20
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DU TK, Ning XH, Zhu HD, Shi D, Li JY. [Cognition and Ability of Emergency Physicians for Palliative Care in Tertiary Hospitals]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2021; 43:563-570. [PMID: 34494527 DOI: 10.3881/j.issn.1000-503x.13594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Objective To understand the cognition and related abilities of emergency physicians for palliative care in China. Methods A total of 115 emergency physicians were selected by convenient sampling to conduct a questionnaire survey.The questionnaire included the physicians' basic information,feelings and attitudes towards end-stage patients and their families,cognition of palliative care,and personal ability for palliative care. Results 25.2%,59.1%,and 15.7% of the emergency physicians considered they had "no understanding","partial understanding",and "full understanding" of palliative care,respectively.32(27.8%)physicians participated in palliative care-related lectures and they showed higher self-rated cognition levels(P=0.002).Wechat(39.1%),media(36.5%),and word of mouth(33.0%)were the main ways for emergency physicians to acquire the knowledge of palliative care.Among the emergency physicians,68.7% felt "powerless" in the face of end-stage patients,and 60.9% and 59.1% felt tangled and worried about death causing disputes,respectively.The emergency physicians had low self-rated ability in relieving dyspnea after removal of ventilator[3(2,4)]and eliminating the fear of death[3(3,4)].The self-rated cognition level of emergency physicians to palliative care was positively correlated with most of the self-rated ability indexes. Conclusions Lectures have a significant impact on emergency physicians' cognition level of palliative care.Most of the self-rated indexes of palliative care ability are positively correlated with the cognition level of palliative care.In the face of end-stage patients,most of the emergency physicians are powerless,tangled,and worried about disputes,and their self-rated indexes in relieving dyspnea after removal of ventilator and eliminating the fear of death are low,which necessitates relevant training.
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Affiliation(s)
- Tie-Kuan DU
- Department of Emergency Medicine,Beijing 100730,China
- Department of Geriatrics,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
- CAMS and PUMC,Beijing 100730,China
| | - Xiao-Hong Ning
- Department of Emergency Medicine,Beijing 100730,China
- Department of Geriatrics,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
- CAMS and PUMC,Beijing 100730,China
| | - Hua-Dong Zhu
- Department of Emergency Medicine,Beijing 100730,China
- Department of Geriatrics,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
- CAMS and PUMC,Beijing 100730,China
| | - Di Shi
- Department of Emergency Medicine,Beijing 100730,China
- Department of Geriatrics,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
- CAMS and PUMC,Beijing 100730,China
| | - Jia-Yi Li
- Department of Emergency Medicine,Beijing 100730,China
- Department of Geriatrics,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
- CAMS and PUMC,Beijing 100730,China
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21
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Bouillon-Minois JB, Trousselard M, Pereira B, Schmidt J, Clinchamps M, Thivel D, Ugbolue UC, Moustafa F, Occelli C, Vallet G, Dutheil F. Protocol of the Study on Emergency Health Care Workers' Responses Evaluated by Karasek Questionnaire: The SEEK-Study Protocol. Int J Environ Res Public Health 2021; 18:4068. [PMID: 33921527 PMCID: PMC8069162 DOI: 10.3390/ijerph18084068] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/02/2021] [Accepted: 04/03/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Stress is a significant public health concern that can be self-evaluated using the job control demands model from Karasek. Emergency health care workers are particularly exposed to stress because of the intrinsic characteristics associated with the job (i.e., life-threatening emergencies, overcrowding, lack of bed spaces). However, these attributes have never been studied using the Karasek model. METHODS An observational, prospective, multicentric study in French Emergency Departments will be conducted using a cohort of emergency health care workers. Four questionnaires before a control day and after a nightshift will be assessed every 5 years in the same emergency departments. Also, the Karasek questionnaire, a sociodemographic questionnaire, the Maslach Burnout Inventory scale, the Hospital Anxiety, Depression Scale, and a food intake questionnaire will be evaluated. Salivary biomarkers (cortisol, immunoglobulin A, lysozyme) will be collected from every emergency health care worker who consents to participating in the study. CONCLUSION This study will provide a point of care for the emergency health care workers' stress situation every 5 years. Ethics: This protocol was registered in Clinical Trials under the identification NCT02401607 after the French Ethics Committee's approval.
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Affiliation(s)
- Jean-Baptiste Bouillon-Minois
- Emergency Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (J.S.); (F.M.)
- LaPSCo, Université Clermont Auvergne, CNRS, 63000 Clermont-Ferrand, France; (G.V.); (F.D.)
| | - Marion Trousselard
- French Armed Forces Biomedical Research Institute, BP73, 91223 Brétigny-sur-Orge, France;
- APEMAC/EPSAM, EA 4360, Ile du Saulcy, BP 30309, 57006 Metz, France
| | - Bruno Pereira
- Clinical Research and Innovation Direction, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France;
| | - Jeannot Schmidt
- Emergency Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (J.S.); (F.M.)
| | - Maelys Clinchamps
- Occupational and Environmental Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France;
| | - David Thivel
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Université Clermont Auvergne, 63000 Clermont-Ferrand, France;
| | - Ukadike Chris Ugbolue
- Institute for Clinical Exercise & Health Science, University of the West of Scotland, Glasgow G720LH, UK;
- Department of Biomedical Engineering, University of Strathclyde, Glasgow G1 1XQ, UK
| | - Farès Moustafa
- Emergency Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (J.S.); (F.M.)
| | - Céline Occelli
- Emergency Department, CHU Nice, 06000 Nice, France;
- Emergency Department, Université Côte d’Azur, 06000 Nice, France
| | - Guillaume Vallet
- LaPSCo, Université Clermont Auvergne, CNRS, 63000 Clermont-Ferrand, France; (G.V.); (F.D.)
| | - Frédéric Dutheil
- LaPSCo, Université Clermont Auvergne, CNRS, 63000 Clermont-Ferrand, France; (G.V.); (F.D.)
- Occupational and Environmental Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France;
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Strauss M, Dahmen J, Hutter S, Brade M, Leischik R. Rescue Operations Lead to Increased Cardiovascular Stress in HEMS Crew Members: A Prospective Pilot Study of a German HEMS Cohort. J Clin Med 2021; 10:jcm10081602. [PMID: 33918944 PMCID: PMC8069023 DOI: 10.3390/jcm10081602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/04/2021] [Accepted: 04/06/2021] [Indexed: 01/14/2023] Open
Abstract
Helicopter emergency medical service (HEMS) is an essential part of prehospital emergency medicine. The working conditions lead to high physical stress, especially in rescue operations. The study aimed to determine the cardiovascular stress profile during rescue situations in HEMS crew members. Twenty-one HEMS crew members (male n = 20) participated in the prospective study. Heart rate, blood pressure and long-term ECG measurements were recorded during the whole operation day. The changes of measurements during rescue operation (52 operations in total) were compared to these of standby time. Rescue operations lead to increased load on the cardiovascular system, as expressed by significantly higher blood pressure, heart rate values and rate of cardiac events compared to standby time. Of special note, the difference in systolic blood pressure mean was 7.4 ± 9.0 mmHg (CI [5.1; 9.7], p < 0.001). Maximal heart rate was on average 33.7 bpm higher during rescue operation than in the standby time (CI [26.2; 40.8], p < 0.001). Cardiac events occurred significantly more frequently during the period of rescue operation than in standby time hours (p = 0.02). The results reported a significant load on the cardiovascular system during rescue operations in HEMS crew members. Therefore, it is necessary to carry out a risk stratification of the HEMS crew members to prevent cardiovascular risk and events.
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Affiliation(s)
- Markus Strauss
- Department of Cardiology I—Coronary and Peripheral Vascular Disease, Heart Failure Medicine, University Hospital Muenster, Cardiol, 48149 Muenster, Germany
- Department of Cardiology, Faculty of Health, School of Medicine, University Witten/Herdecke, 58095 Hagen, Germany;
- Correspondence: (M.S.); or (R.L.)
| | - Janosch Dahmen
- Department of Trauma and Orthopedic Surgery, Faculty of Health, School of Medicine, University Witten/Herdecke, 51109 Cologne, Germany;
- Berlin Fire and Emergency Medical Service, Medical Director Committee, 10179 Berlin, Germany
| | - Sophia Hutter
- Department of Cardiology, Faculty of Health, School of Medicine, University Witten/Herdecke, 58095 Hagen, Germany;
| | - Marko Brade
- BG Klinikum Duisburg, Department of Anesthesia and Intensive Care, 47249 Duisburg, Germany;
| | - Roman Leischik
- Department of Cardiology, Faculty of Health, School of Medicine, University Witten/Herdecke, 58095 Hagen, Germany;
- Correspondence: (M.S.); or (R.L.)
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de Alencar JCG, Marques B, Marchini JFM, Marino LO, Ribeiro SCDC, Bueno CG, da Cunha VP, Lazar Neto F, Valente FS, Rahhal H, Pereira JBR, Padrão EMH, Wanderley APB, Costa MGP, Brandão Neto RA, Souza HP. First-attempt intubation success and complications in patients with COVID-19 undergoing emergency intubation. J Am Coll Emerg Physicians Open 2020; 1:699-705. [PMID: 32838394 PMCID: PMC7436702 DOI: 10.1002/emp2.12219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/17/2020] [Accepted: 07/23/2020] [Indexed: 11/08/2022] Open
Abstract
Objectives To evaluate the first-attempt success rates and complications of endotracheal intubation of coronavirus disease 2019 (COVID-19) patients by emergency physicians. Methods This prospective observational study was conducted from March 24, 2020 through May 28, 2020 at the emergency department (ED) of an urban, academic trauma center. We enrolled patients consecutively admitted to the ED with suspected or confirmed COVID-19 submitted to endotracheal intubation. No patients were excluded. The primary outcome was first-attempt intubation success, defined as successful endotracheal tube placement with the first device passed (endotracheal tube) during the first laryngoscope insertion confirmed with capnography. Secondary outcomes included the following complications: hypotension, hypoxemia, aspiration, and esophageal intubation. Results A total of 112 patients with confirmed or suspected COVID-19 were enrolled. Median age was 61 years and 61 patients (54%) were men. The primary outcome, first-attempt intubation success, was achieved in 82% of patients. Among the 20 patients who were not intubated on the first attempt, 75% were intubated on the second attempt and 20% on the third attempt; cricothyrotomy was performed in 1 patient. Forty-eight (42%) patients were hypotensive and required norepinephrine immediately post-intubation. Fifty-eight (52%) experienced peri-intubation hypoxemia, and 2 patients (2%) had cardiac arrest. There were no cases of failed intubation resulting in death up to 24 hours after the procedure. Conclusion Emergency physicians achieve high success rates when intubating COVID19 patients, although complications are frequent. However, these findings should be considered provisional until their generalizability is assessed in their institutions and setting.
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Affiliation(s)
| | - Bruno Marques
- Emergency DepartmentHospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | | | - Lucas Oliveira Marino
- Emergency DepartmentHospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | | | - Cauê Gasparotto Bueno
- Emergency DepartmentHospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Victor Paro da Cunha
- Emergency DepartmentHospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Felippe Lazar Neto
- Emergency DepartmentHospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Fernando Salvetti Valente
- Emergency DepartmentHospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Hassan Rahhal
- Emergency DepartmentHospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | | | | | | | | | | | - Heraldo Possolo Souza
- Emergency DepartmentHospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
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Van Bogaert I, Depuydt C, Hachimi-Idrissi S. Dissatisfaction and Burnout among Flemish emergency physicians: a qualitative study. Acta Clin Belg 2020; 75:329-333. [PMID: 31185836 DOI: 10.1080/17843286.2019.1629077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Emergency physicians have shown difficulties to combine their private and professional life. In addition to a very stressful environment, they have to deal with multiple sources of uncertainty. These factors may lead to psychological distress. The aim of this study is to determine the factors leading to dissatisfaction and burnout among Flemish emergency physicians (EPs). Which are the barriers hindering EPs to seek help and what are the potential solutions for this problem? Methods:This is a prospective, explorative qualitative study where seven Flemish EPs were interviewed. These were in-depth semi-structured interviews. The information from the interviews was analyzed using NVivo 12. Results:The common contributors were the working schedule, the increasing number of patients, the mental and physical impact of the job and the relatively low income. The most important barrier to seek help is the existence of an unforgiving medical culture. The solutions provided by the EPs are less patients and a better financing. Conclusion:Dissatisfaction and burnout are common among the EP profession. There is a need for awareness and a change in the unforgiving medical culture to a 'no shame no blame culture'. Improvement of EPs' work schedule and income to the level of other medical specialties are other important needs. Finally, reducing the number of patient contact at the emergency department, by highlighting the difference between medical urgency rather than personal convenience.
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Affiliation(s)
- Ine Van Bogaert
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Catheline Depuydt
- Department of Emergency Medicine, Sint Lucas Hospital Ghent, Ghent, Belgium
| | - Said Hachimi-Idrissi
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Emergency Medicine, Ghent University Hospital, Ghent, Belgium
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25
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Bogseth MC, Gawthrope IC, Rippey JC. Emergency Medicine Advanced Ultrasound Service: A new paradigm. Emerg Med Australas 2020; 32:737-746. [PMID: 32249549 DOI: 10.1111/1742-6723.13501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/13/2020] [Accepted: 02/20/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Point-of-care ultrasound (POCUS) is now ubiquitous in emergency medicine. Increased accessibility does not, however, ensure expertise in its use. We present a unique model of an Emergency Medicine Advanced Ultrasound Service (EMAUS). In our model specialist emergency physicians with advanced ultrasound (US) qualifications (emergency sonologists), provide images and reports for the entire department. The service is considered an extension of the traditional radiology model. It is consultative, diagnostic and procedural, and includes full US examinations as well as POCUS examinations. METHODS A 4-month prospective descriptive observational study was conducted at a tertiary hospital during which data was recorded about emergency medicine US use and its outcomes. RESULTS A total of 1336 US scans were recorded. Emergency sonologists conducted the majority of examinations, 69.8%. Half the consultative USs demonstrated positive findings. Follow-up computed tomography (CT) was recommended in 8.8% of consultative US studies and 12.4% of POCUS studies. Concerning incidental findings requiring further investigation (usually CT/magnetic resonance imaging) were infrequent at 1.6%. CONCLUSION Globally POCUS has proliferated with varying expertise and data to support its use. The EMAUS provides a trusted and accountable service with the advantages of simultaneously integrating consultative US into the clinical context by an emergency physician. A diverse range of indications, scan types and pathology was recorded over the period demonstrating the utility of combining the roles of senior clinician, sonographer and radiologist and the benefits of advanced training and credentialing.
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Affiliation(s)
- Michael C Bogseth
- Emergency Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Ian C Gawthrope
- Emergency Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Hyperbaric Medicine Unit, Fiona Stanley Hospital, Perth, Western Australia, Australia.,School of Medicine, The University of Notre Dame, Fremantle, Western Australia, Australia
| | - James C Rippey
- Emergency Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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26
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Dana R, Torneck CD, Iglar K, Lighvan NL, Quiñonez C, Azarpazhooh A. Knowledge and Practices of Family and Emergency Physicians in Managing Nontraumatic Dental Conditions: A Case-based Survey. J Endod 2019; 45:263-271.e1. [PMID: 30803533 DOI: 10.1016/j.joen.2018.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/23/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Physicians are often patients' first point of contact for management of nontraumatic dental conditions (NTDCs). This study's aim was to evaluate the knowledge and practices of Ontario physicians in managing NTDCs, with a specific focus on antibiotic usage. METHODS A Web-based survey featured 4 NTDC clinical scenarios: irreversible pulpitis, localized acute apical abscess with or without systemic involvement, and chronic apical abscess. The survey link was distributed to active Ontario family and emergency physicians. The sample group was asked questions about their management of and experience with NTDCs, and demographic and practice characteristics were collected. Descriptive and multivariate logistic regression analyses were undertaken (P ≤ .05). RESULTS Sampled Ontario physicians tend to manage NTDCs in a manner that is not consistent with evidence-based care. For irreversible pulpitis and for localized acute apical abscess with or without systemic involvement, most physicians would prescribe an antibiotic (57.4%, 84.8%, and 96.3%, respectively), and 23.5% would prescribe an antibiotic for chronic apical abscess. Approximately half the sample (52.9%) felt discomfort in managing NTDCs, and 85.3% felt they were inadequately trained to manage NTDCs. CONCLUSION Areas that present opportunities for improvement in the physician management of NTDCs were identified, including the incorporation of further NTDC training in medical curricula and continuing medical education courses, and development and dissemination of guidelines for physicians in managing NTDCs.
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Affiliation(s)
- Ralph Dana
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Calvin D Torneck
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Karl Iglar
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Carlos Quiñonez
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Amir Azarpazhooh
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada; Clinical Epidemiology & Health Care Research, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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27
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Hoonpongsimanont W, Sahota PK, Chen Y, Patel M, Tarapan T, Bengiamin D, Sutham K, Imsuwan I, Dadeh AA, Nakornchai T, Narajeenron K. Physician professionalism: definition from a generation perspective. Int J Med Educ 2018; 9:246-252. [PMID: 30269110 PMCID: PMC6387766 DOI: 10.5116/ijme.5ba0.a584] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 09/18/2018] [Indexed: 05/23/2023]
Abstract
OBJECTIVES The primary objective of this study was to determine whether consensuses on the definition of emergency physician professionalism exist within and among four different generations. Our secondary objective was to describe the most important characteristic related to emergency physician professionalism that each generation values. METHODS We performed a cross-sectional survey study, using a card-sorting technique, at the emergency departments of two university-based medical centers in the United States. The study was conducted with 288 participants from February to November 2017. Participants included adult emergency department patients, emergency medicine supervising physicians, emergency medicine residents, emergency department nurses, and fourth- and second-year medical students who independently ranked 39 cards that represent qualities related to emergency physician professionalism. We used descriptive statistics, quantitative cultural consensuses and Spearman's correlation coefficients to analyze the data. RESULTS We found cultural consensuses on emergency physician professionalism in Millennials and Generation X overall, with respect for patients named the most important quality (eigenratio 5.94, negative competency 0%; eigenratio 3.87, negative competency 1.64%, respectively). There were consensuses on emergency physician professionalism in healthcare providers throughout all generations, but no consensuses were found across generations in the patient groups. CONCLUSIONS While younger generations and healthcare providers had consensuses on emergency physician professionalism, we found that patients had no consensuses on this matter. Medical professionalism curricula should be designed with an understanding of each generation's values concerning professionalism. Future studies using qualitative methods across specialties, to assess definitions of medical professionalism in each generation, should be pursued.
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Affiliation(s)
| | - Preet K Sahota
- Department of Emergency Medicine, University of California, Irvine, Orange, CA, USA
| | - Yanjun Chen
- Institute for Clinical and Translational Sciences, University of California, Irvine, Irvine, CA, USA
| | - Mayuri Patel
- Department of Emergency Medicine, University of California, Irvine, Orange, CA, USA
| | - Tanawat Tarapan
- Department of Emergency Medicine, University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
| | - Deena Bengiamin
- Department of Emergency Medicine, University of California, San Francisco-Fresno, Fresno, CA, USA
| | - Krongkarn Sutham
- Department of Emergency Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Intanon Imsuwan
- Department of Emergency Medicine, Thammasat University, Pathumthani, Thailand
| | - Ar-Aishah Dadeh
- Department of Emergency Medicine, Prince of Songkla University, Songkla, Thailand
| | - Tanyaporn Nakornchai
- Department of Emergency Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Khuansiri Narajeenron
- Department of Emergency Medicine, University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
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28
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Chen E, Tsoy D, Upadhye S, Chan TM. The Acute Care of Chronic Pain Study: Perceptions of Acute Care Providers on Chronic Pain, a Social Media-based Investigation. Cureus 2018; 10:e2399. [PMID: 29854574 PMCID: PMC5976271 DOI: 10.7759/cureus.2399] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction The diagnosis of chronic pain involves symptoms of pain of various etiologies lasting longer than six months. The prevalence of chronic pain in society ranges from 19% to 31% in North America. While chronic pain patient perceptions on the care provided to them in the Emergency Department (ED) have been studied, there has not been significant attention given to the attitudes of acute care providers towards these patients. Methods We utilized online questionnaires disseminated on Twitter, Facebook, Reddit, and emergency medicine blogs to gauge care provider attitudes of chronic pain patients. Survey respondents included ED physicians and their trainees, ED nurses and nurse practitioners, paramedics, and physician assistants. Results Responses revealed numerous factors impacting care provider dissatisfaction with treating chronic pain in the ED; significant factors included the lack of longitudinal care and inappropriate medication of chronic pain resulting in dependency. We found that additional chronic pain-specific training was associated with increased care provider confidence in the treatment of chronic pain. Practice patterns were found to be varied, with half of the respondents stating that chronic pain should be medicated acutely. Conclusions We conclude that acute care provider dissatisfaction with chronic pain treatment is multifactorial in origin and that confidence in the acute treatment of chronic pain can be improved with chronic pain-specific training.
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Affiliation(s)
- Eric Chen
- Faculty of Health Sciences, Department of Medicine, Division of Emergency Medicine, McMaster University
| | - Daniel Tsoy
- Faculty of Health Sciences, Department of Medicine, Division of Emergency Medicine, McMaster University
| | - Suneel Upadhye
- Faculty of Health Sciences, Department of Medicine, Division of Emergency Medicine, McMaster University
| | - Teresa M Chan
- Faculty of Health Sciences, Department of Medicine, Division of Emergency Medicine, McMaster University
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Rowlands R, Rippey J, Tie S, Flynn J. Bedside Ultrasound vs X-Ray for the Diagnosis of Forearm Fractures in Children. J Emerg Med 2016; 52:208-215. [PMID: 27814988 DOI: 10.1016/j.jemermed.2016.10.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 09/08/2016] [Accepted: 10/03/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Painful forearm injuries after a fall occur frequently in children. X-ray study is currently the gold standard investigation. Ultrasound (US) is a potential alternative that avoids exposure to ionizing radiation and may be less painful than x-ray study; and familiarity and skill with US is increasing among emergency physicians. OBJECTIVES The primary aim of this study was to determine if a cohort of physicians with little or no previous experience with US could, after a short training program, safely exclude forearm fractures in children. Secondary aims were to compare any pain or discomfort associated with clinical examination, US, and x-ray study and to determine the acceptability of US as a diagnostic tool to parents and patients. METHODS A prospective, nonrandomized, interventional diagnostic study was performed on children between the ages of 0 and 16 years who had a suspected fracture of the forearm. US scanning was performed by a group of physicians, most with little or no previous US experience. RESULTS After the brief training program, a group of pediatric emergency physicians could diagnose forearm fractures in children with a sensitivity of 91.5% and a specificity of 87.6%. Pain associated with US was no better or worse than pain associated with x-ray study. Patients and parents preferred US over x-ray study as an investigation modality for suspected forearm fractures. CONCLUSION A group of pediatric emergency physicians with limited previous experience could, after a short training program, diagnose forearm fractures in children. Pain associated with US was no better or worse than pain associated with x-ray study.
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Affiliation(s)
- Rachel Rowlands
- Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia; University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - James Rippey
- Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, Australia; School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Nedlands, Western Australia, Australia
| | - Sing Tie
- Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia; Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, Australia
| | - James Flynn
- Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia; School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Nedlands, Western Australia, Australia; School of Paediatrics and Child Health, University of Western Australia, Nedlands, Western Australia, Australia
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30
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Wang HI, Yiang GT, Hsu CW, Wang JC, Lee CH, Chen YL. Thyroid Storm in a Patient with Trauma - A Challenging Diagnosis for the Emergency Physician: Case Report and Literature Review. J Emerg Med 2016; 52:292-298. [PMID: 27742400 DOI: 10.1016/j.jemermed.2016.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/27/2016] [Accepted: 09/05/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Thyroid storm, an endocrine emergency, remains a diagnostic and therapeutic challenge. It is recognized to develop as a result of several factors, including infection, surgery, acute illness, and rarely, trauma. Recognition of thyroid storm in a trauma patient is difficult because the emergency physician usually focuses on managing more obvious injuries. OBJECTIVE OF THE REVIEW We present a case of trauma-related thyroid storm and review the previous literature on posttraumatic thyroid storm to delineate risk factors of the disease. The case occurred in a 32-year-old man after a motorcycle accident. DISCUSSION Careful investigation of patient history and risk factors of trauma-related thyroid storms and utilization of the scoring system may facilitate early diagnosis. Traumatically induced thyroid storm usually responds to medical treatment developed for hyperthyroidism. Surgical intervention may be needed for patients who failed medical treatment or those with direct thyroid gland injuries. The outcome is usually fair under appropriate management. CONCLUSION We present a case of trauma-related thyroid storm to illustrate the diagnostic and therapeutic approach with a summary of the previous literature. Emergency physicians should be aware of the clinical presentation and risk factors of patients with trauma-related thyroid storm to reduce the rate of misdiagnosis and prevent catastrophic outcomes.
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Affiliation(s)
- Hsiang-I Wang
- Department of Emergency Medicine, Taichung Armed Forces General Hospital, Taichung, Taiwan
| | - Giou-Teng Yiang
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan; Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Chin-Wang Hsu
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Jen-Chun Wang
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Hsing Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Long Chen
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
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DeLiema M, Homeier DC, Anglin D, Li D, Wilber KH. The Forensic Lens: Bringing Elder Neglect Into Focus in the Emergency Department. Ann Emerg Med 2016; 68:371-7. [PMID: 27005449 PMCID: PMC5003723 DOI: 10.1016/j.annemergmed.2016.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 01/21/2016] [Accepted: 02/03/2016] [Indexed: 11/28/2022]
Abstract
We present 2 case studies of older patients who were brought to the emergency department (ED) in severely debilitated states. Both presented with severe malnutrition, contractures, and decubitus ulcers, and were nonverbal, with histories of dementia and end-stage disease. Their primary caregivers, adult children, were uncooperative with Adult Protective Services and disregarded treatment recommendations. Although both elders had signs suspicious for neglect, a comprehensive review revealed many layers of complexity. We use these cases to illustrate an approach to the assessment of possible elder neglect in ED settings and how to intervene to ensure patient safety. We begin with a discussion of the differences between willful, unintentional, and unsubstantiated neglect by a caregiver and then describe when to suspect neglect by evaluating the elder, interviewing the caregiver and first responders, assessing the caregiver's ability to meet the elder's needs, and, if possible, obtaining medical history and information about the home care environment. These cases illustrate the importance of careful documentation in cases of suspected neglect to assist investigative agencies, reduce the risk of further harm, and improve patient outcomes.
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Affiliation(s)
| | | | - Deirdre Anglin
- University of Southern California, Keck School of Medicine
| | - Danielle Li
- University of California Irvine, School of Medicine
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Roh H, Park KH. A Scoping Review: Communication Between Emergency Physicians and Patients in the Emergency Department. J Emerg Med 2016; 50:734-43. [PMID: 26818383 DOI: 10.1016/j.jemermed.2015.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 06/19/2015] [Accepted: 11/10/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Understanding the basic qualities of communication between emergency physicians and patients could improve communication in the emergency department. OBJECTIVE The objectives of this scoping review are to map the literature about the gaps in communication between emergency physicians and patients in the emergency department and make recommendations for further research. METHODS A scoping review of literature published since 1980 and written in English was undertaken using the following databases: Pubmed, Scopus, and SocINDEX. The articles were searched for using two-keyword combinations of the following keywords joined by "AND": "communication," "patient," "emergency physician," "emergency department/emergency room/accident," and "emergency room." Seventeen articles were included in the final review. RESULTS Five research issues were covered by the 17 papers: patient-centered communication, information sharing, bad news delivery, shared decision making, and physicians' perspectives on communication. Emergency physicians have several communication characteristics: doctor-driven decision making, focusing on efficient information gathering, immature communication techniques, and obstacles to overcoming miscommunication. Patients also have several communication characteristics: active participation in medical encounters, expectation of physician as a reliable guide, understanding physicians' difficulties, and factors that contribute to understanding. CONCLUSIONS Several conclusions about emergency department communication between patients and emergency physicians were drawn. Additional research is required to consider diverse patient needs in the emergency department. Furthermore, training programs for emergency physicians to improve the quality of communication should be developed and implemented in line with our research findings.
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Affiliation(s)
- HyeRin Roh
- Department of Medical Education, Inje University College of Medicine, Busan, South Korea
| | - Kyung Hye Park
- Department of Emergency Medicine, Inje University College of Medicine, Busan, South Korea
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Vanni S, Nazerian P, Casati C, Moroni F, Risso M, Ottaviani M, Pecci R, Pepe G, Vannucchi P, Grifoni S. Can emergency physicians accurately and reliably assess acute vertigo in the emergency department? Emerg Med Australas 2015; 27:126-31. [PMID: 25756710 DOI: 10.1111/1742-6723.12372] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To validate a clinical diagnostic tool, used by emergency physicians (EPs), to diagnose the central cause of patients presenting with vertigo, and to determine interrater reliability of this tool. METHODS A convenience sample of adult patients presenting to a single academic ED with isolated vertigo (i.e. vertigo without other neurological deficits) was prospectively evaluated with STANDING (SponTAneousNystagmus, Direction, head Impulse test, standiNG) by five trained EPs. The first step focused on the presence of spontaneous nystagmus, the second on the direction of nystagmus, the third on head impulse test and the fourth on gait. The local standard practice, senior audiologist evaluation corroborated by neuroimaging when deemed appropriate, was considered the reference standard. Sensitivity and specificity of STANDING were calculated. On the first 30 patients, inter-observer agreement among EPs was also assessed. RESULTS Five EPs with limited experience in nystagmus assessment volunteered to participate in the present study enrolling 98 patients. Their average evaluation time was 9.9 ± 2.8 min (range 6-17). Central acute vertigo was suspected in 16 (16.3%) patients. There were 13 true positives, three false positives, 81 true negatives and one false negative, with a high sensitivity (92.9%, 95% CI 70-100%) and specificity (96.4%, 95% CI 93-38%) for central acute vertigo according to senior audiologist evaluation. The Cohen's kappas of the first, second, third and fourth steps of the STANDING were 0.86, 0.93, 0.73 and 0.78, respectively. The whole test showed a good inter-observer agreement (k = 0.76, 95% CI 0.45-1). CONCLUSIONS In the hands of EPs, STANDING showed a good inter-observer agreement and accuracy validated against the local standard of care.
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Affiliation(s)
- Simone Vanni
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy
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Hassen GW, Bruck I, Donahue J, Mason B, Sweeney B, Saab W, Weedon J, Patel N, Perry K, Matari H, Jaiswal R, Kalantari H. Accuracy of optic nerve sheath diameter measurement by emergency physicians using bedside ultrasound. J Emerg Med 2014; 48:450-7. [PMID: 25497897 DOI: 10.1016/j.jemermed.2014.09.060] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 07/25/2014] [Accepted: 09/30/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Ultrasound (US) measurement of the optic nerve sheath diameter (ONSD) has been utilized as an indirect assessment of intracranial pressure. It is usually performed by trained ultrasonographers. OBJECTIVES To evaluate whether or not emergency physicians (EP) are capable of measuring the ONSD accurately by US. MATERIALS AND METHODS A retrospective measurement of ONSD was conducted on computed tomography (CT) scans of the head or facial bones. These patients had undergone ocular US performed by EPs prior to CT scanning. The CT scan measurements of ONSD read by a board-certified radiologist were compared with that of the US read by a registered diagnostic medical sonographer. A difference in measurements of the ONSD ≥ 0.5 mm between the two modalities was considered as significant for this study. RESULTS The ONSD measurements were performed with CT scan and compared to that of the US. Of the 61 patients studied, 36 (59%) were male and 25 (41%) were female. The average age was 56 ± 17 years. All but 4 patients had ONSD measurements that were between 5 and 6 mm [Corrected]. Discrepancy in measurements of the ONSD between US and CT for both groups fell within our predetermined value (0.5 mm) for the majority of cases. None of the measurements were above 6 mm. The intraclass correlation coefficient was 0.9 (95% confidence interval 0.8846-0.9303). CONCLUSION Emergency physicians were capable of accurately measuring the ONSD using bedside US. Prospective studies with a larger sample size are recommended to validate these findings.
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Affiliation(s)
- Getaw Worku Hassen
- Department of Emergency Medicine, New York Medical College (NYMC), Metropolitan Hospital Center, New York, New York
| | - Isaac Bruck
- Department of Emergency Medicine, New York Medical College (NYMC), Metropolitan Hospital Center, New York, New York
| | - Joseph Donahue
- Department of Emergency Medicine, New York Medical College (NYMC), Metropolitan Hospital Center, New York, New York
| | - Benjamin Mason
- Department of Emergency Medicine, New York Medical College (NYMC), Metropolitan Hospital Center, New York, New York
| | - Brett Sweeney
- Department of Emergency Medicine, New York Medical College (NYMC), Metropolitan Hospital Center, New York, New York
| | - Weafue Saab
- Department of Emergency Medicine, New York Medical College (NYMC), Metropolitan Hospital Center, New York, New York
| | - Jeremy Weedon
- Department of Scientific Computing, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Neal Patel
- Department of Emergency Medicine, New York Medical College (NYMC), Metropolitan Hospital Center, New York, New York
| | - Kenneth Perry
- Department of Emergency Medicine, New York Medical College (NYMC), Metropolitan Hospital Center, New York, New York
| | - Hussein Matari
- Department of Radiology, NYMC, Metropolitan Hospital Center, New York, New York
| | - Rajnish Jaiswal
- Department of Emergency Medicine, New York Medical College (NYMC), Metropolitan Hospital Center, New York, New York
| | - Hossein Kalantari
- Department of Emergency Medicine, New York Medical College (NYMC), Metropolitan Hospital Center, New York, New York
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Abstract
The progressive rise of ED visits globally, and insufficient numbers of emergency physicians, has resulted in the use of mid-level providers as adjuncts for the provision of emergency care, especially in the US and Canada. Military medics, midwives, aeromedical paramedics, EMT-Ps, flight nurses, forensic nurses, sexual assault nurse examiner nurses--are some examples of well-established mid-level provider professionals who achieve their clinical credentials through accredited training programmes and formal certification. In emergency medicine, however, mid-level providers are trained for general care, and typically acquire emergency medicine skills through on-the-job experience. There are very few training programmes for NPs and PAs in emergency care. The manpower gap for physicians in general, and emergency physicians specifically, will not be eliminated in the reasonable future. Mid-level providers--ENTs, paramedics, NPs, PAs--are an excellent addition to the emergency medicine workforce. However, the specialty of emergency medicine developed because specific and focused training was needed for physicians to practice safe and qualify emergency care. This same principle applies to mid-level providers. Emergency Medicine needs to develop a vision and a plan to train emergency medicine specialist NPs and PAs, and explore other innovations to expand our emergency care workforce.
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Affiliation(s)
- Judith E Tintinalli
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
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Kameda T, Murata Y, Fujita M, Isaka A. Transabdominal ultrasound-guided urethral catheterization with transrectal pressure. J Emerg Med 2013; 46:215-9. [PMID: 24199721 DOI: 10.1016/j.jemermed.2013.08.072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 06/24/2013] [Accepted: 08/15/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Occasionally, difficulty with standard urethral catheterization is encountered. OBJECTIVE We conducted a pilot study to evaluate whether transabdominal ultrasound (TAUS) showed the tip of a urethral catheter and whether TAUS-guided catheterization with transrectal pressure is successful in male patients in whom performing standard catheterization is difficult. METHODS The eligible study participants included adult male patients in whom standard catheterization failed in our emergency department or who were transferred from other facilities after failure of catheterization and subsequent urethral bleeding. The enrolled patients included those in whom the tip of a catheter could not be advanced through the posterior and bulbar urethra judging from the inserted length. First, an emergency nurse advanced a catheter until the progress was obstructed. Next, an emergency physician performed TAUS to detect the tip of the catheter. If the tip was detected, the physician inserted the index finger into the rectum and kept pushing the site of the obstruction. After following these procedures, the nurse again advanced the catheter. RESULTS Six patients were enrolled. The tip of a catheter was detected in the urethra or the false passage using TAUS in 4 of the 6 patients. In these 4 patients, the curve of the urethra became gentle or the false passage was compressed by transrectal pressure and the tip was advanced smoothly to the bladder. CONCLUSIONS In some male patients in whom performing standard urethral catheterization is difficult, TAUS reveals the tip of the catheter and TAUS-guided catheterization with transrectal pressure can be safe and useful.
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Affiliation(s)
- Toru Kameda
- Department of Emergency Medicine, Red Cross Society Azumino Hospital, Azumino, Nagano, Japan
| | - Yasushi Murata
- Department of Urology, Red Cross Society Azumino Hospital, Azumino, Nagano, Japan
| | - Masato Fujita
- Department of Emergency Medicine, Red Cross Society Azumino Hospital, Azumino, Nagano, Japan
| | - Akira Isaka
- Department of Emergency Medicine, Red Cross Society Azumino Hospital, Azumino, Nagano, Japan
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Rafi M, Shetty A, Gunja N. Accuracy of computed tomography of the kidneys, ureters and bladder interpretation by emergency physicians. Emerg Med Australas 2013; 25:422-6. [PMID: 24099370 DOI: 10.1111/1742-6723.12117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The study aims to determine the interpretation accuracy of computed tomography of the kidneys, ureters and bladder (CT-KUB) by emergency physicians (EPs) compared with the formal radiology report, as the reference standard, in patients with suspected acute urinary tract calculous disease. METHODS A sample of 20 consecutive CT-KUB scans for suspected acute calculous disease was compiled from the medical imaging department of an adult tertiary teaching hospital. Ten EPs with a minimum of 2 years' experience post-Fellowship interpreted each scan using a template form. The total sample of 200 reports by EPs was compared with the formal radiology report for agreement in detecting renal tract stones, signs of obstruction and other clinical findings. Interrater agreement and the kappa statistic were used for comparative data analysis. RESULTS There was a high level of agreement (%, kappa value) between EPs and radiologists for the detection of large (≥5 mm) calculi (94.5%, κ 0.89), signs of obstruction (93%, κ 0.86) and clinically significant findings (90%, κ 0.78). The level of agreement was low for the detection of small (<5 mm) calculi (79%, κ 0.48) and clinically non-significant findings (67.5%, κ 0.33). CONCLUSION EPs can accurately detect clinically significant acute calculous disease and signs of obstruction on CT-KUB, allowing for ongoing acute management and early disposition of the patient. However, their findings should be verified against the formal radiology report when available.
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Affiliation(s)
- Momtaz Rafi
- Emergency Department, Nepean Hospital, Sydney, New South Wales, Australia
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Abstract
BACKGROUND The 3-hour window for treating stroke with intravenous tissue plasminogen activator (t-PA) requires well-organized, integrated efforts by emergency physicians and stroke neurologists. OBJECTIVE To evaluate attitudes and knowledge of emergency physicians about intravenous t-PA for acute ischemic stroke, particularly in primary stroke centers (PSCs) with stroke neurology teams. METHODS A 15-question pilot Internet survey administered by the Arizona College of Emergency Physicians. RESULTS Between March and August 2005, 100 emergency physicians responded: 71 in Arizona and 29 in Missouri. Forty-eight percent practiced at PSCs; 48% thought t-PA was effective, 20% did not, and 32% were uncertain. PSC or non-PSC location of practice did not influence endorsement (odds ratio, 0.96; 95% confidence interval, 0.27-1.64). Of those opposing t-PA, 87% cited risk of hemorrhage. CONCLUSIONS Most emergency physicians did not endorse t-PA. Improved collaboration between emergency physicians and stroke neurologists is needed.
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Affiliation(s)
- Bentley J Bobrow
- Department of Emergency Medicine Mayo Clinic, Scottsdale, Arizona
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Shoenberger JM, Massopust K, Henderson SO. The use of bedside ultrasound in cardiac arrest. Cal J Emerg Med 2007; 8:47-50. [PMID: 20440400 PMCID: PMC2860421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND The decision to terminate resuscitative measures in the setting of cardiac arrest is based on several criteria, some of which are subjective. Ultrasound in the emergency department has potentially added an objective data point to assist in this decision. OBJECTIVE We sought to determine if emergency physicians who were trained in the use of ultrasound use it in cardiac arrest scenarios and if so, what effect they believe it has on the duration of the resuscitative event. Our hypothesis was that emergency physicians terminate resuscitative efforts sooner with visualization of cardiac standstill and feel more comfortable in doing so. METHODS The ultrasound training program at Los Angeles County + University of Southern California Medical Center began in 1995. We surveyed all graduates of the residency program since that date about their use of ultrasound in cardiac arrest. RESULTS Surveys were mailed to 154 practicing emergency physicians. One hundred and sixteen surveys (75%) surveys were returned. During residency, the majority of individuals (68%) reported that they had used ultrasound during at least 10 cardiac arrests. It was used to search for a reversible cause of cardiac arrest (pericardial effusion) or for documentation of cardiac standstill. Ninety-one percent of individuals used the ultrasound result as an aid in deciding when to terminate resuscitative efforts and 59% believed it shortened their resuscitation time. After graduation, only 53% of individuals in this study have ultrasound available in their daily clinical practice. For these individuals, 60% use it in more than 50% of their cardiac arrest situations. Ultrasound was used to shorten the code time (63%) as well as to reassure and confirm the presence of cardiac standstill for the physician (88%) and the resuscitation team (59%). CONCLUSION Most emergency physicians in this cohort who have access to ultrasound use it in cardiac arrest cases and believe that it shortens code times.
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Affiliation(s)
- Jan M. Shoenberger
- Department of Emergency Medicine, Keck/USC School of Medicine, Los Angeles, CA
| | - Kristy Massopust
- Department of Preventive Medicine Keck/USC School of Medicine, Los Angeles, CA
| | - Sean O. Henderson
- Department of Emergency Medicine, Keck/USC School of Medicine, Los Angeles, CA
- Department of Preventive Medicine Keck/USC School of Medicine, Los Angeles, CA
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Langdorf MI, Bearie BJ, Kazzi AA, Blasko B, Kohl A. Patients' vs. Physicians' Assessments of Emergencies: The Prudent Layperson Standard. Cal J Emerg Med 2003; 4:75-81. [PMID: 20847842 PMCID: PMC2906958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To compare perception of the need for emergency care by emergency department (ED) patients vs. emergency physicians (EPs). METHODS Mailed survey to EPs and a convenience sample of ED patients. Survey rated urgency of acute sore throat, ankle injury, abdominal pain, and hemiparesis, as well as the best definition of "emergency." Responses were compared with chi-square (p < .05). RESULTS 119/140 (85%) of EPs and 1453 ED patients responded. EPs were more likely to judge acute abdominal pain (79.8% vs. 43.4%, p < 0.001, odds ratio (OR) 5.16, 95% confidence interval (CI) 3.19-8.40) and hemiparesis (100% vs. 82.6%, p < 0.001, OR 24.9, 95% CI 3.75-94.4) as an emergency. Similar proportions of ED patients and EPs considered sore throat (12.2% vs. 7.6%, p = 0.18, OR 0.59, CI 0.27-1.23) and ankle injury (46.9% vs. 38.6%, p = 0.10, OR 0.71, CI 0.48-1.06) an emergency. EPs (35%) and ED patients (40%) agreed to a similar degree with the "prudent layperson" definition, "a condition that may result in death, permanent disability, or severe pain." (p = .36, OR 1.22, CI 0.81-1.84). EPs were more likely to add, "the condition prevented work," (27% vs. 16%, p = 0.003, OR 0.51, CI 0.33-0.81). Patients more often added, "occurred outside business hours" (15% vs. 4%, p = 0.002, OR 4.0, CI = 1.5-11.3). CONCLUSION For serious complaints, ED patients' thresholds for seeking care are higher than judged appropriate by EPs. Stroke is not uniformly recognized as an emergency. Absent consensus for the "correct" threshold, the prudent layperson standard is appropriate.
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Affiliation(s)
- Mark I. Langdorf
- Correspondence: Mark I. Langdorf, MD, MHPE, RDMS, Department of Emergency Medicine, 101 City Drive, Route 128, Orange, CA 92868, (714) 456-5239, (714) 456-5390 (fax),
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