Objective:To analyze the effect of using a problem-based(PBL)independent learning model in teaching cerebral ischemic stroke(CIS)first aid in emergency medicine.Methods:90 interns in the emergency department of our ho...Objective:To analyze the effect of using a problem-based(PBL)independent learning model in teaching cerebral ischemic stroke(CIS)first aid in emergency medicine.Methods:90 interns in the emergency department of our hospital from May 2022 to May 2023 were selected for the study.They were divided into Group A(45,conventional teaching method)and Group B(45 cases,PBL independent learning model)by randomized numerical table method to compare the effects of the two groups.Results:The teaching effect indicators and student satisfaction scores in Group B were higher than those in Group A(P<0.05).Conclusion:The use of the PBL independent learning model in the teaching of CIS first aid can significantly improve the teaching effect and student satisfaction.展开更多
BACKGROUND: Sleep deprivation resulting from night shifts, is a major cause of burnout among physicians. Exogenous melatonin may improve sleep quality in night-shift workers. The study aims to compare the effectivenes...BACKGROUND: Sleep deprivation resulting from night shifts, is a major cause of burnout among physicians. Exogenous melatonin may improve sleep quality in night-shift workers. The study aims to compare the effectiveness of melatonin versus placebo on sleep effi ciency in emergency medicine(EM) residents. METHODS: A randomized, double-blind, replicated crossover trial was performed on EM residents. This study consisted of 4 phases within a month with intervention periods of 2 nights and washouts of 6 days. In our study, EM residents had nine-hour shifts on 6 consecutive days, 2 mornings, 2 evenings and 2 nights and then 2 days off. At the end of shifts' cycle, 24 EM residents were given 3 mg melatonin or placebo(12 in each arm of the study) for 2 consecutive nights after the second night shift with crossover to the other arm after a six-day off drug. This crossover intervention was repeated for two more another time. Finally, we created 48 cases and comparisons in each arm. Different items related to sleep quality were assessed and compared both within the same group and between the two groups. RESULTS: In the melatonin group, daytime sleepiness(calculated by Karolinska Sleep Scale) had a signifi cant reduction after taking the second dose of drug(P=0.003) but the same result was not observed when comparing the 2 groups. Mood status(calculated by Profile of Mood States) showed no remarkable difference between the 2 groups. CONCLUSION: Melatonin might have a limited benefi t on sleep quality in EM residents working night shifts.展开更多
BACKGROUND: In Iran, few studies have evaluated emergency medicine as a career option. In the present study, we aimed to find out how Iranian emergency-medicine specialists view their specialty as a career.METHODS: Fo...BACKGROUND: In Iran, few studies have evaluated emergency medicine as a career option. In the present study, we aimed to find out how Iranian emergency-medicine specialists view their specialty as a career.METHODS: Following a qualitative study, a Likert-scale questionnaire was developed. Iranian emergency physician specialists who had at least two years' job experience were contacted via email. A uniform link to a Web-based survey and a cover letter that explained the survey were sent to the recipients. We used the Kruskal-Wallis test and post hoc analysis to determine the differences between demographic subgroups.RESULTS: A total of 109 eligible responses were received, a response rate of 72.63%. Of the responders, 57.8% were 30–40 years of age, 86.2% were male, 86.2% were single, 84.4% were faculty members and 90.8% had fewer than 10 years' job experience. The main problems occurring during the career of Iranian emergency physicians were: insuffi cient income, inadequate recognition of the specialty by the community, inadequate union support, insecurity in the emergency wards, overcrowding, job stresses and night shifts. Despite insufficiency of income, Iranian emergency physicians(EPs) did not care about the financial benefits of patient care. Academic activity had positive effects on the perspectives of Iranian emergency physicians regarding their careers.CONCLUSION: Iranian emergency physicians and leaders in emergency medicine should struggle to improve the present situation, aiming at an ideal state.展开更多
BACKGROUND: Communication failure in prehospital emergency medicine can affect patient safety as it does in other areas of medicine as well. We analyzed the database of the critical incident reporting system for preho...BACKGROUND: Communication failure in prehospital emergency medicine can affect patient safety as it does in other areas of medicine as well. We analyzed the database of the critical incident reporting system for prehospital emergency medicine in Germany retrospectively regarding communication errors.METHODS: Experts of prehospital emergency medicine and risk management screened the database for verbal communication failure, non-verbal communication failure and missing communication at all.RESULTS: Between 2005 and 2015, 845 reports were analyzed, of which 247 reports were considered to be related to communication failure. An arbitrary classifi cation resulted in six different kinds: 1) no acknowledgement of a suggestion; 2) medication error; 3) miscommunication with dispatcher; 4) utterance heard/understood improperly; 5) missing information transfer between two persons; and 6) other communication failure.CONCLUSION: Communication defi cits can lead to critical incidents in prehospital emergency medicine and are a very important aspect in patient safety.展开更多
BACKGROUND: We compare educational environments(i.e. physical, emotional and intellectual experiences) of emergency medicine(EM) residents training in the United States of America(USA) and Saudi Arabia(SA).METHODS: A ...BACKGROUND: We compare educational environments(i.e. physical, emotional and intellectual experiences) of emergency medicine(EM) residents training in the United States of America(USA) and Saudi Arabia(SA).METHODS: A cross-sectional survey study was conducted using an adapted version of the validated Postgraduate Hospital Educational Environment Measure(PHEEM) survey instrument from April 2015 through June 2016 to compare educational environments in all emergency medicine residency programs in SA and three selected programs in the USA with a history of training Saudi physicians. Overall scores were compared across programs, and for subscales(autonomy, teaching, and social Support), using chi-squared, t-tests, and analysis of variance.RESULTS: A total of 219 surveys were returned for 260 residents across six programs(3 SA, 3 USA), with a response rate of 84%. Program-specific response rates varied from 79%–100%. All six residencies were qualitatively rated as "more positive than negative but room for improvement". Quantitative PHEEM scores for the USA programs were significantly higher: 118.7 compared to 109.9 for SA, P=0.001. In subscales, perceptions of social support were not different between the two countries(P=0.243); however, role autonomy(P<0.001) and teaching(P=0.005) were better in USA programs. There were no significant differences by post-graduate training year.CONCLUSION: EM residents in all three emergency medicine residency programs in SA and the three USA programs studied perceive their training as high quality in general, but with room for improvements. USA residency programs scored higher in overall quality. This was driven by more favorable perceptions of role autonomy and teaching. Understanding how residents perceive their programs may help drive targeted quality improvement efforts.展开更多
BACKGROUND:Despite the fact that traditional Chinese medicine(TCM) has been developed and used to treat acute and urgent illness for many thousands of years.TCM has been widely perceived in western societies that TCM ...BACKGROUND:Despite the fact that traditional Chinese medicine(TCM) has been developed and used to treat acute and urgent illness for many thousands of years.TCM has been widely perceived in western societies that TCM may only be effective to treat chronic diseases.The aim of this article is to provide some scientific evidence regarding the application of TCM in emergency medicine and its future potential.METHODS:Multiple databases(PubMed,ProQuest,Academic Search Elite and Science Direct) were searched using the terms:Traditional Chinese Medicine/ Chinese Medicine,Emergency Medicine,China.In addition,three leading TCM Journals in China were searched via Oriprobe Information Services for relevant articles(published from 1990—2012).Particular attention was paid to those articles that are related to TCM treatments or combined medicine in dealing with intensive and critical care.RESULTS:TCM is a systematic traditional macro medicine.The clinical practice of TCM is guided by the TCM theoretical framework- a methodology founded thousands of years ago.As the methodologies between TCM and Biomedicine are significantly different,it provides an opportunity to combine two medicines,in order to achieve clinical efficacy.Nowadays,combined medicine has become a common clinical model particular in TCM hospitals in China.CONCLUSIONS:It is evident that TCM can provide some assistance in emergency although to combine them in practice is still its infant form and is mainly at TCM hospitals in China.The future effort could be put into TCM research,both in laboratories and clinics,with high quality designs,so that TCM could be better understood and then applied in emergency medicine.展开更多
BACKGROUND:Fifty years of our history in developing and advancing emergency medicine into an independent medical specialty will surely provide emergency medicine colleagues from all over the world with valuable sugges...BACKGROUND:Fifty years of our history in developing and advancing emergency medicine into an independent medical specialty will surely provide emergency medicine colleagues from all over the world with valuable suggestions and guidance.DATA SOURCES:This systemic review is based on the author's extensive experience through active involvement in the national and international development of emergency medicine.RESULTS:Emergency physicians in the U.S.emergency departments and sometimes other settings provide urgent and emergency care to patients of all ages,including definitive diagnosis of emergent conditions,prolonged stabilization of patients when necessary,airway management,and life-saving procedures using rapid sequence intubation and sedation.They use a multitude of diagnostic technologies including laboratory studies,bedside ultrasound and other sophisticated radiology,such as CT scan,and MRI.CONCLUSION:In the U.S.,emergency medicine fits extremely well into the overall medical system,and is clearly the most efficient way to provide emergency patient care.展开更多
BACKGROUND:This study was undertaken to examine the current level of operations and management education within US-based Emergency Medicine Residency programs.METHODS:Residency program directors at all US-based Emerge...BACKGROUND:This study was undertaken to examine the current level of operations and management education within US-based Emergency Medicine Residency programs.METHODS:Residency program directors at all US-based Emergency Medicine Residency programs were anonymously surveyed via a web-based instrument.Participants indicated their levels of residency education dedicated to documentation,billing/coding,core measure/quality indicator compliance,and operations management.Data were analyzed using descriptive statistics for the ordinal data/Likert scales.RESULTS:One hundred and six(106)program directors completed the study instrument of one hundred and fifty-six(156)programs(70%).Of these,82.6%indicated emergency department(ED)operations and management education within the training curriculum.Dedicated documentation training was noted in all but 1 program(99%).Program educational offerings also included billing/coding(83%),core measure/quality indicators(78%)and operations management training(71%).In all areas,the most common means of educating came through didactic sessions and direct attending feedback or 69%-94%and 72%-98%respectively.Residency leadership was most confident with resident understanding of quality documentation(80%)and less so with core measures(72%),billing/coding/RVUs(58%),and operations management tools(23%).CONCLUSIONS:While most EM residency programs integrate basic operational education related to documentation and billing/coding,a smaller number provide focused education on the dayto-day management and operations of the ED.Residency leadership perceives graduating resident understanding of operational management tools to be limited.All respondents value further resident curriculum development of ED operations and management.展开更多
The outbreak of coronavirus disease 2019(COVID-19)was declared a global public health emergency on 31 January 2020.Emergency medicine procedures in Emergency Department should be optimized to cope with the current COV...The outbreak of coronavirus disease 2019(COVID-19)was declared a global public health emergency on 31 January 2020.Emergency medicine procedures in Emergency Department should be optimized to cope with the current COVID-19 pandemic by providing subspecialty services,reducing the spread of nosocomial infections,and promoting its capabilities to handle emerging diseases.Thus,the Chinese Society of Emergency Medicine and Wuhan Society of Emergency Medicine drafted this consensus together to address concerns of medical staffs who work in Emergency Department.Based on in-depth review of COVID-19 diagnosis and treatment plans,literatures,as well as management approval,this consensus proposes recommendations for improving the rationalization and efficiency of emergency processes,reducing the risk of nosocomial infections,preventing hospital viral transmission,and ensuring patient safety.展开更多
BACKGROUND: A national standardized emergency medicine(EM) curriculum for medical students, including specific competencies in procedural skills, are absent in many countries. The development of an intensive simulatin...BACKGROUND: A national standardized emergency medicine(EM) curriculum for medical students, including specific competencies in procedural skills, are absent in many countries. The development of an intensive simulating training program in EM, based on a tight schedule, is anticipated to enhance the competency of medical students.METHODS: A 3-day intensive EM training program, consisting of four procedural skills and 8-hour case-based learning(CBL), was developed by experienced physicians from the EM department in Peking Union Medical College Hospital(PUMCH). Medical students from Peking Union Medical College(PUMC) and Tsinghua University(THU) participated in the training. Three written tests were cautiously designed to examine the short-term(immediately after the program) and long-term(6 months after the program) efficacy of the training. After completion of the training program, an online personal appraisal questionnaire was distributed to the students on WeChat(a mobile messaging App commonly used in China) to achieve anonymous self-evaluation.RESULTS: Ninety-seven out of 101 students completed the intensive training and took all required tests. There was a significant increase in the average score after the intensive simulating training program(pre-training 13.84 vs. 15.57 post-training, P<0.001). Compared with the pre-training test, 63(64.9%) students made progress. There was no significant difference in scores between the tests taken immediately after the program and 6 months later(15.57±2.22 vs. 15.38±2.37, P=0.157). Students rated a higher score in all diseases and procedural skills, and felt that their learning was fruitful.CONCLUSIONS: The introduction of a standardized intensive training program in EM focusing on key competencies can improve clinical confidence, knowledge, and skills of medical students toward the specialty. In addition, having such a program can also enhance student’s interest in EM as a career choice which may enhance recruitment into the specialty and workplace planning.展开更多
BACKGROUND: Feedback on patient outcomes is invaluable to the practice of emergency medicine but examples of effective forms of feedback have not been well characterized in the literature. We describe one system of em...BACKGROUND: Feedback on patient outcomes is invaluable to the practice of emergency medicine but examples of effective forms of feedback have not been well characterized in the literature. We describe one system of emergency department(ED) outcome feedback called the return visit report(RVR) and present the results of a survey assessing physicians' perceptions of this novel form of feedback. METHODS: An Opinio web-based survey was conducted in 81 emergency physicians(EPs) at three EDs.RESULTS: Of the 81 physicians surveyed, 40(49%) responded. Most participants indicated that they frequently review their RVRs(83%), that RVRs are valuable to their practice of medicine(80%), and that RVRs alter their practice in future encounters(57%). Respondents reported seeking other forms of outcome feedback including speaking with other EPs(83%) and reviewing discharge summaries of admitted patients(87%). There was no correlation between demographic data and use of RVRs.CONCLUSION: EPs value RVRs as a form of feedback. RVRs could be improved by reducing the observational interval and optimizing report relevance and differential weighting.展开更多
Aims and Scope World Journal of Emergency Medicine (ISSN 1920-8642, CN 33-1408/R), a quarterly journal,publishes peer-reviewed original research articles,review articles including systematic review and meta-analysis, ...Aims and Scope World Journal of Emergency Medicine (ISSN 1920-8642, CN 33-1408/R), a quarterly journal,publishes peer-reviewed original research articles,review articles including systematic review and meta-analysis, editorials, commentaries, etc in different fields of emergency medicine. The content of articles could be varied in medical, surgical,展开更多
BACKGROUND: Emergency medicine providers(EMPs) prescribe about 25% of opioids, but the effect of EMP risk perception on decisions to prescribe opioids is unknown. This study was undertaken to identify factors that inf...BACKGROUND: Emergency medicine providers(EMPs) prescribe about 25% of opioids, but the effect of EMP risk perception on decisions to prescribe opioids is unknown. This study was undertaken to identify factors that infl uence EMP risk and opioid prescribing practices.METHODS: We distributed an anonymous questionnaire to EMPs at a military trauma and referral center. Response frequencies and distributions were assessed for independence using the Chi-square test.RESULTS: Eighty-nine EMPs completed the questionnaire(100% response). Respondents were primarily younger male physicians(80%) in practice under fi ve years(55%). Male EMPs were more likely to prescribe more opioid tablets than female ones both when and when not concerned for opioid misuse(P<0.001, P<0.007, respectively). Of the providers, 70% stated that patient age would inf luence their prescribing decisions. Hydrocodone and oxycodone were the opioids prescribed most frequently. About 60% of the providers reported changing their prescribing behavior would not prevent opioid misuse. Additionally, 40% of the providers believed at least 10% of patients seen at this military ED misused opioids.CONCLUSION: Female EM providers reported prescribing fewer opioid tablets. Patient age infl uenced prescribing behavior, but the effect is unknown. Finally, EM providers reported that altering their prescribing behavior would not prevent prescription opioid misuse.展开更多
BACKGROUND:Macedonia has universal public health care coverage.Acute and emergency patient care is provided in different care environments based on the medical complaint and resource proximity.While emergency medicine...BACKGROUND:Macedonia has universal public health care coverage.Acute and emergency patient care is provided in different care environments based on the medical complaint and resource proximity.While emergency medicine and well organized emergency departments(EDs) are an essential component of any developed health care system,emergency medicine as a specialty is relatively non-existent in Macedonia.DATA RESOURCES:A system assessment regarding presence,availability and capacity of EDs was completed from 2013-2015,based upon assessments of 21 institutions providing emergency care and information provided by the Ministry of Health.This assessment establishes a benchmark from which to strategically identify,plan and implement the future of emergency medicine in Macedonia.RESULTS:In general,emergency departments- defined by offering acute care 24 hours per day,7 days per week- were available at all general and university hospitals.However,care resources,emergency and acute care training,and patient care capacity vary greatly within the country.There is limited uniformity in acute care approach and methodology.Hospital EDs are not organized as separate divisions run by a head medical doctor,nor are they staffed by specialists trained in emergency medicine.The diagnostic and treatment capacities are insufficient or outdated by current international emergency medicine standards and frequently require patient transfer or admission prior to initiation.CONCLUSION:Most of the surveyed hospitals are capable of providing essential diagnostic tests,but very few are able to do so at the point or time of presentation.While emergency medical services(EMS) have improved system-wide,emergent care interventions by EMS and within all hospitals remain limited.Further system-wide acute and emergency care improvements are forthcoming.展开更多
As people live longer and fewer babies are born, the elderly became the fastest and largest growing population of the world, expected to increase further from 86 million in 2005 to 394 million in 2050 worldwide. Older...As people live longer and fewer babies are born, the elderly became the fastest and largest growing population of the world, expected to increase further from 86 million in 2005 to 394 million in 2050 worldwide. Older patients represent a large bulk of the population arriving in emergency departments （EDs） all over the world.[1] They use hospitals more frequently than younger patients, have more hospital admissions from the ED and more prolonged hospital stays.[2] Elder abuse is defined as a single, or repeated, act which causes harm or distress to an older person and it can occur within any relationship where there is an expectation of trust from the elder person＇s perspective.[3,4] The ED setting is a particularly important environment being the first point of contact with formal services for the abused elderly population.[5] Careful consideration is demanded when older people attend the ED, with particular attention paid to assessment of subjective and objective data in terms of manifestations and potential indicators of abuse.展开更多
This paper first explores the development and direction of disaster and emergency medicine in China and abroad from the perspective of international environment and history background, analyses four elements of disast...This paper first explores the development and direction of disaster and emergency medicine in China and abroad from the perspective of international environment and history background, analyses four elements of disaster and emergency medicine, including subject content, professionals, education practice and technical innovation, clarifies the interdependency between disaster medicine and emergency medicine, and reveals the developing rules of disaster medicine and emergency medicine. It also provides suggestions for China's development of disaster medicine and emergency medicine.展开更多
Coronavirus disease 2019(COVID-19),caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)and SARS-CoV-2 variants,has become a global pandemic resulting in significant morbidity and mortality.Severe case...Coronavirus disease 2019(COVID-19),caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)and SARS-CoV-2 variants,has become a global pandemic resulting in significant morbidity and mortality.Severe cases of COVID-19 are characterized by hypoxemia,hyperinflammation,cytokine storm in lung.Clinical studies have reported an association between COVID-19 and cardiovascular disease(CVD).Patients with CVD tend to develop severe symptoms and mortality if contracted COVID-19 with further elevations of cardiac injury biomarkers.Furthermore,COVID-19 itself can induce and promoted CVD development,including myocarditis,arrhythmia,acute coronary syndrome,cardiogenic shock,and venous thromboembolism.Although the direct etiology of SARS-CoV-2–induced cardiac injury remains unknown and underinvestigated,it is suspected that it is related to myocarditis,cytokine-mediated injury,microvascular injury,and stress-related cardiomyopathy.Despite vaccinations having provided the most effective approach to reducing mortality overall,an adapted treatment paradigm and regular monitoring of cardiac injury biomarkers is critical for improving outcomes in vulnerable populations at risk for severe COVID-19.In this review,we focus on the latest progress in clinic and research on the cardiovascular complications of COVID-19 and provide a perspective of treating cardiac complications deriving from COVID-19 in emergency medicine.展开更多
Background: Hand injuries are very common and responsible for a significant number of emergency department (ED) visits, most of which are not to hand specialists [1]. The functionality and outcome of hand injuries can...Background: Hand injuries are very common and responsible for a significant number of emergency department (ED) visits, most of which are not to hand specialists [1]. The functionality and outcome of hand injuries can vary significantly depending on the mechanism and pattern of injuries, which is why it is imperative for emergency physicians to recognize the complexities, and the potential repercussion of missed injuries in such cases. Objective: The aim of this study is to provide epidemiological information on hand injuries and their patterns. The objective is 1) to assess whether most hand injuries are superficial (simple), or involve underlying deeper structures (complex) and 2) to assess whether most hand injuries presented to the emergency department were managed by the emergency physician or plastic/orthopaedic surgeon. Methods: This retrospective single-centre observational study conducted at an emergency department in a tertiary care hospital in Mumbai, India collected data from hand trauma patients using a standardized documentation form. Demographic data, trauma-related data, and disposition plans were analysed. Results: A total of 489 cases sustained hand injuries over a period of one year. The patients were predominantly males in the 20 - 30 year age group and injuries were mainly sustained over the right hand. Most of the injuries were sustained at home (42%). The most common mechanism (34%) was sharp object injury (including needle-stick and other sharps in hospital), followed by blunt injury (30%). Among grievous hand injuries, door jamb was a mechanism noted in 11% of patients, accounting for 50% of all crush injuries. Lacerations were the most common pattern (24.7%) noticed, followed closely by fractures (23.3%). Digits II - IV were injured most commonly (54%), followed by carpals (14%) and the thumb (10%). Nearly 80% of the hand injuries were managed by emergency physicians alone, with 61% of cases involving superficial structures. Though 14% of the cases required plastic surgery intervention, the initial evaluation of all these patients was performed by the emergency physician. Conclusions: Our study highlights the burden of hand injuries on the emergency physician, as well as the odds of missed injuries, directly indicating the necessity of a thorough anatomical knowledge of the structures of the hand, and in turn, a proper physical examination. A dedicated registry for hand trauma would help quantify the mechanism and pattern of injuries, and formulate preventive strategies.展开更多
Using sudden cardiac deaths as an example and maximizing survival rate as the goal, this paper studies the influence of multi-stage medical logistics system optimization on the survival rate of sudden illness. A distr...Using sudden cardiac deaths as an example and maximizing survival rate as the goal, this paper studies the influence of multi-stage medical logistics system optimization on the survival rate of sudden illness. A distribution model of survival is built, drone and ambulance arrival probability over time are discussed, a formula is proposed for maximum possible survival rate based on the probability of emergency medical logistics reaching the patient, and the results are analyzed using empirical data fitting distribution and numerical experiments performed with the model. The model is discussed as a reference point for management decision making by changing model parameters. Results show that compared to using current ambulance vehicles, ambulance drones delivering medical equipment for first aid on-site in emergencies can significantly increase survival rate, and the effect of collaborative multi-stage logistics optimization is better than that of any single stage logistics response optimization. Simulation results show that the medical rescue logistics service radius, speed, loading capacity and performance of ambulance drones impact the probability of survival, and there is an optimal service radius depending on the shape of probability distribution, which provides new information for management decisions.展开更多
文摘Objective:To analyze the effect of using a problem-based(PBL)independent learning model in teaching cerebral ischemic stroke(CIS)first aid in emergency medicine.Methods:90 interns in the emergency department of our hospital from May 2022 to May 2023 were selected for the study.They were divided into Group A(45,conventional teaching method)and Group B(45 cases,PBL independent learning model)by randomized numerical table method to compare the effects of the two groups.Results:The teaching effect indicators and student satisfaction scores in Group B were higher than those in Group A(P<0.05).Conclusion:The use of the PBL independent learning model in the teaching of CIS first aid can significantly improve the teaching effect and student satisfaction.
文摘BACKGROUND: Sleep deprivation resulting from night shifts, is a major cause of burnout among physicians. Exogenous melatonin may improve sleep quality in night-shift workers. The study aims to compare the effectiveness of melatonin versus placebo on sleep effi ciency in emergency medicine(EM) residents. METHODS: A randomized, double-blind, replicated crossover trial was performed on EM residents. This study consisted of 4 phases within a month with intervention periods of 2 nights and washouts of 6 days. In our study, EM residents had nine-hour shifts on 6 consecutive days, 2 mornings, 2 evenings and 2 nights and then 2 days off. At the end of shifts' cycle, 24 EM residents were given 3 mg melatonin or placebo(12 in each arm of the study) for 2 consecutive nights after the second night shift with crossover to the other arm after a six-day off drug. This crossover intervention was repeated for two more another time. Finally, we created 48 cases and comparisons in each arm. Different items related to sleep quality were assessed and compared both within the same group and between the two groups. RESULTS: In the melatonin group, daytime sleepiness(calculated by Karolinska Sleep Scale) had a signifi cant reduction after taking the second dose of drug(P=0.003) but the same result was not observed when comparing the 2 groups. Mood status(calculated by Profile of Mood States) showed no remarkable difference between the 2 groups. CONCLUSION: Melatonin might have a limited benefi t on sleep quality in EM residents working night shifts.
文摘BACKGROUND: In Iran, few studies have evaluated emergency medicine as a career option. In the present study, we aimed to find out how Iranian emergency-medicine specialists view their specialty as a career.METHODS: Following a qualitative study, a Likert-scale questionnaire was developed. Iranian emergency physician specialists who had at least two years' job experience were contacted via email. A uniform link to a Web-based survey and a cover letter that explained the survey were sent to the recipients. We used the Kruskal-Wallis test and post hoc analysis to determine the differences between demographic subgroups.RESULTS: A total of 109 eligible responses were received, a response rate of 72.63%. Of the responders, 57.8% were 30–40 years of age, 86.2% were male, 86.2% were single, 84.4% were faculty members and 90.8% had fewer than 10 years' job experience. The main problems occurring during the career of Iranian emergency physicians were: insuffi cient income, inadequate recognition of the specialty by the community, inadequate union support, insecurity in the emergency wards, overcrowding, job stresses and night shifts. Despite insufficiency of income, Iranian emergency physicians(EPs) did not care about the financial benefits of patient care. Academic activity had positive effects on the perspectives of Iranian emergency physicians regarding their careers.CONCLUSION: Iranian emergency physicians and leaders in emergency medicine should struggle to improve the present situation, aiming at an ideal state.
文摘BACKGROUND: Communication failure in prehospital emergency medicine can affect patient safety as it does in other areas of medicine as well. We analyzed the database of the critical incident reporting system for prehospital emergency medicine in Germany retrospectively regarding communication errors.METHODS: Experts of prehospital emergency medicine and risk management screened the database for verbal communication failure, non-verbal communication failure and missing communication at all.RESULTS: Between 2005 and 2015, 845 reports were analyzed, of which 247 reports were considered to be related to communication failure. An arbitrary classifi cation resulted in six different kinds: 1) no acknowledgement of a suggestion; 2) medication error; 3) miscommunication with dispatcher; 4) utterance heard/understood improperly; 5) missing information transfer between two persons; and 6) other communication failure.CONCLUSION: Communication defi cits can lead to critical incidents in prehospital emergency medicine and are a very important aspect in patient safety.
文摘BACKGROUND: We compare educational environments(i.e. physical, emotional and intellectual experiences) of emergency medicine(EM) residents training in the United States of America(USA) and Saudi Arabia(SA).METHODS: A cross-sectional survey study was conducted using an adapted version of the validated Postgraduate Hospital Educational Environment Measure(PHEEM) survey instrument from April 2015 through June 2016 to compare educational environments in all emergency medicine residency programs in SA and three selected programs in the USA with a history of training Saudi physicians. Overall scores were compared across programs, and for subscales(autonomy, teaching, and social Support), using chi-squared, t-tests, and analysis of variance.RESULTS: A total of 219 surveys were returned for 260 residents across six programs(3 SA, 3 USA), with a response rate of 84%. Program-specific response rates varied from 79%–100%. All six residencies were qualitatively rated as "more positive than negative but room for improvement". Quantitative PHEEM scores for the USA programs were significantly higher: 118.7 compared to 109.9 for SA, P=0.001. In subscales, perceptions of social support were not different between the two countries(P=0.243); however, role autonomy(P<0.001) and teaching(P=0.005) were better in USA programs. There were no significant differences by post-graduate training year.CONCLUSION: EM residents in all three emergency medicine residency programs in SA and the three USA programs studied perceive their training as high quality in general, but with room for improvements. USA residency programs scored higher in overall quality. This was driven by more favorable perceptions of role autonomy and teaching. Understanding how residents perceive their programs may help drive targeted quality improvement efforts.
文摘BACKGROUND:Despite the fact that traditional Chinese medicine(TCM) has been developed and used to treat acute and urgent illness for many thousands of years.TCM has been widely perceived in western societies that TCM may only be effective to treat chronic diseases.The aim of this article is to provide some scientific evidence regarding the application of TCM in emergency medicine and its future potential.METHODS:Multiple databases(PubMed,ProQuest,Academic Search Elite and Science Direct) were searched using the terms:Traditional Chinese Medicine/ Chinese Medicine,Emergency Medicine,China.In addition,three leading TCM Journals in China were searched via Oriprobe Information Services for relevant articles(published from 1990—2012).Particular attention was paid to those articles that are related to TCM treatments or combined medicine in dealing with intensive and critical care.RESULTS:TCM is a systematic traditional macro medicine.The clinical practice of TCM is guided by the TCM theoretical framework- a methodology founded thousands of years ago.As the methodologies between TCM and Biomedicine are significantly different,it provides an opportunity to combine two medicines,in order to achieve clinical efficacy.Nowadays,combined medicine has become a common clinical model particular in TCM hospitals in China.CONCLUSIONS:It is evident that TCM can provide some assistance in emergency although to combine them in practice is still its infant form and is mainly at TCM hospitals in China.The future effort could be put into TCM research,both in laboratories and clinics,with high quality designs,so that TCM could be better understood and then applied in emergency medicine.
文摘BACKGROUND:Fifty years of our history in developing and advancing emergency medicine into an independent medical specialty will surely provide emergency medicine colleagues from all over the world with valuable suggestions and guidance.DATA SOURCES:This systemic review is based on the author's extensive experience through active involvement in the national and international development of emergency medicine.RESULTS:Emergency physicians in the U.S.emergency departments and sometimes other settings provide urgent and emergency care to patients of all ages,including definitive diagnosis of emergent conditions,prolonged stabilization of patients when necessary,airway management,and life-saving procedures using rapid sequence intubation and sedation.They use a multitude of diagnostic technologies including laboratory studies,bedside ultrasound and other sophisticated radiology,such as CT scan,and MRI.CONCLUSION:In the U.S.,emergency medicine fits extremely well into the overall medical system,and is clearly the most efficient way to provide emergency patient care.
文摘BACKGROUND:This study was undertaken to examine the current level of operations and management education within US-based Emergency Medicine Residency programs.METHODS:Residency program directors at all US-based Emergency Medicine Residency programs were anonymously surveyed via a web-based instrument.Participants indicated their levels of residency education dedicated to documentation,billing/coding,core measure/quality indicator compliance,and operations management.Data were analyzed using descriptive statistics for the ordinal data/Likert scales.RESULTS:One hundred and six(106)program directors completed the study instrument of one hundred and fifty-six(156)programs(70%).Of these,82.6%indicated emergency department(ED)operations and management education within the training curriculum.Dedicated documentation training was noted in all but 1 program(99%).Program educational offerings also included billing/coding(83%),core measure/quality indicators(78%)and operations management training(71%).In all areas,the most common means of educating came through didactic sessions and direct attending feedback or 69%-94%and 72%-98%respectively.Residency leadership was most confident with resident understanding of quality documentation(80%)and less so with core measures(72%),billing/coding/RVUs(58%),and operations management tools(23%).CONCLUSIONS:While most EM residency programs integrate basic operational education related to documentation and billing/coding,a smaller number provide focused education on the dayto-day management and operations of the ED.Residency leadership perceives graduating resident understanding of operational management tools to be limited.All respondents value further resident curriculum development of ED operations and management.
文摘The outbreak of coronavirus disease 2019(COVID-19)was declared a global public health emergency on 31 January 2020.Emergency medicine procedures in Emergency Department should be optimized to cope with the current COVID-19 pandemic by providing subspecialty services,reducing the spread of nosocomial infections,and promoting its capabilities to handle emerging diseases.Thus,the Chinese Society of Emergency Medicine and Wuhan Society of Emergency Medicine drafted this consensus together to address concerns of medical staffs who work in Emergency Department.Based on in-depth review of COVID-19 diagnosis and treatment plans,literatures,as well as management approval,this consensus proposes recommendations for improving the rationalization and efficiency of emergency processes,reducing the risk of nosocomial infections,preventing hospital viral transmission,and ensuring patient safety.
基金supported by grants from Chinese Academy of Medical Science Teaching Reform Research Fund(2018zlgc0101)Chinese Academy of Medical Science Online Open Course Construction Fund(J2009022861)+1 种基金CAMS Innovation Fund for Medical Sciences(CIFMS)(serial number 2021-1-I2M-020)CAMS Innovation Fund for Medical Sciences(CIFMS)(serial number 2020-I2M-C&T-B-014).
文摘BACKGROUND: A national standardized emergency medicine(EM) curriculum for medical students, including specific competencies in procedural skills, are absent in many countries. The development of an intensive simulating training program in EM, based on a tight schedule, is anticipated to enhance the competency of medical students.METHODS: A 3-day intensive EM training program, consisting of four procedural skills and 8-hour case-based learning(CBL), was developed by experienced physicians from the EM department in Peking Union Medical College Hospital(PUMCH). Medical students from Peking Union Medical College(PUMC) and Tsinghua University(THU) participated in the training. Three written tests were cautiously designed to examine the short-term(immediately after the program) and long-term(6 months after the program) efficacy of the training. After completion of the training program, an online personal appraisal questionnaire was distributed to the students on WeChat(a mobile messaging App commonly used in China) to achieve anonymous self-evaluation.RESULTS: Ninety-seven out of 101 students completed the intensive training and took all required tests. There was a significant increase in the average score after the intensive simulating training program(pre-training 13.84 vs. 15.57 post-training, P<0.001). Compared with the pre-training test, 63(64.9%) students made progress. There was no significant difference in scores between the tests taken immediately after the program and 6 months later(15.57±2.22 vs. 15.38±2.37, P=0.157). Students rated a higher score in all diseases and procedural skills, and felt that their learning was fruitful.CONCLUSIONS: The introduction of a standardized intensive training program in EM focusing on key competencies can improve clinical confidence, knowledge, and skills of medical students toward the specialty. In addition, having such a program can also enhance student’s interest in EM as a career choice which may enhance recruitment into the specialty and workplace planning.
文摘BACKGROUND: Feedback on patient outcomes is invaluable to the practice of emergency medicine but examples of effective forms of feedback have not been well characterized in the literature. We describe one system of emergency department(ED) outcome feedback called the return visit report(RVR) and present the results of a survey assessing physicians' perceptions of this novel form of feedback. METHODS: An Opinio web-based survey was conducted in 81 emergency physicians(EPs) at three EDs.RESULTS: Of the 81 physicians surveyed, 40(49%) responded. Most participants indicated that they frequently review their RVRs(83%), that RVRs are valuable to their practice of medicine(80%), and that RVRs alter their practice in future encounters(57%). Respondents reported seeking other forms of outcome feedback including speaking with other EPs(83%) and reviewing discharge summaries of admitted patients(87%). There was no correlation between demographic data and use of RVRs.CONCLUSION: EPs value RVRs as a form of feedback. RVRs could be improved by reducing the observational interval and optimizing report relevance and differential weighting.
文摘Aims and Scope World Journal of Emergency Medicine (ISSN 1920-8642, CN 33-1408/R), a quarterly journal,publishes peer-reviewed original research articles,review articles including systematic review and meta-analysis, editorials, commentaries, etc in different fields of emergency medicine. The content of articles could be varied in medical, surgical,
文摘BACKGROUND: Emergency medicine providers(EMPs) prescribe about 25% of opioids, but the effect of EMP risk perception on decisions to prescribe opioids is unknown. This study was undertaken to identify factors that infl uence EMP risk and opioid prescribing practices.METHODS: We distributed an anonymous questionnaire to EMPs at a military trauma and referral center. Response frequencies and distributions were assessed for independence using the Chi-square test.RESULTS: Eighty-nine EMPs completed the questionnaire(100% response). Respondents were primarily younger male physicians(80%) in practice under fi ve years(55%). Male EMPs were more likely to prescribe more opioid tablets than female ones both when and when not concerned for opioid misuse(P<0.001, P<0.007, respectively). Of the providers, 70% stated that patient age would inf luence their prescribing decisions. Hydrocodone and oxycodone were the opioids prescribed most frequently. About 60% of the providers reported changing their prescribing behavior would not prevent opioid misuse. Additionally, 40% of the providers believed at least 10% of patients seen at this military ED misused opioids.CONCLUSION: Female EM providers reported prescribing fewer opioid tablets. Patient age infl uenced prescribing behavior, but the effect is unknown. Finally, EM providers reported that altering their prescribing behavior would not prevent prescription opioid misuse.
文摘BACKGROUND:Macedonia has universal public health care coverage.Acute and emergency patient care is provided in different care environments based on the medical complaint and resource proximity.While emergency medicine and well organized emergency departments(EDs) are an essential component of any developed health care system,emergency medicine as a specialty is relatively non-existent in Macedonia.DATA RESOURCES:A system assessment regarding presence,availability and capacity of EDs was completed from 2013-2015,based upon assessments of 21 institutions providing emergency care and information provided by the Ministry of Health.This assessment establishes a benchmark from which to strategically identify,plan and implement the future of emergency medicine in Macedonia.RESULTS:In general,emergency departments- defined by offering acute care 24 hours per day,7 days per week- were available at all general and university hospitals.However,care resources,emergency and acute care training,and patient care capacity vary greatly within the country.There is limited uniformity in acute care approach and methodology.Hospital EDs are not organized as separate divisions run by a head medical doctor,nor are they staffed by specialists trained in emergency medicine.The diagnostic and treatment capacities are insufficient or outdated by current international emergency medicine standards and frequently require patient transfer or admission prior to initiation.CONCLUSION:Most of the surveyed hospitals are capable of providing essential diagnostic tests,but very few are able to do so at the point or time of presentation.While emergency medical services(EMS) have improved system-wide,emergent care interventions by EMS and within all hospitals remain limited.Further system-wide acute and emergency care improvements are forthcoming.
文摘As people live longer and fewer babies are born, the elderly became the fastest and largest growing population of the world, expected to increase further from 86 million in 2005 to 394 million in 2050 worldwide. Older patients represent a large bulk of the population arriving in emergency departments （EDs） all over the world.[1] They use hospitals more frequently than younger patients, have more hospital admissions from the ED and more prolonged hospital stays.[2] Elder abuse is defined as a single, or repeated, act which causes harm or distress to an older person and it can occur within any relationship where there is an expectation of trust from the elder person＇s perspective.[3,4] The ED setting is a particularly important environment being the first point of contact with formal services for the abused elderly population.[5] Careful consideration is demanded when older people attend the ED, with particular attention paid to assessment of subjective and objective data in terms of manifestations and potential indicators of abuse.
基金National Key Research Program(2017YFC0806702-8)。
文摘This paper first explores the development and direction of disaster and emergency medicine in China and abroad from the perspective of international environment and history background, analyses four elements of disaster and emergency medicine, including subject content, professionals, education practice and technical innovation, clarifies the interdependency between disaster medicine and emergency medicine, and reveals the developing rules of disaster medicine and emergency medicine. It also provides suggestions for China's development of disaster medicine and emergency medicine.
基金This work was supported by National Institutes of Health(HL096686,Dr Ma/Dr Wang,MPI,HL-123404,Dr Ma,HL158612 and HL157495,Dr Wang)the American Heart Association(20TPA35490095,Dr Wang).
文摘Coronavirus disease 2019(COVID-19),caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)and SARS-CoV-2 variants,has become a global pandemic resulting in significant morbidity and mortality.Severe cases of COVID-19 are characterized by hypoxemia,hyperinflammation,cytokine storm in lung.Clinical studies have reported an association between COVID-19 and cardiovascular disease(CVD).Patients with CVD tend to develop severe symptoms and mortality if contracted COVID-19 with further elevations of cardiac injury biomarkers.Furthermore,COVID-19 itself can induce and promoted CVD development,including myocarditis,arrhythmia,acute coronary syndrome,cardiogenic shock,and venous thromboembolism.Although the direct etiology of SARS-CoV-2–induced cardiac injury remains unknown and underinvestigated,it is suspected that it is related to myocarditis,cytokine-mediated injury,microvascular injury,and stress-related cardiomyopathy.Despite vaccinations having provided the most effective approach to reducing mortality overall,an adapted treatment paradigm and regular monitoring of cardiac injury biomarkers is critical for improving outcomes in vulnerable populations at risk for severe COVID-19.In this review,we focus on the latest progress in clinic and research on the cardiovascular complications of COVID-19 and provide a perspective of treating cardiac complications deriving from COVID-19 in emergency medicine.
文摘Background: Hand injuries are very common and responsible for a significant number of emergency department (ED) visits, most of which are not to hand specialists [1]. The functionality and outcome of hand injuries can vary significantly depending on the mechanism and pattern of injuries, which is why it is imperative for emergency physicians to recognize the complexities, and the potential repercussion of missed injuries in such cases. Objective: The aim of this study is to provide epidemiological information on hand injuries and their patterns. The objective is 1) to assess whether most hand injuries are superficial (simple), or involve underlying deeper structures (complex) and 2) to assess whether most hand injuries presented to the emergency department were managed by the emergency physician or plastic/orthopaedic surgeon. Methods: This retrospective single-centre observational study conducted at an emergency department in a tertiary care hospital in Mumbai, India collected data from hand trauma patients using a standardized documentation form. Demographic data, trauma-related data, and disposition plans were analysed. Results: A total of 489 cases sustained hand injuries over a period of one year. The patients were predominantly males in the 20 - 30 year age group and injuries were mainly sustained over the right hand. Most of the injuries were sustained at home (42%). The most common mechanism (34%) was sharp object injury (including needle-stick and other sharps in hospital), followed by blunt injury (30%). Among grievous hand injuries, door jamb was a mechanism noted in 11% of patients, accounting for 50% of all crush injuries. Lacerations were the most common pattern (24.7%) noticed, followed closely by fractures (23.3%). Digits II - IV were injured most commonly (54%), followed by carpals (14%) and the thumb (10%). Nearly 80% of the hand injuries were managed by emergency physicians alone, with 61% of cases involving superficial structures. Though 14% of the cases required plastic surgery intervention, the initial evaluation of all these patients was performed by the emergency physician. Conclusions: Our study highlights the burden of hand injuries on the emergency physician, as well as the odds of missed injuries, directly indicating the necessity of a thorough anatomical knowledge of the structures of the hand, and in turn, a proper physical examination. A dedicated registry for hand trauma would help quantify the mechanism and pattern of injuries, and formulate preventive strategies.
基金supported by the National Natural Science Foundation of China (Grant No. 71390333)the National Key Technology R&D Program of China during the 12th Five-Year Plan Period (Grant No. 2013BAD19B05)
文摘Using sudden cardiac deaths as an example and maximizing survival rate as the goal, this paper studies the influence of multi-stage medical logistics system optimization on the survival rate of sudden illness. A distribution model of survival is built, drone and ambulance arrival probability over time are discussed, a formula is proposed for maximum possible survival rate based on the probability of emergency medical logistics reaching the patient, and the results are analyzed using empirical data fitting distribution and numerical experiments performed with the model. The model is discussed as a reference point for management decision making by changing model parameters. Results show that compared to using current ambulance vehicles, ambulance drones delivering medical equipment for first aid on-site in emergencies can significantly increase survival rate, and the effect of collaborative multi-stage logistics optimization is better than that of any single stage logistics response optimization. Simulation results show that the medical rescue logistics service radius, speed, loading capacity and performance of ambulance drones impact the probability of survival, and there is an optimal service radius depending on the shape of probability distribution, which provides new information for management decisions.
