Hyperbaric oxygen therapy research: an analysis of the 100 most-cited publications from 2011 to 2020.

Objective: Hyperbaric oxygen (HBO2) is used in several clinical and research fields. This study aimed to analyze the 100 most-cited hyperbaric-related publications of the past 10 years to understand the trends in HBO2 research. Methods: This was a literature review. All publication and citation data were retrieved from the Scopus database. Publications with "hyperbaric oxygen," "hyperbaric oxygenation," "HBO," and "HBOT" in the title, abstract, or keywords published between January 01, 2011, and December 31, 2020, were enrolled. The 100 most-cited HBO2-focused publications were identified, and their publication title, authors' nationality, publication journal, year, type (original or review), and application field were recorded and analyzed using descriptive statistics. Linear regression was used to evaluate the trends in publication numbers. Results: A total of 6,517 publications were enrolled. The annual rate of increase was 4.56 per year (p-value = 0.13, 95% CI: -1.62 to 10.74). The total, average, median and mode of citations were 67,726, 10.4, 4, and 0, respectively. The 100 most-cited HBO2-focused publications accounted for 1.5% (100/6,517) of all publications and 8.1% (5509/67,726) of the total number of times cited. The most-cited publications originated from 17 countries and were published in 65 journals, led by the Cochrane Database of Systematic Reviews. Conclusions: The annual number of HBO2 publications was stationary. The citation numbers showed a skewed distribution. The United States was the leading country in HBO2 research. Of 26 application fields, traumatic brain injury, stroke, and diabetic foot were the leading three fields.

Scientific publication trends of emergency department of International Federation for Emergency Medicine members, 2009 to 2018.

BACKGROUND: Emergency medicine (EM) is a rapidly developing specialty worldwide. The scientific publications trend is one of the parameters to evaluate national EM developmental milestones. This study was performed to analyze the publication trends from emergency departments (EDs) of International Federation for Emergency Medicine (IFEM) full member countries from 2009 to 2018. METHODS: All data were retrieved from the SciVerse Scopus database. IFEM full member countries where EM was recognized as a specialty before 2009 and annual publication numbers exceeded 12 in 2018 were included. The EM journals list was adopted from the 2017 Journal Citation Reports. Publications with the first author affiliated with EDs were divided into EM or non-EM journal groups according to the publishing journal. The slope (ß) of the linear regression was used to assess the trends of publication numbers. The correlation between the 2009 publication number and the trend of publication between 2009 and 2018 was measured by Pearson's correlation coefficient (r). The correlation between funding numbers and publication numbers was analyzed by Spearman's rank correlation coefficient (rs). RESULTS: We identified 30,130 publications with first authors from EDs in 19 countries. The numbers of publications in both EM and non-EM journals showed an increasing trend in 12 countries. Fifteen of the 19 countries had a greater increasing trend in non-EM journals than in EM journals. The 2009 publication numbers were positively correlated with the publication increasing trend between 2009 and 2018 in both EM and non-EM journals (r = 0.854 and 0.947, respectively, both p < 0.001). The funded publication number was positively correlated with the total national publication amount (rs = 0.748, p < 0.001). CONCLUSIONS: The research capacity of EDs has been increasingly recognized by other medical specialties. The national publication numbers from EDs may predict the academic publication increasing trends in the subsequent 10 years.

Top-cited publications on point-of-care ultrasound: The evolution of research trends.

STUDY OBJECTIVES: Point-of-care ultrasound (POCUS) has been a rapidly growing and broadly used modality in recent decades. The purpose of this study was to determine how POCUS is incorporated into clinical medicine by analyzing trends of use in the published literature. METHODS: POCUS-related publications were retrieved from the Web of Science (WoS) database. The search results were ranked according to the number of times an article was cited during three time frames and average annual number of citations. Of the top 100 most cited publications in the four rankings, information regarding the publication journal, publication year, first author's nationality, field of POCUS application, and number of times the article was cited was recorded for trend analysis. RESULTS: A total of 7860 POCUS-related publications were retrieved, and publications related to POCUS increased from 8 in 1990 to 754 in 2016. The top 148 cited publications from the four ranking groups were included in this study. Trauma was the leading application field in which POCUS was studied prior to 2001. After 2004, thorax, cardiovascular, and procedure-guidance were the leading fields in POCUS research. >79% (118/148) of the top-cited publications were conducted by authors in the United States, Italy, and France. The majority of publications were published in critical care medicine and emergency medicine journals. CONCLUSIONS: In recent years, publications relating to POCUS have increased. POCUS-related research has mainly been performed in thorax, cardiovascular, and procedure-guidance ultrasonography fields, replacing trauma as the major field in which POCUS was previously studied.

Exploring the influence of gender, seniority and specialty on paper and computer-based feedback provision during mini-CEX assessments in a busy emergency department.

The mini-clinical evaluation exercise (mini-CEX) is a well-established method of assessing trainees' clinical competence in the workplace. In order to improve the quality of clinical learning, factors that influence the provision of feedback are worthy of further investigation. A retrospective data analysis of documented feedback provided by assessors using the mini-CEX in a busy emergency department (ED) was conducted. The assessors comprised emergency physicians (EPs) and trauma surgeons. The trainees were all postgraduate year one (PGY1) residents. The completion rate and word count for each of three feedback components (positive feedback, suggestions for development, and an agreed action plan) were recorded. Other variables included observation time, feedback time, the format used (paper versus computer-based), the seniority of the assessor, the gender of the assessor and the specialty of the assessor. The components of feedback provided by the assessors and the influence of these contextual and demographic factors were also analyzed. During a 26-month study period, 1101 mini-CEX assessments (from 273 PGY1 residents and 67 assessors) were collected. The overall completion rate for the feedback components was 85.3 % (positive feedback), 54.8 % (suggestions for development), and 29.5 % (agreed action plan). In only 22.9 % of the total mini-CEX assessments were all three aspects of feedback completed, and 7.4 % contained no feedback. In the univariate analysis, the mini-CEX format, the seniority of the assessor and the specialty of the assessor were identified as influencing the completion of all three components of feedback. In the multivariate analysis, only the mini-CEX format and the seniority of the assessor were statistically significant. In a subgroup analysis, the feedback-facilitating effect of the computer-based format was uneven across junior and senior EPs. In addition, feedback provision showed a primacy effect: assessors tended to provide only the first or second feedback components in a busy ED setting. In summary, the authors explored the influence of gender, seniority and specialty on paper and computer-based feedback provision during mini-CEX assessments for PGY1 residency training in a busy ED. It was shown that junior assessors were more likely to provide all three aspects of written feedback in the mini-CEX than were senior assessors. The computer-based format facilitated the completion of feedback among EPs.

Challenges of feedback provision in the workplace: A qualitative study of emergency medicine residents and teachers.

BACKGROUND: Feedback is an effective pedagogical tool in clinical teaching and learning, but is often perceived as unsatisfactory. Little is known about the effect of a busy clinical environment on feedback-giving and -seeking behaviors. This study aims to determine the perceptions and challenges of feedback provision in a busy clinical setting, exemplified by an emergency department (ED). METHODS: A qualitative semi-structured interview study design was employed. Thirty-six participants (18 attending physicians, 18 residents) were purposively sampled from three EDs in northern Taiwan between August 2015 and July 2016. Interviews were recorded, transcribed, and analyzed thematically. RESULTS: Three major themes were identified with illustrative quotes: (1) the balance between patient safety and providing feedback, (2) variability in feedback, and (3) influential factors, barriers and enablers. CONCLUSIONS: In real practice, clinical duties competed with the impulse to provide feedback. The variety and complexity of feedback extended beyond style and content. Clinical and contextual factors - some of which may be presented as barriers - influenced how, when and whether a teacher or learner decided to give or seek feedback.

Successful Extracorporeal Life Support in a Case of Severe Glyphosate-Surfactant Intoxication.

OBJECTIVE: To describe the experience of emergency extracorporeal membrane oxygenation in treating life-threatening glyphosate-surfactant intoxication. DESIGN: Case report. SETTING: Emergency department and ICU. PATIENT: A patient with cardiopulmonary failure after glyphosate-surfactant intoxication. INTERVENTION: Extracorporeal membrane oxygenation. CASE REPORT: A 47-year-old man presented with mildly decreased consciousness in our emergency department after ingesting approximately 100 mL of glyphosate-surfactant 1.5 hours previously. Respiratory failure, persistent ventricular tachycardia, profound shock refractory to inotropic agents, and metabolic acidosis developed in the patient within 2 hours. Extracorporeal membrane oxygenation was applied within 4 hours of cardiopulmonary failure. The patient's condition improved considerably. He was transferred to the general ward on the eighth day with stable hemodynamic status and complete neurological recovery. CONCLUSIONS: On the basis of our research, this was the first case in which extracorporeal membrane oxygenation was used to treat severe glyphosate-surfactant intoxication. We recommend early initiation of extracorporeal membrane oxygenation therapy to mitigate cardiopulmonary compromise in patients with glyphosate-surfactant intoxication.

International Collaboration in Taiwan Emergency Department Publications: A Social Network Analysis.

Background: Emergency medicine (EM) is a growing specialty both clinically and academically. Academic EM development can be measured by number of scientific publications. This study aimed to evaluate the academic international cooperation trend of Taiwan emergency departments (EDs) in the past two decades using social network analysis (SNA). Methods: The study population were publications with first author affiliated with Taiwan EDs and the study duration was publication year before 2021. The enrolled publications were categorized into two groups: Group one, all authors were affiliated with Taiwan (domestic publications) and Group two, authors were affiliated with Taiwan and other countries (international publications). The primary outcome measurement was the degree centrality of Taiwan before 2021. The secondary outcome measurements included the trend in annual publication number of Group one and Group two, the trend in country number of each year in Group two, the top five countries that collaborate with Taiwan, the difference between the median of citation numbers in Group one and Group two, and the difference between the median of author numbers in Group one and Group two. Results: A total 4,363 publications were enrolled, of which 4,046 publications were classified in Group one and 317 publications were in Group two. The annual publication number of both groups increased significantly. The annual country number of collaboration with Taiwan ED publications had also significantly increased. The median of citation number and author number in Group two were both significantly higher than Group one. The top five countries collaborating with Taiwan were the United States, China, Malaysia, Japan, and Australia. Conclusions: Taiwan EDs' growing international collaboration in the past two decades indicated a capacity to conduct multi-country research. International collaboration publications obtained higher citations compared to domestic publications. Researchers should enhance international collaborations for academic advancement.

Trends in Palliative Care Research During the COVID-19 Pandemic.

To demonstrate the trends and variety of research on palliative care during the COVID-19 pandemic. A systematic search of the Web of Science database. Since the outbroke of the COVID-19 pandemic, the adjustment of palliative care systems is warranted to maintain a high quality of care. The COVID-19 -related palliative care studies account for approximately 4% of all publications on palliative care. However, there is a dearth of research investigating the nature of these studies. A total of 293 studies were included. Of the included studies, those related to system improvement were the most common (181/293, 61.8%), followed by those related to patient care (79/293, 27.0%), bereavement support for patients or family members (19/293, 6.5%), and the mental health of frontline practitioners (14/293, 4.8%). From these studies, 82, 137, and 74 studies were published in 2020, 2021, and 2022 (until August 1), respectively. The research trends of palliative care demonstrate the flexibility and rapid response of the global palliative care system to the COVID-19 pandemic and show how the palliative care system is evolving. While most studies are interested in system improvement, patient care, and bereavement support, the mental health of frontline practitioners has received less attention. Our findings provide palliative care practitioners with current valuable information and highlight possible future trends.

Top-cited articles on hyperbaric oxygen therapy published from 2000 to 2010.

OBJECTIVE: Hyperbaric oxygen therapy (HBO2T) is a specialty with wide clinical applications and study fields. An evaluation of the major research direction of HBO2T studies would be helpful for researchers in this field. In this study, we identified the most frequently cited HBO2T articles to analyze the study focus of HBO2T research in the past 10 years. METHODS: "Hyperbaric oxygen" was used as the keyword to search articles in PubMed between January 2000 and November 2010. The cited times of an article were tracked in Google Scholar. The top 100 most-cited articles were identified and their publication year, author nationalities, journal, study field and style were recorded and analyzed. RESULTS: In total, 2,362 HBO2T-related articles were retrieved. The number of HBO2T articles published per year has been increasing during the past 10 years. More than half of the top-cited articles (52/100) were from studies in the United States. Studies focusing on stroke (20), radiation injury (11), carbon monoxide (10), and wounds (9) accounted for 50% of the top-cited articles. CONCLUSION: HBO2T has been a field of increasing scientific publications in the past 10 years. The focus of research fields were stroke, radiation injury, carbon monoxide and wounds. The United States maintains an important influence on HBO2T studies.

COVID-19 Literature Published in Emergency Medicine Journals in 2020.

INTRODUCTION: Coronavirus disease 2019 (COVID-19)-related articles published in emergency medicine (EM) journals provide insight into the responses of EM researchers and journal editors globally to a newly emerging infectious disease. We studied trends in the number, types, and national origins of COVID-19 literature published in EM journals to investigate knowledge transmission via scientific publication during the pandemic. METHODS: This was a retrospective observational study. The EM journal list was adopted from the 2019 Journal Citation Reports. We retrieved data from the SCOPUS database, limited to publication year 2020, and identified COVID-19 publications when the title, abstract, or keywords included "COVID" or "SARS." The outcome measurements were as follows: 1) monthly COVID-19 publication numbers in EM journals; 2) the percentage of COVID-19 published literature in terms of total journal publications; 3) the countries, affiliations, and authors of COVID-19-related publications; 4) the differences in the proportions of "Articles" and "Letters" between COVID-19 and non-COVID-19 publications; and 5) the total, average, and maximum number of times cited for different types of COVID-19-related scientific literature. RESULTS: We retrieved a total of 7,457 published papers from 31 EM journals. There were 765 (10.26%) COVID-19-related publications in 27 journals contributed by 67 countries; the first authors were from 49 countries. The monthly COVID-19 publication numbers in the categories of "Letters" and "Articles" were nearly equal before July 2020. The yearly proportions of COVID-19-focused articles and letters were 48.8% and 29.9%, respectively, while non-COVID-19 proportions were 72.1% and 9.8%, respectively. The chi-squared statistic of the differences between the numbers of articles and letters in COVID-19 and non-COVID-19 published research was significant (P < .001). CONCLUSION: An analysis of COVID-19 publications in EM journals indicated that, in the early stage of a newly emerging infectious disease, the number of letters and articles increased simultaneously. The proportion of COVID-19-focused letters was higher than those published on other topics. The "Article" and "Review" category of COVID-19 research was cited more times than that of "Letters."

Trends of Regional Anesthesia Studies in Emergency Medicine: An Observational Study of Published Articles.

INTRODUCTION: Regional anesthesia (RA) has become a prominent component of multimodal pain management in emergency medicine (EM), and its use has increased rapidly in recent decades. Nevertheless, there is a paucity of data on how RA practice has evolved in the specialty. In this study we sought to investigate how RA has been implemented in EM by analyzing trends of published articles and to describe the characteristics of the published research. METHODS: We retrieved RA-related publications from the SciVerse Scopus database from inception to January 13, 2022, focusing on studies associated with the use of RA in EM. The primary outcome was an analysis of trend based on the number of annual publications. Other outcomes included reports of technique diversity by year, trends in the use of individual techniques, and characteristics of published articles. We used linear regression analysis to analyze trends. RESULTS: In total, 133 eligible publications were included. We found that overall 23 techniques have been described and results published in the EM literature. Articles related to RA increased from one article in 1982 to 18 in 2021, and the rate of publication has increased more rapidly since 2016. Reports of lower extremity blocks (60.90%) were published most frequently in ranked-first aggregated citations. The use of thoracic nerve blocks, such as the erector spinae plane block, has increased exponentially in the past three years. The United States (41.35%) has published the most RA-related articles. Regional anesthesia administered by emergency physicians (52.63%) comprised the leading field in published articles related to RA. Most publications discussed single-shot (88.72%) and ultrasound-guided methods (55.64%). CONCLUSION: This study highlights that the number of published articles related to regional anesthesia in EM has increased. Although RA research has primarily focused on lower extremity blocks, clinical researchers continue to broaden the field of study to encompass a wide spectrum of techniques and indications.

Indirect Radiological Signs of Hollow Organ Perforation.

Hollow organ perforation is a serious and common abdominal emergency. The diagnosis depends on history taking, physical examination, and radiological fi ndings. We reported a hollow organ perforation patient with only indirect radiological signs of the heterogenous enhanced lesion between the stomach, duodenum, and liver over initial abdominal computed tomography. Pneumoperitoneum occurred in follow-up chest X-ray 5 hours after the emergency department visit. The reason for the delayed occurrence of pneumoperitoneum, direct/indirect radiological signs of hollow organ perforation, and ways to avoid this pitfall are discussed.

Children with lethal streptococcal fasciitis after a minor contusion injury.

Necrotizing fasciitis is a severe life-threatening soft tissue infection characterized by rapidly spreading necrosis of the fascia and the subcutaneous tissue. Mortality as a result of streptococcal necrotizing fasciitis has been associated with the presence of hypotension, streptococcal toxic shock syndrome, or bacteremia in the literature. These infections are rare in children, and the diagnosis should be considered in the presence of any soft tissue infection presenting with signs of toxicity and marked wound edema. In addition, traumatic compartment syndrome has also gained public attention. This condition is also potentially lethal if diagnosis and management are delayed, especially in patients with swollen limbs without fracture. A high index of suspicion is most important when there is a paucity of specific cutaneous findings early in the course of the disease. The diagnosis of necrotizing fasciitis should be considered for any individual who has unexplained limb pain. Even for treating patients with minor trauma, the emergency department physician should keep a high level of suspicion of the possibility of a fatal outcome from the subsequent invasive streptococcal infection.

Tension pneumocephalus: a rare complication after hyperbaric oxygen therapy.

The study aimed to describe a patient with multiple skull bone fractures and a cerebrospinal fluid (CSF) leak who received hyperbaric oxygen therapy (HBOT). A 40-year-old man presented with subdural hemorrhage, skull bone fractures, facial bone fractures, sinus fractures, and CSF leakage after a one-story fall. He received HBOT as an adjunctive treatment to reduce brain edema and increase oxygen availability in brain tissue. Tension pneumocephalus developed after HBOT. Bur hole drainage was performed emergently to relieve the tension pneumocephalus. Cranioplasty and repair of skull base fracture were subsequently performed. The patient was discharged in a vegetative state. We proposed a possible mechanism by which tension pneumocephalus developed after HBOT sessions in this patient. Pneumocephalus, untreated skull base fracture, and CSF leakage should be considered contraindications to HBOT.

Prognostic indicators of open globe injuries in children.

PURPOSE: To determine the prognostic indicators of visual outcome in children with open globe injuries. BASIC PROCEDURES: The charts of 62 patients, 16 years of age or younger, who had been treated for open globe injuries were reviewed. MAIN FINDINGS: The types of injury included penetrating (30 eyes), rupture (20 eyes), intraocular foreign body (10 eyes), and perforation (2 eyes). Sharp objects, such as knives or scissors, were the most common causes of open globe injuries. A visual acuity (VA) of at least 20/40 was achieved in 80.8% (21/26) of eyes with a corneal injury only, in 45.5% (5/11) of eyes with additional lens damage, and in 17.4% (4/23) of eyes with extensive anterior and posterior injuries. CONCLUSIONS: Unfavorable outcomes were related to the location of injury, the extent of injury, the initial presentation of hyphema, vitreous hemorrhage, retina detachment, cornea wound across the pupil, and the development of endophthalmitis.