Detección molecular de patógenos en deposiciones en niños consultantes por diarrea aguda en Servicios de Urgencia

Introducción: La diarrea aguda continúa siendo una de las principales causas de morbilidad en niños; sin embargo, el diagnóstico etiológico presenta limitaciones dada la baja sensibilidad de los métodos tradicionales. Objetivo: Describir los microorganismos identificados en niños que acudieron al Servicio de Urgencia (SU) de un hospital universitario en Santiago, Chile, por diarrea aguda y a los que se le solicitó panel molecular gastrointestinal. Métodos: Se revisaron fichas clínicas y resultados de panel gastrointestinal realizados entre junio de 2017 y marzo de 2020. Resultados: Se incluyeron 198 pacientes, edad promedio de 54,5 meses y 60,6% (120/198) de sexo masculino. La positividad del panel fue de 78,8% (156/198) con 35,3% (55/156) de las muestras polimicrobianas. Se identificaron 229 microorganismos, de los cuales 72,9% (167/229) corresponden a bacterias, 25,8% (59/229) a virus y 1,3% (3/229) a parásitos. Destacaron Campylobacter spp. y Escherichia coli enteropatógena (ECEP) como las bacterias más frecuentemente identificadas. Los pacientes con detección de Campylobacter spp. presentaron con mayor frecuencia fiebre (p = 0,00). ECEP se aisló principalmente (82,5%) en muestras polimicrobianas. Discusión: Los resultados enfatizan el potencial que poseen los estudios moleculares para mejorar el diagnóstico etiológico de la diarrea, pero a la vez llevan a cuestionar el rol patogénico de algunos microorganismos identificados.

Background: Acute diarrhea continues to be one of the main causes of morbidity in children, however the etiologica diagnosis presents limitations given the low sensitivity of traditional methods. Aim: To describe the microorganisms identified in children who attended the emergency department (ED) in Santiago, Chile, due to acute diarrhea and to whom a gastrointestinal panel was requested as part of their study. Material and Methods: Clinical records and results of the gastrointestinal panel carried out between June 2017 and March 2020 were reviewed. Results: 198 patients were included, the average age was 54.5 months and 60.6% (120/198) were males. Positivity was 78.8% (156/198) with 35.3% (55/156) of the samples being polymicrobial. 229 microorganisms were identified, of which 72.9% (167/229) corresponded to bacteria, 25.8% (59/229) to viruses, and 1.3% (3/229) to parasites. Campylobacter spp. and enteropathogenic Escherichia coli (EPEC) were the most frequently identified bacteria. Patients with detection of Campylobacter spp. presented a higher frequency of fever (p = 0.00). EPEC was isolated in 82.5% of the cases in polymicrobial samples. Discussion: The results emphasize the potential of molecular studies to improve the etiological diagnosis of diarrhea and at the same time lead to question the pathogenic role of some microorganisms.

Investigating Emergency Department Healthcare Professionals’ Intention to Use the Poison Information System

@#Introduction: The objective of this paper is to investigate the behavioural intention to use the Poison Information System (PIS) among healthcare professionals based on the extension of the Technology Acceptance Model. Methods: A quantitative approach used a five-point Likert scale questionnaire adapted from previous research. Data were obtained from 136 health professionals working in the Emergency Department of public hospitals in Malaysia. Results: A multiple linear regression model showed that approximately 40% of the variation in intention to use was related to positive attitude, staff category, and inversely to computer anxiety. Perceived usefulness, perceived ease of use, and computer usage were related to intention to use, but their correlation was accounted for by positive attitude, staff category, and computer anxiety. A factor analysis grouped positive attitude, intention to use, and perceived usefulness on Factor I and perceived ease of use, inverse computer anxiety, and computer habit on Factor II. Cluster analysis indicated three clusters. Gender, age, experience, and staff category were strongly inter-related; intention to use clustered with perceived ease of use and perceived usefulness; positive attitude clustered with computer habit; and the latter two clustered together. Conclusion: These findings show that positive attitude, staff category, and computer anxiety of healthcare professionals, working in emergency departments, may have the greatest effect on PIS usage.

Pediatric emergency preparedness in Canadian family physician offices: A national survey / 世界急诊医学杂志（英文）

@#Family physicians often serve as the primary resource for parents seeking medical treatment for their children, and it is not uncommon for children with medical emergencies to be brought into primary care offices instead of local emergency departments (EDs). Although estimated incidence rates of pediatric emergencies in primary care offices vary based on the definition used, the number of patients seen, and clinic location,[1,2,3] any healthcare provider who sees pediatric patients should be ready for immediate medical intervention to minimize adverse outcomes.

Triage hospitalario. La clasificación de la atención según el nivel de urgencia, en los servicios de urgencias / Hospital triage. Classification of care according to level of urgency, at emergency departments

El triage hospitalario en los servicios de urgencias es un proceso de valoración clínica preliminar. Permite clasificar a los pacientes según su nivel de urgencia y no por orden de llegada. Prioriza la asistencia de los pacientes graves. Organiza la atención de acuerdo a la demanda, los recursos físicos y humanos disponibles. Debe incluir protocolos que definan la clasificación del nivel de urgencia, los tiempos de asistencia y reevaluación, las intervenciones que se pueden ejecutar en el sector y el registro de las actuaciones. La clasificación del nivel de urgencia se define mediante el triángulo de evaluación pediátrica, el problema principal, las constantes vitales y la consideración de modificadores o alertas. Aunque resulta imprescindible, su uso no está uinversalmente difundido(AU)

At emergency departments, triage is the process of initial clinical assessment. It allows for the classification of patients based on their level of emergency regardless of order of arrival. It prioritizes care for severe patients and organizes care according to the demand and available physical and human resources. The triage should include protocols that define classification of the level of urgency, necessary times for care and reassessment, interventions that may be performed in the area, and recording of the activities. The level of emergency is classified based on the triad of pediatric assessment, consisting of the main complaint, vital signs, and consideration of modifiers or alerts. Although essential, it is not universally used (AU).

Evaluación del tratamiento de la fibrilación auricular valvular y no valvular y su relación con eventos adversos en pacientes hospitalizados en el servicio de urgencias de un hospital de tercer nivel / Evaluation of the treatment of valvular and non-valvular atrial fibrillation and its relationship with adverse events in patients admitted to the Emergency Department of a third level hospital

Resumen Introducción: La fibrilación auricular es la arritmia más frecuente, y a pesar de importantes avances en su tratamiento, sigue siendo una de las principales causas de accidente cerebrovascular, insuficiencia cardíaca, muerte súbita y morbimortalidad cardiovascular en el mundo (1,2). En Colombia se cuenta con muy pocos registros que determinen su prevalencia y patrón epidemiológico. Objetivo: Describir el tratamiento de los pacientes que ingresan al servicio de urgencias con diagnóstico de fibrilación auricular, así como establecer la prevalencia, epidemiología y eventos adversos asociados con el tratamiento. Materiales y método: Se utilizaron los programas EXCEL, para la organización de los datos, y SPSS versión 23, para el análisis. Resultados: Durante el periodo del estudio 105 pacientes fueron admitidos en el servicio de Urgencias con diagnóstico de fibrilación auricular. 58% eran hombres, con promedio de edad de 67.8 años. Las comorbilidades más asociadas a la fibrilación auricular fueron hipertensión arterial y falla cardiaca. El 35% de los pacientes habían tenido alguna complicación cardioembólica, principalmente ataque cerebrovascular, y 12% ingresaron por complicaciones derivadas de la anticoagulación. En la mayoría de los casos se prefirió una estrategia de control de frecuencia cardíaca y anticoagulación. En cuanto al manejo anticoagulante, el 45% fueron tratados con warfarina y el 37% con anticoagulantes orales directos. Se documentaron tres casos de sangrados mayores en pacientes tratados con warfarina y ninguno en pacientes tratados con anticoagulantes orales directos. Conclusión: La fibrilación auricular continúa siendo una de las principales causas de atención en el servicio de urgencias, así como una importante causa de accidente cerebrovascular. Las comorbilidades asociadas son hipertensión arterial y falla cardiaca. La estrategia terapéutica más utilizada es el control de la frecuencia cardiaca y la anticoagulación; adicionalmente, hay un porcentaje creciente de pacientes en tratamiento con anticoagulantes directos.

Abstract Introduction: Atrial fibrillation is the most common arrhythmia, and despite the significant advances in its treatment, it continues to be one of the main causes of cerebrovascular accident, heart failure, sudden death, and cardiovascular morbidity and mortality in the world. In Colombia, there are very few registers that help to determine its prevalence and epidemiological pattern. Objective: To describe the treatment of the patients admitted to the Emergency Department with a diagnosis of atrial fibrillation, as well as to establish the prevalence, epidemiology, and adverse events associated with the treatment. Materials and method: Excel programs were used for the organisation of the data, SPSS version 23, for the analysis. Results: During the study period, a total of 105 patients were admitted into the Emergency Department with a diagnosis of atrial defibrillation. The mean age was 67.8 years and the majority (58%) were males. Arterial hypertension and heart failure were comorbidities most associated with the atrial fibrillation. More than one-third (35%) of the patients had suffered some cardio-embolic complication, mainly a stroke, and 12% were admitted due to complications arising from anticoagulation. Monitoring heart rate and anticoagulation was the preferred strategy in the majority of patients. As regards anticoagulant management, 45% were treated with warfarin, and 37% with direct oral anticoagulants. Three cases of major bleeding were documented in patients on warfarin, and none in patients treated with direct oral anticoagulants. Conclusion: Atrial fibrillation continues to be one of the main causes in the Emergency Department, as well as a significant cause of cerebrovascular accident. Arterial hypertension and heart failure were the most associated comorbidities. The most used therapeutic strategy was monitoring of heart rate and the anticoagulation. Furthermore, there was an increasing percentage of patients on treatment with direct oral anticoagulants.

Outcome predictors for severely brain-injured patients directly admitted or transferred from emergency departments to a trauma center / 世界急诊医学杂志（英文）

@#Dear editor, After sustaining severe traumatic brain injury (TBI), patients frequently require invasive mechanical ventilation (MV). However, up to 26% of patients require tracheostomy due to failure to wean from the ventilator.[1] The decision of when to perform tracheostomy is important as it balances the risk between avoiding prolonged MV and avoiding risk of tracheostomy. Early predictors for tracheostomy, i.e., clinical factors when patients first present to an Emergency Department after trauma or when patient first arrive at a regional trauma center, can help clinicians’ medical decision-making process.

Availability and quality of procedural sedation and analgesia in emergency departments without emergency physicians: A national survey in the Netherlands / 世界急诊医学杂志（英文）

BACKGROUND@# Emergency physicians have been successful in implementing procedural sedation and analgesia (PSA) to treat emergency department (ED) patients who need to undergo painful procedures. However, 25% of the EDs in the Netherlands are not staffed by emergency physicians. The aim of this study was to investigate PSA availability and quality in EDs without emergency physicians.@*METHODS@# We performed an exploratory cross-sectional study amongst ED nurses and physicians in all 13 EDs without emergency physicians in the Netherlands. Data were gathered using a standardized questionnaire.@*RESULTS@# The response rate was 34.3% (148/432). Of the respondents, 84/148 (56.8%) provided adult PSA and 30/148 (20.3%) provided paediatric PSA. Main reasons for not providing PSA were insufficient numbers of trained staff to support PSA in the ED and insufficient training and exposure. The providers agreed significantly stronger when reflecting their PSA competencies in adults compared to paediatric patients.@*CONCLUSION@# The key to improve pain management in the ED-setting may lay in investing in continuous training of ED health care professionals and/or acquiring professionals who are both qualified in PSA and available in the ED.

A study on the role of paediatric assessment triangle, clinical scoring and serum lactate in the management of septic shock in children

Background: There is dearth of studies in India on the management of paediatric septic shock. So it is prudent to do a study on paediatric septic shock management. The objective of the study is to determine the correlation between Paediatric Assessment Triangle and serum lactate levels., to determine the role Paediatric Assessment Triangle in predicting mortality in septic shock and to the determine the role of elevated lactate levels in predicting mortality in septic shock.Methods: Descriptive study of 100 children from 31 days to 12 years of age who are admitted with septic shock in a tertiary care hospital are assessed with paediatric assessment triangle and clinical score and serum lactate was tested along with other standard tests and the children are managed as per the standard protocols. Outcome is analysed.Results: In this study, septic shock children with total clinical score >22 are having statistically significant low levels of diastolic blood pressure and low mean arterial pressure. There was a significant difference in median serum lactate levels between the survivors (28.08 mg/dl) and non-survivors (40.92 mg/dl).Conclusions: Paediatric assessment triangle and clinical scoring based on it more than 22 and serum lactate levels of more than 2mmol/L or 18mg/dl predict the mortality.

Trends in mortality of emergency departments patients in China / 世界急诊医学杂志（英文）

BACKGROUND@#Emergency medical service system (EMSS) in China is becoming more important. However, studies on mortality of emergency departments (EDs) patients in tertiary hospitals and on the trends in mortality of ED patients all over China are stagnant. The objective of this study was to quantify and describe the trends in mortality of ED patients in China.@*METHODS@#Nine tertiary teaching hospitals were selected from tertiary teaching hospitals in different regions. The annual numbers of ED visits and deaths of these hospitals in 2004, 2009 and 2014 were recorded and analyzed. Chi-square test was used to compare the mortality of the EDs' visits. Moreover, data on the mortality of ED patients in China from 2005 to 2015 were summarized and analyzed from the China Health and Family Planning Statistical Yearbooks (2006–2016).@*RESULTS@#From 2004 to 2014, the overall annual mortalities in EDs increased among the tertiary hospitals (P<0.001). However, the overall annual mortality in EDs all over China decreased from 0.12% in 2005 to 0.08% in 2015. And the mortalities of EDs patients in the eastern, central and western regions of China all decreased. In addition, the average mortality of EDs patients in northern China was obviously higher than that in southern China (P<0.05).@*CONCLUSION@#The ED mortality was increased in tertiary hospitals while decreased all over China during the past decade, which may be partly caused by some critical challenges faced by China's EMSS, such as overcrowding and long length of stay in EDs of tertiary hospitals.

Relationship between Violence Response, Professional Quality of Life and Workplace Violence against Nurses in Emergency Departments in Korea / 임상간호연구

PURPOSE: The purpose of this study was to investigate the reality of workplace violence experienced by emergency nurses and the relationship of violence response to professional quality of life. METHODS: The participants in this study were 899 emergency nurses from Korea nationwide. Data were obtained through an online survey done during October, 2017. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficient. RESULTS: Of the emergency nurses, 72.1% recognized that workplace violence is serious. Experience with workplace violence correlated positively with violence reaction (r=.32, p < .001), burnout (r=.20, p < .001) and secondary trauma (r=.22, p < .001). Also, reaction to violence was positively correlated with burnout (r=.28, p < .001) and secondary trauma (r=.56, p < .001). CONCLUSION: Findings indicate that the diverse workplace violence experienced by emergency nurses decreases their professional quality of life. Further study is needed to develop solutions to the problem of workplace violence in emergency settings.

Caracterización clínica de los pacientes con síncope / Clinical profile of patients with syncope

Resumen Introducción: Se hizo una caracterización clínica de los pacientes con síncope en un Hospital Universitario en Bogotá. Objetivo: Describir las características clínicas de los pacientes con síncope que consultaron al Hospital Militar Central en Bogotá en el período 2012-2015, y analizar la contribución de las ayudas diagnósticas y de las escalas EGSYS y OESIL para orientar el diagnóstico etiológico. Métodos: Se realizó un estudio observacional, descriptivo, de pacientes mayores de 18 años que ingresaron a urgencias del Hospital Militar Central por síncope; se analizaron características clínicas, estudios solicitados y puntajes de las escalas EGSYS y OESIL. Resultados: Se evaluaron 705 historias clínicas, de las cuales 116 fueron excluidas por datos faltantes; la edad promedio fue 58 años y el 46,52% eran mujeres. El 41,6% tenía hipertensión arterial y el 21% enfermedad cardiaca previa. Según el diagnóstico etiológico, 75% fueron clasificados como síncope no cardiaco, 23% como síncope cardiaco y en 2% no se identificó la etiología. El examen más solicitado fue el electrocardiograma (79%), seguido por troponina (63%) y TAC cerebral (58%). Al aplicar las escalas, 60% de los pacientes tuvo un puntaje menor a 3 (EGSYS) y 2 puntos (OESIL), lo que sugería que eran de etiología no cardiogénica/bajo riesgo de mortalidad respectivamente. Conclusiones: La etiología del síncope en la mayoría de los casos fue no cardiaca. El electrocardiograma debe ser solicitado a todos los pacientes con síncope. El uso rutinario de las escalas de riesgo puede contribuir a disminuir la solicitud de estudios no indicados, optimizar el uso de recursos y reducir los días de hospitalización.

Abstract Introduction: A clinical profile was constructed on patients with syncope in a Bogota University Hospital. Objective: To describe the clinical characteristics of patients with syncope that were seen in the Hospital Militar Central in Bogota in the period 2012-2015, as well as to analyse the contribution of diagnostic aids and the Evaluation of Guidelines in Syncope Study (EGSYS) and the Lazio epidemiological syncope Observation (OESIL) scores in order to determine the aetiological diagnosis. Methods: A descriptive observational study was performed on patients over 18 years admitted to the Emergency Department of the Hospital Militar Central due to syncope. An analysis was carried out on the clinical characteristics, examinations requested, and the scores on the EGSYS and OESI L scales. Results: A total of 705 clinical histories were evaluated, of which 116 were excluded due to lack of data. The mean age was 58 years, and 46.52% were women. Arterial hypertension was observed in 41.6%, and 21% had a previous heart disease. According to the aetiological diagnosis, 75% were classified as non-cardiac syncope, 23% as cardiac syncope, and 2% of unknown origin. The most requested examination was the electrocardiogram (79%), followed by troponin (63%), and a computed tomography brain scan (58%). On applying the scales, 60% of the patients had a score of less than 3 (EGSYS) and 2 points (OESIL), which suggested that they were of non-cardiogenic origin/low mortality risk, respectively. Conclusions: The origin of syncope in the majority of cases was non-cardiac. An electrocardiogram must be requested on all patients with syncope. The routine use of risk scales can contribute to reducing the number of non-indicated examinations, as well as optimise the use of resources and reduce hospital stay.

Community-associated methicillin-resistant Staphylococcus aureus infections in Aboriginal children attending hospital emergency departments in a regional area of New South Wales, Australia: a seven-year descriptive study

Objective: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) can cause bacterial skin infections that are common problems for Aboriginal children in New South Wales (NSW). MRSA is not notifiable in NSW and surveillance data describing incidence and prevalence are not routinely collected. The study aims to describe the epidemiology of CA-MRSA in Aboriginal children in the Hunter New England Local Health District (HNELHD). Methods: We linked data from Pathology North Laboratory Management System (AUSLAB) and the HNELHD patient administration system from 33 hospital emergency departments. Data from 2008–2014 for CA-MRSA isolates were extracted. Demographic characteristics included age, gender, Aboriginality, rurality and seasonality. Results: Of the 1222 individuals in this study, 408 (33.4%) were Aboriginal people. Aboriginal people were younger with 45.8% aged less than 10 years compared to 25.9% of non-Aboriginal people. Most isolates came from Aboriginal people who attended the regional Tamworth Hospital (193/511 isolates from 149 people). A larger proportion of Aboriginal people, compared to non-Aboriginal people, resided in outer regional (64.9% vs 37.2%) or remote/very remote areas (2.5% vs 0.5%). Most infections occurred in summer and early autumn. For Aboriginal patients, there was a downward trend through autumn, continuing through winter and spring. Discussion: Aboriginal people at HNELHD emergency departments appear to represent a greater proportion of people with skin infections with CA-MRSA than non-Aboriginal people. CA-MRSA is not notifiable in NSW; however, pathology and hospital data are available and can provide valuable indicative data to health districts for planning and policy development.

Efficacy of Red Cell Distribution Width as Prognostic Factor for Sepsis-3 Patients in Emergency Department

PURPOSE: Red cell distribution width (RDW) was introduced as a new biomarker for the prognosis of sepsis patients. In addition, the definition of sepsis has changed recently to sepsis-3 criteria. The aim of this study was to compare the efficacy of RDW as a prognostic factor for sepsis-3 patients in the emergency department. METHODS: We conducted a retrospective study of patients who were suspected of having sepsis between October, 2015 and April, 2016. The demographic data, comorbidities, blood test results, including RDW, lactate, C-reactive protein, and procalcitonin at admission, as well as the Mortality in Emergency Department Sepsis score were compared between the 30-day survivors and nonsurvivors. Analysis compared the areas under the receiver operator characteristic curves for 30-day mortality. Multivariate Cox proportional hazards regression analysis was performed to determine the risk factors for mortality. RESULTS: A total of 222 patients were included. The mean age was 75, 51.8% of the patient population was male, and the overall mortality rate was 16.7%. The non-survival group had higher RDW levels than the survivor group (14.5% vs 13.4%). The area under the receiver operating characteristic curve of RDW to predict mortality was 0.724. In a Cox proportional hazards analysis, RDW had 1.292 hazard ratio. Setting the RDW cutoff value to 14.3, we found that sensitivity and specificity of predicting mortality was 75.1% and 70.3%, respectively. CONCLUSION: It may be possible to use RDW to predict mortality in sepsis-3 patients.

The Effect of Having a Regular Doctor as a Primary Care Provider on Emergency Room Utilization in South Korea / 가정의학회지

BACKGROUND: Because primary care is the cornerstone of an effective health care system, many developed countries have striven to establish and strengthen their primary care systems. However, the primary care system in South Korea is not well established, and primary care research is still in its infancy. This study aimed to show the benefits of regular doctors as primary care providers in South Korea by analyzing the effect of regular doctor visits on emergency room (ER) visits. METHODS: We analyzed cross-sectional data on 11,293 adults aged 18 years and over collected from the 2013 Korea Health Panel Survey (beta version 1.0). We classified those participants with and without regular doctors into the treatment and control groups, respectively, and estimated the average treatment effect (ATE) of having a regular doctor on ER visits. We used counterfactual framework and propensity score analysis to adjust for unevenly distributed confounding covariates between treatments and control groups. RESULTS: The estimated conditional ATE of a regular doctor on ER visits was statistically insignificant in the general population (-0.4%; 95% confidence interval [CI], -2.0 to 1.2) and in the subgroup of patients with hypertension (-1.8%; 95% CI, -4.5 to 0.9). However, in patients with diabetes mellitus (DM), the estimated ATE was statistically significant (-5.0; 95% CI, -9.2 to -0.7). CONCLUSION: In the total study population, having a regular doctor did not result in a significant difference in ER visits. However, there was a decrease in ER visits in patients with DM in South Korea.

Admission route and use of invasive procedures during hospitalization for acute myocardial infarction: analysis of 2007-2011 National Health Insurance database / 한국역학회지

OBJECTIVES: The goal of this study was to investigate trends in admission to the emergency department and the use of invasive or surgical procedures during hospitalization for acute myocardial infarction (AMI) in Korea. METHODS: The National Health Insurance (NHI) claims database between 2007 and 2011 was used. We identified all admission claims that included codes from the tenth revision of the International Classification of Diseases beginning with I21 as the primary or secondary diagnosis. Information about the admission route, admission date, discharge date, and whether coronary artery angiography, angioplasty, or bypass surgery was performed was also obtained from the NHI database. RESULTS: Of the 513,886 relevant admission claims over the five years encompassed by this study, 295,001 discrete episodes of admission for AMI were identified by analyzing the date and length of each admission and the interval between admissions. The number of AMI admissions gradually decreased from 66,883 in 2007 to 47,656 in 2011. The number and proportion of admissions through the emergency department also decreased from 38,118 (57.0%) in 2007 to 24,001 (50.4%) in 2011. However, during the same period, admissions in which invasive or surgical procedures were performed increased from 15,342 (22.9%) to 17,505 (36.7%). CONCLUSIONS: The reported numbers of emergency department visits and admissions for AMI decreased from 2007 to 2011. However, only a small portion of the patients underwent invasive or surgical procedures during hospitalization, although the number of admissions involving invasive or surgical procedures has increased. These findings suggest that simply counting the number of admission claims cannot provide valid information on trends in AMI occurrence.

Importance of Nurses' Caring Behaviors as Perceived by Nurses and Patients at Emergency Departments / 한국간호교육학회지

PURPOSE: This study was to investigate the importance of nurses' caring behaviors as perceived by nurses and patients at emergency departments, and to determine the differences between the two groups. METHODS: The subjects of this study were 159 nurses working at emergency departments in 9 general hospitals in B Metropolitan City and 153 in-patients in 6 general hospitals, who were transferred to a general ward after being admitted to an emergency room. Research tool was a self-report questionnaire, which was a translated version of Caring Behavior Assessment(CBA). In this study, Cronbach's alpha was ranged from .83 to .93 in the seven subscale's reliability of CBA. RESULTS: In terms of caring behaviors at emergency departments, both nurses and patients perceived that the most important subscale was . The subscale which showed the least importance from both groups was . CONCLUSION: The results of this study have demonstrated that nurses' caring behaviors can meet the patient's needs if the gap in perceptions between nurses and patients would be reduced.

Clinical Characteristics of 372 Cases of Transient Global Amnesia in the Emergency Department: A Single Center Study

PURPOSE: Transient global amnesia (TGA) is characterized by abrupt onset of antegrade amnesia usually seeking emergency care. We analyzed the clinical characteristics of TGA patients and the significance of diffusion weighted imaging (DWI) in the diagnosis of TGA. METHODS: Retrospective analysis was performed using electronic medical records of patients diagnosed as TGA in the emergency departments from January 2003 to December 2013. The patient's clinical characteristics and precipitants were analyzed, and detection rate of hippocampal lesion was compared according to the time to DWI after symptom onset (24 h). RESULTS: Of 372 consecutive TGA patients studied, 27 had a positive DWI lesion in hippocampus. Demographics and vascular risk profile were not significantly different between those in DWI (+) and DWI (-), and neither was duration of amnesia (p=0.076). However, the median time interval to DWI was significantly longer in DWI (+) than DWI (-) [7.5 (5.5~15.0) h vs. 6.0 (3.5~9.0) h, p=0.011]. In addition, the detection rate of hippocampal lesion increased with the time interval [0-6 h (4.1%), 6~12 h (10.7%), 12~24 h (11.1%), and >24 h (16.1%), p=0.004]. CONCLUSION: Positive hippocampal lesion on DWI can confirm the diagnosis of TGA; however, difference in lesion detectability in regard to time interval from symptom onset to DWI should be considered in diagnosis of TGA with DWI.

Traumatic brain injury: A case-based review / 世界急诊医学杂志（英文）

@#BACKGROUND: Traumatic brain injuries are common and costly to hospital systems. Most of the guidelines on management of traumatic brain injuries are taken from the Brain Trauma Foundation Guidelines. This is a review of the current literature discussing the evolving practice of traumatic brain injury. DATA SOURCES: A literature search using multiple databases was performed for articles published through September 2012 with concentration on meta-analyses, systematic reviews, and randomized controlled trials. URESULTS: The focus of care should be to minimize secondary brain injury by surgically decompressing certain hematomas, maintain systolic blood pressure above 90 mmHg, oxygen saturations above 93%, euthermia, intracranial pressures below 20 mmHg, and cerebral perfusion pressure between 60–80 mmHg. CONCLUSION: Much is still unknown about the management of traumatic brain injury. The current practice guidelines have not yet been sufficiently validated, however equipoise is a major issue when conducting randomized control trials among patients with traumatic brain injury.

An academic emergency department:residents' perspective / 世界急诊医学杂志（英文）

BACKGROUND: Since demographic changes have contributed to the growth of emergency medicine, a highly populous nation such as India needs to give physicians associated due credit and recognition. The management of knowledge source must also be conducted with due care as the work environment is completely different from that of any other clinicians. METHODS: The data were collected by direct interaction with residents of the department. Additional information was gathered by observation. The data were verified for validity. RESULTS: This study was to bring out the benefits of proactive decisions that could further enhance the emergency department. But such decisions did not always result in positive responses and improved morale. When such decisions were retracted as it causes misalignment with the existing system. An academic emergency department was expected and physicians should enrich their knowledge about emergency medicine. CONCLUSIONS: The problems faced by emergency department might be similar but the way in which one tackles the situation would be different. Decision making in this hospital may not be the best but it would've been the optimum one given the conditions available.

Analysis of Prescriptions in the Outpatient and Emergency Departments of Our Hospital in 2006 / 中国药房

OBJECTIVE: To analyze the drug use in outpatient and emergency departments of our hospital.METHODS: A total of 12 000 prescriptions in outpatient and emergency departments in 2006 were randomly sampled for the analysis of drug use.RESULTS: 43% of the drugs were used singly and 13% were combined use of 4 or more than 4 drugs.Oral administration and intravenous injection were the leading routes of administration.3.10% of the prescriptions were irrational in dosage,repeated drug use,dosage regimen,use of dissolvants,drug combination,and drug choice etc.CONCLUSION: The drug use in the outpatient and emergency departments of our hospital were rational basically,yet there are still some problems remains to be tackled.Great importance should be attached to the prescription check.