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1.
Emerg Med J ; 37(12): 773-777, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33127743

RESUMO

BACKGROUND: Public health mitigation strategies in British Columbia during the pandemic included stay-at-home orders and closure of non-essential services. While most primary physicians' offices were closed, hospitals prepared for a pandemic surge and emergency departments (EDs) stayed open to provide care for urgent needs. We sought to determine whether ED paediatric presentations prior and during the COVID-19 pandemic changed and review acuity compared with seasonal adjusted prior year. METHODS: We analysed records from 18 EDs in British Columbia, Canada, serving 60% of the population. We included children 0-16 years old and excluded those with no recorded acuity or discharge disposition and those left without being seen by a physician. We compared prepandemic (before the first COVID-19 case), early pandemic (after first COVID-19 case) and peak pandemic (during public health emergency) periods as well as a similar time from the previous year. RESULTS: A reduction of 57% and 70% in overall visits was recorded in the children's hospital ED and the general hospitals EDs, respectively. Average daily visits declined significantly during the peak-pandemic period (167.44±40.72) compared with prepandemic period (543.53±58.8). Admission rates increased mainly due to the decrease in the rate of visits with lower acuity. Children with complaints of 'fever' and 'gastrointestinal' symptoms had both the largest overall volume and per cent reduction in visits between peak-pandemic and prior year (79% and 74%, respectively). CONCLUSION: Paediatric emergency medicine attendances were reduced to one-third of normal numbers during the 2020 COVID-19 lockdown in British Columbia, Canada, with the reduction mainly seen in minor illnesses that do not usually require admission.


Assuntos
Infecções por Coronavirus/epidemiologia , Medicina de Emergência/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Hospitais Pediátricos/organização & administração , Pneumonia Viral/epidemiologia , Adolescente , Betacoronavirus/patogenicidade , Colúmbia Britânica/epidemiologia , Criança , Pré-Escolar , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Emergências/epidemiologia , Medicina de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Pandemias/prevenção & controle , Admissão do Paciente/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Triagem/organização & administração , Triagem/estatística & dados numéricos
2.
West J Emerg Med ; 21(6): 83-87, 2020 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-33052816

RESUMO

INTRODUCTION: We are currently in the midst of the coronavirus disease 2019 (COVID-19) pandemic. Research into previous infectious disease outbreaks has shown that healthcare workers are at increased risk for burnout during these dire times, with those on the front lines at greatest risk. The purpose of this prospective study was to determine the effect that the COVID-19 pandemic has had on the wellness of emergency physicians (EP). METHODS: A survey was sent to 137 EPs in a multi-hospital network in eastern Pennsylvania. We compared 10 primary and two supplemental questions based on how the physicians had been feeling in the prior 2-3 weeks (COVID-19 period) to the same questions based on how they were feeling in the prior 4-6 months (pre-COVID-19 period). RESULTS: We received 55 responses to the survey (40.1% response rate). The study found that during the pandemic, EPs felt less in control (p-value = 0.001); felt decreased happiness while at work (p-value 0.001); had more trouble falling asleep (p-value = 0.001); had an increased sense of dread when thinking of work needing to be done (p-value = 0.04); felt more stress on days not at work (p-value <0.0001); and were more concerned about their own health (p-value <0.0001) and the health of their families and loved ones (p-value <0.0001). CONCLUSION: This study showed a statistically significant decrease in EP wellness during the COVID-19 pandemic when compared to the pre-pandemic period. We need to be aware of evidence-based recommendations to help mitigate the risks and prevent physician burnout.


Assuntos
Esgotamento Profissional/prevenção & controle , Infecções por Coronavirus/epidemiologia , Saúde do Trabalhador , Estresse Ocupacional/epidemiologia , Médicos/psicologia , Pneumonia Viral/epidemiologia , Adulto , Esgotamento Profissional/epidemiologia , Infecções por Coronavirus/prevenção & controle , Medicina de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Masculino , Pandemias/prevenção & controle , Pennsylvania , Pneumonia Viral/prevenção & controle , Estudos Prospectivos , Inquéritos e Questionários
3.
J Ayub Med Coll Abbottabad ; 32(3): 346-351, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32829549

RESUMO

BACKGROUND: The length of stay (LOS) is an important operational parameter closely followed in emergency department (ED). This study aims to assess operations impacts of a large postresidency EM Fellowship (EMF) program on LOS. METHODS: This was a retrospective database analysis of data collected automatically by the study ED's electronic medical record (EMR) for one full academic year, starting in September 2016. The main dependent variable was LOS for the cases discharged after EM-only evaluation (LOSDCEM), and the independent variable of interest was the proportion of EMFs as a % of all on-duty ED physicians during the shift the patient presented. RESULTS: During the study period, the ED census for patients discharged after EM-only evaluation was 327,527. Exclusion of 5,803 EMR-downtime cases (1.8% of 327,527) and 845 (0.3% of 327,527) cases with LOS exceeding 24 hours, the final study set comprised 320,879 LOSDCEM cases. The EMF proportion of on-duty ED physicians, was statistically significant at the lowest three τ levels but not significant at the higher six τ levels. For the 10th, 20th, and 30th percentiles of LOSDCEM, the % relative improvements in LOSDCEM achieved by increasing the EMF proportion 1% were, respectively, 13% (6.5/52), 8% (6.8/83), and 7% (8.1/115). CONCLUSIONS: The LOSDCEM does not appear to be unfavourably impacted by increasing the proportion of EMFs as a % of all on-duty ED physicians. The EMFs numbers (as a percentage of all on-duty physicians) disproportionately improves LOSDCEM for those patients with shorter LOS.


Assuntos
Medicina de Emergência , Bolsas de Estudo , Internato e Residência , Tempo de Internação/estatística & dados numéricos , Medicina de Emergência/educação , Medicina de Emergência/organização & administração , Medicina de Emergência/estatística & dados numéricos , Humanos , Estudos Retrospectivos
4.
Dtsch Med Wochenschr ; 145(16): 1152-1156, 2020 08.
Artigo em Alemão | MEDLINE | ID: mdl-32791551

RESUMO

In view of dramatically increasing patient numbers worldwide in the face of the corona pandemic and scarce resources in intensive care medicine in many countries, some of which are dramatically undersupplied, concerns and fears have spread among the population in Germany. Healthcare workers didn't know how to deal with an overload of the healthcare system. Numerous inquiries from concerned physicians as well as ethics committees prompted the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) together with seven other medical associations to work out a clinical-ethical recommendation on "Decisions on resource allocation in emergency and intensive care in the context of the COVID-19 pandemic".


Assuntos
Infecções por Coronavirus/terapia , Cuidados Críticos/ética , Pandemias/ética , Pneumonia Viral/terapia , Planejamento Antecipado de Cuidados/ética , Cuidados Críticos/estatística & dados numéricos , Medicina de Emergência/ética , Medicina de Emergência/estatística & dados numéricos , Alemanha/epidemiologia , Prioridades em Saúde/ética , Humanos
7.
CJEM ; 22(5): 603-607, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32576321

RESUMO

INTRODUCTION: Emergency medicine (EM) is a high-risk specialty for burnout. COVID-19 has had and will continue to have important consequences on wellness and burnout for EM physicians in Canada. Baseline data are crucial to monitor the health of EM physicians in Canada, and evaluate any interventions designed to help during and after COVID-19. OBJECTIVES: To describe the rates of burnout, depression, and suicidality in practicing EM physicians in Canada, just before the COVID-19 pandemic. METHODS: A modified snowball method was used for survey distribution. Participants completed the Maslach Burnout Inventory - Health Services Tool (MBI-HSS), a screening measure for depression (PHQ-9), and a question regarding if the physician had ever or in the past 12 months contemplated suicide. RESULTS: A total of 384 respondent surveys were included in the final analysis: 86.1% (329/382) met at least one of the criteria for burnout, 58% (217/374) scored minimal to none on the PHQ-9 screening tool for depression, 14.3% (53/371) had contemplated suicide during their staff career in EM, and of those, 5.9% (22/371) had actively considered suicide in the past year. CONCLUSION: Canadian EM physicians just before the COVID-19 pandemic had an alarming number of respondents meet the threshold for burnout, confirming EM as a high-risk specialty. This important baseline information can be used to monitor the physical and mental risks to EM physicians during and after COVID-19, and evaluate support for mental health and wellness, which is urgently needed now and post pandemic.


Assuntos
Esgotamento Profissional/epidemiologia , Esgotamento Profissional/prevenção & controle , Infecções por Coronavirus/epidemiologia , Saúde do Trabalhador , Estresse Ocupacional/epidemiologia , Médicos/psicologia , Pneumonia Viral/epidemiologia , Adulto , Canadá , Infecções por Coronavirus/prevenção & controle , Medicina de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Inquéritos e Questionários
8.
Arch Phys Med Rehabil ; 101(8): 1407-1413, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32437688

RESUMO

OBJECTIVE: To determine whether the initial care provider for neck pain was associated with opioid use for individuals with neck pain. DESIGN: Retrospective cohort study. SETTING: Marketscan research databases. PARTICIPANTS: Patients (N=427,966) with new-onset neck pain from 2010-2014. MAIN OUTCOME MEASURES: Opioid use was defined using retail pharmacy fills. We performed logistic regression analysis to assess the association between initial provider and opioid use. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using bootstrapping logistic models. We performed propensity score matching as a robustness check on our findings. RESULTS: Compared to patients with neck pain who saw a primary health care provider, patients with neck pain who initially saw a conservative therapist were 72%-91% less likely to fill an opioid prescription in the first 30 days, and between 41%-87% less likely to continue filling prescriptions for 1 year. People with neck pain who initially saw emergency medicine physicians had the highest odds of opioid use during the first 30 days (OR, 3.58; 95% CI, 3.47-3.69; P<.001). CONCLUSIONS: A patient's initial clinical contact for neck pain may be an important opportunity to influence subsequent opioid use. Understanding more about the roles that conservative therapists play in the treatment of neck pain may be key in unlocking new ways to lessen the burden of opioid use in the United States.


Assuntos
Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Cervicalgia/tratamento farmacológico , Modalidades de Fisioterapia/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Terapia por Acupuntura/estatística & dados numéricos , Adulto , Quiroprática/estatística & dados numéricos , Bases de Dados Factuais , Medicina de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/terapia , Neurologia/estatística & dados numéricos , Ortopedia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Estudos Retrospectivos
9.
Wilderness Environ Med ; 31(1): 63-70, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32044209

RESUMO

The UK General Medical Councils' approved curricula share only 3 topics with the Fellowship in the Academy of Wilderness Medicine core curriculum, suggesting an underrepresentation of wilderness medicine (WM) in medical education. We developed a 5-mo course to address the gaps between these curricula to run in parallel with the conventional curriculum. Our 71-h course is composed of lectures and practical exercises. We set out to evaluate the effectiveness of this concept and assess its suitability for use by other institutions. The course was undertaken by 18 medicine and healthcare undergraduates. Semiquantitative evaluation of the course was done using participants' self-reported WM knowledge and interest before and after the course using a Likert scale. Participants were further assessed with a WM objective structured clinical examination. Before the course, students had a lower understanding of WM (2.8/5.0) and were not confident in prehospital medicine (2.5/5.0). After the course, knowledge and confidence increased in all teaching categories, with a mean gain of 1.4/5.0 (P<0.05). Students demonstrated competence in a range of WM categories by completing the WM objective structured clinical examination, with a pass rate of 82%. Providing students with a WM course is effective in introducing components of the Fellowship in the Academy of Wilderness Medicine curriculum and inspiring future engagement in the field. We have developed a framework for successful implementation of WM teaching and shown that the concept may be used in other undergraduate settings.


Assuntos
Educação Médica/estatística & dados numéricos , Medicina de Emergência/educação , Estudantes de Medicina/estatística & dados numéricos , Medicina Selvagem/educação , Educação Médica/organização & administração , Medicina de Emergência/estatística & dados numéricos , Reino Unido , Medicina Selvagem/estatística & dados numéricos
10.
Am J Emerg Med ; 38(6): 1203-1208, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32107130

RESUMO

INTRODUCTION: Peripheral nerve blocks and regional anesthesia are routinely used to alleviate pain in the emergency department. Our objective is to report on the feasibility and initial experience of emergency physicians initiating and managing continuous nerve blocks for trauma patients. METHODS: This was a retrospective, observational cohort study of a convenience sample of patients 18 years or older presenting with either rib or hip fractures between August 15, 2016 and January 15, 2019. Demographic and clinical data was abstracted using a structured data collection form. Data collected included basic demographics, mechanism of injury, type of regional anesthesia, admission location, respiratory complications, pre- and post-procedure opioid use, efficacy of anesthesia and duration of continuous nerve blockade. All analyses were descriptive in nature, including means, median, and range when appropriate. RESULTS: Forty-one patients presented during the study period with rib or hip fractures and received a nerve block catheter and a continuous infusion pump. The mean age of patients was 65.9 years and 26 (63.4%) patients were male. The mean duration of continuous nerve blockade was 3.4 days (range 1-9 days). Hourly opioid use was reduced by 58%. The most common complication was accidental dislodgement of the catheter;, no patient developed a pneumothorax, hemothorax, catheter related infection, or hematoma. CONCLUSIONS: It is feasible and effective for emergency physicians to initiate and manage continuous nerve blockade for acute hip and rib fractures. Continuous nerve blockade may allow trauma patients to significantly decrease their use of opioids.


Assuntos
Bloqueio Nervoso/normas , Manejo da Dor/normas , Médicos/psicologia , Adulto , Idoso , Anestésicos Locais/uso terapêutico , Medicina de Emergência/métodos , Medicina de Emergência/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Fraturas do Quadril/complicações , Fraturas do Quadril/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/métodos , Bloqueio Nervoso/estatística & dados numéricos , Manejo da Dor/estatística & dados numéricos , Medição da Dor/métodos , Médicos/estatística & dados numéricos , Estudos Retrospectivos , Fraturas das Costelas/complicações , Fraturas das Costelas/tratamento farmacológico , Ropivacaina/uso terapêutico , Fatores de Tempo , Resultado do Tratamento
13.
Emerg Med J ; 37(6): 324-329, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32047075

RESUMO

OBJECTIVE: We aimed to determine trends over time in article origin, and article and methodology characteristics. METHOD: We examined original research articles published every fifth year over a 20-year period (1997-2017) in six emergency medicine (EM) journals (Ann Emerg Med, Acad Emerg Med, Eur J Emerg Med, Emerg Med J, Am J Emerg Med, Emerg Med Australas). Explicit data extraction of 21 article characteristics was undertaken. These included regional contributions, specific article items and research methodology. RESULTS: 2152 articles were included. Over the study period, the proportional contributions from the USA and the UK steadily fell while those from Australasia, Europe and 'other' countries increased (p<0.001). All specific article items increased (p<0.01). Institutional Review Board/Ethics Committee approval and conflicts of interest were almost universal by 2017. There were substantial increases in the reporting of keywords and authorship contributions. The median (IQR) number of authors increased from 4 (2) in 1997 to 6 (3) in 2017 (p<0.001) and the proportion of female first authors increased from 24.3% to 34.2% (p<0.01). Multicentre and international collaborations, consecutive sampling, sample size calculations, inferential biostatistics and the reporting of CIs and p values all increased (p<0.001). There were decreases in the use of convenience sampling and blinding (p<0.001). The median (IQR) study sample size increased from 148 (470) to 349 (2225) (p<0.001). CONCLUSION: Trends over time are apparent within the EM research literature. The dominance in contributions from the US and UK is being challenged. There is more reporting of research accountability and greater rigour in both research methodology and results presentation.


Assuntos
Medicina de Emergência/história , Estudos de Avaliação como Assunto , Projetos de Pesquisa/tendências , Medicina de Emergência/métodos , Medicina de Emergência/estatística & dados numéricos , História do Século XXI , Humanos , Estudos Retrospectivos , Reino Unido
14.
Ann Emerg Med ; 75(5): 597-608, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31973914

RESUMO

STUDY OBJECTIVE: Accountable care organizations are provider networks aiming to improve quality while reducing costs for populations. It is unknown how value-based care within accountable care organizations affects emergency medicine care delivery and payment. Our objective was to describe how accountable care has impacted emergency care redesign and payment. METHODS: We performed a qualitative study of accountable care organizations, consisting of semistructured interviews with emergency department (ED) and accountable care organization leaders responsible for strategy, care redesign, and payment. We analyzed transcripts for key themes, using thematic analysis techniques. RESULTS: We performed 22 interviews across 7 accountable care organizations. All sites were enrolled in the Medicare Shared Savings Program; however, sites varied in region and maturity with respect to population health initiatives. Nearly all sites were focused on reducing low-value ED visits, expanding alternate venues for acute unscheduled care, and redesigning care to reduce ED admission rates through expanded care coordination, including programs targeting high-risk populations such as older adults and frequent ED users, telehealth, and expanded use of direct transfer to skilled nursing facilities from the ED. However, there has been no significant reform of payment for emergency medical care within these accountable care organizations. Nearly all informants expressed concern in regard to reduced ED reimbursement, given accountable care organization efforts to reduce ED utilization and increase clinician participation in alternative payment contracts. No participants expressed a clear vision for reforming payment for ED services. CONCLUSION: Care redesign within accountable care organizations has focused on outpatient access and alternatives to hospitalization. However, there has been little influence on emergency medicine payment, which remains fee for service. Evidence-based policy solutions are urgently needed to inform the adoption of value-based payment for acute unscheduled care.


Assuntos
Organizações de Assistência Responsáveis , Medicina de Emergência/economia , Medicare , Medicina de Emergência/estatística & dados numéricos , Prática Clínica Baseada em Evidências , Planos de Pagamento por Serviço Prestado , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Medicare/economia , Medicare/estatística & dados numéricos , Pesquisa Qualitativa , Mecanismo de Reembolso , Estados Unidos
15.
Trials ; 21(1): 83, 2020 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-31937341

RESUMO

BACKGROUND: Bayesian adaptive designs can be more efficient than traditional methods for multi-arm randomised controlled trials. The aim of this work was to demonstrate how Bayesian adaptive designs can be constructed for multi-arm phase III clinical trials and assess potential benefits that these designs offer. METHODS: We constructed several alternative Bayesian adaptive designs for the Collaborative Ankle Support Trial (CAST), which was a randomised controlled trial that compared four treatments for severe ankle sprain. These designs incorporated response adaptive randomisation (RAR), arm dropping, and early stopping for efficacy or futility. We studied the operating characteristics of the Bayesian designs via simulation. We then virtually re-executed the trial by implementing the Bayesian adaptive designs using patient data sampled from the CAST study to demonstrate the practical applicability of the designs. RESULTS: We constructed five Bayesian adaptive designs, each of which had high power and recruited fewer patients on average than the original designs target sample size. The virtual executions showed that most of the Bayesian designs would have led to trials that declared superiority of one of the interventions over the control. Bayesian adaptive designs with RAR or arm dropping were more likely to allocate patients to better performing arms at each interim analysis. Similar estimates and conclusions were obtained from the Bayesian adaptive designs as from the original trial. CONCLUSIONS: Using CAST as an example, this case study shows how Bayesian adaptive designs can be constructed for phase III multi-arm trials using clinically relevant decision criteria. These designs demonstrated that they can potentially generate earlier results and allocate more patients to better performing arms. We recommend the wider use of Bayesian adaptive approaches in phase III clinical trials. TRIAL REGISTRATION: CAST study registration ISRCTN, ISRCTN37807450. Retrospectively registered on 25 April 2003.


Assuntos
Traumatismos do Tornozelo/terapia , Medicina de Emergência/organização & administração , Recuperação de Função Fisiológica/fisiologia , Traumatismos do Tornozelo/diagnóstico , Teorema de Bayes , Braquetes/efeitos adversos , Braquetes/estatística & dados numéricos , Ensaios Clínicos Fase III como Assunto , Pesquisa Comparativa da Efetividade/métodos , Pesquisa Comparativa da Efetividade/estatística & dados numéricos , Simulação por Computador , Tomada de Decisões/ética , Medicina de Emergência/estatística & dados numéricos , Inglaterra/epidemiologia , Humanos , Ortopedia , Projetos de Pesquisa , Índices de Gravidade do Trauma
16.
Trials ; 21(1): 84, 2020 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-31937351

RESUMO

BACKGROUND: Phase III trials often require large sample sizes, leading to high costs and delays in clinical decision-making. Group sequential designs can improve trial efficiency by allowing for early stopping for efficacy and/or futility and thus may decrease the sample size, trial duration and associated costs. Bayesian approaches may offer additional benefits by incorporating previous information into the analyses and using decision criteria that are more practically relevant than those used in frequentist approaches. Frequentist group sequential designs have often been used for phase III studies, but the use of Bayesian group sequential designs is less common. The aim of this work was to explore how Bayesian group sequential designs could be constructed for phase III trials conducted in emergency medicine. METHODS: The PARAMEDIC2 trial was a phase III randomised controlled trial that compared the use of adrenaline to placebo in out-of-hospital cardiac arrest patients on 30-day survival rates. It used a frequentist group sequential design to allow early stopping for efficacy or harm. We constructed several alternative Bayesian group sequential designs and studied their operating characteristics via simulation. We then virtually re-executed the trial by applying the Bayesian designs to the PARAMEDIC2 data to demonstrate what might have happened if these designs had been used in practice. RESULTS: We produced three alternative Bayesian group sequential designs, each of which had greater than 90% power to detect the target treatment effect. A Bayesian design which performed interim analyses every 500 patients recruited produced the lowest average sample size. Using the alternative designs, the PARAMEDIC2 trial could have declared adrenaline superior for 30-day survival with approximately 1500 fewer patients. CONCLUSIONS: Using the PARAMEDIC2 trial as a case study, we demonstrated how Bayesian group sequential designs can be constructed for phase III emergency medicine trials. The Bayesian framework enabled us to obtain efficient designs using decision criteria based on the probability of benefit or harm. It also enabled us to incorporate information from previous studies on the treatment effect via the prior distributions. We recommend the wider use of Bayesian approaches in phase III clinical trials. TRIAL REGISTRATION: PARAMEDIC2 Trial registration ISRCTN, ISRCTN73485024. Registered 13 March 2014, http://www.isrctn.com/ISRCTN73485024.


Assuntos
Medicina de Emergência/organização & administração , Epinefrina/uso terapêutico , Parada Cardíaca Extra-Hospitalar/tratamento farmacológico , Simpatomiméticos/uso terapêutico , Teorema de Bayes , Estudos de Casos e Controles , Tomada de Decisão Clínica , Comitês de Monitoramento de Dados de Ensaios Clínicos , Simulação por Computador , Medicina de Emergência/estatística & dados numéricos , Epinefrina/administração & dosagem , Humanos , Placebos/administração & dosagem , Projetos de Pesquisa , Tamanho da Amostra , Taxa de Sobrevida , Simpatomiméticos/administração & dosagem
17.
Acad Med ; 95(1): 89-96, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31517682

RESUMO

PURPOSE: Educational podcasts are an increasingly popular platform for teaching and learning in health professions education. Yet it remains unclear why residents are drawn to podcasts for educational purposes, how they integrate podcasts into their broader learning experiences, and what challenges they face when using podcasts to learn. METHOD: The authors used a constructivist grounded theory approach to explore residents' motivations and listening behaviors. They conducted 16 semistructured interviews with residents from 2 U.S. and 1 Canadian institution from March 2016 to August 2017. Interviews were recorded and transcribed. The transcripts were analyzed using constant comparison, and themes were identified iteratively, working toward an explanatory framework that illuminated relationships among themes. RESULTS: Participants described podcasts as easy to use and engaging, enabling both broad exposure to content and targeted learning. They reported often listening to podcasts while doing other activities, being motivated by an ever-present desire to use their time productively; this practice led to challenges retaining and applying the content they learned from the podcasts to their clinical work. Listening to podcasts also fostered participants' sense of connection to their peers, supervisors, and the larger professional community, yet it created tensions in their local relationships. CONCLUSIONS: Despite the challenges of distracted, contextually constrained listening and difficulties translating their learning into clinical practice, residents found podcasts to be an accessible and engaging learning platform that offered them broad exposure to core content and personalized learning, concurrently fostering their sense of connection to local and national professional communities.


Assuntos
Ocupações em Saúde/educação , Internato e Residência/métodos , Aprendizagem/fisiologia , Ensino/tendências , Canadá/epidemiologia , Medicina de Emergência/estatística & dados numéricos , Feminino , Teoria Fundamentada , Humanos , Masculino , Motivação/fisiologia , Pesquisa Qualitativa , Estados Unidos/epidemiologia , Webcasts como Assunto
18.
Br J Radiol ; 93(1106): 20190781, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31868522

RESUMO

OBJECTIVE: Sedation for pediatric patients undergoing interventional procedures in radiology is in increasing demand. Once only anesthesiology-performed, there is a demand for sedation services to perform sedations for these procedures. However, the safety of performing long sedations by non-anesthesiologists in interventional radiology has not been reported. This pilot study aimed at describing a single center's experience and outcome with sedation. METHODS: This study reviews the sedations performed at a single center by a pediatric emergency physician who performed the sedation. The results regarding safety and satisfaction were reviewed. RESULTS: A total of 52 sedations were documented. Four cases of significant adverse events and three adverse events occurred. In all cases, the procedures were completed. None of the patients required intubation or admission following the sedation. There was high satisfaction by the interventional radiologists. CONCLUSION: This small pilot study shows that sedations for procedures in interventional radiology can be performed safely and successfully by dedicated non-anesthesiology sedation services. This may be considered as an alternative when anesthesiology service is not available. ADVANCES IN KNOWLEDGE: This small, single center pilot study examines the safety of sedation by a non-anesthesiologist for interventional radiology procedures. This may offer an additional method of performing procedures in the pediatric population while anesthesia is not readily available.


Assuntos
Sedação Consciente/métodos , Medicina de Emergência/estatística & dados numéricos , Malformações Vasculares/cirurgia , Adolescente , Anestesiologistas , Criança , Pré-Escolar , Sedação Consciente/efeitos adversos , Medicina de Emergência/normas , Métodos Epidemiológicos , Feminino , Humanos , Lactente , Masculino , Segurança do Paciente
19.
Pediatr Emerg Care ; 36(1): 16-20, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31851079

RESUMO

BACKGROUND: Routine use of chest X-ray (CXR) in pediatric patients presenting with their first episode of wheezing was recommended by many authors. Although recent studies conclude that a CXR is not routinely indicated in these children, there continues to be reports of overuse. OBJECTIVE: To examine the attitudes of practicing physicians in ordering CXRs in pediatric patients presenting with their first episode of wheezing to an emergency department (ED) and the factors that influence this practice by surveying ED physicians. METHODS: A survey targeting pediatric emergency medicine (PEM) and general emergency medicine attending physicians was distributed electronically to the nearly 3000 members of the PEM Brown listserve and the Pediatric Section of American College of Emergency Physicians listserve. The 14-item survey included closed ended and free text questions to assess the respondent's demographic characteristics, their belief and current practice of obtaining a CXR in pediatric patients presenting with their first episode of wheezing. Data were analyzed using descriptive statistics and χ test. RESULTS: Of the 537 attending physicians who participated, their primary residency training was: 42% pediatrics, 54% emergency medicine, and 4% other. Seventy-two percent of participating physicians supervise residents, 54% were board-eligible or -certified in PEM. Thirty percent (95% confidence interval [CI], 26-34) of participants indicated that they would always obtain a CXR in pediatric patients presenting with their first episode of wheezing. Eighty-one percent (95% CI, 75-87) of those who always obtain a CXR believe that it is the standard of care. Of the 376 physicians who do not always obtain a CXR, 18% (95% CI, 15-23) always obtain a CXR under certain age (2 weeks to 12 years, median of 1 year). Physicians who report a primary residency in pediatrics, who supervise residents, who were board-eligible or -certified in PEM, and who were practicing for greater than 5 years were less likely to obtain a CXR (P < 0.001, P < 0.001, P < 0.001, P = 0.001). CONCLUSIONS: In our study, a significant number of practicing ED physicians routinely obtain a CXR in children with their first episode of wheezing presenting to the ED. The factors influencing this practice are primary residency training, fellowship training, resident supervision, and years of independent practice. This identifies a target audience that would benefit from education to decrease the overuse of CXRs in children with wheezing.


Assuntos
Asma/diagnóstico por imagem , Medicina de Emergência/estatística & dados numéricos , Pulmão/diagnóstico por imagem , Radiografia Torácica/estatística & dados numéricos , Sons Respiratórios , Criança , Medicina de Emergência/educação , Serviço Hospitalar de Emergência , Feminino , Humanos , Internato e Residência , Masculino , Corpo Clínico Hospitalar , Padrões de Prática Médica , Inquéritos e Questionários , Estados Unidos , Procedimentos Desnecessários/estatística & dados numéricos
20.
Revista Espaço para a Saúde ; 21(1): [26 - 32], 2020. tab, ilus
Artigo em Português | LILACS | ID: biblio-1116043

RESUMO

Objetivo: Descrever o perfil dos atendimentos realizados pelo Serviço de Atendimento Móvel de Urgência (SAMU) do município de Colombo (PR). Método: Estudo descritivo de abordagem quantitativa, utilizando as informações contidas nas fichas de atendimentos do SAMU do município de Colombo (PR) para a coleta dos dados no período de dezembro de 2016 a agosto de 2017. Resultados: Foram analisados 2.784 fichas e os resultados mostram predominância do sexo masculino com 1.441 (51,76%), faixa etária de 19-59 anos com 1.531 (54,99%), ocorrências de perfil clínico com 1.715 (61,60%) e, tendo como destino final a UPA do município 1.377 casos (63,75%). Conclusões: O estudo contribui na quantificação de informações de atendimento do SAMU realizados no município de Colombo, a fim de qualificar a organização das demandas de atendimento pela rede de Urgência e Emergência no município


Assuntos
Humanos , Medicina de Emergência/estatística & dados numéricos
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