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4.
BMJ Open ; 11(1): e043836, 2021 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-33408213

RESUMO

INTRODUCTION: The Western Australia (WA) Acute TeleStroke Programme commenced incrementally across regional WA during 2016-2017. Since the introduction of the TeleStroke Programme, there has been monitoring of service outputs, including regional patient access to tertiary stroke specialist advice and reperfusion treatment; however, the impact of consultation with a stroke specialist via telehealth (videoconferencing or telephone) on the effectiveness and cost-effectiveness of stroke care and the drivers of cost-effectiveness has not been systematically evaluated. METHODS AND ANALYSIS: The aim of the case study was to examine the impact of consultation with a stroke specialist via telehealth on the effectiveness and cost-effectiveness of stroke and transient ischaemic attack care using a mixed methods approach. A categorical decision tree model will be constructed in collaboration with clinicians and programme managers. A before and after comparison using state-wide administrative datasets will be used to run the base model. If sample size and statistical power permits, the cases and comparators will be matched by stroke type and presence of CT scan at the initial site of presentation, age category and presenting hospital. The drivers of cost-effectiveness will be explored through stakeholder interviews. Data from the qualitative analysis will be cross-referenced with trends emerging from the quantitative dataset and used to guide the factors to be involved in subgroup and sensitivity analysis. ETHICS AND DISSEMINATION: Ethics approval for this case study has been granted from the Western Australian Country Health Service Human Research and Ethics Committee (RGS3076). Reciprocal approval has been granted from Curtin University Human Research Ethics Office (HRE2019-0740). Findings will be disseminated publicly through conference presentation and peer-review publications. Interim findings will be released as internal reports to inform the service development.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Encaminhamento e Consulta/economia , Consulta Remota/métodos , Acidente Vascular Cerebral/terapia , Telemedicina/estatística & dados numéricos , Austrália , Análise Custo-Benefício , Medicina de Emergência/métodos , Humanos , Encaminhamento e Consulta/estatística & dados numéricos , Acidente Vascular Cerebral/economia , Resultado do Tratamento , Austrália Ocidental
5.
Rev Med Suisse ; 17(720-1): 50-53, 2021 Jan 13.
Artigo em Francês | MEDLINE | ID: mdl-33443831

RESUMO

2020 has seen the birth of several relevant studies in emergency medicine of which the following is a selection : 1) conservative treatment for primary spontaneous pneumothorax may be offered ; 2) tranexamic acid does not provide benefit in gastrointestinal bleeding ; 3) the Canadian Syncope Risk Score is validated for the risk stratification of syncopal patients ; 4) early administration of tranexamic acid does not have a significant effect on the neurological prognosis of patients with moderate to severe trauma brain injury ; 5) the notion of frailty seems to be predictive of mortality in the event of intra-hospital cardiac arrest in elderly patients ; 6) a pharmacological cardioversion strategy followed by electrical cardioversion is as effective as initial electrical cardioversion for atrial fibrillation in the emergency room.


Assuntos
Medicina de Emergência/métodos , Medicina de Emergência/tendências , Idoso , Fibrilação Atrial/terapia , Lesões Encefálicas Traumáticas/terapia , Canadá , Cardioversão Elétrica , Fragilidade , Humanos , Pneumotórax/terapia , Medição de Risco , Síncope , Ácido Tranexâmico
6.
Ann Emerg Med ; 77(2): 221-232, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33341294

RESUMO

Although induced abortion is generally a safe outpatient procedure, many patients subsequently present to the emergency department, concerned about a postabortion complication. It is helpful for emergency physicians to understand the medications and procedures used in abortion care in the United States to effectively and efficiently triage and treat women presenting with potential complications from an abortion. Furthermore, because many states are experiencing increased abortion restrictions that limit access to care, emergency medicine physicians may encounter more patients presenting after self-managed abortions, which presents additional challenges. This article reviews the epidemiology and background of abortion care, including the range of symptoms and adverse effects that are within the scope of an uncomplicated procedure. This review also offers a comprehensive overview of management of abortion complications, including algorithms for more common complications and descriptions of less common but more severe adverse events. The article concludes with a recognition of the social stigma and legal regulations unique to abortion care.


Assuntos
Aborto Induzido/efeitos adversos , Assistência ao Convalescente , Medicina de Emergência/métodos , Feminino , Humanos , Gravidez
9.
Rev Med Suisse ; 16(707): 1757-1762, 2020 Sep 23.
Artigo em Francês | MEDLINE | ID: mdl-32969613

RESUMO

The effectiveness of hypnosis in the management of pain and anxiety has been widely demonstrated today. While this technique is commonly used in anesthesia and psychiatry, its use in emergencies is still poorly developed. The fields of application in hospital and extra-hospital emergency are however multiple and, contrary to popular belief, emergencies are the ideal place for the practice of hypnosis. Hypnosis is a reliable, safe, effective and inexpensive technique that any caregiver can learn. It strengthens the caregiver-patient relationship and helps us to treat differently, more humanly and more serenely.


Assuntos
Medicina de Emergência/métodos , Hipnose , Ansiedade/psicologia , Ansiedade/terapia , Hábitos , Humanos , Dor/prevenção & controle , Manejo da Dor
10.
PLoS One ; 15(7): e0235315, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32634172

RESUMO

BACKGROUND: The effect of paramedic crew size in the resuscitation of patients with out-of-hospital cardiac arrest (OHCA) remains inconclusive. We hypothesised that teams with a larger crew size have better resuscitation performance including chest compression fraction (CCF), advanced life support (ALS), and teamwork performance than those with a smaller crew size. METHODS: We conducted a randomized controlled study in a simulation setting. A total of 140 paramedics from New Taipei City were obtained by stratified sampling and were randomly allocated to 35 teams with crew sizes of 2, 3, 4, 5, and 6 (i.e. 7 teams in every paramedic crew size). A scenario involving an OHCA patient who experienced ventricular fibrillation and was attached to a cardiopulmonary resuscitation (CPR) machine was simulated. The primary outcome was the overall CCF; the secondary outcomes were the CCF in manual CPR periods, time from the first dose of epinephrine until the accomplishment of intubation, and teamwork performance. Tasks affecting the hands-off time during CPR were also analysed. RESULTS: In all 35 teams with crew sizes of 2, 3, 4, 5, and 6, the overall CCFs were 65.1%, 64.4%, 70.7%, 72.8%, and 71.5%, respectively (P = 0.148). Teams with a crew size of 5 (58.4%, 61.8%, 68.9%, 72.4%, and 68.7%, P<0.05) had higher CCF in manual CPR periods and better team dynamics. Time to the first dose of epinephrine was significantly shorter in teams with 4 paramedics, while time to completion of intubation was shortest in teams with 6 paramedics. Troubleshooting of M-CPR machine decreased the hands-off time during resuscitation (39 s), with teams comprising 2 paramedics having the longest hands-off time (63s). CONCLUSION: Larger paramedic crew size (≧4 paramedics) did not significantly increase the overall CCF in OHCA resuscitation but showed higher CCF in manual CPR period before the setup of the CPR machine. A crew size of ≧4 paramedics can also shorten the time of ALS interventions, while teams with 5 paramedics will have the best teamwork performance. Paramedic teams with a smaller crew size should focus more on the quality of manual CPR, teamwork, and training how to troubleshoot a M-CPR machine.


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , Reanimação Cardiopulmonar/métodos , Serviços Médicos de Emergência/métodos , Parada Cardíaca Extra-Hospitalar/prevenção & controle , Adulto , Cuidados Críticos/métodos , Auxiliares de Emergência , Medicina de Emergência/métodos , Epinefrina/administração & dosagem , Feminino , Humanos , Intubação/métodos , Masculino , Parada Cardíaca Extra-Hospitalar/epidemiologia , Parada Cardíaca Extra-Hospitalar/patologia , Fibrilação Ventricular/fisiopatologia , Fibrilação Ventricular/prevenção & controle
12.
West J Emerg Med ; 21(3): 555-565, 2020 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-32421501

RESUMO

Medicine recognizes burnout as a threat to quality patient care and physician quality of life. This issue exists throughout medicine but is notably prevalent in emergency medicine (EM). Because the concept of "wellness" lacks a clear definition, attempts at ameliorating burnout that focus on achieving wellness make success difficult to achieve and measure. Recent work within the wellness literature suggests that the end goal should be to achieve a culture of wellness by addressing all aspects of the physician's environment. A review of the available literature on burnout and wellness interventions in all medical specialties reveals that interventions focusing on individual physicians have varying levels of success. Efforts to compare these interventions are hampered by a lack of consistent endpoints. Studies with consistent endpoints do not demonstrate clear benefits of achieving them because improving scores on various scales may not equate to improvement in quality of care or physician quality of life. Successful interventions have uncertain, long-term effects. Outside of EM, the most successful interventions focus on changes to systems rather than to individual physicians. Within EM, the number of well-structured interventions that have been studied is limited. Future work to achieve the desired culture of wellness within EM requires establishment of a consistent endpoint that serves as a surrogate for clinical significance, addressing contributors to burnout at all levels, and integrating successful interventions into the fabric of EM.


Assuntos
Esgotamento Profissional , Medicina de Emergência , Médicos/psicologia , Qualidade da Assistência à Saúde/organização & administração , Qualidade de Vida , Esgotamento Profissional/etiologia , Esgotamento Profissional/prevenção & controle , Esgotamento Profissional/psicologia , Medicina de Emergência/métodos , Medicina de Emergência/normas , Humanos , Cultura Organizacional , Objetivos Organizacionais , Psicologia
14.
J Surg Res ; 254: 142-146, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32445929

RESUMO

BACKGROUND: Invasive surgical procedures occur infrequently in an emergency department setting; however, procedural competence is expected from trauma residents. Emergent procedures are challenging to train in a formal manner because of the urgent nature when they present. To supplement education, new and creative teaching tools such as simulation and multidisciplinary training are being used. Our study organized a multidisciplinary simulated learning workshop with surgery and emergency medicine residents for invasive, emergent procedures. MATERIALS AND METHODS: In total, 14 surgical and 36 emergency medicine residents at our institution participated in a simulated learning experience. Ten workshops were organized, with six to seven residents participating in each session. Using a human cadaveric model, all residents were taught by senior-level residents and attendings from both specialties on how to perform uncommonly or anatomically challenging emergent invasive procedures. A pre- and post-laboratory survey was completed by all the residents to assess confidence in performing each of the 13 procedures. RESULTS: All residents (N = 50), who participated in the study, completed pre- and post-laboratory surveys. Comparison of the pre- and post-laboratory confidence levels indicated significant increases in confidence in performing all procedures. Residents stated that this multidisciplinary approach to education in a controlled setting was helpful and fostered a collaborative relationship between both specialties. CONCLUSIONS: Although some surgical procedures remain uncommon in the emergency department, competency is nevertheless expected for appropriate patient care. Using a collaborative simulation-based cadaver laboratory to teach emergent procedures significantly improved residents' confidence while concurrently fostering professional relationships.


Assuntos
Educação de Pós-Graduação em Medicina/métodos , Medicina de Emergência/educação , Cirurgia Geral/educação , Internato e Residência/métodos , Equipe de Assistência ao Paciente , Ferimentos e Lesões/cirurgia , Cadáver , Competência Clínica , Medicina de Emergência/métodos , Humanos , Treinamento por Simulação
18.
Emerg Med Clin North Am ; 38(2): 363-382, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32336331

RESUMO

Simulation has been steadily changing the safety culture in the healthcare industry and allowing individual clinicians and interdisciplinary teams to be proactive in the culture of risk reduction and improved patient safety. Literature has demonstrated improved patient outcomes, improved team based skills, systems testing and mitigation of latent safety threats. Simulation may be incorporated into practice via different modalities. The simulation lab is helpful for individual procedures, in situ simulation (ISS) for system testing and teamwork, community outreach ISS for sharing of best practices and content resource experts. Serious medical gaming is developing into a useful training adjunct for the future.


Assuntos
Medicina de Emergência , Simulação de Paciente , Gestão de Riscos , Medicina de Emergência/educação , Medicina de Emergência/métodos , Medicina de Emergência/organização & administração , Humanos , Gestão de Riscos/métodos , Gestão de Riscos/organização & administração
19.
Emerg Med Clin North Am ; 38(2): 383-400, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32336332

RESUMO

More than half of pediatric malpractice cases arise from emergency departments, primarily due to missed or delayed diagnoses. All providers who take care of children in emergency departments should be aware of this risk and the most common diagnoses associated with medicolegal liability. This article focuses on diagnosis and management of high-risk diagnoses in pediatric patients presenting to emergency departments, including meningitis, pneumonia, appendicitis, testicular torsion, and fracture. It highlights challenges and pitfalls that may increase risk of liability. It concludes with a discussion on recognition and management of abuse in children, including when to report and decisions on disposition.


Assuntos
Emergências , Imperícia , Gestão de Riscos , Adolescente , Fatores Etários , Apendicite/diagnóstico , Apendicite/terapia , Criança , Maus-Tratos Infantis/diagnóstico , Maus-Tratos Infantis/terapia , Pré-Escolar , Medicina de Emergência/legislação & jurisprudência , Medicina de Emergência/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Meningite/diagnóstico , Meningite/terapia , Pneumonia/diagnóstico , Pneumonia/terapia , Torção do Cordão Espermático/diagnóstico , Torção do Cordão Espermático/terapia , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia
20.
Crit Care ; 24(1): 99, 2020 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-32204718

RESUMO

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.


Assuntos
Fenômenos Fisiológicos Cardiovasculares , Ressuscitação/normas , Sepse/terapia , Medicina de Emergência/métodos , Humanos , Substitutos do Plasma/uso terapêutico , Ressuscitação/métodos , Ressuscitação/tendências
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