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Burnout in the emergency department: Randomized controlled trial of an attention-based training program

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Journal of Integrative Medicine 2019年第3期17卷 173-180页

作者： Pádraic J.Dunne Julie Lynch Lucia Prihodova Caoimhe O'Leary Atiyeh Ghoreyshi Sharee A.Basdeo Donal J.Cox Rachel Breen Ali Sheikhi áine Carroll Cathal Walsh Geraldine McMahon Barry White Trinity Translational Medicine Institute Trinity College Research department Royal College of Physicians of Ireland department of Innovation Fitbit Inc. health Research Institute Main BuildingUniversity of Limerick health Service Executive Dr Steevens' Hospital department of emergency Medicine St.James' s Hospital National Centre for Hereditary Coagulation Disorders St.James' s Hospital

Background: Burnout(encompassing emotional exhaustion, depersonalization and personal accomplishment) in healthcare professionals is a major issue worldwide. emergency medicine physicians are particularly affected, potentially impacting on quality of care and attrition from the ***: The aim of this study was to apply an attention-based training(ABT) program to reduce burnout among emergency multidisciplinary team(MDT) members from a large urban ***, setting, participants and interventions: emergency MDT members were randomized to either a notreatment control or an intervention group. Intervention group participants engaged in a four session(4 h/session) ABT program over 7 weeks with a practice target of 20 min twice-daily. practice adherence was measured using a smart phone application together with a wearable Charge 2 *** outcome measures: The primary outcome was a change in burnout, comprising emotional exhaustion, depersonalization and personal achievement. The secondary outcomes were changes in other psychological and biometric ***: The ABT program resulted in a significant reduction(P emergency department staff burnout compared to a no-treatment control group.

关键词： Burnout Emotional exhaustion Meditation healthcare professional Sleep Stress Cytokines Cortisol Randomized controlled trial

Implementation science:A critical but undervalued part of the healthcare innovation ecosystem

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Health Care Science

health Care Science 2022年第3期1卷 160-165页

作者： Sze Ling Chan Elaine Lum Marcus E.H.Ong Nicholas Graves health Services Research Centre SingHealthSingaporeSingapore health Services and Systems Research Duke-NUS Medical SchoolSingaporeSingapore department of emergency Medicine Singapore General HospitalSingaporeSingapore

healthcare systems face many competing demands and insufficient *** innovations to improve efficiency are important to address this *** can range from new pharmaceuticals,alternate models of care,novel devices,and the use other *** implementation can mean lost *** review article aims to highlight the role of implementation science,summarize how settings have leveraged this methodology to promote translation of innovation into practice,and describe our own experience of embedding implementation science into an academic medical center in *** science offers a range of methods to promote systematic uptake of research findings about innovations and is gaining recognition worldwide as an important discipline for health services *** systems around the world have tried to promote implementation research in their settings by establishing(1)dedicated centers/programs,(2)offering funding,and(3)building knowledge and capacity among *** science is a critical piece in the translational pathway of“evidence to innovation”.The three efforts we describe should be strengthened to integrate implementation science into the innovation ecosystem around the world.

关键词： evidence translation implementation research intervention

Can Be Done Better for the Diagnosis of Non-Differentiated Diseases in community Hospital?

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Case Reports in Clinical Medicine 2021年第10期10卷 323-329页

作者： Xurui Li Zhangshun Shen Chang Lv Huiling Zang Junna Zhang Qian Zhao Hui Guo Jianguo Li General practice department Hebei General Hospital Shijiazhuang China department of emergency Hebei General Hospital Shijiazhuang China

General practice is a comprehensive subject with a wide spectrum of diseases. It is challenging to make a more correct diagnosis timely and reasonable treatment with the least instrument examination for the diagnosis of medically unexplained physical symptoms (MUPS). This article reviews the case report of a patient who presented to a community hospital with a one-month history of constant diffuse abdominal pain and underwent eight weeks of examinations, finally experienced deterioration of their condition. Based on this case, this article discusses the problems in the diagnosis of abdominal pain in a community hospital, and according to the clinical thinking mode and checklist of abdominal pain, the diagnostic process of abdominal pain can be improved, and the diagnosis of non-differentiated diseases can be done better, the harm caused by delayed diagnosis may be reduced.

关键词： Medically Unexplained Physical Symptoms General practice Thinking Checklist Abdominal Pain

emergency medicine providers＇ opioid prescribing practices stratified by gender, age, and years in practice

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World Journal of emergency Medicine 2016年第2期7卷 106-110页

作者： Shawn M. Varney Vikhyat S. Bebarta Lisa M. Mannina Rosemarie G. Ramos Victoria J. Ganem Katherine R. Carey department of emergency Medicine University of Texas Health Science Center San Antonio 78229 USA department of emergency Medicine University of Colorado School of Medicine Aurora 80045 USA department of emergency Medicine Mike O'Callaghan Federal Medical Center Nellis 89191 USA Air Force Enroute Care Research Center Fort Sam Houston 78208 USA The Geneva Foundation Tacoma 98402 USA

BACKGROUND: emergency medicine providers(EMPs) prescribe about 25% of opioids, but the effect of EMP risk perception on decisions to prescribe opioids is unknown. This study was undertaken to identify factors that infl uence EMP risk and opioid prescribing ***: We distributed an anonymous questionnaire to EMPs at a military trauma and referral center. Response frequencies and distributions were assessed for independence using the Chi-square ***: Eighty-nine EMPs completed the questionnaire(100% response). Respondents were primarily younger male physicians(80%) in practice under fi ve years(55%). Male EMPs were more likely to prescribe more opioid tablets than female ones both when and when not concerned for opioid misuse(P<0.001, P<0.007, respectively). Of the providers, 70% stated that patient age would inf luence their prescribing decisions. Hydrocodone and oxycodone were the opioids prescribed most frequently. About 60% of the providers reported changing their prescribing behavior would not prevent opioid misuse. Additionally, 40% of the providers believed at least 10% of patients seen at this military ED misused ***: Female EM providers reported prescribing fewer opioid tablets. Patient age infl uenced prescribing behavior, but the effect is unknown. Finally, EM providers reported that altering their prescribing behavior would not prevent prescription opioid misuse.

关键词： Prescription opioid misuse emergency medicine provider Prescribing practices

Common carotid artery distortion before percutaneous dilatational tracheostomy

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World Journal of emergency Medicine 2022年第3期13卷 242-244页

作者： Li-wen Du Kai Xun Lei-lei Zhu Peng Liu emergency department Hwa Mei HospitalUniversity of Chinese Academy of SciencesNingbo 315010China Ningbo Institute of Life and health Industry University of Chinese Academy of SciencesNingbo 315010China

Dear editor,The neck is rich in blood *** origins are rarely seen in clinical practice,but some are found accidentally during relevant imaging examinations,autopsy,and *** neck vessels are mostly asymptomatic;however,approximately 10%of patients with abnormal blood vessels may have clinical manifestations due to the compression of adjacent tissues and organs.

关键词： organs clinical surgery

Analysis of good practice of Public health emergency Operations Centers

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Asian Pacific Journal of Tropical Medicine 2015年第8期8卷 665-670页

作者： Min Xu Shi-Xue Li department of Public health Shandong University

Objective: To study the public health emergency Operations Centers(EOCs)in the US, the European Union, the UK and Australia, and summarize the good practice for the improvement of National health emergency Response Command Center in Chinese National health and Family Planning Commission. Methods: Literature review was conducted to explore the EOCs of selected countries. Results: The study focused on EOC function, organizational structure, human resources and information management. The selected EOCs had the basic EOC functions of coordinating and commanding as well as the public health related functions such as monitoring the situation, risk assessment, and epidemiological briefings. The organizational structures of the EOCs were standardized, scalable and flexible. Incident Command System was the widely applied organizational structure with a strong preference. The EOCs were managed by a unit of emergency management during routine time and surge staff were engaged upon emergencies. The selected EOCs had clear information management framework including information collection, assessment and dissemination. Conclusions: The performance of National health emergency Response Command Center can be improved by learning from the good practice of the selected EOCs, including setting clear functions, standardizing the organizational structure, enhancing the human resource capacity and strengthening information management.

关键词： Public health emergency operations center Coordination Command Communication

A cadaveric model for transesophageal echocardiography transducer placement training: A pilot study

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World Journal of emergency Medicine 2022年第1期13卷 18-22页

作者： Ryan W.Horton Kian R.Niknam Viveta Lobo Kathryn H.Pade Drew Jones Kenton L.Anderson department of emergency Medicine Stanford University School of MedicinePalo Alto 94304USA emergency Medicine Residency Program University of Texas at Austin Dell Medical SchoolAustin 78756USA University of California San Francisco School of Medicine San Francisco 94143USA department of emergency Medicine Rady Children’s HospitalSan Diego 92123USA department of emergency Medicine University of Central Florida/HCA Ocala RegionalOcala 34471USA

BACKGROUND: Transesophageal echocardiography(TEE) is used in the emergency department to guide resuscitation during cardiac arrest. Insertion of a TEE transducer requires manual skill and experience, yet in some residency programs cardiac arrest is uncommon, so some physicians may lack the means to acquire the manual skills to perform TEE in clinical practice. For other infrequently performed procedural skills, simulation models are used. However, there is currently no model that adequately simulates TEE transducer insertion. The aim of this study is to evaluate the feasibility and efficacy of using a cadaveric model to teach TEE transducer placement among novice ***: A convenience sample of emergency medicine residents was enrolled during a procedure education session using cadavers as tissue models. A pre-session assessment was used to determine prior knowledge and confidence regarding TEE manipulation. Participants subsequently attended a didactic and hands-on education session on TEE placement. All participants practised placing the TEE transducer until they were able to pass a standardized assessment of technical skill(SATS). After the educational session, participants completed a post-session assessment. RESULTS: Twenty-five residents participated in the training session. Mean assessment of knowledge improved from 6.2/10 to 8.7/10(95% confidence interval [CI] of knowledge difference 1.6–3.2, P<0.001) and confidence improved from 1.6/5 to 3.1/5(95% CI of confidence difference 1.1–2.0, P<0.001). There was no relationship between training level and the delta in knowledge or ***: In this pilot study, the use of a cadaveric model to teach TEE transducer placement methods among novice users is feasible and improves both TEE manipulation knowledge and confidence levels.

关键词： Cardiopulmonary resuscitation Echocardiography Education Simulation

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World Journal of emergency Medicine 2023年第3期14卷 253-254页

作者： Ya-qing An Yan-ling Dong Yi-jiao Men Liang Liu Yu Gong Jian-ling Su Heng-bo Gao Ying-ping Tian emergency department the Second Hospital of Hebei Medical UniversityShijiazhuang 050051China

Ritodrine hydrochloride(ritodrine)is a β2-adrenoceptor stimulant that has been effectively prescribed for the prevention of premature labor.[1]In clinical practice,one of the biggest drawbacks ofβ-mimetics is their adverse eff ects,including arrhythmias,myocardial ischemia,and pulmonary edema,due to theirβ-sympathomimetic effects.[2]Here,we report a rare pregnant case of spontaneous coronary artery dissection(SCAD)after intravenous infusion of ritodrine.

关键词： prevention artery ischemia

Expert consensus on prevention and cardiopulmonary resuscitation for cardiac arrest in COVID-19

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Asian Pacific Journal of Tropical Medicine 2021年第6期14卷 241-253页

作者： Wei Song Jie Wei Xiangdong Jian Deren Wang Yanhong Ouyang Yuanshui Liu Xianjin Du Ying Chen Yingqi Zhang Heping Xu Shuming Xianyu Qiong Ning Xiang Li Xiaotong Han Feng Zhan Tao Yu Wenteng Chen Jun Zhang Wenwei Cai Sheng’ang Zhou Shengyang Yi Yu Cao Xiaobei Chen Shunjiang Xu Zong’an Liang Duohu Wu Fen Ai Zhong Wang Qingyi Meng Yuhong Mi Sisen Zhang Rongjia Yang Shouchun Yan Wenbin Han Yong Lin Chuanyun Qian Wenwu Zhang Yan Xiong Jun Lv Baochi Liu Yan Cao Xiaojun He Xuelian Sun Yufang Cao Tian’en Zhou department of emergency Medicine Hainan General HospitalHainan Affiliated Hospital of Hainan Medical UniversityHaikou 570311China emergency department&Intensive Care Unit Renmin Hospital of Wuhan UniversityWuhan 430060China department of Poisoning and Occupational Diseases EmergencyQilu HospitalCheeloo College of MedicineShandong UniversityJinan 250012China Center of Cerebrovascular Diseases Department of NeurologyWest China Hospital of Sichuan UniversityChengdu 610041China department of emergency People's Hospital of Wuhan UniversityWuhan 430060China department of emergency Medicine the First Hospital of Hebei Medical UniversityShijiazhuang 050030China Hospital Infection Control Office Hainan General HospitalHaikou 570311China department of Occupational Diseases Jinan HospitalJinan 250013China department of emergency Medicine Hunan Provincial People's HospitalChangsha 410005China department of emergency Medicine Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhou 510120China department of emergency Medicine Zhejiang Provincial People's HospitalHangzhou 310014China department of emergency department West China Hospital of Sichuan UniversityChengdu 610041China department of Infectious Diseases People's Hospital of Wuhan UniversityWuhan 430060China department of Teaching Affairs The First Hospital of Hebei Medical UniversityShijiazhuang 050031China department of Pulmonary and Critical Care Medicine West China Hospital of Sichuan UniversityChengdu 610041China Medical Service department Hainan General HospitalHainan Affiliated Hospital of Hainan Medical UniversityHaikou 570311China department of emergency Medicine the Central Hospital of WuhanWuhan 430015China Tsinghua Changgung Hospital School of Clinical MedicineTsinghua UniversityBeijing 102218China department of emergency Medicine the First Medical CenterChinese PLA General HospitalBeijing 100853China emergency&Critical Care Center Beijing Anzhen HospitalCapital Medical University.Beijing 100029China Peopl

Background:Cardiopulmonary resuscitation(CPR)strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac *** CPR,both healthcare and non-healthcare workers who provide resuscitation are at risk of *** Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 *** recommendations:1)A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs.2)Psychological counseling and treatment are highly recommended,since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest.3)healthcare workers should wear personal protective equipment(PPE).4)Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19.5)Hands-only chest compression and mechanical chest compression are recommended.6)Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early.7)CPR should be provided for 20-30 min.8)Various factors should be taken into consideration such as the interests of patients and family members,ethics,transmission risks,and laws and regulations governing infectious disease *** in management:The following changes or modifications to CPR strategy in COVID-19 patients are proposed:1)healthcare workers should wear PPE.2)Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols.3)Both the benefits to patients and the risk of infection should be considered.4)Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.

关键词： SARS-CoV-2 COVID-19 Cardiac arrest CPR Nosocomial infection Personal protective equipment