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Validating a point of care lactate meter in adult patients with sepsis presenting to the emergency department of a tertiary care hospital of a low-to middle-income country

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World Journal of emergency Medicine 2017年第3期8卷 184-189页

作者： Muhammad Akbar Baig Hira Shahzad Erfan Hussain Asad Mian department of emergency Medicine Aga Khan University Hospital department of Medicine Aga Khan University Hospital Adult Critical care Services Aga Khan University Hospital department of emergency Medicine Pediatrics and Child Health Aga Khan University Hospital

BACKGROUND: Timely identifi cation of high blood lactate levels in septic patients may allow faster detection of those patients requiring immediate resuscitation. Point-of-care(POC) testing is being increasingly utilized in the emergency department(ED). We examined the accuracy and timesaving effect of a handheld POC lactate device for the measurement of fingertip and whole blood lactate as compared with reference laboratory blood testing in septic ED ***: A convenience sample of adult ED patients receiving serum lactate testing were enrolled prospectively in the ED of a multidisciplinary tertiary care hospital serving the population of one of the major cities of Pakistan. Participants underwent fi ngertip POC lactate measurement with a portable device and simultaneous whole blood sampling for analysis by both the POC lactate device and standard laboratory method. Lactate measurements were compared by intraclass correlation(ICC) and Bland and Altman ***: Forty-three septic patients were included in the study. The fingertip POC & whole blood POC lactate measurements each correlated tightly with the reference method(ICC=0.93 & ICC=0.92, respectively). Similarly at 6 hours, the fingertip POC & whole blood POC lactate measurements demonstrated satisfactory correlation with the reference method(ICC=0.95 & ICC=0.97, respectively).CONCLUSION: Fingertip POC lactate measurement is an accurate method to determine lactate levels in septic ED *** WORDS: Sepsis; Point of care; Lactate; emergency department;

关键词： Sepsis Point of care Lactate emergency department Pakistan

Evaluation of hand infections in the emergency department using point-of-care ultrasound

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World Journal of emergency Medicine 2024年第4期15卷 283-288页

作者： David Ahmad Haidar David Mintz Brandon M Wubben Omar Rizvi Srikar Adhikari department of emergency Medicine Michigan MedicineAnn Arbor 48109-1382USA University of Arizona College of Medicine Tucson 85724USA department of emergency Medicine University of IowaIowa City 52242-1009USA department of Surgery University of Arizona College of MedicineTucson 85724USA department of emergency Medicine University of Arizona College of MedicineTucson 85724USA

BACKGROUND:We aimed to evaluate the utility of point-of-care ultrasound(POCUS)in the assessment of hand infections that present to the emergency department(ED)and its impact on medical decision making and patient ***:We conducted a retrospective review of patients who presented to two urban academic EDs with clinical presentations concerning for skin and soft tissue infections(SSTI)of the hand between December 2015 and December *** trained POCUS fellowship physicians reviewed an ED POCUS database for POCUS examinations of the *** then reviewed patients’electronic health records(EHR)for demographic characteristics,history,physical examination findings,ED course,additional imaging studies,consultations,impact of POCUS on patient care and final ***:We included a total of 50 cases(28 male,22 female)in the final *** most common presenting symptoms and exam findings were pain(100%),swelling(90%),and erythema(74%).The most common sonographic findings were edema(76%),soft tissue swelling(78%),and fluid surrounding the tendon(57%).POCUS was used in medical decision making 68%of the time(n=34),with the use of POCUS leading to changes in management 38%of the time(n=19).POCUS use led to early antibiotic use(11/19),early consultation(10/19),and led to the performance of a required procedure(8/19).The POCUS diagnosis was consistent with the discharge diagnosis of flexor tenosynovitis 8/12 times,abscess 12/16 times,and cellulitis 14/20 ***:POCUS is beneficial for evaluating of hand infections that present to the ED and can be used as an important part of medical decision making to expedite patient care.

关键词： Ultrasound Point-of-care ultrasound Cellulitis Abscess Flexor tenosynovitis

Integrated emergency department and general intensive care unit management on health outcomes

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Chinese Medical Journal 2021年第21期134卷 2553-2555页

作者： Shan-Lin Mao Zi Ge Hui Zhao Yan-Xue Wang Jun Cao Zhi-Jie Xia emergency and Acute Critical care department Huashan Hospital NorthFudan UniversityShanghai 201907China

The emergency department(ED)should reliably provide the required medical treatment to patients who are in an emergency or are critically ***,the ED faced two challenges in China.

关键词： China department critically

Detection of adrenal mass during an educational point-of-care ultrasound in the emergency department

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World Journal of emergency Medicine 2021年第2期12卷 154-156页

作者： Kay Negishi Jorge Short Apellaniz Daniel Ratanski Sarah E.Frasure Andrew S.Liteplo Hamid Shokoohi department of emergency Medicine Massachusetts General HospitalHarvard Medical SchoolBoston 02115USA department of emergency Medicine George Washington University School of Medicine and Health SciencesWashington 20037USA

Dear editor,Incidental adrenal mass is a common radiological finding that is mostly detected in abdominal computed tomography (CT) scans.^([1]) Though pheochromocytomas are a relatively rare chromaffin cell tumor,they... 详细信息

关键词： adrenal diagnosis editor

Point-of-care ultrasound versus radiology department pelvic ultrasound on emergency department length of stay

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World Journal of emergency Medicine 2016年第3期7卷 178-182页

作者： Scan P. Wilson Kiah Connolly Shadi Lahham Mohammad Subeh Chanel Fischetti Alan Chiem Ariel Aspen Craig Anderson John C. Fox department of emergency Medicine University of California Irvine Irvine California 92697 USA department of emergency Medicine University of California Los Angeles Los Angeles California 90095 USA

BACKGROUND: The study aimed to compare the time to overall length of stay(LOS) for patients who underwent point-of-care ultrasound(POCUS) versus radiology department ultrasound(RDUS).METHODS: This was a prospective study on a convenience sample of patients who required pelvic ultrasound imaging as part of their emergency department(ED) ***: We enrolled a total of 194 patients who were on average 32 years-old. Ninety-eight(51%) patients were pregnant(<20 weeks). Time to completion of RDUS was 66 minutes longer than POCUS(95%CI 60–73, P<0.01). Patients randomized to the RDUS arm experienced a 120 minute longer ED length of stay(LOS)(95%CI 66–173, P<0.01)CONCLUSION: In patients who require pelvic ultrasound as part of their diagnostic evaluation, POCUS resulted in a signifi cant decrease in time to ultrasound and ED LOS.

关键词： Point-of-care ultrasound Pelvic ultrasound Length of stay Intrauterine pregnancy

A comparison of perspectives on costs in emergency care among emergency department patients and residents

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World Journal of emergency Medicine 2017年第1期8卷 39-42页

作者： Stefanie K.Gilbert Leana S.Wen Jesse M.Pines department of emergency Medicine The George Washington UniversityWashingtonDC 20037USA

BACKGROUND: Costs of care are increasingly important in healthcare policy and, more recently, in clinical care in the emergency department(ED). We compare ED resident and patient perspectives surrounding costs in emergency ***: We conducted a mixed methods study using surveys and qualitative interviews at a single, academic ED in the United States. The two study populations were a convenience sample of adult ED patients(>17 years of age) and ED residents training at the same institution. Participants answered open- and closed-ended questions on costs, medical decision making, cost-related compliance, and communication about costs. Closed-ended data were tabulated and described using standard statistics while open-ended responses were analyzed using grounded ***: Thirty ED patients and 24 ED residents participated in the study. Both patients and residents generally did not have knowledge of medical costs. Patients were comfortable discussing costs while residents were less comfortable. Residents agreed that doctors should consider costs when making medical decisions whereas patients somewhat disagreed. Additionally, residents generally took costs into consideration during clinical decision-making, yet nearly all residents agreed that they had too little education on ***: There were several notable differences in ED patient and resident perspectives on costs in this U.S. sample. While patients somewhat disagree that cost should factor into decision making, generally they are comfortable discussing costs yet report having insuf? cient knowledge of what care costs. Conversely, ED residents view costs as important and agree that cost should factor into decision making but lack education on what emergency care costs.

关键词： emergency medicine Clinical decision-making Cost Communication Residency education

Utility of point-of-care musculoskeletal ultrasound in the evaluation of emergency department musculoskeletal pathology

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World Journal of emergency Medicine 2018年第4期9卷 262-266页

作者： Elaine Situ-LaCasse Ryan W. Grieger Stephen Crabbe Anna L. Waterbrook Lucas Friedman Srikar Adhikari department of emergency Medicine Banner University Medical Center Tucson AZ USA The University of Arizona College of Medicine Tucson AZ USA department of emergency Medicine The University of Arizona Tucson AZ USA University of California Riverside Riverside CA USA

BACKGROUND: To evaluate the utilization of point-of-care ultrasound(POCUS) for the assessment of emergency department(ED) patients with musculoskeletal symptoms and the impact of musculoskeletal POCUS on medical decision-making and patient management in the ***: This was a retrospective review of ED patients presenting with musculoskeletal symptoms who received a POCUS over a 3.5-year period. An ED POCUS database was reviewed for musculoskeletal POCUS examinations used for medical decision-making. Electronic medical records were then reviewed for demographic characteristics, history, physical examination findings, ED course, additional imaging studies, and impact of musculoskeletal POCUS on patient management in ED. RESULTS: A total of 264 subjects(92 females, 172 males) and 292 musculoskeletal POCUS examinations were included in the fi nal analysis. Most common symptomatic sites were knee(31.8%) and ankle(16.3%). Joint effusion was the most common fi nding on musculoskeletal POCUS, noted in 33.7% of the patients, and subcutaneous edema/cobblestoning was found in 10.2% of the patients. Muscle or tendon rupture was found in 2.3% of the patients, and 1.9% of the patients had joint dislocation. Bursitis or bursa fluid was found in 3.4% of patients, and tendonitis/tendinopathy was found in 2.3%. Twenty percent of them were ultrasound-guided musculoskeletal procedures, and most of them(73.3%) were arthrocentesis. Of the included studies, all except three either changed or helped guide patient management as documented in the patients' medical ***: Our study fi ndings illustrate the utility of POCUS in the evaluation of a variety of musculoskeletal pathologies in the ED.

关键词： Point-of-care ultrasound Musculoskeletal emergency department

Mobile technology:Usage and perspective of patients and caregivers presenting to a tertiary care emergency department

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World Journal of emergency Medicine 2020年第1期11卷 5-11页

作者： Zhenghong Liu Mingwei Ng Dinesh V.Gunasekeran Huihua Li Kishanti Ponampalam R Ponampalam SingHealth emergency Medicine Residency Programme Singapore Health ServicesSingapore Ministry of Health Holdings Singapore Health Services Research Unit Singapore General HospitalSingapore University of Newcastle Australia department of emergency Medicine Singapore General HospitalSingapore

BACKGROUND:Developments in information technology(IT)have driven a push in healthcare innovation in the emergency department(ED).Many of these applications rely on mobile technology(MT)such as smartphones but not everyone is comfortable with MT *** study aims to characterize the technology usage behavior of users in the ED so as to guide the implementation of IT interventions in the ***:A cross-sectional survey was conducted in the emergency department of a tertiary *** and their caregivers aged 21 and above were *** survey collected demographic information,technology usage patterns,and participant reported comfort level in the usage of *** performed descriptive statistics and multivariate logistic regression to identify factors differentially associated with comfort in usage of ***:A total of 498 participants were recruited,and 299(60%)were *** was the most commonly written and read language(66.9%)and 64.2%reported a comfort level of 3/5 or more in using *** that were associated with being comfortable in using MT include having a tertiary education,being able to read and write English,as well as being a frequent user of *** were more likely to display these ***:A large proportion of ED patients are not comfortable in the usage of *** that predicted comfort level in the usage of MT were common amongst *** interventions should take this into consideration in the design of MT interventions.

关键词： Mobile health technology Information technology emergency department

Impact of an emergency department nursing intervention on continuity of care, self-care, and psychological symptoms

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World Journal of Psychiatry 2023年第12期13卷 1046-1052页

作者： Song Xu Yi-Fang Gu Ai-Hua Dong department of emergency Room The First Affiliated Hospital of Soochow UniversitySuzhou 215000Jiangsu ProvinceChina

BACKGROUND The emergency department plays a crucial role in providing acute care to *** interventions in this setting are essential for improving the continuity of care,enhancing patients’self-care abilities,and reducing psychological *** To evaluate the effect of nursing interventions in the emergency department on these indicators in an emergency *** A retrospective analysis was conducted on 120 patients admitted to the emergency department between January 2022 and May *** patients were divided into two groups:The control group(conventional nursing intervention)and the observation group(conventional nursing intervention+emergency department nursing intervention).The two groups were compared regarding continuity of care,self-care ability,psychological symptoms,and satisfaction with *** The emergency department nursing interventions significantly improved the continuity of care,enhanced patients’self-care abilities,and reduced psycho-logical symptoms such as anxiety and *** Nursing interventions in the emergency department positively impact continuity of care,self-care,and psychological ***,it is important to acknowledge the limitations of this study,including the small number of studies,variable methodological quality,and the heterogeneity of the study *** research should address these limitations and further explore the effects of different types of nursing interventions in the emergency ***,efforts should be made to enhance the application and evaluation of these interventions in clinical practice.

关键词： emergency department Nursing interventions Continuity of care Self-care psychological symptoms