Emergency Care Research Articles

Point-of-Care Lung Ultrasound in Small Animal Emergency and Critical Care Medicine: A Clinical Review

Thoracic point-of-care ultrasound (T-POCUS) has grown in popularity and usage in small animal emergencies and critical care settings due to its non-invasive nature, mobility, and ability to acquire images in real time. This review summarizes current understanding about T-POCUS in dogs and cats with respiratory illnesses, including normal thoracic ultrasonography appearance and numerous pathological situations. The basics of T-POCUS are covered, including equipment, scanning procedures, and picture settings. Practical applications in patients with respiratory distress are discussed, with an emphasis on pleural space abnormalities and lung diseases. Ultrasound results define pulmonary disorders such as pneumonia, atelectasis, cardiogenic and non-cardiogenic pulmonary edema, lung lobe torsion, pulmonary fibrosis, pulmonary thromboembolism, pulmonary neoplasms, and pulmonary bleeding. The evaluation focuses on T-POCUS diagnostic skills in a variety of clinical settings. Limitations and the need for more study to standardize techniques, establish agreed terminology, and create specialized educational routes are highlighted.

Pre-hospital emergency: analyzing the status of medication and equipment in pre-hospital emergency bases.

Pre-hospital emergency care is a comprehensive system that responds to the medical needs of injured patients outside of health care centers. The right equipment and facilities are necessary to provide proper and satisfactory services. Due to the increase in pre-hospital emergency services and the high prevalence of emergency events, the present study was conducted to investigate the status of medication and equipment in pre-hospital emergency bases and compare it with national standards. This descriptive-analytical study was conducted in Iran in 2022-2023. Sampling was done in 46 urban and road bases using the census method. Data collection was done using two checklists. The first checklist, in 17 sections, was based on the latest edition of the instructions for medication and equipment of Iran's pre-hospital emergency organization. The second checklist included the specifications of the base. The collected data were analyzed using descriptive and analytical statistics and SPSS25 software. Of the 46 bases included in the study, 41.3% were urban bases and the rest were road bases. The mean age for building the bases was 13.76±9.47 years (the minimum was one year and the maximum was 45 years). The mean score of the status of medication and equipment in the bases was 224.34 ± 32.05 (minimum score 155 and maximum 322), which was 56.09% of the total score. The highest score was obtained in the medication section of the patient cabin (81.88%) and the lowest score was in the CBRNe bag equipment section (4.55%). The results showed that the status of the medication and equipment of the pre-hospital emergency bases is far from the standards. This long distance can affect the quality of pre-hospital emergency services. Resolving deficiencies and reaching standards requires more attention.

Travel Time as an Indicator of Poor Access to Care in Surgical Emergencies

Timely access to care is a key metric for health care systems and is particularly important in conditions that acutely worsen with delays in care, including surgical emergencies. However, the association between travel time to emergency care and risk for complex presentation is poorly understood. To evaluate the impact of travel time on disease complexity at presentation among people with emergency general surgery conditions and to evaluate whether travel time was associated with clinical outcomes and measures of increased health resource utilization. This retrospective cohort study used administrative statewide inpatient and emergency department databases with linkage across encounters, including nearly every inpatient or emergency department encounter in the states of Florida and California in 2021. Participants included adult patients who presented to an emergency department with 1 of 5 common emergency surgical conditions. Data were collected from January to December 2021 and analyzed from June to December 2023. The primary exposure was travel time from the patient's home to the facility where they initially received emergency care. The primary outcome of interest was surgical disease complexity at the time of presentation to emergency care. Secondary outcomes included inpatient complications, mortality, and indicators of health system resource utilization. Multivariable logistic regression models were used, and adjusted odds ratios (aOR) and 95% CIs were reported. Among 190 311 adults with emergency general surgery conditions, 7138 (3.8%) lived further than 60 minutes from the facility where they sought emergency care. Longer travel times were associated with higher odds of complex disease presentation for travel time of more than 120 minutes vs 15 minutes or less (aOR, 1.28; 95% CI, 1.17-1.40). Patients with a travel time 60 minutes or more were more likely to require operative intervention (aOR, 1.17; 95% CI, 1.10-1.26), inpatient admission (aOR, 1.41; 95% CI, 1.33-1.50), interfacility transfer (aOR, 1.32; 95% CI, 1.15-1.51), and longer inpatient stay (adjusted mean difference, 0.47 days; 95% CI, 0.35-0.59), and had higher charges (adjusted mean difference, $8284; 95% CI, $5532-$11 035). In this cohort study of patients with emergency surgical conditions, travel time to emergency care was associated with markers of delayed presentation and increased facility resource utilization. As opposed to static measures, such as rurality, travel time may serve as a more useful metric to inform policy efforts aimed at preserving access to care amidst rural hospital closures and regionalization.

Artificial intelligence in emergency medicine

Artificial intelligence attracts controversy, but it is impossible to ignore its potential to transform healthcare. This article examines some of the established and potential applications of artificial intelligence in emergency care settings, noting where clinicians may be able to apply this technology to their departmental practice.

Competency Assessment of Primary Health-care Physicians in Iraq Regarding the Interpretation of Chest X-ray in Acute and Emergency Conditions

Abstract Background: Primary health-care (PHC) physicians may encounter a wide variety of conditions including acute and emergent cases considering the limited access to diagnostic investigation in PHC practice. Chest X-ray (CXR) remains the imaging modality of choice to diagnose pulmonary, cardiac and other chest diseases, and it is the unique imaging technique available in Iraqi PHC centers (PHCCs), relatively inexpensive and has a low dose of radiation exposure. Aim of the Study: Competency assessment of diagnostic accuracy and confidence degree for Iraqi PHC physicians (PHCPs), regarding the interpretation of CXR in acute and emergent conditions. Subjects and Methods: A cross-sectional study that included a convenient sample of 330 participants through an online questionnaire, during the period from January 2023 to January 2024. The study included some background information such as gender, years in practice, training type, interest in pulmonary medicine and diagnostic radiology, and having adequate training on the interpretation of CXR. The questionnaire consists of 10 chest radiographs with brief clinical information for each case. Participants were asked to choose the most likely diagnosis and to rate their degree of confidence in the interpretation of the CXR for each case. Descriptive statistics were presented using tables and graphs, continuous variables summarized by mean and standard deviation. The categorical variables summarized by percentages and frequency distributions and compared using Fisher’s exact test. The level of statistical significance was set at a P < 0.05. Cutoff point of diagnostic accuracy is considered equal or more than 5 correct answers from 10 is competent, and that of confidence rate equal or more than 3 scores from 5 is confident. Results: Overall diagnostic accuracy is 296 (89.7%) and overall diagnostic confidence is 116 (77%). Diagnostic accuracy among family medicine specialist 164 (91.1%) and diagnostic confidence are 138 (76.7%) within their group, while among nonspecialist PHCPs, diagnostic accuracy only 132 (88%) and diagnostic confidence 116 (77.3%) within their group. Proportion of competent family medicine specialists among all competent participants was more than half 164 (55.4%) and for nonspecialists was 132 (44.6%). A moderately positive correlation (r = 0.417) between diagnostic accuracy and confidence level appeared. Cardiogenic pulmonary edema 300 (90.9%) and normal CXR 284 (86.1%) cases had the highest diagnostic accuracy scores, whereas the lowest scores were for lobar collapse 168 (50.9%) and pneumomediastinum 140 (42.4%). More than half of the participants 202 (61.2%) lived in the capital and more than three quarters of the participants 266 (80.6%) were females. Family medicine specialists was constitute the largest number 180 (54.5%) of the participants and more than half of the sample 170 (51.5%) having more than 10 years of experience. Approximately 230 (70%) of the participants had no elective rotation in diagnostic radiology and about half of the sample 162 (49.1%) were uncertain about their training adequacy. More than three quarters of the sample 258 (78.2%) interested in diagnostic radiology and 198 (60%) interested in pulmonary medicine. Conclusions: The competency of Iraqi PHCPs in CXR interpretation in acute and emergency conditions was optimal generally. Nonspecialist PHCPs had fewer competencies than specialists that belong to knowledge and training deficiency. An introduction of radiology training courses in emergent conditions and the use of tele-radiology platform in PHCCs should be considered.

Functions of communication during emergency care of children with medical complexity: Caregiver perspectives.

We investigated communication experiences of caregivers of children with medical complexity (CMC) during emergency care. Fifteen caregivers of CMC participated in semi-structured interviews regarding communication while seeking care for their child in the emergency department (ED). Thematic analysis was applied using a previously established functional communication model as an a priori framework. Each of the previously established 8 core functions of communication were identified in this population. "Building relationships" manifested as clinicians soliciting caregiver input and responding to the needs of the caregiver. "Exchanging information" included clearly explaining next steps to caregivers. "Responding to emotions" acknowledged the inherent distress of seeking emergency care. "Providing validation" included recognizing caregivers as the expert of their own child. "Enabling self-management" manifested as identifying caregiver needs and directing toward resources. "Making decisions" manifested as involving caregivers in the decision-making process and recognizing caregiver decision fatigue. "Managing uncertainty" involved developing plans with caregivers. "Supporting hope" was the least commonly described function and manifested as emphasizing positive aspects of a child's condition. Many caregivers described negative communication experiences in which their concerns and insights were unheard or invalidated. Caregivers of CMC described communication experiences and goals that align with 8 communication functions that were identified in other serious childhood illnesses with unique operationalizations. This communication framework can support ED clinicians in better understanding the communication needs of caregivers of CMC during emergency care.

The Impact of Insulin Resistance on the Development of Post-PCI Contrast-Induced Nephropathy in Non-Diabetic STEMI.

Contrast-induced nephropathy (CIN) is a condition characterized by rapidly decreasing renal funciton following by the application of contrast material. Precutaneous coronary intervention (PCI) is a life-saving treatment method that should be applied under emergent conditions. Unfortunately, the incidence of CIN after PCI is common. Patients with insulin resistance or diabetes have a greater risk of developing CIN than most of the population. Therefore, studies on the predictive effects of insulin resistance indicators on CIN are gaining momentum. One of the most popular indicators is triglyceride/glucose-body mass index (TyG-BMI). In this study we aimed to evaluate the effect of TyG-BMI index on CIN. A total of 960 patinets who underwent emergency PCI due to ST elevation myocardial infarction (STEMI) between 2020 and 2023 were included in the study. Laboratory and demographic parameters were compared between the patients who did and did not develop CIN. While CIN developed in 120 of the 980 patients included in the study, it did not develop in 860 patients. There were significant differences between the groups in terms of age (p < 0.001), gender (p = 0.005), presence of hypertension (p = 0.021), heart rate (p = 0.049), amount of contrast material (p < 0.001), left ventricular ejection fraction (p < 0.001), stent length (p = 0.022), SYNTAX score (p < 0.001), fasting plasma glucose (p < 0.001), baseline creatinine (p < 0.001), glomerular filtration rate (p < 0.001), uric acid (p < 0.001), C reactive protein (CRP) (p < 0.001), baseline creatin kinase myocard band (CKMB) (p = 0.019), CKMB peak (p = 0.030), triglyceride (p = 0.017), and TyG-BMI (p < 0.001). CRP, creatinine, uric asid, amount of contrast material, and TyG-BMI were independent predictors for the development of CIN. TyG-BMI was a predictor of CIN in STEMI patient who underwent PCI under emergency conditions. In addition, the predicitive power of TyG-BMI was stronger than triglyceride-glucose index.

Lived Experience Advisor Program initiative: harnessing consumer leadership for best care.

The Lived Experience Advisor Program (LEAP), introduced at Western Health in January 2023, is an innovative approach to consumer engagement in mainstream health care, integrating lived experience perspectives into organisational decision-making, research, and quality improvement. As health care has increasingly embraced consumer involvement at both direct care and governance levels, the LEAP was implemented to expand the role of health consumers beyond traditional volunteer positions, recognising lived experience as a valuable form of expertise. Through employment of Lived Experience Advisors (LEAs) across a range of clinical and operational projects, this program has enhanced service planning and health literacy for diverse communities. This case study details the development, implementation, and outcomes of the LEAP, focusing on how LEAs have contributed to areas such as youth health services, carer support, emergency care, and consumer engagement strategies. With support from a Community of Practice, LEAs receive ongoing mentorship and training, fostering skill development and promoting sustainable career pathways. The program has also driven shifts in staff perspectives, supporting a patient-centred culture where consumer voices are prioritised. Challenges in program funding, role clarity, and matching lived experience to project needs, underscore the need for thoughtful recruitment, executive sponsorship, and adaptable role design. The impact of the LEAP has extended beyond individual projects, influencing organisational culture, and enhancing staff capabilities in consumer partnership. The case study offers practical insights for other healthcare organisations aiming to integrate lived experience roles, emphasising the potential for consumer-led initiatives to drive transformative change in healthcare delivery and policy.

Improving Patient Outcomes in mTBI: The Role of Integrated Nursing Interventions in the Emergency Department.

Traumatic brain injury (TBI) is a major cause of morbidity and mortality, often requiring emergency department (ED) management. Integrated Nursing Interventions play a critical role in the care of TBI patients, but limited research has evaluated their efficacy in this setting. This study aims to assess the impact of Integrated Nursing Interventions on patient outcomes and complications in the ED. This retrospective study included 246 patients with mild traumatic brain injury (mTBI) treated in the emergency department from January 2022 to December 2022. Of these, 138 patients received Integrated Nursing Interventions, while 108 did not. Baseline characteristics, clinical outcomes, and complications were compared between the two groups. Descriptive statistics, logistic regression, and receiver operating characteristic (ROC) curve analysis were used to evaluate the effect of nursing interventions on outcomes such as mortality, complications, and hospital stay. Among the 246 mTBI patients, those receiving Integrated Nursing Interventions (n=138, 56.1%) experienced significantly lower rates of adverse events, including perioperative intracranial hemorrhage (4.3% vs 12.0%, P=0.025) and shorter hospital stays (6±2 days vs 11±3 days, P<0.001). The study sample included 56.5% female, with 80.1% age ≤ 80. Integrated Nursing Interventions refer to coordinated care strategies that combine multiple nursing approaches tailored to address both physical and psychological needs of patients. For instance, the use of patient education combined with individualized pain management strategies. Logistic regression analysis revealed that Integrated Nursing Interventions were associated with a significant reduction in in-hospital mortality (OR=1.828, 95% CI: 1.619-2.318, P<0.001). ROC curve analysis demonstrated strong predictive accuracy for outcomes such as readmission rate (AUC=0.757), 30-day mortality (AUC=0.836), and 90-day mortality (AUC=0.760). Integrated Nursing Interventions in the emergency department significantly improve patient outcomes for mTBI patients, reducing mortality, complications, and length of hospital stay. These interventions, which include early assessment, timely intervention, patient education, and collaborative care, are essential for optimizing TBI management. The high predictive value of these interventions further underscores their importance in emergency care. Future research should focus on the long-term effects of Integrated Nursing Interventions on patient outcomes across different age groups, particularly in chronic disease management. Further studies could explore the role of digital health tools in enhancing integrated care.

Impact of Continuous Positive Airway Pressure on Patient Outcomes in Acute Cardiogenic Pulmonary Edema Within Physician-Led Prehospital Care.

CPAP has been shown to be particularly beneficial in the management of acute cardiogenic pulmonary edema by reducing both preload and afterload, thus decreasing the work of breathing and improving oxygenation. This study was a prospective observational study, conducted in the period from 2022 to 2024, assessing the effectiveness and safety of prehospital CPAP therapy use in patients with acute cardiogenic pulmonary edema, administered alongside standard care. In this study, 50 patients with acute cardiogenic pulmonary edema were treated by physician-led emergency teams in the Canton of Sarajevo. CPAP significantly improved clinical parameters across all time points. Systolic blood pressure decreased from 151.0 ± 41.0 mmHg at initial contact to 138.4 ± 32.0 mmHg before transportation and further to 130.2 ± 28.5 mmHg upon hospital admission (p < 0.001). Diastolic pressure dropped from 85.6 ± 17.2 mmHg to 81.1 ± 15.2 mmHg before transportation (p = 0.018), with a slight further decrease to 80.2 ± 13.9 mmHg (p = 0.083). Heart rate fell from 114 ± 26.4 bpm to 111.3 ± 24.9 bpm before transportation (p = 0.003) and finally to 99.5 ± 18.2 bpm before hospital admission (p < 0.001). Respiratory rate decreased from 31.0 ± 10.2 to 28.0 ± 10.5 breaths/min (p = 0.002) and further to 22.6 ± 7.3 breaths/min (p < 0.001). End-tidal CO2 levels increased from 28.0 mmHg (23.5; 33.5) to 30.0 mmHg before transportation (p < 0.001), and to 35.0 mmHg (32.0; 37.5) before hospital admission (p < 0.001). Oxygen saturation improved from 79.0% (72.0; 81.0) to 84.0% before transportation (p < 0.001) and reached 94.0% (91.0; 98.2) before hospital admission (p < 0.001). VAS scores for dyspnea significantly dropped from 8.0 (6.0; 8.2) at initial contact to 6.0 (4.0; 8.0) before transportation (p < 0.001) and further to 4.0 (3.0; 5.0) before hospital admission (p < 0.001), indicating substantial symptom relief. ECG findings remained stable throughout the intervention. Prehospital CPAP therapy significantly improved clinical outcomes in cardiogenic pulmonary edema, including reductions in blood pressure, heart rate, respiratory rate, and enhanced oxygenation and symptom relief. These findings support its broader use in emergency care, even during short transport times.

Effect of the provision of estimated waiting time on patient satisfaction with the Emergency Department: A randomized controlled trial

Abstract: BACKGROUND: Patient satisfaction is a quality measure that provides important details on the medical care provided. This study aimed to assess the effect of displaying “estimated waiting time” on patient’s satisfaction with emergency care. MATERIALS AND METHODS: This study included 190 patients from the Emergency Department (ED) of King Fahad Hofuf Hospital (KFHH) who were aged 18 and above and were triaged as 3 and above on the Canadian triage and acuity scale (CTAS). One hundred eighteen patients were selected as the entrance group, and 72 selected as the inside group that were further divided into intervention group (35) and control group (37); Intervention group received estimated waiting time. Two questionnaires were administered, first at the triage entrance and the second at the ED after being seen by the physician. Fischer’s exact test was applied to test for association between categorical variables, and Mann– Whitney U test was used to compare satisfaction scores between the groups. RESULTS: For the 118 patients at the triage entrance, 50% were aged 18-39 years, 62% were females, and 61% were triaged as category 3. One-third patients were willing to wait for 0-1 hour, and 28% described their symptoms as severe. Only 29.7% patients said they would wait until seen by doctor. No statistically significant difference in the level of satisfaction between patients who were provided with the estimated waiting time and those who were not (P=0.962). CONCLUSION: There were no statistically significant variations between the two groups’ preferences regarding patients’ awareness of their predicted waiting times. The results indicated that managing patients’ perceptions and expectations of waiting times effectively is inconsequential for the improvement of patient experience.

Chronic Disease Management in Emergency Medicine

Chronic diseases now account for 86% of health care spending, and more than half of Americans live with a chronic illness, creating an epidemic. The rising incidence of chronic illness was not recognized or sufficiently addressed by the medical community or its leaders. As a result, a health-care crisis took place, with poor access and quality of service, as well as exorbitant expenses. With over half of Americans living with a chronic illness, chronic diseases now account for 86% of health care spending, causing an epidemic. The medical community and its leaders failed to acknowledge or adequately address the growing prevalence of chronic illness. As a result, a health-care crisis took place, with poor access and quality of service, as well as exorbitant expenses. They found that as a result, patient satisfaction rose, healthcare costs decreased, and patients&amp;apos; health outcomes improved. There was a significant overlap between the health care crisis and the rise of an epidemic of chronic diseases. Although the epidemic was not the cause of the crisis, it did play a significant part. The present challenge for the medical community and its leaders is to create a medical practice and a health care system that better meet the needs of those with chronic illnesses while simultaneously lowering the health care crisis. The importance of emergency preparedness plans for chronic conditions has been brought to light by recent crises, especially those that have occurred in wealthy nations. Many of the patients who survived had chronic conditions like diabetes, cancer, hypertension, and chronic respiratory diseases, which deteriorated due to stress from the disaster, care withdrawal, or both. For some of these patients, the exacerbations were lethal. In this paper, we review experiences from earlier disasters in developed nations and give guidelines for chronically sick patients&amp;apos; disaster preparedness. Based on lessons learned from recent disasters, numerous recommendations have been made that provide essential and useful protocols for managing chronic illness in emergency care.

Profile of female survivors of sexual violence in the first 6 months of the COVID-19 quarantine in the city of Campinas, Brazil: A cross-sectional retrospective study.

Describe the characteristics and changes in the profile of women who sought care after experiencing sexual violence (SV) during the first six months of the COVID-19 pandemic in a Brazilian city. This is a cross-sectional retrospective study. Data from emergency care and legal abortion requests of women assisted at the Women's Health Care Center Hospital (School of Medical Sciences, University of Campinas, Brazil) due to SV experienced between March 23 and August 23, 2020 (Quarantine Group, QG), were collected and compared with data from the same period of the previous biennium (Comparison Group, CG). χ2 and Fisher's exact tests were used to compare groups; the significance level was 5%. Data for 236 women were analyzed; 70 women were included in the QG and 166 in the CG. In the QG, there was a restriction in the area of origin of women, with a higher proportion of women who lived in Campinas (P = 0.0007) and a higher frequency of chronic SV (P = 0,035). There were no rapes associated with the use of social media or apps in the QG, but 9.8% of women in the CG experienced rape associated with the use of social media or apps. There were higher rates of domestic violence (P = 0.022) and intimidation through physical force (P = 0.011) in the first two months. The COVID-19 quarantine affected the profile of women who sought care after experiencing SV. The quarantine resulted in changes in the area of origin of patients, hindering access to health services and leading to higher rates of chronic and domestic SV, particularly in the first 2 months of the pandemic.

Epidemiology, patterns, and outcomes of road traffic accidents in Saudi Arabia: a systematic review and meta-analysis

Road traffic accidents (RTAs) remain a significant public health concern worldwide, contributing to high morbidity and mortality rates. In Saudi Arabia, RTAs are a leading cause of injuries and fatalities. This study aimed to analyze the epidemiological patterns, demographics, crash characteristics, and injury outcomes of RTAs in Saudi Arabia. This systematic review and meta-analysis followed PRISMA 2020 guidelines, with a comprehensive search in PubMed, Scopus, and Web of Science using relevant keywords and MeSH terms. Observational studies reporting data on RTAs in Saudi Arabia were included. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Pooled prevalence estimates were calculated using a random-effects model, and heterogeneity was assessed using the I² statistic and Cochran&amp;apos;s Q test. A total of 10 studies were included, representing diverse regions of Saudi Arabia and involving 154,165 participants. Male predominance was consistent across studies, with males comprising 59.1% to 91% of participants. Younger males (20–35 years) were disproportionately affected, often engaging in high-risk behaviors such as speeding and mobile phone use. Head and neck injuries were the most common (50%–63%), followed by chest and abdominal injuries. Urban areas accounted for the majority of accidents (63%–68.6%). Pooled prevalence estimates revealed substantial heterogeneity across studies (I² &amp;gt; 90%). RTAs in Saudi Arabia predominantly affect young males and are frequently associated with high-risk behaviors and urbanization. While safety measures have mitigated some outcomes, targeted interventions addressing risky behaviors, traffic enforcement, and emergency care are essential to reduce the burden of RTAs further.

Obstacles to emergency medical consultation in cases of conflict-related sexual violence.

Despite the availability of a well-developed holistic care model for victims of conflict-related sexual violence, little is known about the factors that determine late presentation for care post-sexual violence care. Drawing from data from the Democratic Republic of the Congo, this study aimed to determine obstacles to accessing emergency medical care within 72-hours of sexual violence (SV). We retrospectively analyzed data from 4048 victims of SV treated at Panzi Hospital (PH) in Bukavu city between 2015 and 2018. The factors of access to care within 72h were analyzed using logistic regression. 88% of the victims consulted after 72h post sexual violence. Several sociodemographic factors were found to limit access to the medical care post-sexual violence including the victim's age (p = 0,022), place of residence (p = 0,000) and education level (p = 0,039). Clinical discomfort from pain during urination (p = 0,002) and fear of pregnancy (p = 0,000) were also associated with late assessment of care. Seeking medical care within 72 hours after sexual violence within the critical 72-hours timeframe is crucial to avoid several medical complications stemming from SV. Improvement will be achieved by integrating the post-exposure prophylaxis protocol into primary health care, as well as by increasing community awareness of the relevance of timely consultation after sexual abuse.

Inventory of ethical problems in mobile pre-hospital care.

to construct and validate the content of an inventory of ethical problems experienced by nurses in mobile pre-hospital care. a psychometric approach study, developed with the following stages: (1) instrument construction through a theoretical matrix based on deliberative bioethics, scoping review and online qualitative research; (2) content validity by judges; (3) pre-testing with Mobile Emergency Care Service nurses in various Brazilian states. For content validity analysis, the Content Validity Ratio was calculated (CVR>0.45 for judges and CVR>0.35 for the target population). the instrument had 44 items, distributed across four dimensions. the constructed instrument presented sources of evidence of content validity, providing good psychometric measurements and constituting a useful tool for nurses' practice in the pre-hospital setting.

Vivência no Serviço de Atendimento Móvel de Urgência durante o internato: um relato de experiência

ABSTRACT Introduction: This study aims to report the experiences lived in the Mobile Emergency Care Service (SAMU) of the city of Santos, São Paulo, Brazil, by fifth-year medical students from Centro Universitário Lusíada during their internship. Experience Report: Part of the time, the students were stationed at the Regulation Center, in a space specifically reserved for Medical Regulation, dedicated to handling calls already directed and triaged to the emergency number 192. At other times, the students participated in theoretical-practical classes covering the main topics of pre-hospital care, and when possible and necessary, they would go out in an ambulance to provide assistance to victims within the municipality. Thus, the students had the opportunity to refine their actions in urgent and emergency situations with patients, particularly through a more succinct and objective approach. Discussion: The service environment was distinct from university hospitals or specialty outpatient clinics to which the students were more accustomed, as the current setting was much more dynamic. It provided the students with the opportunity to hone their communication and leadership skills, crisis management, as well as to revisit and refine essential topics for their profession, whether as a general practitioner or an emergency physician. All of this occurred in a supportive environment provided by the teachers and SAMU workers who supervised them, enhancing the students’ appreciation for these days. Conclusion: The weeks spent in the service were reported by the students as extremely valuable, allowing them to contemplate the challenges faced by the workers in the field on a daily basis. Moreover, it promoted the perception of the Mobile Emergency Care Service as a potential career path for these university students in the near future, in addition to aiding in the enhancement of medical knowledge and the training of soft skills for those involved.

The effect of a team-based service model on treatment processes and outcomes and healthcare usage among people with type 2 diabetes in North Karelia, Finland.

In North Karelia, Finland, a team-based service model was implemented in primary healthcare (PHC) during 2020. In this model, a healthcare customer contacts a nurse who initiates the service process immediately, possibly consulting or directing customers to other professionals. The effect of this new service model among patients with type 2 diabetes (T2D) was assessed. Data from T2D patients diagnosed by 2016 and still residing in North Karelia in 2023 (N = 6312) were extracted from electronic health records. Diabetes-related contacts with nurses or physicians in PHC and specialised healthcare (SHC) were considered, along with emergency care contacts, measurement activity and levels of glycated haemoglobin (HbA1c) and low-density lipoproteins (LDL) between 2017 and 2022. Annual differences between areas were analysed using logistic and Poisson mixed models. The team-based service model increased T2D-related PHC remote contacts with nurses for a couple of years, but eventually they decreased to a lower level than before. Additionally, the number of other contacts reduced. It had no effect on measurement activity or treatment levels of HbA1c and LDL. The team-based service model might reduce the number of healthcare contacts among T2D patients, but more evidence is needed on its effectiveness and cost-effectiveness.

Experience at the Mobile Emergency Care Service during internship: an experience report

RESUMO Introdução: Este estudo tem como objetivo relatar as experiências vividas no Serviço de Atendimento Móvel de Urgência (SAMU) da cidade de Santos, no estado de São Paulo, no Brasil, pelos alunos do quinto ano de Medicina do Centro Universitário Lusíada durante o estágio no internato. Relato de experiência: Parte do tempo, os discentes ficavam na Central de Regulação, em um espaço reservado especificamente para a regulação médica, destinada para atender às ligações já triadas e direcionadas ao número 192. Em outros momentos, os acadêmicos tinham aulas teórico-práticas sobre os principais tópicos do atendimento pré-hospitalar e, quando possível e demandado, saíam de ambulância para prestar socorro às vítimas no município. Assim, os alunos tinham chance de lapidar suas ações na urgência e emergência com os pacientes, principalmente em uma abordagem mais sucinta e objetiva. Discussão: O serviço era diferente dos hospitais universitários ou do ambulatório de especialidades aos quais os estudantes estavam mais habituados, pois o atual meio era bem mais dinâmico, proporcionando aos discentes a chance de treinar suas habilidades de comunicação, liderança, manejo de crises, assim como relembrar e lapidar temas fundamentais para a profissão, seja de um médico generalista ou emergencista. Tudo isso ocorreu em um cenário acolhedor proporcionado pelos professores e trabalhadores do SAMU que ficaram supervisionando e maximizando o gosto dos acadêmicos por esses dias. Conclusão: As semanas passadas no serviço foram consideradas extremamente proveitosas pelos alunos, pois esse período proporcionou contemplações dos desafios que os trabalhadores do local enfrentam no dia a dia. Essa vivência também promoveu a percepção do SAMU como um possível vínculo empregatício na vida daqueles universitários em um futuro próximo, além de auxiliar no aprimoramento de saberes na área médica e no treinamento de soft skills dos que lá estavam.

Same-day emergency care: a retrospective observational study of the incidence and predictors of venous thromboembolism following hospital-based acute ambulatory medical care.

Same-day emergency care (SDEC) is an expanding area of hospital acute medical care. It aims to minimize delays and manage medical emergency patients within the same day, enabling hospitalization to be avoided; the expectation is that the patients would have required inpatient hospitalization in the absence of the SDEC service. Venous thromboembolism (VTE) prevention is a key medical inpatient safety measure. Whether VTE prevention should be considered for SDEC patients is unknown. To examine the incidence and predictors of VTE diagnosed within 90 days of SDEC assessment. Data were obtained from electronic health records of people who received SDEC at our hospital during a 5-year period (April 2016 to March 2021). There were 40 045 attendance episodes by 33 715 individuals. Median age was 60 years (IQR, 41.0-76.0 years), and 55.2% were women. Three hundred forty-nine patients (0.9%) developed a VTE within 90 days of SDEC. Increased risk of VTE was associated with age more than 60 years, prior malignancy (adjusted odds ratio [OR], 4.12; 95% CI, 3.19-5.32; P< .0001), history of diseases of the circulatory system (adjusted OR, 2.92; 95% CI, 2.27-3.76; P< .0001), and having 1 or more additional SDEC attendances within 30 days (adjusted OR, 4.61; 95% CI, 3.65-5.82; P< .0001). In the 90 days prior to VTE diagnosis, 36.6% of patients had a separate inpatient admission in addition to SDEC. There was no association with completion of an electronic VTE risk assessment (adjusted OR, 0.96; 95% CI, 0.76-1.20). The incidence of VTE following SDEC is similar to that reported for symptomatic VTE in traditional medical inpatients without thromboprophylaxis.