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[PMID]:29268641
[Au] Autor:Junge JH; Sieber T; Hugentobler-Campell B
[Ad] Endereço:1 Departement Anästhesie, Notfall, Intensiv, Rettung, Kantonsspital Graubünden, Chur.
[Ti] Título:Präklinische Notfallmedizin..
[So] Source:Ther Umsch;74(7):399-404, 2017.
[Is] ISSN:0040-5930
[Cp] País de publicação:Switzerland
[La] Idioma:ger
[Mh] Termos MeSH primário: Cuidados Críticos/métodos
Estado Terminal/terapia
Serviços Médicos de Emergência/métodos
Medicina de Emergência/métodos
[Mh] Termos MeSH secundário: Medicina Baseada em Evidências
Seres Humanos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171223
[St] Status:MEDLINE
[do] DOI:10.1024/0040-5930/a000932


  2 / 11761 MEDLINE  
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[PMID]:28454768
[Au] Autor:Kotkowski K; Ellison RT; Barysauskas C; Barton B; Allison J; Mack D; Finberg RW; Reznek M
[Ad] Endereço:Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA. Electronic address: kevin.kotkowski@umassmemorial.org.
[Ti] Título:Association of hospital contact precaution policies with emergency department admission time.
[So] Source:J Hosp Infect;96(3):244-249, 2017 Jul.
[Is] ISSN:1532-2939
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Contact precautions are a widely accepted strategy to reduce in-hospital transmission of meticillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). However, these practices may have unintended deleterious effects on patients. AIM: To evaluate the effect of a modification in hospital-wide contact precaution practices on emergency department (ED) admission times. METHODS: During the study period, the hospital changed its contact precaution policy from requiring contact precautions for all patients with a history of MRSA or VRE to only those who presented with clinical conditions likely to contaminate the environment with pathogens. An interrupted time series analysis of ED admission times for adults for one year preceding and one year following this change was performed at a two-campus hospital. The main outcome was admission time, defined as time from decision to admit to arrival in an inpatient bed, for patients with MRSA or VRE compared with all other patients. The in-hospital MRSA and VRE acquisition rates were evaluated over the same period and have been published previously. FINDINGS: At one campus, admission time decreased immediately by 161min for MRSA patients (P=0.008) and 135min for VRE patients (P=0.003), and both continued to decrease over the duration of the study. There was no significant change in admission time at the second campus. CONCLUSIONS: Modifying contact precaution requirements for MRSA and VRE may be associated with improved ED admission time without significantly altering in-hospital MRSA and VRE acquisition.
[Mh] Termos MeSH primário: Infecção Hospitalar/prevenção & controle
Medicina de Emergência/métodos
Infecções por Bactérias Gram-Positivas/diagnóstico
Controle de Infecções/métodos
Staphylococcus aureus Resistente à Meticilina/isolamento & purificação
Admissão do Paciente
Enterococos Resistentes à Vancomicina/isolamento & purificação
[Mh] Termos MeSH secundário: Adulto
Portador Sadio/diagnóstico
Serviço Hospitalar de Emergência
Hospitais
Seres Humanos
Política Organizacional
Estudos Retrospectivos
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE


  3 / 11761 MEDLINE  
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[PMID]:29169593
[Au] Autor:Tosti R; Eberlin KR
[Ad] Endereço:Department of Orthopedic Surgery, The Philadelphia Hand Center, Sidney Kimmel Medical College, Thomas Jefferson University, 834 Chestnut Street Suite G114, Philadelphia, PA 19107, USA.
[Ti] Título:"Damage Control" Hand Surgery: Evaluation and Emergency Management of the Mangled Hand.
[So] Source:Hand Clin;34(1):17-26, 2018 02.
[Is] ISSN:1558-1969
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Mangled hand injuries are defined as those with significant damage to multiple structures, which may be limb threatening. Historically these injuries resulted in amputation or death, but modern surgical and perioperative advances allow for complex reconstruction and the possibility of a sensate and functional limb. Evaluation begins with surveying for life-threatening injuries followed by a systematic approach to identify injured structures; management begins with preserving all parts, minimizing warm ischemia time, performing débridement, and planning an operative approach to optimize the chance of a functional limb. With careful surgical planning and a well-executed reconstruction, most limbs can be salvaged.
[Mh] Termos MeSH primário: Traumatismos da Mão/cirurgia
[Mh] Termos MeSH secundário: Amputação
Antibacterianos/uso terapêutico
Medicina de Emergência
Seres Humanos
Traumatismos dos Nervos Periféricos/cirurgia
Cuidados Pós-Operatórios
Reimplante
Terapia de Salvação
Retalhos Cirúrgicos
Traumatismos dos Tendões/cirurgia
Lesões do Sistema Vascular/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180303
[Lr] Data última revisão:
180303
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171125
[St] Status:MEDLINE


  4 / 11761 MEDLINE  
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[PMID]:28450467
[Au] Autor:Germini F; Marcucci M; Fedele M; Galli MG; Mbuagbaw L; Salvatori V; Veronese G; Worster A; Thabane L
[Ad] Endereço:Department of Emergency, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milano, Italy.
[Ti] Título:Quality of reporting in abstracts of RCTs published in emergency medicine journals: a protocol for a systematic survey of the literature.
[So] Source:BMJ Open;7(4):e014981, 2017 04 27.
[Is] ISSN:2044-6055
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: The quality of reporting of abstracts of randomised controlled trials (RCTs) in major general medical journals and in some category-specific journals was shown to be poor before the publication of the ConsolidatedStandards of ReportingTrials (CONSORT) extension for abstracts in 2008, and an improvement in the quality of reporting of abstracts was observed after its publication. The effect of the publication of the CONSORT extension for abstracts on the quality of reporting of RCTs in emergency medicine journals has not been studied. In this paper, we present the protocol of a systematic survey of the literature, aimed at assessing the quality of reporting in abstracts of RCTs published in emergency medicine journals and at evaluating the effect of the publication of the CONSORT extension for abstracts on the quality of reporting. METHODS AND ANALYSIS: The Medline database will be searched for RCTs published in the years 2005-2007 and 2014-2015 in the top 10 emergency medicine journals, according to their impact factor. Candidate studies will be screened for inclusion in the review. Exclusion criteria will be the following: the abstract is not available, they are published only as abstracts, still recruiting, or duplicate publications. The study outcomes will be the overall quality of reporting (number of items reported) according to the CONSORT extension and the compliance with its individual items. Two independent reviewers will screen each article for inclusion and will extract data on the CONSORT items and on other variables, which can possibly affect the quality of reporting. ETHICS AND DISSEMINATION: This is a library-based study and therefore exempt from research ethics board review. The review results will be disseminated through abstract submission to conferences and publication in a peer-reviewed biomedical journal.
[Mh] Termos MeSH primário: Medicina de Emergência
Publicações/normas
Ensaios Clínicos Controlados Aleatórios como Assunto/normas
Relatório de Pesquisa/normas
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1136/bmjopen-2016-014981


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Registro de Ensaios Clínicos
Registro de Ensaios Clínicos
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[PMID]:29233854
[Au] Autor:Mohan D; Farris C; Fischhoff B; Rosengart MR; Angus DC; Yealy DM; Wallace DJ; Barnato AE
[Ad] Endereço:Scaife Hall, 3550 Terrace St, University of Pittsburgh, Pittsburgh, PA 15261, USA.
[Ti] Título:Efficacy of educational video game versus traditional educational apps at improving physician decision making in trauma triage: randomized controlled trial.
[So] Source:BMJ;359:j5416, 2017 12 12.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To determine whether a behavioral intervention delivered through a video game can improve the appropriateness of trauma triage decisions in the emergency department of non-trauma centers. DESIGN: Randomized clinical trial. SETTING: Online intervention in national sample of emergency medicine physicians who make triage decisions at US hospitals. PARTICIPANTS: 368 emergency medicine physicians primarily working at non-trauma centers. A random sample (n=200) of those with primary outcome data was reassessed at six months. INTERVENTIONS: Physicians were randomized in a 1:1 ratio to one hour of exposure to an adventure video game (Night Shift) or apps based on traditional didactic education (myATLS and Trauma Life Support MCQ Review), both on iPads. Night Shift was developed to recalibrate the process of using pattern recognition to recognize moderate-severe injuries (representativeness heuristics) through the use of stories to promote behavior change (narrative engagement). Physicians were randomized with a 2×2 factorial design to intervention (game traditional education apps) and then to the experimental condition under which they completed the outcome assessment tool (low high cognitive load). Blinding could not be maintained after allocation but group assignment was masked during the analysis phase. MAIN OUTCOME MEASURES: Outcomes of a virtual simulation that included 10 cases; in four of these the patients had severe injuries. Participants completed the simulation within four weeks of their intervention. Decisions to admit, discharge, or transfer were measured. The proportion of patients under-triaged (patients with severe injuries not transferred to a trauma center) was calculated then (primary outcome) and again six months later, with a different set of cases (primary outcome of follow-up study). The secondary outcome was effect of cognitive load on under-triage. RESULTS: 149 (81%) physicians in the game arm and 148 (80%) in the traditional education arm completed the trial. Of these, 64/100 (64%) and 58/100 (58%), respectively, completed reassessment at six months. The mean age was 40 (SD 8.9), 283 (96%) were trained in emergency medicine, and 207 (70%) were ATLS (advanced trauma life support) certified. Physicians exposed to the game under-triaged fewer severely injured patients than those exposed to didactic education (316/596 (0.53) 377/592 (0.64), estimated difference 0.11, 95% confidence interval 0.05 to 0.16; P<0.001). Cognitive load did not influence under-triage (161/308 (0.53) 155/288 (0.54) in the game arm; 197/300 (0.66) 180/292 (0.62) in the traditional educational apps arm; P=0.66). At six months, physicians exposed to the game remained less likely to under-triage patients (146/256 (0.57) 172/232 (0.74), estimated difference 0.17, 0.09 to 0.25; P<0.001). No physician reported side effects. The sample might not reflect all emergency medicine physicians, and a small set of cases was used to assess performance. CONCLUSIONS: Compared with apps based on traditional didactic education, exposure of physicians to a theoretically grounded video game improved triage decision making in a validated virtual simulation. Though the observed effect was large, the wide confidence intervals include the possibility of a small benefit, and the real world efficacy of this intervention remains uncertain. TRIAL REGISTRATION: clinicaltrials.gov; NCT02857348 (initial study)/NCT03138304 (follow-up).
[Mh] Termos MeSH primário: Aplicativos Móveis/utilização
Médicos/estatística & dados numéricos
Triagem/métodos
Jogos de Vídeo/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Tomada de Decisões
Tomada de Decisões Assistida por Computador
Medicina de Emergência/normas
Serviço Hospitalar de Emergência/normas
Feminino
Heurística
Seres Humanos
Masculino
Meia-Idade
Aplicativos Móveis/estatística & dados numéricos
Avaliação de Resultados (Cuidados de Saúde)
Centros de Traumatologia/normas
[Pt] Tipo de publicação:CLINICAL TRIAL; COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171214
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j5416


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[PMID]:28454548
[Au] Autor:Khan Y; Sanford S; Sider D; Moore K; Garber G; de Villa E; Schwartz B
[Ad] Endereço:Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, Canada, M5G 1V2. yasmin.khan@oahpp.ca.
[Ti] Título:Effective communication of public health guidance to emergency department clinicians in the setting of emerging incidents: a qualitative study and framework.
[So] Source:BMC Health Serv Res;17(1):312, 2017 04 28.
[Is] ISSN:1472-6963
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Evidence to inform communication between emergency department clinicians and public health agencies is limited. In the context of diverse, emerging public health incidents, communication is urgent, as emergency department clinicians must implement recommendations to protect themselves and the public. The objectives of this study were to: explore current practices, barriers and facilitators at the local level for communicating public health guidance to emergency department clinicians in emerging public health incidents; and develop a framework that promotes effective communication of public health guidance to clinicians during emerging incidents. METHODS: A qualitative study was conducted using semi-structured interviews with 26 key informants from emergency departments and public health agencies in Ontario, Canada. Data were analyzed inductively and the analytic approach was guided by concepts of complexity theory. RESULTS: Emergent themes corresponded to challenges and strategies for effective communication of public health guidance. Important challenges related to the coordination of communication across institutions and jurisdictions, and differences in work environments across sectors. Strategies for effective communication were identified as the development of partnerships and collaboration, attention to specific methods of communication used, and the importance of roles and relationship-building prior to an emerging public health incident. Following descriptive analysis, a framework was developed that consists of the following elements: 1) Anticipate; 2) Invest in building relationships and networks; 3) Establish liaison roles and redundancy; 4) Active communication; 5) Consider and respond to the target audience; 6) Leverage networks for coordination; and 7) Acknowledge and address uncertainty. The qualities inherent in local relationships cut across framework elements. CONCLUSIONS: This research indicates that relationships are central to effective communication between public health agencies and emergency department clinicians at the local level. Our framework which is grounded in qualitative evidence focuses on strategies to promote effective communication in the emerging public health incident setting and may be useful in informing practice.
[Mh] Termos MeSH primário: Comunicação
Comportamento Cooperativo
Medicina de Emergência
Saúde Pública
[Mh] Termos MeSH secundário: Medicina de Emergência/educação
Serviço Hospitalar de Emergência
Pesquisa sobre Serviços de Saúde
Seres Humanos
Relações Interprofissionais
Entrevistas como Assunto
Ontário
Pesquisa Qualitativa
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180117
[Lr] Data última revisão:
180117
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE
[do] DOI:10.1186/s12913-017-2220-5


  7 / 11761 MEDLINE  
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[PMID]:29219289
[Au] Autor:McCarthy J; Patel AP; Spain AE; Whitaker T
[Ti] Título:Crawl, Walk, Run: Various modalities can enhance and improve activity effectiveness.
[So] Source:JEMS;42(4):22-3, 2017 04.
[Is] ISSN:0197-2510
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Pessoal Técnico de Saúde/educação
Medicina de Emergência/educação
Treinamento por Simulação
[Mh] Termos MeSH secundário: Seres Humanos
Competência Profissional
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:171209
[St] Status:MEDLINE


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[PMID]:29215845
[Au] Autor:Berry S
[Ti] Título:#Millennials: A baby boomer compromises with Gen Y.
[So] Source:JEMS;42(2):66, 2017 02.
[Is] ISSN:0197-2510
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Pessoal Técnico de Saúde/educação
Medicina de Emergência/educação
Relação entre Gerações
Mentores
[Mh] Termos MeSH secundário: Seres Humanos
Senso de Humor e Humor como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:171208
[St] Status:MEDLINE


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[PMID]:29215831
[Au] Autor:Benoit JL; Widmeier KC; McMullan JT
[Ti] Título:Evaluating Research: Seven essential questions to evaluate clinical research.
[So] Source:JEMS;42(2):50-3, 2017 02.
[Is] ISSN:0197-2510
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Serviços Médicos de Emergência
Medicina de Emergência
Pesquisa
[Mh] Termos MeSH secundário: Difusão de Inovações
Seres Humanos
Revisão da Pesquisa por Pares
Publicações Periódicas como Assunto
Projetos de Pesquisa
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:171208
[St] Status:MEDLINE


  10 / 11761 MEDLINE  
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[PMID]:29215257
[Au] Autor:McCarthy J; Patel AP; Spain AE; Whitaker T
[Ti] Título:Starting Points: Integrating simulation into EMS education.
[So] Source:JEMS;42(2):20-3, 2017 02.
[Is] ISSN:0197-2510
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Serviços Médicos de Emergência
Auxiliares de Emergência/educação
Medicina de Emergência/educação
Treinamento por Simulação
[Mh] Termos MeSH secundário: Seres Humanos
Competência Profissional
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:171208
[St] Status:MEDLINE



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