Articles: emergency-medicine.
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Randomized Controlled Trial Multicenter Study
Adjusting Early Warning Score by clinical assessment: a study protocol for a Danish cluster-randomised, multicentre study of an Individual Early Warning Score (I-EWS).
Track and trigger systems (TTSs) based on vital signs are implemented in hospitals worldwide to identify patients with clinical deterioration. TTSs may provide prognostic information but do not actively include clinical assessment, and their impact on severe adverse events remain uncertain. The demand for prospective, multicentre studies to demonstrate the effectiveness of TTSs has grown the last decade. Individual Early Warning Score (I-EWS) is a newly developed TTS with an aggregated score based on vital signs that can be adjusted according to the clinical assessment of the patient. The objective is to compare I-EWS with the existing National Early Warning Score (NEWS) algorithm regarding clinical outcomes and use of resources. ⋯ The study was presented for the Regional Ethics committee who decided that no formal approval was needed according to Danish law (J.no. 1701733). The I-EWS study is a large prospective, randomised multicentre study that investigates the effect of integrating a clinical assessment performed by the nursing staff in a TTS, in a head-to-head comparison with the internationally used NEWS with the opportunity to use CROS.
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Multicenter Study
Diversity in Emergency Medicine: Are We Supporting a Career Interest in Emergency Medicine for Everyone?
Women and students underrepresented in medicine are less likely to apply for residency in emergency medicine. The latter are from racial or ethnic populations that are underrepresented as physicians relative to the general population. The factors that result in lower application rates from women and groups underrepresented in medicine are inadequately described in the literature. This study's objective was to test whether female students and those underrepresented in medicine have lower interest in emergency medicine even after controlling for academic ability, student indebtedness, and common career values consistent with emergency medicine career interest. ⋯ Female medical students and those underrepresented in medicine were less likely to plan for a career in emergency medicine. This correlation remained significant even when other previously identified factors that have predicted a career in emergency medicine were controlled for.
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Multicenter Study
What Emergency Medicine Rewards: Is There Implicit Gender Bias in National Awards?
Multiple studies have demonstrated a gender gap in the percentage of women recognized in national awards, but to our knowledge this gap has not been studied within emergency medicine. This study is designed to evaluate the presence of a gender gap in female representation in awards from national emergency medicine organizations in the United States and Canada. ⋯ Emergency medicine is unique among other specialties in that the percentage of women represented in national awards (28%) closely mirrors the overall representation of women in emergency medicine (27.6% in the United States, 31% in Canada). This is in contrast to the documented leadership gap in academic medicine and emergency medicine, which may reflect a lag time between receiving national awards and earning academic and professional promotion. Although some organizations had significantly lower representation of female awardees, the overall trends indicate that women have closed the gender gap in award representation. This may signal a forthcoming change in other domains with established gaps in emergency medicine; specifically, in leadership and pay.
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Multicenter Study
Procedural Experience With Intubation: Results From a National Emergency Medicine Group.
Although intubation is a commonly discussed procedure in emergency medicine, the number of opportunities for emergency physicians to perform it is unknown. We determine the frequency of intubation performed by emergency physicians in a national emergency medicine group. ⋯ These findings provide insights into the frequency with which emergency physicians perform intubations.
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Randomized Controlled Trial Multicenter Study Comparative Study
HVNI vs NIPPV in the treatment of acute decompensated heart failure: Subgroup analysis of a multi-center trial in the ED.
Managing respiratory failure (RF) secondary to acute decompensated heart failure (ADHF) with non-invasive positive-pressure ventilation (NIPPV) has been shown to significantly improve morbidity and mortality in patients presenting to the emergency department (ED). This subgroup analysis compares high-velocity nasal insufflation (HVNI), a form of high-flow nasal cannula, with NIPPV in the treatment of RF secondary to ADHF with respect to therapy failure, as indicated by the requirement for intubation or all-cause arm failure including subjective crossover to the alternate therapy. ⋯ In conclusion, this subgroup analysis suggests HVNI may be non-inferior to NIPPV in patients with respiratory failure secondary to ADHF that do not need emergent intubation.