Preventive Care in the Emergency Department: Should Emergency Departments Institute a Falls Prevention Program for Elder Patients? A Systematic Review

OBJECTIVE: To perform a systematic review of the emergency medicine literature to assess the appropriateness of an intervention to identify, counsel, and refer emergency department (ED) patients >64 years old who are at high risk for falls. METHODS: The systematic review was facilitated through the use of a structured template, a companion explanatory piece, and a grading and methodological scoring system based on published criteria for critical appraisal. A reference librarian did two PubMed searches using the following: ED visits, patients >64 years old, falls, high risk, and effectiveness of intervention. Emergency Medical Abstracts, Science Citation Index, and the Cochrane Collaboration database were searched. Two team members reviewed the abstracts and selected pertinent articles. References were screened for additional pertinent articles. RESULTS: Twenty-six articles were reviewed. None were ED-based primary or secondary falls prevention in older patients. One randomized controlled trial of an intervention to decrease subsequent falls in elder community-dwelling patients who presented with a fall showed a structured interdisciplinary approach significantly reducing the number of falls. Two ED-based studies showed it was possible to identify ED patients at risk for falls. CONCLUSIONS: Based on one randomized controlled trial demonstrating a significant reduction in the risk of further falls, the burden of suffering caused by falls, and other studies demonstrating the value of interventions to reduce the risk of falling, the authors recommend that EDs conduct research to evaluate the effectiveness of clinical interventions to identify, counsel, and refer ED patients >64 years old who are at high risk for an unintentional fall.     

Segway® Personal Transporter-Related Injuries: A Systematic Literature Review and Implications for Acute and Emergency Care

Background

The Segway® Personal Transporter? (SPT) is used widely as a means of transport for city sightseeing tours, law enforcement, and professionals working in large facilities and factories.

Do United States Medical Licensing Examination (USMLE) Scores Predict In-Training Test Performance for Emergency Medicine Residents?

Background: Residency selection committees commonly utilize USMLE scores as criteria to screen residency applicants. Objectives: The purpose of this study is to evaluate the relationship between United States Medical Licensing Examination (USMLE) and American Board of Emergency Medicine (ABEM) in-training examination scores (ITEs). Methods: In an Accreditation Council for Graduate Medical Education-accredited emergency medicine residency program, data were collected for this retrospective cohort study for the classes of 2002–2006. USMLE Step 1 and 2 scores and the ABEM ITEs were recorded for each post-graduate year (PGY) within the aforementioned time frame. Step 1 and 2 scores were compared to consecutive PGY ABEM ITEs to evaluate for an association. Results: There were 51 USMLE Step 1 and 39 Step 2 scores available for comparison with 153 ABEM ITEs. The mean USMLE Step 1 and Step 2 scores were 228.9 (range 197–252) and 228.4 (range 168–259), respectively. The mean in-training percentiles for the PGY 1, 2, and 3 years were 40.4, 68.3, and 81.7, respectively. The R-squared values for the Step 1 scores compared to the PGY 1, 2, and 3 years' ITEs were 0.25, 0.18, and 0.16, respectively. The R-squared values for Step 2 scores as compared to the ABEM ITEs for the PGY 1, 2, and 3 years were 0.43, 0.44, and 0.38, respectively. Residents who scored below 200 on either USMLE Step 1 or Step 2 had significantly lower mean ABEM ITEs than residents who scored above 200 (p < 0.05) and were 10-fold more likely than residents who scored above 220 to score below the 70^th percentile in their PGY3 ABEM ITE. Conclusions: USMLE Step 1 scores are mildly correlated and Step 2 scores are moderately correlated with ABEM ITEs. Scoring below 200 on either test is associated with significantly lower ABEM ITEs.     

The Impact of Burnout on Emergency Nurses’ Intent to Leave: A Cross-Sectional Survey

IntroductionEmergency nurses work in one of the busiest and most stressful departments in a hospital and, as such, may experience burnout more often than nurses working in other nursing units. This study examined the relationship among orientation, burnout (emotional exhaustion, depersonalization, and low sense of personal accomplishment), and intent to leave.MethodsA cross-sectional survey design was used. Emergency nurses who were members of the Emergency Nurses Association were invited to participate in an anonymous survey. The Maslach Burnout Inventory tool was used to explore emotional exhaustion, depersonalization, and sense of personal accomplishment. Emergency nurses’ intent to leave was assessed with the Turnover Intention Scale. A logistic regression analysis was used to investigate the odds of intent to leave for those who scored at or above versus below the median on each burnout subscale.ResultsThe findings revealed that a formal orientation enhanced emergency nurses’ sense of personal accomplishment and was associated with lower intent to leave. The odds of intent to leave were almost 9 times greater for participants with 5 or more years of experience, approximately 13 times greater for those with above-median emotional exhaustion, and more than 6 times lower for those with above-median sense of personal accomplishment.DiscussionEmotional exhaustion and low sense of personal accomplishment were key factors influencing emergency nurses’ intent to leave. Emergency nurse leaders may find that a formal orientation program enhances sense of personal accomplishment and decreases intent to leave. Creating work environments to help emergency nurses find joy in their work may be critical to work–life balance and staff retention.     

Health Care Professionals’ Knowledge and Attitudes Toward Physical Activity in Cancer Patients: A Systematic Review

ObjectivesThe purpose of this study was to, combine current available literature across health professionals to determine commonalities and differences between knowledge and attitudes of physical activity (PA) and its importance within the cancer population. It aimed to identify any gaps in the literature to inform future study directions to enhance PA participation and improve health outcomes and quality of life.Data SourcesDesign: systematic review. Data sources: Google Scholar, EBSCO, PubMed, Scopus, Web of Science. Inclusion criteria: survey-based studies specifically reporting PA levels for both cancer patients and survivors from the perspective of oncology health care professionals. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was used to guide this review. The initial search highlighted 15,342 articles and returned 190 articles with relevant titles, of which 20 met the eligibility criteria; 15.8% of cancer patients reported to meeting PA guidelines during treatment and 36.5% after treatment. On average 58.1% of health care professionals self-reported discussing PA with their cancer patients, with the average referral rate to an exercise specialist or rehabilitation program being 18.3%.ConclusionOnly a limited number of health care professionals are initiating a discussion about PA with their cancer patients. Some health care professionals reported limited knowledge of PA guidelines for cancer patients. Their own personal PA levels do not seem to be associated with whether they discuss PA with their patients. Common barriers to providing PA advice were experienced across all health care professions such as time, limited referral pathways, and patient interest. Future research should be carried out to substantiate these barriers and discover which strategies could be implemented to improve the levels of PA discussions and referrals within clinical practice.Implications for Nursing PracticeGiven the position nurses hold within the health care system, it would be beneficial to upskill and improve their understanding of PA and exercise as medicine for the cancer population. This has enormous potential that could enhance PA advice and boost referrals to exercise professionals improving the health and quality of life of the cancer population.     

SALIENT FINDINGS: A Potentially Groundbreaking Study on the Neuroscience of Hypnotizability,a Critical Review of Hypnosis’ Efficacy,and the Neurophysiology of Conversion Disorder

Three papers of special interest to researchers and clinicians alike have recently appeared in the general scientific and medical literatures. Two of these papers are original research studies that employ brain-imaging technologies, one using Magnetic Resonance Imaging (MRI), the other position emission tomography (PET). A third paper is a comprehensive review of the empirical findings on the clinical use of hypnosis in pediatric oncology. The research study using MRI technology is extraordinary, because it is the first to document differences in brain morphology between high hypnotizable and low hypnotizable individuals. Arguably, if its findings replicate, the study could be one of the most important developments in scientific hypnosis since the genesis of the Stanford scales 45 years ago. The PET study notes differences in brain activation during intentionally simulated and hypnotically experienced paralysis. The review article examines empirical work addressing the efficacy of hypnosis for procedural pain in pediatric oncology.     

Effect of Pain Education Interventions on Registered Nurses’ Pain Management: A Systematic Review and Meta-Analysis

ObjectivesThis review and meta-analysis aims to reveal how pain education interventions affect registered nurses’ pain management.DesignA systematic review and meta-analysisData sourcesPubMed, Scopus, CINAHL (EBSCOhost), and ERICReview methodsA systematic search of four electronic databases was conducted to identify relevant peer-reviewed English or Finnish-language articles published between 2008 and 2021. The review included a quality appraisal and a meta-analysis of articles providing group-level data before and after the intervention (n = 12). The methods followed the PRISMA guidelines.ResultsOverall, 23 articles met the inclusion criteria for the review, of which 15 were evaluated as good quality. Based on the articles on document audits (n = 10), pain education interventions reduced the risk of not receiving the best pain management by 40%, whereas based on the articles on patients’ experiences (n = 4), they reduced the risk by 25%. The study quality and design of these articles were considerably heterogenous.ConclusionsPain education study strategies varied widely among the included articles. These articles used multivariate interventions without systematization or sufficient opportunity to transfer the study protocols. It can be concluded that versatile pain nursing education interventions, as well as auditing of pain nursing and its documentation combined with feedback, can be effective to nurses in adapting pain management and assessment practices and increasing patient satisfaction. However, further research is required in this regard. In addition, well-designed, implemented, and reproducible evidence-based pain education intervention is required in the future.