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1.
Robert J. McLoughlin Jonathan Green Pradeep P. Nazarey Michael P. Hirsh Muriel Cleary Jeremy T. Aidlen 《The American journal of emergency medicine》2019,37(3):439-443
Purpose
In 2015, approximately 13,436 snowboarding or skiing injuries occurred in children younger than 15. We describe injury patterns of pediatric snow sport participants based on age, activity at the time of injury, and use of protective equipment.Methods
A retrospective analysis was performed of 10–17?year old patients with snow-sport related injuries at a Level-1 trauma center from 2005 to 2015. Participants were divided into groups, 10–13 (middle-school, MS) and 14–17?years (high-school, HS) and compared using chi-square, Student's t-tests, and multivariable logistic regression.Results
We identified 235 patients. The HS group had a higher proportion of females than MS (17.5% vs. 7.4%, p?=?0.03) but groups were otherwise similar. Helmet use was significantly lower in the HS group (51.6% vs. 76.5%, p?<?0.01). MS students were more likely to suffer any head injury (aOR 4.66, 95% CI: 1.70–12.8), closed head injury (aOR 3.69 95% CI: 1.37–9.99), or loss of consciousness (aOR 5.56 95% CI 1.76–17.6) after 4?pm. HS students engaging in jumps or tricks had 2.79 times the risk of any head injury (aOR 2.79 95% CI: 1.18–6.57) compared to peers that did not. HS students had increased risk of solid organ injury when helmeted (aOR 4.86 95% CI: 1.30–18.2).Conclusions
Injured high-school snow sports participants were less likely to wear helmets and more likely to have solid organ injuries when helmeted than middle-schoolers. Additionally, high-schoolers with head injuries were more like to sustain these injures while engaging in jumps or tricks. Injury prevention in this vulnerable population deserves further study.Level of evidence
Level III (Retrospective Comparative Study). 相似文献2.
Chrysovalantis Stafylis Claire C Bristow Lauren J Natoli Katheryn R Salow Emma Davidson Yancy Granados Mark McGrath Jeffrey D Klausner 《Diagnostic microbiology and infectious disease》2019,93(4):325-328
Introduction
Dual human immunodeficiency virus/syphilis rapid diagnostic devices can play an important role in prevention efforts. The field performance of the INSTI Multiplex HIV-1/HIV-2/Syphilis Antibody Test (Multiplex) was evaluated.Methods
Fingerstick whole blood was tested using the rapid test. A fourth-generation HIV laboratory assay and treponemal-specific laboratory assays were used as reference. Rapid plasma reagin (RPR) was used to stratify treponemal results. Sensitivity and specificity were calculated.Results
Overall, 274 patients participated. Sensitivity of the Multiplex for detection of HIV was 98.8% (95% CI, 93.4–100%), and specificity was 100% (95% CI, 98.1–100%). Sensitivity for detection of syphilis antibodies was 56.8% (95% CI, 44.7–68.2%), and specificity was 98.5% (95% CI, 95.7–99.7%). Sensitivity for treponemal antibodies improved with increasing RPR and was 100% (95% CI, 78.2–100%) among samples with RPR titers ≥1:8.Conclusions
The Multiplex showed excellent performance for detection of HIV antibodies and increasing sensitivity for detection of treponemal antibody with increasing RPR titer. 相似文献3.
Sameer Sharif Michelle Eventov Clive Kearon Sameer Parpia Meirui Li River Jiang Paula Sneath Carmen Otero Fuentes Christopher Marriott Kerstin de Wit 《The American journal of emergency medicine》2019,37(5):845-850
Background
Diagnosing pulmonary embolism (PE) in the emergency department (ED) can be challenging because its signs and symptoms are non-specific.Objective
We compared the efficacy and safety of using age-adjusted D-dimer interpretation, clinical probability-adjusted D-dimer interpretation and standard D-dimer approach to exclude PE in ED patients.Design/methods
We performed a health records review at two emergency departments over a two-year period. We reviewed all cases where patients had a D-dimer ordered to test for PE or underwent CT or VQ scanning for PE. PE was considered to be present during the emergency department visit if PE was diagnosed on CT or VQ (subsegmental level or above), or if the patient was subsequently found to have PE or deep vein thrombosis during the next 30?days. We applied the three D-dimer approaches to the low and moderate probability patients. The primary outcome was exclusion of PE with each rule. Secondary objective was to estimate the negative predictive value (NPV) for each rule.Results
1163 emergency patients were tested for PE and 1075 patients were eligible for inclusion in our analysis. PE was excluded in 70.4% (95% CI 67.6–73.0%), 80.3% (95% CI 77.9–82.6%) and 68.9%; (95% CI 65.7–71.3%) with the age-adjusted, clinical probability-adjusted and standard D-dimer approach. The NPVs were 99.7% (95% CI 99.0–99.9%), 99.1% (95% CI 98.3–99.5%) and 100% (95% CI 99.4–100.0%) respectively.Conclusion
The clinical probability-adjusted rule appears to exclude PE in a greater proportion of patients, with a very small reduction in the negative predictive value. 相似文献4.
Brian J. Yun Robert M. Rodriguez Anand M. Prabhakar David A. Peak DaMarcus E. Baymon Ali S. Raja 《The American journal of emergency medicine》2019,37(5):909-912
Introduction
Increased use of computed tomography (CT) during injury-related Emergency Department (ED) visits has been reported, despite increased awareness of CT radiation exposure risks. We investigated national trends in the use of chest CT during injury-related ED visits between 2012 and 2015.Methods
Analyzing injury-related ED visits from the 2012–2015 United States (U.S.) National Hospital Ambulatory Medical Care Survey (NHAMCS), we determined the percentage of visits that had a chest CT and the diagnostic yield of these chest CTs for clinically-significant findings. We used survey-weighted multivariable logistic regression to determine which patient and visit characteristics were associated with chest CT use.Results
Injury-related visits accounted for 30% of the 135 million yearly ED visits represented in NHAMCS. Of these visits, 817,480 (2%) received a chest CT over the study period. The diagnostic yield was 3.88%. Chest CT utilization did not change significantly from a rate of 1.73% in 2012 to a rate of 2.31% in 2015 (p?=?0.14). Multivariate logistic regression demonstrated increased odds of chest CT for patients seen by residents versus by attendings (adjusted odds ratio [AOR] 2.08, 95% confidence interval [CI] 1.41–3.08). Patients aged 18–59 and 60+ had higher AORs (5.75, CI 3.44–9.61 and 9.81, CI 5.90–16.33, respectively) than those <18?years of receiving chest CT.Conclusions
Overall chest CT utilization showed an increased trend from 2012 to 2015, but the results were not statistically significant. 相似文献5.
Richard B. Chow Andre Lee Bryan G. Kane Jeanne L. Jacoby Robert D. Barraco Stephen W. Dusza Matthew C. Meyers Marna Rayl Greenberg 《The American journal of emergency medicine》2019,37(3):457-460
Objective
We sought to evaluate the effectiveness of the “Timed Up and Go” (TUG) and the Chair test as screening tools in the Emergency Department (ED), stratified by sex.Methods
This prospective cohort study was conducted at a Level 1 Trauma center. After consent, subjects performed the TUG and the Chair test. Subjects were contacted for phone follow-up and asked to self-report interim falling.Results
Data from 192 subjects were analyzed. At baseline, 71.4% (n?=?137) screened positive for increased falls risk based on the TUG evaluation, and 77.1% (n?=?148) scored below average on the Chair test. There were no differences by patient sex.By the six-month evaluation 51 (26.6%) study participants reported at least one fall. Females reported a non-significant higher prevalence of falls compared to males (29.7% versus 22.2%, p?=?0.24). TUG test had a sensitivity of 70.6% (95% CI: 56.2%–82.5%), a specificity of 28.4% (95% CI: 21.1%–36.6%), a positive predictive (PP) value 26.3% (95% CI: 19.1%–34.5%) and a negative predictive (NP) value of 72.7% (95% CI: 59.0%–83.9%). Similar results were observed with the Chair test. It had a sensitivity of 78.4% (95% CI: 64.7%–88.7%), a specificity of 23.4% (95% CI: 16.7%–31.3%), a PP value 27.0% (95% CI: 20.1%–34.9%) and a NP value of 75.0% (95% CI: 59.7%–86.8%). No significant differences were observed between sexes.Conclusions
There were no sex specific significant differences in TUG or Chair test screening performance. Neither test performed well as a screening tool for future falls in the elderly in the ED setting. 相似文献6.
Shuzhen Wei Ting Wu Ying Wu Ding Ming Xiaoli Zhu 《Diagnostic microbiology and infectious disease》2019,93(4):339-345
Background
Candida albicans germ tube antibody (CAGTA) may be helpful as a marker for the diagnosis of invasive candidiasis (IC). However, the performance has been variable. We conducted a meta-analysis to assess the diagnostic accuracy of this assay for diagnosing IC.Method
We searched MEDLINE, EMBASE, Cochrane Collaboration databases, reference lists of retrieved studies, and review articles. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and a summary receiver-operating characteristic curve of CAGTA for diagnosing IC were pooled using meta-analysis.Results
A total of 976 patients (262 with proven or probable IC), included in 7 studies, were analyzed. The pooled sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratios and area under the curve were 66% (95% confidence interval [95% CI], 59% to 73%), 76% (95% CI, 58% to 88%), 2.8 (95% CI, 1.5 to 5.8), 0.44 (95% CI, 0.34 to 0.57), 6 (95% CI, 3 to 5), and 0.68 (95% CI, 0.64 to 0.72), respectively. Heterogeneity of specificity was significant.Conclusion
The diagnostic accuracy of the CAGTA assay is moderate for IC. Since the CAGTA assay is not absolutely sensitive and specific for IC, the CAGTA results should be interpreted in parallel with other biomarkers and clinical findings. 相似文献7.
Trauma team activation criteria and outcomes of geriatric trauma: 10 year single centre cohort study
Kevin Kei-ching Hung Janice H.H. Yeung Catherine S.K. Cheung Ling-yan Leung Raymond C.H. Cheng N.K. Cheung Colin A. Graham 《The American journal of emergency medicine》2019,37(3):450-456
Background
With the aging population, the number of older patients with multiple injuries is increasing. The aim of this study was to understand the patterns and outcomes of older patients admitted to a major trauma centre in Hong Kong from 2006 to 2015, and investigate the performance of the trauma team activation (TTA) criteria for these elderly patients.Methods
This was a retrospective cohort study from a university hospital major trauma centre in Hong Kong from 2006 to 2015. Patients aged 55 or above who entered the trauma registry were included. Patients were divided into those aged 55–70, and above 70. To test the performance of the TTA criteria, we defined injured patients with severe outcomes as those having any of the following: death within 30?days; the need for surgery; or the need for intensive care unit (ICU) care.Results
2218 patients were included over the 10?year period. The 30-day mortality was 7.5% for aged 55–70 and 17.7% for those aged above 70. The sensitivity of TTA criteria for identifying severe outcomes for those aged 55 or above was 35.6%, with 91.6% specificity. The under-triage rate was 59% for age 55–70, and 69.1% for those aged above 70.Conclusion
There is a need to consider alternative TTA criteria for our geriatric trauma population, and to more clearly define the process and standards of care in Hong Kong. 相似文献8.
Catherine A. Marco Robert P. Wahl James D. Thomas Ramon W. Johnson O. John Ma Anne L. Harvey Earl J. Reisdorff 《The American journal of emergency medicine》2019,37(5):859-863
Objective
The ABEM ConCert Examination is a summative examination that ABEM-certified physicians are required to pass once in every 10-year cycle to maintain certification. This study was undertaken to identify practice settings of emergency physicians, and to determine if there was a difference in performance on the 2017 ConCert between physicians of differing practice types and settings.Methods
This was a mixed methods cross sectional-study, using a post-examination survey and test performance data. All physicians taking the 2017 ConCert Examination who completed three survey questions pertaining to practice type, practice locations, and teaching were included. These three questions address different aspects of academia: self-identification, an academic setting, and whether the physician teaches.Results
Among 2796 test administrations of the 2017 ConCert Examination, 2693 (96.3%) completed the three survey questions about practice environment. The majority (N?=?2054; 76.3%) self-identified as primarily being a community physician, 528 (19.6%) as academic, and 111 (4.1%) as other. The average ConCert Examination score for community physicians was 83.5 (95% CI, 83.3–83.8); the academic group was 84.8 (95% CI, 84.3–85.3); and the other group was 82.3 (95% CI, 81.1–83.6). After controlling for initial ability as measured by the Qualifying Examination score, there was no significant difference in performance between academic and community physicians (p?=?.10).Conclusions
Academic emergency physicians and community emergency physicians scored similarly on the ConCert. Working at a community teaching hospital was associated with higher examination performance. Teaching medical learners, especially non-emergency medicine residents, was also associated with better examination performance. 相似文献9.
Lauren R. Klein Brian E. Driver Gabriella Horton Sarah Scharber Marc L. Martel Jon B. Cole 《The Journal of emergency medicine》2019,56(5):484-490
Background
Rapid treatment of agitation in the emergency department (ED) is critical to avoid injury to patients and providers. Treatment with intramuscular antipsychotics is often utilized, but there is a paucity of comparative effectiveness evidence available.Objective
The purpose of this investigation was to compare the effectiveness of droperidol, olanzapine, and haloperidol for treating agitation in the ED.Methods
This was a retrospective observational study of adult patients who received intramuscular medication to treat agitation. Patients were classified based on the initial antipsychotic they received. The primary effectiveness outcome was the rate of additional sedation administered (rescue medication) within 1 h. Secondary outcomes included rescue sedation for the entire encounter and adverse events.Results
There were 15,918 patients included (median age 37 years, 75% male). Rescue rates at 1 h were: 547/4947 for droperidol (11%, 95% confidence interval [CI] 10–12%), 988/8825 olanzapine (11%, 95% CI 10–12%), and 390/2146 for haloperidol (18%, 95% CI 17–20%). Rescue rates for the entire ED encounter were: 832/4947 for droperidol (17%, 95% CI 16–18%), 1665/8825 for olanzapine (19%, 95% CI 18–20%), and 560/2146 for haloperidol (26%, 95% CI 24–28%). Adverse events were uncommon: intubation (49, 0.3%), akathisia (7, 0.04%), dystonia (5, 0.03%), respiratory arrest (1, 0.006%), and torsades de pointes (0), with no significant differences between drugs.Conclusions
Olanzapine and droperidol lead to lower rates of rescue sedation at 1 h and overall, compared with haloperidol. There were no significant differences in major adverse events. 相似文献10.
Jae Yun Jung Eun Mi Ham Hyuksool Kwon Young Ho Kwak Do Kyun Kim Jin Hee Lee Jin Hee Jung 《The American journal of emergency medicine》2019,37(3):468-471
Background
Coronary artery dilatation (CAD) is a great concern with Kawasaki disease (KD). This study aimed to investigate the relationship between serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and CAD in patients with the hyperacute phase (≤4?days of fever) of KD.Methods
Serum NT-proBNP levels were compared between patients with and those without CAD, who underwent transthoracic echocardiography (TTE) within 24?h of the hyperacute phase of KD in the pediatric emergency department (PED). Electronic medical records of patients aged 1?month to 15?years who visited the PED were retrospectively assessed from January 2010 to December 31, 2014.Results
One hundred nine patients were enrolled in the study. Twenty-three of those patients had CAD within 24?h of TTE. Median serum NT-proBNP levels were significantly higher in patients with CAD (824.1?pg/ml; interquartile range [IQR], 515.4–1570.0184.8–767.8?pg/ml) than in patients without CAD (396.4?pg/ml; IQR, 184.8–767.8?pg/ml) (p?≤?0.001). The cutoff value of serum NT-proBNP, which predicted CAD during the hyperacute phase of KD, was 515.4?pg/ml, which yielded sensitivity of 78.26% and specificity of 61.63%. The area under the curve for NT-proBNP for predicting CAD during hyperacute KD was 0.749 (95% CI, 0.642–0.856).Conclusion
Serum NT-proBNP might be an additional laboratory marker for detecting early CAD during the hyperacute phase of KD in the PED. 相似文献11.
Edmond A. Hooker Peter J. Mallow Michelle M. Oglesby 《The Journal of emergency medicine》2019,56(3):344-351
Background
It is important that policy makers, health administrators, and emergency physicians have up-to-date statistics on the most common diagnoses of patients seen in the emergency department (ED).Objectives
We sought to describe the changes that occurred in ED visits from 2010 through 2014 and to describe the frequency of different ED diagnoses.Methods
This is a retrospective analysis of ED visit data from the National Emergency Department Sample from 2010 through 2014. Visits were stratified by age, sex, insurance status, disposition, diagnosis, and diagnostic category. We calculated the total annual ED visits and the ED visit rates by diagnoses and diagnostic categories.Results
Between 2010 and 2014, the number of U.S. ED visits increased from 128.9 million to 137.8 million. The rate of ED Visits per 1000 persons increased from 416.92 (95% confidence interval [CI] 399.47–434.37) in 2010 to 432.51 (95% CI 411.51–453.61) in 2014 (p = 0.0136). ED visits grew twice as quickly (1.7%) as the overall population (0.7%). The most common reason for an ED visit was abdominal pain (11.75% [95% CI 11.61–11.89]). This was followed by mental health problems (4.45% [95% CI 4.19–4.72]).Conclusion
The number of ED visits in the United States continues to increase faster than the rate of population growth. Abdominal problems and mental health issues, including substance abuse, were the most common reasons for an ED visit in 2014. 相似文献12.
Jonathan D. Auten John H. Naheedy Nicole D. Hurst Andrew T. Pennock Kathryn A. Hollenbach John T. Kanegaye 《The American journal of emergency medicine》2019,37(5):832-838
Objective
Emergency department (ED) reduction of pediatric fractures occurs most commonly in the forearm and can be challenging if fluoroscopy is not available. We sought to assess the ability of point of-care ultrasonography (POCUS) to predict adequacy of reduction by fluoroscopy.Methods
We prospectively enrolled ED patients 0–17?years of age with radial and/or ulnar fractures requiring reduction under fluoroscopic guidance. Post-reduction POCUS (probe dorsal, volar, and coronal) and fluoroscopic (AP and lateral) fracture images were recorded. Fracture angles were compared between blinded POCUS and fluoroscopic measurements and between POCUS measurements by a blinded emergency physician and a blinded radiologist, reporting mean differences and 95% confidence intervals. We calculated sensitivity, specificity, and likelihood ratios of POCUS in the prediction of fluoroscopically detected post-reduction malalignment, as interpreted by a blinded pediatric orthopaedist.Results
The 58 patients were 7.9?±?3.5?years of age and had 21 radial (36%), 1 ulnar (2%), and 36 radioulnar (62%) fractures. Fluoroscopy and POCUS angles were within a mean of 0.1°–3.2°, depending on the site and surface measured. Radiologist- and emergency physician-interpreted POCUS measurements were within a mean of 1° in all dimensions. POCUS identified inadequate reductions with 100% sensitivity and 92–93% specificity.Conclusions
Blinded emergency medicine and radiology interpretations of post-reduction POCUS fracture images agree closely. Post-reduction POCUS measurements are comparable to those obtained by fluoroscopy and accurately predict adequacy of reduction. POCUS can be used to guide pediatric fracture reduction when bedside fluoroscopy is not available in the ED. 相似文献13.
Objective
To determine whether prehospital point-of-care lactate (pLA) is associated with mortality, admission, and duration of hospital stay.Design
A retrospective clinical audit, where elevated lactate was defined as ≥2 mmol/L.Setting
The ambulance service and primary referral hospital in the Australian Capital Territory from 1st July 2014 to 30th June 2015.Participants
Adult patients (≥18 years) who had pLA measured and were transported to the primary referral hospital.Main outcome measures
Mortality, admission, and duration of hospital stay.Results
Two hundred fifty-three patients with a median pLA of 2.5 mmol/L (interquartile range [IQR]: 1.5–3.7) were analysed. Overall mortality was 8.3%; 68% were admitted to the hospital; 8.3% to the intensive care unit (ICU). pLA was non-significantly higher in those who died compared to survivors (3.5 [IQR: 2.75–5.85] vs 2.4 [1.5–3.6]; W = 1631.5; p = 0.053). pLA was higher for those admitted to the hospital (2.9 [1.9–3.9] vs 2.0 [1.4–3.1]; W = 5094.5, p = 0.001) and the ICU (3.2 [2.4–5.7] vs 2.4 [1.5–3.6]; W = 1578.5; p = 0.008). There was no relationship between pLA and duration of stay. Considered as a screening tool, at a cut-off of 2.5 mmol/L, pLA had a likelihood ratio+ of 1.61 for mortality and 1.44 for ICU admission; the odds ratio for mortality was 3.76 (95% confidence interval = 1.30, 13.89).Conclusions
Elevated prehospital lactate was associated with significantly increased ICU and hospital admissions. There may be value in pLA as a screening tool. 相似文献14.
Lina Patel Jeff Michael Lisa Schroeder Ashley K. Sherman Lisa Berglund Jason G. Newland 《The Journal of emergency medicine》2019,56(3):241-247
Background
Musculoskeletal (MSK) infections can be difficult to diagnose in acute care settings. The utility of clinical decision tools for pediatric MSK infections in an emergency department has not been well studied.Objective
Our aim was to evaluate the performance of a septic hip clinical decision rule (CDR) in the evaluation of pediatric musculoskeletal infections.Methods
We performed a retrospective study of children evaluated for an MSK infection in our emergency department from 2014 to 2016. Data collection included demographics, discharge diagnoses, and clinical/laboratory predictors from the CDR. A χ2 analysis and Wilcoxon rank-sum tests compared patients with and without MSK infections. Logistic regression analysis examined the predictors for MSK infections. A receiver operating characteristic (ROC) curve was calculated to evaluate the performance of the predictors.Results
Of 996 evaluations included in the final analysis, 109 (10.9%) had MSK infections. In a multivariable model, an adjusted odds ratio (OR) was significant for fever (OR 3.9, 95% confidence interval [CI] 2.4–6.4), refusal to bear weight/pseudoparalysis (OR 4.4, 95% CI 2.7–7.1), and C-reactive protein (CRP) > 2.0 mg/dL (OR 5.4, 95% CI 3.2–9.1). The probability of infection was 75.1% with five predictors present, 1.9% for zero predictors, and 5.1% if one predictor was present. An ROC curve showed an area under the curve of 0.82, indicating moderate accuracy.Conclusions
A septic hip CDR demonstrates a low predicted probability of an MSK infection with zero or one clinical predictor present and moderate predictability with all five predictors. Fever, refusal to bear weight/pseudoparalysis, and CRP > 2.0 mg/dL performed best and should alert providers to consider other MSK infections in addition to septic arthritis. 相似文献15.
Kiran Satpute Toby Hall Richa Bisen Pramod Lokhande 《Archives of physical medicine and rehabilitation》2019,100(5):828-836
Objectives
To evaluate the effect of spinal mobilization with leg movement (SMWLM) on low back and leg pain intensity, disability, pain centralization, and patient satisfaction in participants with lumbar radiculopathy.Design
A double-blind randomized controlled trial.Setting
General hospital.Participants
Adults (N=60; mean age 44y) with subacute lumbar radiculopathy.Interventions
Participants were randomly allocated to receive SMWLM, exercise and electrotherapy (n=30), or exercise and electrotherapy alone (n=30). All participants received 6 sessions over 2 weeks.Main Outcome Measures
The primary outcomes were leg pain intensity and Oswestry Disability Index score. Secondary variables were low back pain intensity, global rating of change (GROC), straight leg raise (SLR), and lumbar range of motion (ROM). Variables were evaluated blind at baseline, post-intervention, and at 3 and 6 months of follow-up.Results
Significant and clinically meaningful improvement occurred in all outcome variables. At 2 weeks the SMWLM group had significantly greater improvement than the control group in leg pain (MD 2.0; 95% confidence interval [95% CI], 1.4-2.6) and disability (MD 3.9; 95% CI, 5.5-2.2). Similarly, at 6 months, the SMWLM group had significantly greater improvement than the control group in leg pain (MD 2.6; 95% CI, 1.9-3.2) and disability (MD 4.7; 95% CI, 6.3-3.1). The SMWLM group also reported greater improvement in the GROC and in SLR ROM.Conclusion
In patients with lumbar radiculopathy, the addition of SMWLM provided significantly improved benefits in leg and back pain, disability, SLR ROM, and patient satisfaction in the short and long term. 相似文献16.
Objective
To determine factors that influence the nurses’ performance in family nursing care in public health centers in Jambi City.Method
A cross-sectional study was conducted from April to October 2016 using questionnaire with public health nurses as participants. The survey included questions on knowledge, attitude, self-confidence, motivation, personality, and nurses’ performance in family nursing care, and was completed by 114 nurses. Data analyses used for this study were chi-square test and logistic regression.Results
The factors affecting the nurses’ performance in family nursing care were attitudes (p 0.003; 95% CI 1.583–9.823), motivation (p 0.002; 95% CI 1.672–9.972), and personality (p 0.005; 95% CI 1.466–8.830).Conclusions
Need efforts to improve the attitude, motivation, and personality of nurses in providing family nursing care, such as training, supervision, and rewards. 相似文献17.
Charmaine L. Blanchard Oluwatosin Ayeni Daniel S. O&#x;Neil Holly G. Prigerson Judith S. Jacobson Alfred I. Neugut Maureen Joffe Keletso Mmoledi Mpho Ratshikana-Moloko Paul E. Sackstein Paul Ruff 《Journal of pain and symptom management》2019,57(5):923-932
Context
Identifying factors that affect terminally ill patients' preferences for and actual place of death may assist patients to die wherever they wish.Objective
The objective of this study was to investigate factors associated with preferred and actual place of death for cancer patients in Johannesburg, South Africa.Methods
In a prospective cohort study at a tertiary hospital in Johannesburg, South Africa, adult patients with advanced cancer and their caregivers were enrolled from 2016 to 2018. Study nurses interviewed the patients at enrollment and conducted postmortem interviews with the caregivers.Results
Of 324 patients enrolled, 191 died during follow-up. Preferred place of death was home for 127 (66.4%) and a facility for 64 (33.5%) patients; 91 (47.6%) patients died in their preferred setting, with a kappa value of congruence of 0.016 (95% CI = ?0.107, 0.139). Factors associated with congruence were increasing age (odds ratio [OR]: 1.03, 95% CI: 1.00–1.05), use of morphine (OR: 1.87, 95% CI: 1.04–3.36), and wanting to die at home (OR: 0.44, 95% CI: 0.24–0.82). Dying at home was associated with increasing age (OR 1.03, 95% CI 1.00–1.05) and with the patient wishing to have family and/or friends present at death (OR 6.73, 95% CI 2.97–15.30).Conclusion
Most patients preferred to die at home, but most died in hospital and fewer than half died in their preferred setting. Further research on modifiable factors, such as effective communication, access to palliative care and morphine, may ensure that more cancer patients in South Africa die wherever they wish. 相似文献18.
Ping Lin Fangyu Shi Lei Wang Zong-An Liang 《The American journal of emergency medicine》2019,37(3):524-529
Introduction
The relationship between time of day and the clinical outcomes of patients with out-of-hospital cardiac arrest (OHCA) remains inconclusive. We undertook a meta-analysis to assess the available evidence on the relationship between nighttime and prognosis for patients with OHCA.Materials and methods
PubMed and EMBASE were searched through June 20, 2018, to identify all studies assessing the relationship between nighttime and prognosis for patients with OHCA. Random effects modes were used to estimate odds ratios (ORs) with 95% confidence intervals (CIs).Results
Eight observational studies met the inclusion criteria. Meta-analysis of 8 studies showed that compared with nighttime, the daytime OHCA patients had higher 1-month/in-hospital survival (OR, 1.25; 95% CI, 1.15–1.37; P?=?0.00), with high heterogeneity among the studies (I2?=?82.8%, P?=?0.00).Conclusions
Patients who experienced OHCA during the nighttime had lower 1-month/in-hospital survival than those with daytime OHCA. In addition to arrest event and pre-hospital care factors, patients' comorbidity and hospital-based care may also be responsible for lower survival at night. 相似文献19.
Sarah E. Reedman Roslyn N. Boyd Stewart G. Trost Catherine Elliott Leanne Sakzewski 《Archives of physical medicine and rehabilitation》2019,100(4):676-686
Objective
To determine the efficacy of a participation-focused therapy (ParticiPAte CP) on leisure-time physical activity goal performance and satisfaction and habitual physical activity (HPA) in children with CP.Design
Randomized waitlist-controlled trial.Setting
Home and community.Participants
Children classified at Gross Motor Function Classification System (GMFCS) levels I-III were recruited (n=37; 18 males; mean age ± SD, 10.0±1.4y) from a population-based register.Interventions
Participants were randomized to ParticiPAte CP (an 8-wk goal-directed, individualized, participation-focused therapy delivered by a physical therapist) or waitlist usual care.Main Outcome Measures
The primary outcome was Canadian Occupational Performance Measure. Accelerometers were worn for objective measurement of HPA (min/d moderate-to-vigorous physical activity [MVPA], sedentary time). Barriers to participation, community participation, and quality-of-life outcomes were also collected. Data were analyzed by intention-to-treat using generalized estimating equations.Results
ParticiPAte CP led to significant improvements in goal performance (mean difference [MD]=3.58; 95% confidence interval [95% CI], 2.19-4.97; P<.001), satisfaction (MD=1.87; 95% CI, 0.37-3.36, P=.014), and barriers to participation (MD=26.39; 95% CI, 6.13-46.67; P=.011) compared with usual care at 8 weeks. There were no between-group differences on minutes per day of MVPA at 8 weeks (MD=1.17; 95% CI, ?13.27 to 15.61; P=.874). There was a significant difference in response to intervention between participants who were versus were not meeting HPA guidelines at baseline (MD=15.85; 95% CI, 3.80-27.89; P<.0061). After ParticiPAte CP, low active participants had increased average MVPA by 5.98±12.16 minutes per day.Conclusion
ParticiPAte CP was effective at increasing perceived performance of leisure-time physical activity goals in children with CP GMFCS I-III by reducing modifiable barriers to participation. This did not translate into change in HPA on average; however, low active children may have a clinically meaningful response. 相似文献20.
David L. Murphy Thomas D. Rea Andrew M. McCoy Michael R. Sayre Carol E. Fahrenbruch Lihua Yin Benjamin A. Tonelli Aaron M. Joffe Steven H. Mitchell 《The American journal of emergency medicine》2019,37(5):937-941