Objectives The primary objective of this study was to determine whether consensuses on the definition of emergency physician professionalism exist within and among four different generations. Our secondary objective was to describe the most important characteristic related to emergency physician professionalism that each generation values. Methods We performed a cross-sectional survey study, using a card-sorting technique, at the emergency departments of two university-based medical centers in the United States. The study was conducted with 288 participants from February to November 2017. Participants included adult emergency department patients, emergency medicine supervising physicians, emergency medicine residents, emergency department nurses, and fourth- and second-year medical students who independently ranked 39 cards that represent qualities related to emergency physician professionalism. We used descriptive statistics, quantitative cultural consensuses and Spearman’s correlation coefficients to analyze the data. Results We found cultural consensuses on emergency physician professionalism in Millennials and Generation X overall, with respect for patients named the most important quality (eigenratio 5.94, negative competency 0%; eigenratio 3.87, negative competency 1.64%, respectively). There were consensuses on emergency physician professionalism in healthcare providers throughout all generations, but no consensuses were found across generations in the patient groups. Conclusions While younger generations and healthcare providers had consensuses on emergency physician professionalism, we found that patients had no consensuses on this matter. Medical professionalism curricula should be designed with an understanding of each generation’s values concerning professionalism. Future studies using qualitative methods across specialties, to assess definitions of medical professionalism in each generation, should be pursued.
ObjectiveTo examine the initial level of lactate to predict sustained return of spontaneous circulation (ROSC) in nontraumatic out-of-hospital cardiac arrest (OHCA) patients.Materials and methodsThis was a 30-month retrospective cohort study in an emergency department (ED) of a tertiary care hospital. The inclusion criteria were adult nontraumatic OHCA patients who came to the ED with ongoing chest compression. The primary outcome was initial serum lactate level at the ED to predict sustained ROSC in nontraumatic OHCA. Logistic regression was used to determine any association between sustained ROSC and significant variables.ResultsThere were 207 patients who met the inclusion criteria. Forty one percent of nontraumatic OHCA patients achieved sustained ROSC. The mean ± SD initial serum lactate in the ROSC group was lower than the non-ROSC group (12.0±4.8 vs 12.6±5), but without statistical significance. The significant factors to predict sustained ROSC were no underlying disease (adjusted odds ratio [aOR] 1.71, 95% CI 0.51–5.71, P=0.014), cardiac arrest in a public area (aOR 2.40, 95% CI 1.2–4.79, P=0.013), and witnessed arrest (aOR 2.39, 95% CI 1.26–4.52, P=0.008). The cut-off points of initial serum lactate to predict mortality at 24 and 48 hours after cardiopulmonary resuscitation were 9.1 (P=0.031) and 9.4 (P=0.049) mmol/L, respectively. Eleven survived to hospital discharge, and 54.5% had good neurological outcome without statistical significance (P=0.553). The significant variables and initial lactate levels were used to develop a scoring system which ranged from −4 to 11. The receiver operating characters curve indicated a cut-off point of 3.6 to predict ROSC with an area under the curve of 0.715.ConclusionThe initial serum lactate had no association with sustained ROSC and hospital discharge with good neurological outcome but can be used to predict 24- and 48-hour postresuscitation mortality in nontraumatic OHCA patients with initial serum lactate cut-off points of 9.1 and 9.4 mmol/L, respectively.
Objective. We aimed to identify factors affecting length of stay in the emergency department in patients who presented with abdominal pain. Methods. A retrospective cohort study was conducted from 1 January 2017 to 31 December 2017. The medical records were reviewed from 217 patients older than 15 years with the chief complaint of abdominal pain. The patients were divided into emergency department length of stay (EDLOS) < 4 hours and ≥4 hours. The two groups were compared in terms of baseline characteristics, physical examination, time of presenting, attending physicians, interdepartmental consultations, investigations, ED disposition, final diagnosis, and mortality. The significant factors affecting longer EDLOS were examined using univariate and multivariate analyses by logistic regression. Results. Factors affecting longer EDLOS were age ≥50 (odds ratio (OR) 3.17, 95% confidence interval (CI) 1.36–7.42), interdepartmental consultation ≥2 specialists (OR 71.82, 95% CI 5.67–909.51), blood testing ≥2 rounds (OR 85.6, 95% CI 4.22–1734.6), and ultrasonography (OR 8.28, 95% CI 1.84–37.26). Conclusion. The study found that the statistically significant factors that prolonged EDLOS in patients with the chief complaint of abdominal pain were age, rounds of blood test, interdepartmental consultation, and the need for ultrasonography.
Introduction The most common surgical condition in children is appendicitis. However, making a diagnosis can be difficult due to poor communication and difficulty in the physical examination. Objective This study aimed to determine the accurate clinical predictive factors for the diagnosis of appendicitis in children in the emergency department (ED). Methods A retrospective cohort study was conducted from January 2015 to December 2019. The electronic medical records were reviewed from 1043 pediatric patients younger than 15 years with the chief complaint of abdominal pain and were admitted to the ED during the study period. The patients were divided into either the appendicitis group or non-appendicitis group. The two groups were compared in terms of baseline characteristics, abdominal symptoms and signs, symptom durations, laboratory results, final diagnosis, treatment in the ED, ED disposition, morbidity, and mortality. The significant predictive factors for the diagnosis of appendicitis were examined using univariate and multivariate analyses by logistic regression. Results Predictive factors for the diagnosis of appendicitis in pediatric patients with abdominal pain were gradual increase in abdominal pain (odds ratio (OR) 3.38, 95% confidence interval (CI) 1.51–7.58), right lower quadrant abdominal tenderness (OR 21.07, 95% CI 9.12–48.67), presentation of peritoneal irritation signs (OR 12.57, 95% CI 5.28–29.92), and an absolute neutrophil count >75% (OR 4.68, 95% CI 2.3–9.51). The significant variables were used to develop a diagnostic predictive probability scoring system that ranged from 0.05 to 0.95. The receiver operating characteristic curve indicated a cut-off point of 0.089 to predict pediatric appendicitis with an area under the curve of 0.963. Conclusion The predictive factors for diagnosing appendicitis in children are useful in determining which children require surgical intervention. However, the clinical symptoms and physical examination of the abdomen continue to be the most important diagnostic tools for the diagnosis of appendicitis in children.
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