Focus: Sex and Gender Health: Patient Preference for Physician Gender in the Emergency Department

Despite historical gender bias against female physicians, few studies have investigated patients’ physician gender preference in the emergency department (ED) setting. We sought to determine if there is an association between ED patient demographics and physician gender preference. We surveyed patients presenting to an ED to determine association between patient demographics and patient physician gender preference for five ED situations: 1) ‘routine’ visit, 2) emergency visit, 3) ‘sensitive’ medical visit, 4) minor surgical/‘procedural’ visit, and 5) ‘bad news’ delivery. A total of 200 ED patients were surveyed. The majority of ED patients reported no physician gender preference for ‘routine’ visits (89.5 percent), ‘emergent’ visits (89 percent), ‘sensitive’ medical visits (59 percent), ‘procedural’ visits (89 percent) or when receiving ‘bad news’ (82 percent). In the setting of ‘routine’ visits and ‘sensitive’ medical visits, there was a propensity for same-sex physician preference.     

The biosecurity of on-farm mortality composting

Composting is a natural biological decomposition process that takes place under aerobic and thermophilic conditions. It can be used for the day-to-day management of mortalities on farms and for carcass disposal in emergency animal disease (EAD) outbreaks. In mortality composting, carcasses are placed in piles or bins together with supplemental carbon sources such as sawdust, litter, straw or wood shavings. Composting is particularly suitable for broiler-farm mortalities and litter. In the case of emergency disease outbreaks, composting can be conducted either inside or outside the poultry house following killing. Composting has been successfully employed for emergency disposal of carcasses in a few cases in North America, but research is lacking on the biosecurity of the process. Composting is a well-established pathogen reduction technology, but process management and heterogenous pile conditions pose particular challenges for validating the microbiological safety of mortality composting. This paper reviews the available information on the biosecurity of mortality composting, identifies potential sources of risk, and highlights emerging research needs. Reports to date of the use of composting in EAD outbreaks are also discussed.     

绕行急诊和直接呼叫120对基层医院胸痛中心急性ST段抬高型心肌梗死患者PCI救治的影响

目的:探讨绕行急诊、直接呼叫120能否缩短基层医院胸痛中心急性ST段抬高型心肌梗死患者急诊PCI的再灌注时间及改善短期预后。方法:回顾性分析自2016年11月至2018年12月邳州市人民医院胸痛中心连续收治的行急诊PCI治疗并符合入组标准的STEMI患者共405例,分为绕行急诊组198例(包括直接呼叫120转运组95例和网络医院转诊组105例)和非绕行急诊组207例,对比分析两组之间一般资料;PCI相关情况;救治质量指标:1.基线及24小时CKMB、cTnI、BNP、hs-CRP、PCT,2.术后30 min及发病24小时ST段回落率,3.术后1周心脏超声LVEF、LVDd,4.术后1周心率变异性时域指标SDNN,5.住院期间MACE事件及总MACE事件发生率,6.住院期间出血并发症,7.住院天数;救治时间指标:S2B时间、S2FMC时间、FMC2ECG时间、FMC2DAPT时间、FMC2B时间、FMC2B达标率、D2B时间、D2B达标率,并进一步对绕行急诊组进行亚组分析,对比分析直接呼叫120组及网络医院转诊组的相关指标。结果:1.绕行急诊组与非绕行急诊组相比,mini-GRACE评分较低,术中再灌注心律失常比例较高,24小时CKMB、cTnI、BNP、hs-CRP、PCT较低,术后30 min及24小时ST段回落率较高,术后1周LVEF较高、LVDd较小,术后1周SDNN较高,住院期间心力衰竭及总MACE事件发生率较低,S2B时间、FMC2ECG时间、FMC2DAPT时间、FMC2B时间、D2B时间较短,FMC2B达标率、D2B达标率高,具有统计学意义(P0.05)。2.直接呼叫120组与网络医院转诊组相比,24小时CKMB、cTnI、BNP、hs-CRP、PCT较低,术后1周LVEF较高、LVDd较小,术后1周SDNN较高,住院期间心力衰竭及总MACE事件发生率较低,S2B时间、FM2B时间较短,FMC2B达标率较高,具有统计学意义(P0.05)。结论:绕行急诊和直接呼叫120能缩短基层医院胸痛中心STEMI患者急诊PCI的救治时间,并能改善预后,对本地区及其他基层医院STEMI救治的规范化建设具有一定参考意义。     

急诊科护士正念度与心理弹性和职业倦怠的相关性分析

为了探讨急诊科护士正念度与心理弹性和职业倦怠的相关性,本研究采用整群抽样法对34名急诊科护士进行问卷调查,所有护士均接受一般状况调查表、五因子正念度问卷(FFMQ)、Conner-Davidson心理弹性量表(CD-RISC)简化版和职业倦怠问卷修订版(MBI-GS)调查。结果表明,急诊科护士情绪耗竭、去人性化、个人成就感的得分分别为(16.25±8.27)分、(16.84±9.17)分、(26.83±9.05)分。急诊科护士FFMQ得分(99.91±8.14)分,项目均分(2.56±0.57)分。急诊科护士CD-RISC得分(69.14±7.43)分,项目均分(2.77±0.54)分。初步结论表明,急诊科护士职业倦怠感严重,正念度与急诊科护士的心理弹性呈正相关,与职业倦怠感呈负相关,通过正念训练提高心理弹性可影响急诊科护士的职业倦怠感。     

Role of thromboelastography in clinical emergency trauma patients

This study aimed to investigate dynamic changes in thromboelastography (TEG) and evaluate its value for emergency trauma patients. TEG values (R, K, Angle, MA and CI) were detected l, 3, and 7 days post trauma. Followup prognosis data were recorded among all patients and correlations between TEG changes and prognosis were assessed. The results revealed that the K and R volumes of the poor prognosis group were obviously higher than those of the good prognosis group at each time point; while the Angle, MA, and CI volumes of the poor prognosis group were relatively lower than those of the good prognosis group, and showed a little rising tendency. This study suggests that variables measured by TEG were closely associated with prognosis evaluation, and highlighted the dangers of coagulation disorder at early stage. TEG is of benefit in evaluating the function of coagulation in clinical emergency trauma patients.     

美托洛尔舌下含服治疗老年急症高血压(24例临床报告)

本文旨在评估舌下含服美托洛尔对老年高血压急症的降压效果。方法：２４例老年急症高血压患者,于舌下含服美托洛尔５０ｍｇ前及含服后５、１０、３０、６０及１２０分钟,动态监测血压及心率,并比较用药前及用药后各时间段降压效果。结果：（１）治疗前、治疗后５、１０分钟,均有非常显著差异（Ｐ＜００１,Ｐ＜００５）,１０分钟血压降至安全水平,３０分钟完全降至正常,且降压效应持续至２小时。（２）无明显副作用。结论：舌下含服美托洛尔对老年急症高血压患者,是一种速效,稳效,无明显副作用,且方法简便的急症降压方法。     

Examination of microbial contaminants of emergency showers and eyewash stations

To evaluate the effects of regular flushing, water from fifty emergency eyewash and shower stations was cultured for the presence of potentially pathogenic protozoa, heterotrophic bacteria, and Legionella species. This study also provided the opportunity to evaluate a commercially available molecular assay for the direct detection of Legionella sp in environmental samples. The Perkin Elmer Legionella EnviroAmp polymerase chain reaction (PCR) kit and culture on buffered charcoal yeast extract agar were used to detect Legionella species in water samples. Chemical and physical parameters of station water measured included: pH, hardness, alkalinity, turbidity, conductivity, total chlorine and assimilable organic carbon. Protozoal isolates were identified by classical identification methods, and isolates from the stations were identified as Hartmannella sp, Vexillifera sp, Vahlkampfia sp, Acanthamoeba sp, and Vanella sp. Heterotrophic plate counts ranged from 10² to 10⁶ CFU ml⁻¹ and acridine orange total counts ranged from 10³ to 10⁶ cells ml⁻¹ after regular flushing. PCR and gene probe analysis showed that 89% of the stations (eyewash and shower) were positive for Legionella species by PCR, while 6% of the samples were culture positive. These results indicate that routine flushing alone is not sufficient to control microbial contamination and disinfection must also be included in a routine maintenance program. In addition, regular maintenance, disinfection, and monitoring of emergency eyewash and shower stations is important in preventing potential secondary microbial infections by either direct inoculation or aerosol transmission. Received 02 September 1997/ Accepted in revised form 29 November 1997     

Upstream passage problems for wild Atlantic salmon (<Emphasis Type="Italic">Salmo salar</Emphasis> L.) in a regulated river and its effect on the population

Due to hydropower development, the upstream migration of wild anadromous salmon and brown trout is impaired in many European rivers, causing negative effects on the long-term survival of natural salmonid populations. This study identified problems for Atlantic salmon during upstream migration in a regulated river in northern Sweden, Umeälven (mean flow: 430 m³ s^?1). Tagging from 1995 to 2005 involved radio tags (n = 503), PIT tags (n = 1574) and Carlin tags (n = 573) to study the spawning migration of salmon from the coast past the regulated section of the river to a fish ladder at the dam/spillway 32 km upriver. The results demonstrate that migration success from the coast to the fish ladder varied between 0% and 47% among years, indicating an average loss of 70% of potential spawners. Discharge from the turbines attracted the salmon away from the bypass route. Echo-sounding in the turbine outlet showed that salmon were normally found at 1–4 m depths. They responded with upstream and/or downstream movements depending on flow changes; increased spill in the bypass channel attracted salmon to the bypass. Once in the bypass channel, salmon could be delayed and had difficulties passing the first rapid at high spills. Additional hindrances to upstream migration were found at rapids and the area of the fish ladder, located further upstream in the regulated river section. The average migration duration was 44 days from the estuary to the top of the fish ladder, with large variation among individuals within years. Modelling the salmon population dynamics showed a potential population increase of 500% in 10 years if the overall migration success could be improved from the current 30% to levels near 75%. Consequently improved migration facilities at the regulated river section should be implemented to achieve a long-term sustainability of these threatened anadromous salmonids.     

Chest pain in the emergency room: value of the HEART score

Background. Chest pain is one of the most common causes of presentation to the emergency room. The diagnosis of non-ST-elevation acute coronary syndrome typically causes uncertainty. Classical considerations for risk stratification are History, ECG, Age, Risk factors and Troponin (HEART). Each can be scored with zero, one or two points, depending on the extent of the abnormality. The HEART score is the sum of these five considerations. Methods. Clinical data from 122 patients referred to the emergency room for chest pain were analysed. The predictive value of the HEART score for reaching an endpoint was evaluated in 120/122 patients. Results. Twenty-nine patients reached one or more endpoints: an acute myocardial infarction was diagnosed in 16 patients, 20 underwent revascularisation and two died. The HEART score in the patients with and without an endpoint was 6.51±1.84 and 3.71±1.83 (p<0.0001) respectively. A HEART score of 0-3 points holds a risk of 2.5% for an endpoint and supports an immediate discharge. With a risk of 20.3%, a HEART score of 4-6 points implies admission for clinical observation. A HEART score ≥7points, with a risk of 72.7%, supports early invasive strategies. Conclusion. The HEART score facilitates accurate diagnostic and therapeutic choices. The HEART score is an easy, quick and reliable predictor of outcome in chest pain patients. (Neth Heart J 2008;16:191-6.)     

African dust clouds are associated with increased paediatric asthma accident and emergency admissions on the Caribbean island of Trinidad

A retrospective ecological study of paediatric asthma patients who attended the Accident and Emergency (A&E) department of the Paediatric Priority Care Facility at the Eric Williams Medical Sciences Complex in relation to Saharan dust visibility and other climatic variables for the period 23 May 2001 to 13 May 2002 was undertaken to determine if there is an association between paediatric A&E asthma visits and Saharan dust cloud cover. A Poisson regression model was used to determine the statistical relationship between acute paediatric asthma A&E visits and Saharan dust cover with and without other variables such as climatic parameters and month. During the study period, there were 2,655 A&E visits for acute asthma. There was an association between increased paediatric asthma admissions and increased Saharan dust cover. The best fitting model estimated that in one month, such as June, a deterioration of visibility due to increased Saharan dust cover from no dust (visibility =16 km) to very dusty (visibility =7 km) would increase a daily admission rate of 7.8 patients to 9.25 when climate variables such as barometric pressure and humidity were kept constant.