scholarly journals The influence of successfully completed triage courses and work experience of advanced emergency medical technicians on their perception of patient disposition

2020 ◽  
Vol 17 ◽  
Author(s):  
Javad Mozafari ◽  
Mohammad Afzalimoghaddam ◽  
Mohammad Taghi Talebian ◽  
Maryam Bahreini ◽  
Esmaeil Mohammadnejad
Keyword(s):  
Emergency Medicine ◽  
Predictive Value ◽  
Work Experience ◽  
Emergency Medical Technicians ◽  
Lead Author ◽  
Patient Disposition ◽  
Emergency Medical ◽  
Sensitivity Specificity ◽  
A Prospective Study ◽  
The Impact

Introduction This study assessed the impact of various one-day workshops and the work experience of advanced emergency medical technicians (AEMTs) on their prediction of patient disposition. Methods We conducted a prospective study on 267 patient transport missions to the emergency department. During the study, convenience sampling was used in all the clinical shifts of the lead author. The AEMTs completed the questionnaires, which comprised of the number of successfully completed workshops; other training courses; work experience and their perception of the patient’s disposition. The latter was compared to the ultimate disposition of patients determined by emergency medicine specialists. Results The respective figures for sensitivity, specificity, positive predictive value and negative predictive value were 86%, 80%, 33% and 66% on predicting patient disposition for AEMTs who passed fewer workshops; and 79%, 76%, 34% and 96% for the participants with less than 4 years’ work experience. The Kappa coefficient for the agreement between AEMTs’ prediction and ultimate patient disposition was 0.387. Conclusion The number of triage courses was not positively effective in the prediction of patient disposition by AEMTs; the number of years of work experience did not make a difference either. The AEMTs were fair in their prediction of patient disposition in comparison with the emergency medicine specialists.

scholarly journals Association between regular arrangement of collecting venules and Helicobacter pylori status in routine endoscopy

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Cong Yuan ◽  
Xue-Mei Lin ◽  
Yan Ou ◽  
Lin Cai ◽  
Qian Cheng ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Predictive Value ◽  
Underlying Mechanism ◽  
High Definition ◽  
Regular Arrangement ◽  
Gastric Corpus ◽  
H Pylori ◽  
Sensitivity Specificity ◽  
A Prospective Study ◽  
Positive Pattern

Abstract Background The sensitivity of regular arrangement of collecting venules (RAC)-positive pattern for predicting Helicobacter pylori (H. pylori)-negative status greatly altered from 93.8 to 48.0% in recent two decades of various studies, while the reason behind it remained obscure. The aim of this study was to investigate the value of RAC as an endoscopic feature for judging H. pylori status in routine endoscopy and reviewed the underlying mechanism. Methods A prospective study with high-definition non-magnifying endoscopy was performed. RAC-positive and RAC-negative patients were classified according to the collecting venules morphology of the lesser curvature in gastric corpus. Gastric biopsy specimens were obtained from the lesser and greater curvature of corpus with normal RAC-positive or abnormal RAC-negative mucosal patterns. Helicobacter pylori status was established by hematoxylin and eosin staining and immunohistochemistry. Results 41 RAC-positive and 124 RAC-negative patients were enrolled from June 2020 to September 2020. The prevalence of H. pylori infection in patients with RAC-positive pattern and RAC-negative pattern was 7.3% (3/41) and 71.0% (88/124), respectively. Among all 124 RAC-negative patients, 36 (29.0%) patients were H. pylori-negative status. Ten patients (32.3%) demonstrated RAC-positive pattern in 31 H. pylori-eradicated cases. The sensitivity, specificity, positive predictive value, and negative predictive value of RAC-positive pattern for predicting H. pylori-negative status were 51.4% (95% CI, 0.395–0.630), 96.7% (95% CI, 0.900–0.991), 92.7% (95% CI, 0.790–0.981), and 71.0% (95% CI, 0.620–0.786), respectively. Conclusions RAC presence can accurately rule out H. pylori infection of gastric corpus, and H. pylori-positive status cannot be predicted only by RAC absence in routine endoscopy. Trial registration The present study is a non-interventional trial.

The Importance of Surgeon-reviewed Computed Tomography for Incisional Hernia Detection: A Prospective Study

2014 ◽  
Vol 80 (7) ◽  
pp. 720-722 ◽  
Author(s):  
Rebeccah B. Baucom ◽  
William C. Beck ◽  
Michael D. Holzman ◽  
Kenneth W. Sharp ◽  
William H. Nealon ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Incisional Hernia ◽  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Radiology Report ◽  
Incisional Hernias ◽  
Radiology Reports ◽  
Sensitivity Specificity ◽  
A Prospective Study ◽  
The Cost

Patients with incisional hernias or abdominal pain are frequently referred with abdominal computed tomography (CT) scans. The purpose of this study was to determine the sensitivity and specificity of a CT radiology report for the detection of incisional hernias. General surgery patients with a history of an abdominal operation and a recent viewable abdominal CT scan were enrolled prospectively. Patients with a stoma, fistula, or soft tissue infection were excluded. The results of the radiology reports were compared with blinded, surgeon-interpreted CT for each patient. Testing characteristics including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. One hundred eighty-one patients were enrolled with a mean age of 54 years. Sixty-eight per cent were women. Hernia prevalence was 55 per cent, and mean hernia width was 5.2 cm. The radiology report had a sensitivity and specificity of 79 per cent and 94 per cent, respectively, for hernia diagnosis. The PPV and NPV were 94 and 79 per cent, respectively. Reliance on the CT report alone underestimates the presence of incisional hernia. Referring physicians should not use CT as a screening modality for detection of hernias. Referral to a surgeon for evaluation before imaging may provide more accurate diagnosis and potentially decrease the cost of caring for this population.

scholarly journals 53BP1 expression as a biomarker to differentiate thyroid follicular tumors

2021 ◽  
Vol 10 (3) ◽  
pp. 309-315
Author(s):  
Ayako Sato ◽  
Katsuya Matsuda ◽  
Takahiro Motoyama ◽  
Zhanna Mussazhanova ◽  
Ryota Otsubo ◽  
...  
Keyword(s):  
Predictive Value ◽  
Follicular Adenoma ◽  
Follicular Carcinoma ◽  
Nuclear Staining ◽  
Adenomatous Goiter ◽  
Damage Response ◽  
Liquid Based Cytology ◽  
Follicular Tumors ◽  
Sensitivity Specificity ◽  
The Impact

We have previously reported that the expression of p53-binding protein 1 (53BP1) in nuclear foci (NF), a marker reflecting DNA damage response (DDR), detected using immunofluorescence (IF) is useful to estimate the malignant potency of diverse cancers. In this prospective study, we clarified the impact of 53BP1 expression via IF as a biomarker to differentiate thyroid follicular tumors (FTs) with liquid-based cytology (LBC). A total of 183 consecutively obtained-LBC samples, which were preoperatively suspected as FTs, were analyzed. Before histological diagnosis, the type of 53BP1 immunoreactivity in LBC was classified as follows: low DDR type, one or two NF; high DDR type, three or more NF; large foci type, larger than 1.0 μm; abnormal type, intense nuclear staining. Among the 183 cases, 136 cases were postoperatively diagnosed as FTs, including adenomatous goiter (AG, n = 30), follicular adenoma (FA, n = 60), FT-uncertain malignant potency (FT-UMP, n = 18), and follicular carcinoma (FC, n = 28), and 47 cases were diagnosed as tumors other than FTs or technically inadequate materials. Total 136 FT cases were collated with the type of 53BP1 immunoreactivity in LBC. The mean incidence expressing abnormal 53BP1 expression was significantly higher in FC than FA (9.5% vs 2.6%, P-value < 0.001). When adopting 4.3% as a cut-off value to distinguish FC from FA, the sensitivity, specificity, positive predictive value, and negative predictive value were 89.3, 83.3, 71.4, and 94.3%, respectively. Therefore, IF analysis of 53BP1 expression can be employed as a novel technique to diagnose FTs and to distinguish between different types of FTs using LBC.

2 × 2 Contingency table

2017 ◽  
Author(s):  
Mark Harrison
Keyword(s):  
Emergency Medicine ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Contingency Table ◽  
Likelihood Ratios ◽  
Negative Results ◽  
Sensitivity Specificity

This chapter describes the 2 × 2 contingency table as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios for positive and negative results, and the 2 × 2 contingency table. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.

Ventilation skills of emergency medical technicians: A teaching challenge for emergency medicine

1986 ◽  
Vol 15 (10) ◽  
pp. 1187-1192 ◽  
Author(s):  
Richard O Cummins ◽  
Douglas Austin ◽  
Judith Reid Graves ◽  
Paul E Litwin ◽  
Judith Pierce
Keyword(s):  
Emergency Medicine ◽  
Emergency Medical Technicians ◽  
Emergency Medical

scholarly journals A prospective study of trauma patients at Gandhi Medical College and associated hospital emergency department, Bhopal, analysing anatomical and physiological scoring systems to predict mortality

2017 ◽  
Vol 5 (3) ◽  
pp. 871
Author(s):  
Moorat Singh Yadav ◽  
Vibhore Agarwal ◽  
Surabhi Garg
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Scoring Systems ◽  
Trauma Patients ◽  
Adult Age ◽  
Medical College ◽  
Life Years ◽  
Gandhi Medical College ◽  
Sensitivity Specificity ◽  
A Prospective Study

Background: Trauma, in a developing country like India, is a leader together with non-communicable diseases, when measured in terms of disability adjusted life years (DALYs) lost. Trauma scoring systems have been shown to decrease the number of preventable deaths caused by trauma. The aim of this study is to compare the various physiological and anatomical scoring systems.Methods: Two hundred and sixty two cases of trauma of adult age group admitted in Gandhi Medical College and Hamidia Hospital, Bhopal, Madhya Pradesh, India from 1 July 2014 to 1 December 2014.Results: Out of the 262 patients included in the study, 242 were discharged alive while 20 (7.6%) died. In our study, in of the patients who died it was observed that RTS was significantly low (<7) and ISS and TRISS were significantly high (>/=25 for ISS and >/=50 for TRISS).Conclusions: Of all the scoring system TRISS has got the best sensitivity, specificity and positive predictive value of 83.3% and also miscalculation rate of 1.5 as per the MOTS norms as compared to RTS, which has sensitivity of 90% but low specificity, and ISS which has sensitivity and specificity comparable to TRISS but low positive predictive value.

scholarly journals How accurate is the prehospital diagnosis of hyperventilation syndrome?

2020 ◽  
Vol 12 (11) ◽  
pp. 445-454
Author(s):  
Caitlin Wilson ◽  
Clare Harley ◽  
Stephanie Steels
Keyword(s):  
Routine Data ◽  
Emergency Medical Technicians ◽  
Likelihood Ratios ◽  
Hyperventilation Syndrome ◽  
Predictive Values ◽  
Emergency Medical ◽  
Retrospective Audit ◽  
Emergency Ambulance ◽  
The Uk ◽  
Sensitivity Specificity

Background: The literature suggests that hyperventilation syndrome (HVS) should be diagnosed and treated prehospitally. Aim: To determine diagnostic accuracy of HVS by paramedics and emergency medical technicians using hospital doctors' diagnosis as the reference standard. Methods: A retrospective audit was carried out of routine data using linked prehospital and in-hospital patient records of adult patients (≥18 years) transported via emergency ambulance to two emergency departments in the UK from 1 January 2012–31 December 2013. Accuracy was measured using sensitivity, specificity, positive and negative predictive values (NPV/PPVs) and likelihood ratios (LRs) with 95% confidence intervals. Results: A total of 19 386 records were included in the analysis. Prehospital clinicians had a sensitivity of 88% (95% CI [82–92%]) and a specificity of 99% (95% CI [99–99%]) for diagnosing HVS, with PPV 0.42 (0.37, 0.47), NPV 1.00 (1.00, 1.00), LR+ 75.2 (65.3, 86.5) and LR− 0.12 (0.08, 0.18). Conclusions: Paramedics and emergency medical technicians are able to diagnose HVS prehospitally with almost perfect specificity and good sensitivity.

scholarly journals Chest x-ray or CT for COVID-19 pneumonia? Comparative study in a simulated triage setting

2021 ◽  
pp. 2004188
Author(s):  
Nicola Sverzellati ◽  
Christopher J Ryerson ◽  
Gianluca Milanese ◽  
Elisabetta A Renzoni ◽  
Annalisa Volpi ◽  
...  
Keyword(s):  
Predictive Value ◽  
Diagnostic Tools ◽  
Clinical Decisions ◽  
First Line ◽  
Diagnosis And Prognosis ◽  
Chest X Ray ◽  
Sensitivity Specificity ◽  
Triage Algorithm ◽  
The Impact ◽  
Extent Of Disease

Introduction:for the management of patients referred to respiratory triage during the early stages of the SARS-CoV-2 pandemic, either chest radiograph (CXR) or computed tomography (CT) were used as first-line diagnostic tools. The aim of this study was to compare the impact on triage, diagnosis and prognosis of patients with suspected COVID-19 when clinical decisions are derived from reconstructed CXR or from CT.Methods:we reconstructed CXR (r-CXR) from high-resolution CT (HRCT) scan. Five clinical observers independently reviewed clinical charts of 300 subjects with suspected COVID-19 pneumonia, integrated with either r-CXR or HRCT report in two consecutive blinded and randomised sessions: clinical decisions were recorded for each session. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and prognostic value were compared between r-CXR and HRCT. The best radiological integration was also examined to develop an optimised respiratory triage algorithm.Results:interobserver agreement was fair (Kendall's W=0.365; p<0.001) by r-CXR-based protocol and good (Kendall's W=0.654; p<0.001) by CT-based protocol. NPV assisted by r-CXR (31.4%) was lower than that of HRCT (77.9%). In case of indeterminate or typical radiological appearence for COVID-19 pneumonia, extent of disease on r-CXR or HRCT were the only two imaging variables that were similarly linked to mortality by adjusted multivariable modelsConclusions:the present findings suggest that clinical triage is safely assisted by CXR. An integrated algorithm using first-line CXR and contingent use of HRCT can help optimise management and prognostication of COVID-19.

Evaluation of initial shockable rhythm as an indicator of short no-flow time in cardiac arrest: a national registry study

2022 ◽  
pp. emermed-2021-211823
Author(s):  
Keita Shibahashi ◽  
Kazuhiro Sugiyama ◽  
Takuto Ishida ◽  
Yuichi Hamabe
Keyword(s):  
Cardiac Arrest ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Cardiac Rhythm ◽  
Flow Time ◽  
Lower Probability ◽  
Time Duration ◽  
Predictive Values ◽  
Sensitivity Specificity ◽  
The Impact

BackgroundThe duration from collapse to initiation of cardiopulmonary resuscitation (no-flow time) is one of the most important determinants of outcomes after out-of-hospital cardiac arrest (OHCA). Initial shockable cardiac rhythm (ventricular fibrillation or ventricular tachycardia) is reported to be a marker of short no-flow time; however, there is conflicting evidence regarding the impact of initial shockable cardiac rhythm on treatment decisions. We investigated the association between initial shockable cardiac rhythm and the no-flow time and evaluated whether initial shockable cardiac rhythm can be a marker of short no-flow time in patients with OHCA.MethodsPatients aged 18 years and older experiencing OHCA between 2010 and 2016 were selected from a nationwide population-based Japanese database. The association between the no-flow time duration and initial shockable cardiac rhythm was evaluated. Diagnostic accuracy was evaluated using the sensitivity, specificity and positive predictive value.ResultsA total of 177 634 patients were eligible for the analysis. The median age was 77 years (58.3%, men). Initial shockable cardiac rhythm was recorded in 11.8% of the patients. No-flow time duration was significantly associated with lower probability of initial shockable cardiac rhythm, with an adjusted OR of 0.97 (95% CI 0.96 to 0.97) per additional minute. The sensitivity, specificity and positive predictive value of initial shockable cardiac rhythm to identify a no-flow time of <5 min were 0.12 (95% CI 0.12 to 0.12), 0.88 (95% CI 0.88 to 0.89) and 0.35 (95% CI 0.34 to 0.35), respectively. The positive predictive values were 0.90, 0.95 and 0.99 with no-flow times of 15, 18 and 28 min, respectively.ConclusionsAlthough there was a significant association between initial shockable cardiac rhythm and no-flow time duration, initial shockable cardiac rhythm was not reliable when solely used as a surrogate of a short no-flow time duration after OHCA.

The Patient/Provider Relationship in Emergency Medicine

2018 ◽  
pp. 74-105
Author(s):  
Julita Soczywko ◽  
Dorota Rutkowska
Keyword(s):  
Emergency Medicine ◽  
Interpersonal Communication ◽  
Communication Skills ◽  
Emergency Care ◽  
Work Experience ◽  
Critical Role ◽  
Diagnostic Process ◽  
Emergency Nurses ◽  
Emergency Medical ◽  
Decisive Action

Emergency medicine is a rapidly developing medical specialty which focuses on the diagnostic process, initial stabilization, and the treatment of patients suffering from acute illnesses or injuries. Emergency care can be provided in prehospital settings by emergency medical services, as well as in emergency departments. The primary providers of emergency care are: emergency medicine physicians, emergency nurses, and paramedics. Emergency medical personnel are required to be prepared to take decisive action at any time of day or night. It is essential for them to possess basic knowledge relating to psychology and an ability to utilize interpersonal communication skills. A critical role of medical workers in emergency settings is to provide a patient with emotional support coupled with medical assistance. Interpersonal communication skills depend on the personal abilities of an individual, however, these skills can be also enhanced through training and work experience.

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