Cognition and Ability of Emergency Physicians for Palliative Care in Tertiary Hospitals / 中国医学科学院学报

Objective To understand the cognition and related abilities of emergency physicians for palliative care in China. Methods A total of 115 emergency physicians were selected by convenient sampling to conduct a questionnaire survey.The questionnaire included the physicians' basic information,feelings and attitudes towards end-stage patients and their families,cognition of palliative care,and personal ability for palliative care. Results 25.2%,59.1%,and 15.7% of the emergency physicians considered they had "no understanding","partial understanding",and "full understanding" of palliative care,respectively.32(27.8%)physicians participated in palliative care-related lectures and they showed higher self-rated cognition levels(

Violence toward emergency physicians: A prospective-descriptive study / 世界急诊医学杂志（英文）

@#BACKGROUND: The highest rate of workplace violence occurs in the health sector, although most cases remain unreported. Emergency services face the majority of these incidents for many reasons, such as the patient profile, long waiting time, and overcrowding. We aimed to determine the characteristics and causes of violence toward emergency physicians. METHODS: The acts of violence toward emergency physicians over a one-year period were prospectively recorded. After a violent incident took place, a third party separately interviewed the physician exposed to the violent behavior and the perpetrator who displayed this behavior. We examined the perpetrator’s reasons for violence, their demographic characteristics, and the medical complaints of patients involved in such events to determine the characteristics and causes of violence. RESULTS: Of the violent acts investigated, 85.1% were verbal, and most were directed toward male doctors by the young male relatives of the patients. More than half of the violent acts occurred within the 15 minutes of presentation to emergency service (60.5%) and at off-hours (69.4%). Concerning the health insurance, 20.4% of the cases were covered by the free green card system, and a small number of the perpetrators of violence lived in rural areas (38.2%). The most common reason for violent behavior was the patients’ or their relatives’ dissatisfaction with the examination or treatment method (38.2%). CONCLUSIONS: Appropriate communication should be established with the patients, and they should be adequately informed about the treatments and interventions to be performed in order to prevent possible acts of violence.

The clinical experience of emergency medical team-initiated extracorporeal membrane oxygenation / 中华急诊医学杂志

Objective To summarize the efficacy of extracorporeal membrane oxygenation (ECMO)utilization in Emergency Department (ED),as well as the establishment of emergency ECMO team.Methods A retrospective analysis was carried out in 16 patients treated with ECMO between April 2015 to December 2016 in ED.The clinical data including demographics,diagnosis,initiating ECMO timing,place of ECMO establishment,intubation approaches,duration of ECMO,complications and outcomes were collected and analyzed.Results Eight patients were successfully weaned from ECMO,and 7 of them survived to discharge from hospital.The duration of ECMO support was 4 to 384 hours.The emergency ECMO team was set up.Conclusions Emergency medical team can successfully operate the ECMO process.The emergency medical team-initiated ECMO can provide effectively adjuvant measures to support patients with respiratory failure,circulatory failure and cardiac arrest.

What Makes Korean Emergency Physician Satisfied?

PURPOSE: Emergency Medicine became a medical specialty in Korea more than 20 years ago. However, Emergency Medicine is struggling due to lack of enthusiasm from young physicians. Working conditions, personal well-being, and all around satisfaction were analyzed in a survey to determine the reality. METHODS: A survey was conducted in 2010. The survey consisted of personal interests, working conditions, and salaries of members of the Korean Society of Emergency Medicine (KSEM). Several factors were estimated to evaluate the satisfaction of emergency physicians (EP). RESULTS: A total of 394 survey results were collected from 635 currently working emergency physicians out of 841 registered EPs. In the survey 48.6% of EPs were considering retiring from current practice. The preferred retirement age was 55. The survey also showed that many EPs considered that night shift was possible up to age 50. According to the responses, 50.5% of EPs in their 30s, 53.4% of EPs in their 40s were considering retiring. Factors influencing their decision were burnout, night shift, age, health issues, rather than social isolation, litigation, and disappointment. However the disappointment was the only statistically significant factor influencing retirement. Using a ten point Likert scale, the score for satisfaction with residency training was 6.4; when asked if they would choose Emergency Medicine again, the score was 5.5; the score for satisfaction with the Korean Emergency Medical Service System was 3.9; the score for prospects of emergency medicine in 10 years was 5.8. CONCLUSION: Korean emergency physicians are under a lot of stress from the job and are unsatisfied. Many in their 30s and 40s are considering retiring from practice. Therefore, establishment of clear cut standards on working hours and environments is imperative to improve the satisfaction of working emergency physicians.

Empathy and Quality of Life in Korean Emergency Physicians

PURPOSE: Empathy in medical practice is related to medical communication and clinical competence. In previous studies, low quality of life and other factors play an integral role in low empathy among physicians. We evaluated the relationships between empathy, quality of life, and other factors among Korean emergency physicians. METHODS: The survey was conducted using email to emergency physicians. The respondents completed a questionnaire including demographic information, the Jefferson Scale of Empathy, and the Brief version of the World Health Organization Quality of Life assessment instrument. Correlation analyses were performed, along with sub-analyses according to gender. RESULTS: A total of 180 questionnaires were analyzed. The median value of the empathy scale was 89.0, and quality of life 64.8. Empathy was positively correlated with quality of life, age, and work experience as a specialist in total samples and males. Only work experience as a specialist showed correlation with empathy in females. Quality of life showed no association with age, work experience, and work load. However, quality of life showed negative correlation with age and work experience in female physicians. CONCLUSION: The more experienced specialist emergency physicians are, and the better quality of life they have, the higher level of empathy scale they have. Therefore, good quality of life could lead to good empathy, and vice versa. Good quality of life and good empathy could lead to the better outcome in emergency care. However, because the female physicians show different patterns of empathy and quality of life, further study is needed.

2010 Korean Society of Emergency Physician Survey

The 2010 Emergency Physician (EP) Survey of the Korean Society of Emergency Medicine (KSEM) was the first comprehensive survey of its members on their working conditions, working environment, and compensation. The survey was conducted using a questionnaire on the web interface and e-mail from March to December of 2010. The subjects were currently active EPs working in an emergency department (ED). Additional e-mails, telephone calls, and visits were necessary in order to encourage the participation of members. Out of 841 members, 394 members completed the questionnaire. Excluding members who are currently not working in an ED, retired, opened a private practice as a primary physician, or unknown status, 635 (75.5%) EPs were working in 203 EDs out of a total of 465 EDs in Korea. There was a wide range of variations in ED employing EP. EP employing practices by the hospitals depended on the size and level of ED and the region of the country. ED employed 4.52+/-2.97 Eps, and 4.80+/-5.69 emergency residents, 4.21+/-3.05 interns, and 26.02+/-16.99 nurses. On average, EPs worked 17.51+/-5.84 days, and 7.87+/-3.17 night shifts in a month, 228.11+/-57.46 hours in a month. The average pay for the hour was 33,300 KRW. Satisfaction of the EPs with their compensation was below average. Important factors in selection of a workplace depended on night-shifts, time for the family, pay, and the relationship with other specialties. On a 10 point scale, satisfaction with their training was 6.38; the answer to selection of the same specialty was 5.53; satisfaction with the current emergency medical services (EMS) system was 3.85; emergency medicine in 10 years was 5.75. The adult APGAR score was 5.05. As in the survey, members of KSEM as a whole are working a large number of heavy duty hours, with insufficient pay. Most of them feel over burdened and unsatisfied with their current state. They also share a dim outlook on the future. In order to increase job satisfaction of EPs, there must be an improvement in the welfare and working conditions. This survey was conducted in order to obtain a clear view of the current status of EPs in Korea, and in hopes of contributing to improvement of the EP status. This survey will lay a cornerstone for development of an EMS system in Korea.

Evaluation of Emergency Consultation Skill: A Preliminary Study

PURPOSE: Emergency consultation is a common and important aspect in the emergency department (ED). Kessler et al. suggested the five Cs of the emergency medicine (EM) consulting checklist; contact, communication, core question, collaboration, and closing the loop as a tool for evaluation of consultation quality. The objective of this study was to evaluate the appropriateness of this checklist as a tool for assessment of the skill of requesting consultation in the ED. METHODS: This study was conducted in the ED at an urban training hospital. Three emergency physicians recorded telephone conversations when they contacted consultant physicians for consultation regarding emergency patients. After recording files were collected, eight raters evaluated each conversation using the five Cs of the EM consulting checklist. RESULTS: A total of 58 cases were gathered. The most frequent emergency acuity level of patients was 3, by 72.4%. The mean duration of conversation was 53+/-30 seconds. The mean total score was 41.9+/-3.1. When the scores for the five Cs' categories were evaluated, the score was lowest, at 2.9+/-1.0 for 'contact' and highest, at 4.8+/-0.5, for 'communication'. Inter-rater agreement (95%confidence interval) of the total score was 0.819 (0.755-0.875). In the case of acuity level 3, the agreement was high, at 0.859(0.796-0.911), whereas it was 0.691 (0.491-0.874) and 0.426(0.115-0.922) in acuity levels 2 and 4, respectively. CONCLUSION: EM consultations were evaluated according to the five Cs of the EM consulting checklist showing high inter-rater agreement. This checklist could be used as a tool for monitoring and feedback in EM residency training.

How Many Emergency Physicians are Needed in Korea?

PURPOSE: Forecasting the demand for Emergency Physicians (EP) is a long, complex problem involving many variables. Although Korean Emergency Medicine Law has guidelines for the minimal numbers of EPs, it doesn't take into account the number of patients or the severity of their symptoms. Previous research involved rough estimates of the number of physicians for Emergency Departments (ED), without any consideration for workload. Our study objective was to determine whether there are an adequate number of EPs by estimating the number of EPs while considering their workload and working hours, according to the 2010 Korean Emergency Physician Survey (KEPS). METHODS: Data on the workload and working hours of Korean EPs were analyzed. The annual increase in the number of emergency patients and the annual application for residency posts were used to calculate the EP demand. Ideally, all patients must be treated by EPs; one full time equivalent (FTE) was calculated as serving 36 hours per week with two patients per hour (PPH) as the minimum. RESULTS: There were 841 EPs working in EDs and 463 EDs across Korea in 2010. A total of 635(75.5%) EPs were clinically active. EPs spent 65.6% of their working hours on clinical duty. Ideally, there should have been 2,871 FTEs and 5,797 EPs needed in 2010. CONCLUSION: There is an absolute shortage of EPs and it will get worse. The excessive hours and workloads of EPs threaten the safety of patients. Therefore, EP demand and forecasting should be focused on increasing patient coverage by EPs.

Indicators' weight of competency model in emergency physicians' different career stages / 中华医院管理杂志

Objective On the basis of previous researches,the paper confirmed the weight of indicators to build emergency physicians'competency models for their different career stages.Methods Using the method of analytic hierarchy process (AHP)to establish evaluation hierarchy for emergency physicians'different career stage and construct the pair wise comparison judgment matrix,checking consistency and judgment matrix at the same time.Results Achieved the construction of competency models for three different stages of emergency physicians,primary,intermediate and advanced included.Conelusion The models can dynamically clarify the career stages of emergency physicians,supporting personalized training and management of the physicians.

Effectiveness of a Cardiopulmonary Resuscitation Team with an Emergency Physician for In-Hospital Cardiac Arrest

PURPOSE: Emergency physicians are usually more experienced in emergency situations; therefore, a cardiopulmonary resuscitation team with an emergency physician as a leader would be operated effectively. The aim of this study is to evaluate the effectiveness of a cardiopulmonary resuscitation that includes an emergency physician. METHODS: A retrospective analysis for in-hospital arrests that occurred in the general ward was conducted based on the in-hospital cardiopulmonary resuscitation registry of a tertiary care university hospital in Korea from January 1, 2005 through December 31, 2010. We compared outcomes of cardiopulmonary resuscitation performed by a team that included an emergency physician with those by a cardiopulmonary resuscitation team that included a non-emergency physician. RESULTS: Survival rates at discharge were 29.6% for the emergency physician team and 17.7% for the non-emergency physician team. The good neurologic outcome rates at discharge were 20.6% and 10.6%, respectively. In multivariate analysis with adjustment for pre-arrest patient condition and arrest variables, survival rate did not differ significantly between the two groups. However, the good neurologic outcomes showed an association with the emergency physician team. CONCLUSION: For in-hospital cardiac arrest, outcomes for patients who were rescued by the emergency physician-directing CPR team might be comparable or better, compared with those by the non-emergency physician team.

Aspectos claves-tiempo dependientes que amenazan la vida en el prehospitalario / Keys issues time-dependent that life: threatening in the prehospital

La organización de un Sistema de Atención Prehospitalaria (SAPh) debe obedecer a la realidad sanitaria de un país enfocado hacia el objetivo de brindar oportunidad y calidad en la atención a los pacientes que sufren una urgencia, emergencia y/o desastre en el medio prehospitalario. Es así como el SAPh en Chile, en sus componentes de subsistemas público y privado, ha respondido con un sistema distinto al Americano o al Europeo (FrancoGermano principalmente), es decir, un modelo más bien organizado con múltiples niveles de respuesta desde conductores de reanimación, paramédicos, profesionales universitarios de la salud no médicos y médicos. Además de contar con un eje central que es la regulación médica continua para la administración o gestión del número único de emergencias sanitarias y los limitados recursos disponibles ante la demanda de la comunidad. En esta misma perspectiva, la resolución de oportunidad y calidad se logra apuntando hacia los aspectos claves-tiempo dependientes que amenazan la vida del paciente, siendo estos clínicos(paro cardiorespiratorio, compromiso de la vía aérea y la ventilación, compromiso de la perfusión tisular y el enfrentamiento al dolor torácico con su expresión máxima que es el síndrome coronario agudo), como también organizacionales (entre algunos la presencia de médicos en el Prehospitalario (Ph) o el uso de determinados recursos sensibles como el traslado heliportado).

The organization of a emergency medical services (EMS) must obey the reality of a country focused on the goal of providing opportunity and quality of care to patients who suffer an urgency, emergency and / or disaster in the prehospital setting. Thus, the EMS in Chile into its component subsystems private and public has responded with a system other than American or European (mainly French /Germany),ie, a more well organized with multiple levels of response from resuscitations drivers, paramedics, health university professionals non-doctors, and doctors. Besides having a central axis that is continuing medical regulation for the administration or management of the unique number of health emergencies and the limited resources available to community demand. In the same context, the resolution of timing and quality is achieved the key issues pointing time-dependent life threatening, and these trials (cardiac arrest out-hospital, compromised airway or ventilation, compromise tissue perfusion and confrontation with chest pain with its highest expression is acute coronary syndrome) as well as organizational (including the presence of some doctors in the Prehospital (Ph) or the use of certain sensitive resources such as rescue for helicopters).

Emergency medicine and social safety

Recently, the disaster emergency medical system (DEMS) has been considered an important component of social safety, since the incidence of various kinds of disasters such as man-made disasters, biological disasters, chemical disasters and nuclear disasters are increasing each year. To minimize the mortality of emergency patients and mass casualties, emergency physicians should directly participate in both emergency care and DEMS. However, most primary emergency care in hospitals depends on residents of emergency medicine, especially at night and holidays, and few certified emergency physicians work at emergency control centers, military hospitals, and rural hospitals that are part of the DEMS. To strengthen DEMS and improve the quality of emergency care, emergency physicians are needed at emergency centers at all times to provide emergency care, and to maintain communication with the DEMS offices that are outside of hospitals. To make DEMS cost-effective, the governments should unify the 119 and 1339 emergency call centers, and also establish a plan for integrating the DEMS components of the Ministry of Health and Welfare, National Emergency Management Agency, and Military Services. By securing the financial support plan for emergency centers, the survival rate of emergency patients and disaster victims will be improved.

Tissue Adhesive Effectiveness in Laceration Site

PURPOSE: To study tissue adhesive effectiveness in with laceration at various body sites. METHODS: From January 2007 to December 2009, we collected the data of laceration patients treated using tissue adhesive in the emergency department of a university hospital. Data concerning treatment satisfaction were collected twice and analyzed. RESULTS: Of the 8665 patients with laceration, 196 (mean age 23 years, 106 males) were treated using tissue adhesive. Many of the 196 patients were <15-years-of-age. Involved body sites mainly comprised head/neck, followed by the upper extremities. The procedure was the most rapid of all treatments. CONCLUSION: Emergency physicians can reliably use tissue adhesive treatment for various lacerations in the emergency setting.

Emergency Physician Turnover in Private Clinics

PURPOSE: This study provided a sample of self-reported turnover rates and their causes for emergency medicine physicians. METHODS: A questionnaire was distributed to 47 emergency physicians practicing in private clinics via post or e-mail. Self-reported demographic data, workload, causes of turnover, psychosocial and job related stress were collected. 27 emergency physicians participated in this study by completing and returning the questionnaire. RESULTS: Turnover rate for emergency physician was 14.3%. The mean age of the participants was 45.19+/-3.43, and 25 of the 27 participants were male. The length of time working in a private clinic was 7.14+/-4.02 years. Years since acquisition of emergency board certification was 3.38+/-2.97 years. Work hours per week were 52.70+/-8.99. Income satisfaction and personal well-being were higher than compared to their time practicing medicine as emergency physicians. The average scores for APGAR and psychosocial stress were 5.63+/-2.71 and 2.19+/-0.85, respectively. Reported causes of turnover in emergency clinical practice included negative impacts to quality of life, impact of aging, negative effects of shift work, negative "fishbowl" work environment, etc. CONCLUSION: The causes of turnover for emergency physicians include concerns regarding health impacts due to shift work, negative impact on quality of life, and concerns related to job security. In order to decrease emergency physician turnover rates, administrative considerations should be put in place to include a decrease in night shift hours per physician, and frequency for senior emergency physician is most important. Investigation into causes of turnover for physicians should not be limited to private clinic operations but should also include administration, research, teaching, and other duties.

Consideration of Features of beta-blocker Medication after Acute Myocardial Infarction in the Emergency Department

PURPOSE: To assess factors that influcence beta-blocker use in ST-segment elevation myocaridal infarction (STEMI) in the emergency department (ED) and to identify features related to beta-blocker use. METHODS: A retrospective study was conducted of STEMI ED patients presenting to tertiary hospital ED from January 2005 to December 2006. Two hundred eighty-seven patients were enrolled. Chi2 analysis was used to assess beta-blocker usage. RESULTS: Two hundreds eighty-seven patients were identified. Total patients eligible for beta-blocker were 241 (84%). Of these, 234 (97%) received a beta-blocker in the ED. Two hundreds twelve patients (73.9%) were male and, 166 patients (57.8%) were over sixty years of age. Eligibility of patients for beta-blocker was not different by gender or age. Only 39 (13.6%) did not take beta-blocker. Although 46 patients had contraindications. Seven patients eligible for beta-blocker did not take the drug and there were inadvertent medications of 14. We categorized all patients receiving beta-blocker into three groups; early, normal, and delayed drug administration. Of 248 patients, 148 (59.6%) were early, 50 (20.2%) were normal, 50 (20.2%) were delayed. There were no differences in the three groups by gender (p=0.869). Only 22 patients received beta-blockers from emergency physicians (EP). All inadvertents medications were administered by internists. CONCLUSION: Several articles have reported underutilization of beta-blocker according to age and gender. In the present study, however, there appears to be no age or gender difference suggesting improvement in practices with beta-blocker. Of concern, though, is the large number of patients (50) who received drug only after more than twelve hours (door to drug time) in the ER. This indicates that although practices of medication were improved in the ER, adequacy and appropriateness of medication is not good. Therefore, an education program for beta-blocker use should be directed towards early medication (especially within two hours). In addition, beta-blocker administration by EPs should be emphasized because of their close early contact with patients.

Clinical Analysis of Trauma Surgery Patients in a Local Emergency Center; Does Emergency Physicians'Treatment Delay the Surgeons'Special Care like Emergency Operations for Trauma Victims?

PURPOSE: Trauma surgery is not an official medical specialty in the Republic of Korea (South Korea). Thus, a trauma victim transported to an emergency room (ER) is resuscitated and surveyed by an intern, a resident, or an emergency physician (EP) at first. Currently an operative management is decreasing because of multiple factors. Nevertheless, trauma surgery is the key for some patients. Does the EP's treatment in the ER delay the surgeon's emergency operation? METHODS: A retrospective study was performed for trauma victims who underwent trauma surgery from March 2004 to February 2005 in a local emergency center of Daegu-city. We reviewed the medical records and analyzed the trauma victim's age, sex, cause of injury, method of transport, time from the trauma to the operation, EP's treatment, surgical department, mortality, and injury severity score (ISS). RESULTS: Of the 223 trauma victims included in this study, males were predominant (83.4%). The mean age was 37.98 years of age. The main Causes of trauma were trauma NOS (not otherwise specified) and motor vehicle accidents (MVA). The main methods of transport was privately owned automobile. The mean time from trauma to operation was 617.46 min. The mean ISS was 7.67. Trauma surgery with the EP's treatment group included 40 trauma victims with higher ISS, and the time from trauma to operation was shorter than it was for the 183 trauma victims not in that group. CONCLUSION: The EP's treatment of high-ISS multiple-injury trauma victims can shorten the time from trauma to trauma surgery and will help the surgical department treatment. In the trauma care system of the Republic of Korea, and increased role should be encouraged for emergency physician.

Corneal Foreign Body Removal by Emergency Physicians

PURPOSE: This study was performed to evaluate the success rate and the safety in the treatment of corneal foreign body injury by an emergency physician trained in their removal. METHODS: Any patients presenting at the emergency department of a large university-based residency teaching hospital with corneal foreign body injuries during ninety months were included in this prospective study. Twenty patients were eligible. Junior residents participated in this study. They were taught to remove corneal foreign bodies by the attending emergency physician. Healing evaluation was performed by an ophthalmologist. Patients not presenting for a visit were contacted by telephone, and information was collected on the assessment of discomfort and the presence of symptoms. RESULTS: All corneal foreign bodies were successfully removed, and no adverse effects were noted. CONCLUSION: Corneal foreign body removal by emergency physician, if properly trained, appears to be successful and safe.