Trends in Palliative Care Research During the COVID-19 Pandemic.

To demonstrate the trends and variety of research on palliative care during the COVID-19 pandemic. A systematic search of the Web of Science database. Since the outbroke of the COVID-19 pandemic, the adjustment of palliative care systems is warranted to maintain a high quality of care. The COVID-19 -related palliative care studies account for approximately 4% of all publications on palliative care. However, there is a dearth of research investigating the nature of these studies. A total of 293 studies were included. Of the included studies, those related to system improvement were the most common (181/293, 61.8%), followed by those related to patient care (79/293, 27.0%), bereavement support for patients or family members (19/293, 6.5%), and the mental health of frontline practitioners (14/293, 4.8%). From these studies, 82, 137, and 74 studies were published in 2020, 2021, and 2022 (until August 1), respectively. The research trends of palliative care demonstrate the flexibility and rapid response of the global palliative care system to the COVID-19 pandemic and show how the palliative care system is evolving. While most studies are interested in system improvement, patient care, and bereavement support, the mental health of frontline practitioners has received less attention. Our findings provide palliative care practitioners with current valuable information and highlight possible future trends.

Trends of Regional Anesthesia Studies in Emergency Medicine: An Observational Study of Published Articles.

INTRODUCTION: Regional anesthesia (RA) has become a prominent component of multimodal pain management in emergency medicine (EM), and its use has increased rapidly in recent decades. Nevertheless, there is a paucity of data on how RA practice has evolved in the specialty. In this study we sought to investigate how RA has been implemented in EM by analyzing trends of published articles and to describe the characteristics of the published research. METHODS: We retrieved RA-related publications from the SciVerse Scopus database from inception to January 13, 2022, focusing on studies associated with the use of RA in EM. The primary outcome was an analysis of trend based on the number of annual publications. Other outcomes included reports of technique diversity by year, trends in the use of individual techniques, and characteristics of published articles. We used linear regression analysis to analyze trends. RESULTS: In total, 133 eligible publications were included. We found that overall 23 techniques have been described and results published in the EM literature. Articles related to RA increased from one article in 1982 to 18 in 2021, and the rate of publication has increased more rapidly since 2016. Reports of lower extremity blocks (60.90%) were published most frequently in ranked-first aggregated citations. The use of thoracic nerve blocks, such as the erector spinae plane block, has increased exponentially in the past three years. The United States (41.35%) has published the most RA-related articles. Regional anesthesia administered by emergency physicians (52.63%) comprised the leading field in published articles related to RA. Most publications discussed single-shot (88.72%) and ultrasound-guided methods (55.64%). CONCLUSION: This study highlights that the number of published articles related to regional anesthesia in EM has increased. Although RA research has primarily focused on lower extremity blocks, clinical researchers continue to broaden the field of study to encompass a wide spectrum of techniques and indications.

Hyperbaric oxygen therapy research: an analysis of the 100 most-cited publications from 2011 to 2020.

Objective: Hyperbaric oxygen (HBO2) is used in several clinical and research fields. This study aimed to analyze the 100 most-cited hyperbaric-related publications of the past 10 years to understand the trends in HBO2 research. Methods: This was a literature review. All publication and citation data were retrieved from the Scopus database. Publications with "hyperbaric oxygen," "hyperbaric oxygenation," "HBO," and "HBOT" in the title, abstract, or keywords published between January 01, 2011, and December 31, 2020, were enrolled. The 100 most-cited HBO2-focused publications were identified, and their publication title, authors' nationality, publication journal, year, type (original or review), and application field were recorded and analyzed using descriptive statistics. Linear regression was used to evaluate the trends in publication numbers. Results: A total of 6,517 publications were enrolled. The annual rate of increase was 4.56 per year (p-value = 0.13, 95% CI: -1.62 to 10.74). The total, average, median and mode of citations were 67,726, 10.4, 4, and 0, respectively. The 100 most-cited HBO2-focused publications accounted for 1.5% (100/6,517) of all publications and 8.1% (5509/67,726) of the total number of times cited. The most-cited publications originated from 17 countries and were published in 65 journals, led by the Cochrane Database of Systematic Reviews. Conclusions: The annual number of HBO2 publications was stationary. The citation numbers showed a skewed distribution. The United States was the leading country in HBO2 research. Of 26 application fields, traumatic brain injury, stroke, and diabetic foot were the leading three fields.

COVID-19 Literature Published in Emergency Medicine Journals in 2020.

INTRODUCTION: Coronavirus disease 2019 (COVID-19)-related articles published in emergency medicine (EM) journals provide insight into the responses of EM researchers and journal editors globally to a newly emerging infectious disease. We studied trends in the number, types, and national origins of COVID-19 literature published in EM journals to investigate knowledge transmission via scientific publication during the pandemic. METHODS: This was a retrospective observational study. The EM journal list was adopted from the 2019 Journal Citation Reports. We retrieved data from the SCOPUS database, limited to publication year 2020, and identified COVID-19 publications when the title, abstract, or keywords included "COVID" or "SARS." The outcome measurements were as follows: 1) monthly COVID-19 publication numbers in EM journals; 2) the percentage of COVID-19 published literature in terms of total journal publications; 3) the countries, affiliations, and authors of COVID-19-related publications; 4) the differences in the proportions of "Articles" and "Letters" between COVID-19 and non-COVID-19 publications; and 5) the total, average, and maximum number of times cited for different types of COVID-19-related scientific literature. RESULTS: We retrieved a total of 7,457 published papers from 31 EM journals. There were 765 (10.26%) COVID-19-related publications in 27 journals contributed by 67 countries; the first authors were from 49 countries. The monthly COVID-19 publication numbers in the categories of "Letters" and "Articles" were nearly equal before July 2020. The yearly proportions of COVID-19-focused articles and letters were 48.8% and 29.9%, respectively, while non-COVID-19 proportions were 72.1% and 9.8%, respectively. The chi-squared statistic of the differences between the numbers of articles and letters in COVID-19 and non-COVID-19 published research was significant (P < .001). CONCLUSION: An analysis of COVID-19 publications in EM journals indicated that, in the early stage of a newly emerging infectious disease, the number of letters and articles increased simultaneously. The proportion of COVID-19-focused letters was higher than those published on other topics. The "Article" and "Review" category of COVID-19 research was cited more times than that of "Letters."

Scientific publication trends of emergency department of International Federation for Emergency Medicine members, 2009 to 2018.

BACKGROUND: Emergency medicine (EM) is a rapidly developing specialty worldwide. The scientific publications trend is one of the parameters to evaluate national EM developmental milestones. This study was performed to analyze the publication trends from emergency departments (EDs) of International Federation for Emergency Medicine (IFEM) full member countries from 2009 to 2018. METHODS: All data were retrieved from the SciVerse Scopus database. IFEM full member countries where EM was recognized as a specialty before 2009 and annual publication numbers exceeded 12 in 2018 were included. The EM journals list was adopted from the 2017 Journal Citation Reports. Publications with the first author affiliated with EDs were divided into EM or non-EM journal groups according to the publishing journal. The slope (ß) of the linear regression was used to assess the trends of publication numbers. The correlation between the 2009 publication number and the trend of publication between 2009 and 2018 was measured by Pearson's correlation coefficient (r). The correlation between funding numbers and publication numbers was analyzed by Spearman's rank correlation coefficient (rs). RESULTS: We identified 30,130 publications with first authors from EDs in 19 countries. The numbers of publications in both EM and non-EM journals showed an increasing trend in 12 countries. Fifteen of the 19 countries had a greater increasing trend in non-EM journals than in EM journals. The 2009 publication numbers were positively correlated with the publication increasing trend between 2009 and 2018 in both EM and non-EM journals (r = 0.854 and 0.947, respectively, both p < 0.001). The funded publication number was positively correlated with the total national publication amount (rs = 0.748, p < 0.001). CONCLUSIONS: The research capacity of EDs has been increasingly recognized by other medical specialties. The national publication numbers from EDs may predict the academic publication increasing trends in the subsequent 10 years.

Indirect Radiological Signs of Hollow Organ Perforation.

Hollow organ perforation is a serious and common abdominal emergency. The diagnosis depends on history taking, physical examination, and radiological fi ndings. We reported a hollow organ perforation patient with only indirect radiological signs of the heterogenous enhanced lesion between the stomach, duodenum, and liver over initial abdominal computed tomography. Pneumoperitoneum occurred in follow-up chest X-ray 5 hours after the emergency department visit. The reason for the delayed occurrence of pneumoperitoneum, direct/indirect radiological signs of hollow organ perforation, and ways to avoid this pitfall are discussed.

Broadening Our Horizons: Increasing Diversity of Scientific Publications From Taiwan Emergency Physicians, 2012-2017.

BACKGROUND: Scientific publications and academic research are objective indicators that provide dynamic views of the evolution of emergency medicine (EM). This study is aimed to evaluate the academic contribution of Taiwan emergency departments (EDs) by analyzing scientific publications. METHODS: This is an observational study and all publications between 2012 and 2017 were retrieved from the Scopus database. The EM journals were adopted from the 2016 Journal Citation Reports (JCR) category of EM. Three groups of publications were enrolled: (1) publications with first authors affiliated with Taiwan EDs in EM journals; (2) publications with first authors affiliated with Taiwan EDs in non-EM journals; (3) publications with first authors affiliated with Taiwan other than EDs in EM journals. Data regarding the name and category of the publishing journal, the publication year, the publication type, and the number of citations were collected for further analysis. The publication and category numbers were also merged with previous study to obtain a longer trend analysis from 1992. RESULTS: A total of 291 publications affiliated with Taiwan EDs were published in EM journals and 697 publications in 275 non-EM journals. A total of 286 publications in EM journals affiliated with Taiwan but other than ED. The trend of publication numbers in all three groups and category numbers since 1992 were increasing (all p < 0.001). Publication numbers in non-EM journals increased the most and obtained the highest cited times. The 275 non-EM journals were classified into 69 categories. The leading five categories were Medicine, General & Internal, Multidisciplinary Sciences, Surgery, Infectious Diseases, Geriatrics & Gerontology. CONCLUSIONS: The importance of researches originating from Taiwan EDs has been increasingly recognized by both the global EM community and by other medical specialties during the past 25 years. The advancement of academic contribution by Taiwan EDs is evident from the perspectives of quantity and breadth.

Predictive Role of QTc Prolongation in Carbon Monoxide Poisoning-Related Delayed Neuropsychiatric Sequelae.

OBJECTIVE: Delayed neuropsychiatric sequelae (DNS) are serious complications of carbon monoxide (CO) poisoning that adversely affect poisoned patients' quality of life as well as socioeconomic status. This study aimed to determine clinical predictors of DNS in patients with CO poisoning. METHODS: This retrospective study included all CO-poisoned patients admitted to the emergency department (ED) of Linkou Chang Gung Memorial Hospital in Taiwan from 1 January 2009 to 31 December 2015. The medical records of all patients with CO poisoning were carefully reviewed, and relevant data were abstracted into a standardised form. Univariate and multivariate logistic regression models were used to identify predictors of DNS after CO poisoning. Receiver operating characteristic (ROC) curve analysis was used to determine the ideal cut-off value for continuous variables that predict the development of DNS. RESULTS: A total of 760 patients with CO poisoning were identified during the study period. Among them, 466 were eligible for the analysis of predictors of DNS. In multivariate analysis, Glasgow Coma Scale <9 (odds ratio [OR], 2.74; 95% confidence interval [CI], 1.21-6.21), transient loss of consciousness (OR, 3.59; 95% CI, 1.31-9.79), longer duration from CO exposure to ED presentation (OR, 1.05; 95% CI, 1.03-1.08), and corrected QT (QTc) prolongation (OR, 2.61; 95% CI, 1.21-5.61) were found to be associated with a higher risk of DNS. The area under the ROC curve (AUC) for QTc interval measured within 6 h after exposure best predicted the development of DNS, with a result of 0.729 (95% CI 0.660-0.791). Moreover, the best cut-off value of the QTc interval was 471 ms, with a sensitivity of 53.3% and a specificity of 85.1%. CONCLUSIONS: We identified several potential predictors of DNS following CO poisoning. Among them, QTc prolongation found within 6 h after exposure is a novel predictor of DNS, which may be helpful in the future care of patients with CO poisoning.

Top-cited publications on point-of-care ultrasound: The evolution of research trends.

STUDY OBJECTIVES: Point-of-care ultrasound (POCUS) has been a rapidly growing and broadly used modality in recent decades. The purpose of this study was to determine how POCUS is incorporated into clinical medicine by analyzing trends of use in the published literature. METHODS: POCUS-related publications were retrieved from the Web of Science (WoS) database. The search results were ranked according to the number of times an article was cited during three time frames and average annual number of citations. Of the top 100 most cited publications in the four rankings, information regarding the publication journal, publication year, first author's nationality, field of POCUS application, and number of times the article was cited was recorded for trend analysis. RESULTS: A total of 7860 POCUS-related publications were retrieved, and publications related to POCUS increased from 8 in 1990 to 754 in 2016. The top 148 cited publications from the four ranking groups were included in this study. Trauma was the leading application field in which POCUS was studied prior to 2001. After 2004, thorax, cardiovascular, and procedure-guidance were the leading fields in POCUS research. >79% (118/148) of the top-cited publications were conducted by authors in the United States, Italy, and France. The majority of publications were published in critical care medicine and emergency medicine journals. CONCLUSIONS: In recent years, publications relating to POCUS have increased. POCUS-related research has mainly been performed in thorax, cardiovascular, and procedure-guidance ultrasonography fields, replacing trauma as the major field in which POCUS was previously studied.

Factors Affecting Unscheduled Return Visits to the Emergency Department among Minor Head Injury Patients.

STUDY OBJECTIVES: Differences between returning and non-returning minor head injury (MHI) emergency department (ED) patients, between the characteristics of the first visit and revisit, and between admitted and nonadmitted returning patients were investigated. METHODS: This was a retrospective study. All discharged ED patients with ICD-9 codes 850.0 to 850.9, 920, and 959.01 in 2013 were enrolled. Patients' demographic data, vital signs, Glasgow Coma Scale, ED diagnosis, length of stay, triage levels, ED examinations performed, and comorbidities were recorded for analysis. RESULTS: A total of 2,815 patients were enrolled. Of 57 (2%) patients who revisited the ED, 47 (82%) were discharged from the ED and ten (18%) were admitted to the hospital. Patients who returned to the ED were older, and they exhibited more comorbidities. Those who presented with vomiting, triage level of 1 or 2, and GCS score of <15 and who received more blood tests during their first visit were more likely to be admitted when they returned to the ED. CONCLUSIONS: Discharging MHI patients who are older or exhibit comorbidities only when symptoms and concerns are relieved completely, providing clear discharge instructions, and arranging timely clinical follow-ups may help reduce such patients' return rate.

Challenges of feedback provision in the workplace: A qualitative study of emergency medicine residents and teachers.

BACKGROUND: Feedback is an effective pedagogical tool in clinical teaching and learning, but is often perceived as unsatisfactory. Little is known about the effect of a busy clinical environment on feedback-giving and -seeking behaviors. This study aims to determine the perceptions and challenges of feedback provision in a busy clinical setting, exemplified by an emergency department (ED). METHODS: A qualitative semi-structured interview study design was employed. Thirty-six participants (18 attending physicians, 18 residents) were purposively sampled from three EDs in northern Taiwan between August 2015 and July 2016. Interviews were recorded, transcribed, and analyzed thematically. RESULTS: Three major themes were identified with illustrative quotes: (1) the balance between patient safety and providing feedback, (2) variability in feedback, and (3) influential factors, barriers and enablers. CONCLUSIONS: In real practice, clinical duties competed with the impulse to provide feedback. The variety and complexity of feedback extended beyond style and content. Clinical and contextual factors - some of which may be presented as barriers - influenced how, when and whether a teacher or learner decided to give or seek feedback.

Exploring the influence of gender, seniority and specialty on paper and computer-based feedback provision during mini-CEX assessments in a busy emergency department.

The mini-clinical evaluation exercise (mini-CEX) is a well-established method of assessing trainees' clinical competence in the workplace. In order to improve the quality of clinical learning, factors that influence the provision of feedback are worthy of further investigation. A retrospective data analysis of documented feedback provided by assessors using the mini-CEX in a busy emergency department (ED) was conducted. The assessors comprised emergency physicians (EPs) and trauma surgeons. The trainees were all postgraduate year one (PGY1) residents. The completion rate and word count for each of three feedback components (positive feedback, suggestions for development, and an agreed action plan) were recorded. Other variables included observation time, feedback time, the format used (paper versus computer-based), the seniority of the assessor, the gender of the assessor and the specialty of the assessor. The components of feedback provided by the assessors and the influence of these contextual and demographic factors were also analyzed. During a 26-month study period, 1101 mini-CEX assessments (from 273 PGY1 residents and 67 assessors) were collected. The overall completion rate for the feedback components was 85.3 % (positive feedback), 54.8 % (suggestions for development), and 29.5 % (agreed action plan). In only 22.9 % of the total mini-CEX assessments were all three aspects of feedback completed, and 7.4 % contained no feedback. In the univariate analysis, the mini-CEX format, the seniority of the assessor and the specialty of the assessor were identified as influencing the completion of all three components of feedback. In the multivariate analysis, only the mini-CEX format and the seniority of the assessor were statistically significant. In a subgroup analysis, the feedback-facilitating effect of the computer-based format was uneven across junior and senior EPs. In addition, feedback provision showed a primacy effect: assessors tended to provide only the first or second feedback components in a busy ED setting. In summary, the authors explored the influence of gender, seniority and specialty on paper and computer-based feedback provision during mini-CEX assessments for PGY1 residency training in a busy ED. It was shown that junior assessors were more likely to provide all three aspects of written feedback in the mini-CEX than were senior assessors. The computer-based format facilitated the completion of feedback among EPs.

Successful Extracorporeal Life Support in a Case of Severe Glyphosate-Surfactant Intoxication.

OBJECTIVE: To describe the experience of emergency extracorporeal membrane oxygenation in treating life-threatening glyphosate-surfactant intoxication. DESIGN: Case report. SETTING: Emergency department and ICU. PATIENT: A patient with cardiopulmonary failure after glyphosate-surfactant intoxication. INTERVENTION: Extracorporeal membrane oxygenation. CASE REPORT: A 47-year-old man presented with mildly decreased consciousness in our emergency department after ingesting approximately 100 mL of glyphosate-surfactant 1.5 hours previously. Respiratory failure, persistent ventricular tachycardia, profound shock refractory to inotropic agents, and metabolic acidosis developed in the patient within 2 hours. Extracorporeal membrane oxygenation was applied within 4 hours of cardiopulmonary failure. The patient's condition improved considerably. He was transferred to the general ward on the eighth day with stable hemodynamic status and complete neurological recovery. CONCLUSIONS: On the basis of our research, this was the first case in which extracorporeal membrane oxygenation was used to treat severe glyphosate-surfactant intoxication. We recommend early initiation of extracorporeal membrane oxygenation therapy to mitigate cardiopulmonary compromise in patients with glyphosate-surfactant intoxication.

The progress of emergency medicine in Taiwan, China, and Hong Kong: perspective from publications in Emergency Medicine Journals, 1992-2011.

STUDY OBJECTIVE: The progress of emergency medicine (EM) in Taiwan, China, and Hong Kong was evaluated from the perspective of publications in EM journals. METHODS: This was a retrospective study. All articles published from 1992 to 2011 in all journals in the EM category in the 2010 Journal Citation Reports (JCR) were included. A computerized literature search was conducted using the SciVerse Scopus database. The slope ( ß ) of the linear regression was used to evaluate the trends in the numbers of articles as well as the ratios to the total number of EM journal articles. RESULTS: The trends in the numbers of articles from Taiwan, China, and Hong Kong were 6.170, 1.908, and 2.835 and the trends in the ratios of their publication numbers to the total number of EM journal articles were 15.0 × 10(-4), 4.60 × 10(-4), and 6.80 × 10(-4), respectively. All P-values were <0.01. The mean, median, and 75th percentiles of the number of citations in all EM journals were greater than those of these three areas. CONCLUSIONS: The publications from Taiwan, China, and Hong Kong have increased at a higher rate than those of the overall EM field in the past 20 years and indicated the rapid progress in these three areas.