Analysis of the Role of Problem-Based Independent Learning Model in Teaching Cerebral Ischemic Stroke First Aid in Emergency Medicine

Objective:To analyze the effect of using a problem-based(PBL)independent learning model in teaching cerebral ischemic stroke(CIS)first aid in emergency medicine.Methods:90 interns in the emergency department of our hospital from May 2022 to May 2023 were selected for the study.They were divided into Group A(45,conventional teaching method)and Group B(45 cases,PBL independent learning model)by randomized numerical table method to compare the effects of the two groups.Results:The teaching effect indicators and student satisfaction scores in Group B were higher than those in Group A(P<0.05).Conclusion:The use of the PBL independent learning model in the teaching of CIS first aid can significantly improve the teaching effect and student satisfaction.

The Emergence of Time from Quantum Information Dynamics

This paper presents a novel framework for understanding time as an emergent phenomenon arising from quantum information dynamics. We propose that the flow of time and its directional arrow are intrinsically linked to the growth of quantum complexity and the evolution of entanglement entropy in physical systems. By integrating principles from quantum mechanics, information theory, and holography, we develop a comprehensive theory that explains how time can emerge from timeless quantum processes. Our approach unifies concepts from quantum mechanics, general relativity, and thermodynamics, providing new perspectives on longstanding puzzles such as the black hole information paradox and the arrow of time. We derive modified Friedmann equations that incorporate quantum information measures, offering novel insights into cosmic evolution and the nature of dark energy. The paper presents a series of experimental proposals to test key aspects of this theory, ranging from quantum simulations to cosmological observations. Our framework suggests a deeply information-theoretic view of the universe, challenging our understanding of the nature of reality and opening new avenues for technological applications in quantum computing and sensing. This work contributes to the ongoing quest for a unified theory of quantum gravity and information, potentially with far-reaching implications for our understanding of space, time, and the fundamental structure of the cosmos.

Research on Technology Development of Traditional Chinese Medicine Extraction Based on Patent Information

Objective To understand the development status of traditional Chinese medicine extraction technology,so as to provide a reference for enterprises and scientific research institutions to determine the direction of technological innovation.Besides,the government can formulate scientific and technological innovation strategies.Methods Based on patent information,statistical methods were applied to analyze the development of traditional Chinese medicine extraction technology.Then,the core technology was identified by constructing a patent citation network.Finally,the main path analysis method was applied to discover the technological evolution path.Results and Conclusion The extraction technology of traditional Chinese medicine is still in the growth stage.At present,its R&D is based on enterprises,supplemented by scientific research institutions.The core technologies are ultrasonic extraction and enzymatic extraction.The main path represented by enzymatic extraction technology reveals the evolution process of traditional Chinese medicine extraction technology.Based on this,relevant suggestions are put forward.Firstly,technological innovation cooperation should be strengthened to explore new models of achievement transformation and cooperation.Secondly,key enterprises of technology clusters should be cultivated to accelerate breakthroughs in core technologies.Thirdly,combined technologies can achieve high-efficiency enzyme-assisted extraction and open up new ways of extracting traditional Chinese medicine.Fourthly,traditional techniques should be improved to develop innovative modern techniques.

Integrative analysis of bone-formation associated genes and immune cell infiltration in osteoporosis, and the prediction of active ingredients in targeted traditional Chinese medicine

Objective To explore the differential expression and mechanisms of bone formation-related genes in osteoporosis(OP)leveraging bioinformatics and machine learning methodologies;and to predict the active ingredients of targeted traditional Chinese medicine(TCM)herbs.Methods The Gene Expression Omnibus(GEO)and GeneCards databases were employed to conduct a comprehensive screening of genes and disease-associated loci pertinent to the pathogenesis of OP.The R package was utilized as the analytical tool for the identification of differentially expressed genes.Least absolute shrinkage and selection operator(LASSO)logis-tic regression analysis and support vector machine-recursive feature elimination(SVM-RFE)algorithm were employed in defining the genetic signature specific to OP.Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analyses for the selected pivotal genes were conducted.The cell-type identification by estimating rela-tive subsets of RNA transcripts(CIBERSORT)algorithm was leveraged to examine the infiltra-tion patterns of immune cells;with Spearman’s rank correlation analysis utilized to assess the relationship between the expression levels of the genes and the presence of immune cells.Coremine Medical Database was used to screen out potential TCM herbs for the treatment of OP.Comparative Toxicogenomics Database(CTD)was employed for forecasting the TCM ac-tive ingredients targeting the key genes.AutoDock Vina 1.2.2 and GROMACS 2020 softwares were employed to conclude analysis results;facilitating the exploration of binding affinity and conformational dynamics between the TCM active ingredients and their biological targets.Results Ten genes were identified by intersecting the results from the GEO and GeneCards databases.Through the application of LASSO regression and SVM-RFE algorithm;four piv-otal genes were selected:coat protein(CP);kallikrein 3(KLK3);polymeraseγ(POLG);and transient receptor potential vanilloid 4(TRPV4).GO and KEGG pathway enrichment analy-ses revealed that these trait genes were predominantly engaged in the regulation of defense response activation;maintenance of cellular metal ion balance;and the production of chemokine ligand 5.These genes were notably associated with signaling pathways such as ferroptosis;porphyrin metabolism;and base excision repair.Immune infiltration analysis showed that key genes were highly correlated with immune cells.Macrophage M0;M1;M2;and resting dendritic cell were significantly different between groups;and there were signifi-cant differences between different groups(P<0.05).The interaction counts of resveratrol;curcumin;and quercetin with KLK3 were 7;3;and 2;respectively.It shows that the interac-tions of resveratrol;curcumin;and quercetin with KLK3 were substantial.Molecular docking and molecular dynamics simulations further confirmed the robust binding affinity of these bioactive compounds to the target genes.Conclusion Pivotal genes including CP;KLK3;POLG;and TRPV4;exhibited commendable significant prognostic value;and played a crucial role in the diagnostic assessment of OP.Resveratrol;curcumin;and quercetin;natural compounds found in TCM;showed promise in their potential to effectively modulate the bone-forming gene KLK3.This study provides a sci-entific basis for the interpretation of the pathogenesis of OP and the development of clinical drugs.

Epidemiology of Hand Injuries That Presented to the Emergency Department of a Tertiary Care Facility in Suburban Mumbai, India: A Study Including 489 Patients

Background: Hand injuries are very common and responsible for a significant number of emergency department (ED) visits, most of which are not to hand specialists [1]. The functionality and outcome of hand injuries can vary significantly depending on the mechanism and pattern of injuries, which is why it is imperative for emergency physicians to recognize the complexities, and the potential repercussion of missed injuries in such cases. Objective: The aim of this study is to provide epidemiological information on hand injuries and their patterns. The objective is 1) to assess whether most hand injuries are superficial (simple), or involve underlying deeper structures (complex) and 2) to assess whether most hand injuries presented to the emergency department were managed by the emergency physician or plastic/orthopaedic surgeon. Methods: This retrospective single-centre observational study conducted at an emergency department in a tertiary care hospital in Mumbai, India collected data from hand trauma patients using a standardized documentation form. Demographic data, trauma-related data, and disposition plans were analysed. Results: A total of 489 cases sustained hand injuries over a period of one year. The patients were predominantly males in the 20 - 30 year age group and injuries were mainly sustained over the right hand. Most of the injuries were sustained at home (42%). The most common mechanism (34%) was sharp object injury (including needle-stick and other sharps in hospital), followed by blunt injury (30%). Among grievous hand injuries, door jamb was a mechanism noted in 11% of patients, accounting for 50% of all crush injuries. Lacerations were the most common pattern (24.7%) noticed, followed closely by fractures (23.3%). Digits II - IV were injured most commonly (54%), followed by carpals (14%) and the thumb (10%). Nearly 80% of the hand injuries were managed by emergency physicians alone, with 61% of cases involving superficial structures. Though 14% of the cases required plastic surgery intervention, the initial evaluation of all these patients was performed by the emergency physician. Conclusions: Our study highlights the burden of hand injuries on the emergency physician, as well as the odds of missed injuries, directly indicating the necessity of a thorough anatomical knowledge of the structures of the hand, and in turn, a proper physical examination. A dedicated registry for hand trauma would help quantify the mechanism and pattern of injuries, and formulate preventive strategies.

An Emergency Plan Selection Method for Emergency Latency

Drawing upon a characteristic analysis of the latency period in emergencies,this paper proposes an emergency plan selection method based on interval language variables and information entropy to address the challenge of acquiring critical information during this crucial stage.Initially,decision-makers employ interval language variables to express the preference information regarding emergency plans,while also introducing an enhanced information entropy theory to derive the weight coefficients of key indicators.Subsequently,the weighted arithmetic average operator of interval language is applied twice to aggregate the preference information alongside the relative importance of decision-makers and the weight coefficients of key indicators.Finally,the ranking coefficients of each emergency plan are sorted to determine the optimal scheme.The feasibility and effectiveness of this method are demonstrated through a case study involving the selection of an emergency plan for a flood disaster in a specific location.

Framework Design of Emergency Public Warning Information Release Platform in Hunan Province

Construction background of Hunan emergency public warning information release platform was introduced,and current status and demands of provincial information release were analyzed.Supported by GIS,Java,and Net,Hunan early warning information release platform of public emergency was constructed based on ORACLE database and Windows 2008 Server,achieving information collection,packaging,transmission,de-packaging,and releasing concentration,standard and processing.In addition,the framework and functional characters of the system were illustrated and the innovation points were explored.The system provides guarantee for meteorological services and disaster prevention or reducing of Hunan public emergencies.

Emergency medicine in China： present and future

BACKGROUND： Emergency medicine was inaugurated, as an official specialty in China, only25 years ago, and its growth in clinical practice and academic development since that time have beenremarkable.METHODS： This paper is a critical and descriptive review on current situations in emergencymedicine in China, based on the literature review, personal observations, interviews with manyChinese emergency medicine doctors and experts, and personal experience in both China and USA.RESULTS： The current practice of emergency medicine in China encompasses three areas： prehospitalmedicine, emergency medicine, and critical care medicine. Most tertiary emergency departments（EDs） are structurally and functionally divided into several clinical areas, allowing the ED itself to functionas a small independent hospital. While Chinese emergency physicians receive specialty training througha number of pathways, national standards in training and certifi cation have not yet been developed. As aresult, the scope of practice for emergency physicians and the quality of clinical care vary greatly betweenindividual hospitals. Physician recruitment, diffi cult working conditions, and academic promotion remain asmajor challenges in the development of emergency medicine in China.CONCLUSION： To further strengthen the specialty advancement, more government leadershipis needed to standardize regional training curriculums, elucidate practice guidelines, provide fundingopportunities for academic development in emergency medicine, and promote the development of asystem approach to emergency care in China.

Emergency medicine as a growing career in Iran： an Internet-based survey

BACKGROUND: In Iran, few studies have evaluated emergency medicine as a career option. In the present study, we aimed to find out how Iranian emergency-medicine specialists view their specialty as a career.METHODS: Following a qualitative study, a Likert-scale questionnaire was developed. Iranian emergency physician specialists who had at least two years' job experience were contacted via email. A uniform link to a Web-based survey and a cover letter that explained the survey were sent to the recipients. We used the Kruskal-Wallis test and post hoc analysis to determine the differences between demographic subgroups.RESULTS: A total of 109 eligible responses were received, a response rate of 72.63%. Of the responders, 57.8% were 30–40 years of age, 86.2% were male, 86.2% were single, 84.4% were faculty members and 90.8% had fewer than 10 years' job experience. The main problems occurring during the career of Iranian emergency physicians were: insuffi cient income, inadequate recognition of the specialty by the community, inadequate union support, insecurity in the emergency wards, overcrowding, job stresses and night shifts. Despite insufficiency of income, Iranian emergency physicians(EPs) did not care about the financial benefits of patient care. Academic activity had positive effects on the perspectives of Iranian emergency physicians regarding their careers.CONCLUSION: Iranian emergency physicians and leaders in emergency medicine should struggle to improve the present situation, aiming at an ideal state.

Comparison of exogenous melatonin versus placebo on sleep efficiency in emergency medicine residents working night shifts： A randomized trial

BACKGROUND: Sleep deprivation resulting from night shifts, is a major cause of burnout among physicians. Exogenous melatonin may improve sleep quality in night-shift workers. The study aims to compare the effectiveness of melatonin versus placebo on sleep effi ciency in emergency medicine(EM) residents. METHODS: A randomized, double-blind, replicated crossover trial was performed on EM residents. This study consisted of 4 phases within a month with intervention periods of 2 nights and washouts of 6 days. In our study, EM residents had nine-hour shifts on 6 consecutive days, 2 mornings, 2 evenings and 2 nights and then 2 days off. At the end of shifts' cycle, 24 EM residents were given 3 mg melatonin or placebo(12 in each arm of the study) for 2 consecutive nights after the second night shift with crossover to the other arm after a six-day off drug. This crossover intervention was repeated for two more another time. Finally, we created 48 cases and comparisons in each arm. Different items related to sleep quality were assessed and compared both within the same group and between the two groups. RESULTS: In the melatonin group, daytime sleepiness(calculated by Karolinska Sleep Scale) had a signifi cant reduction after taking the second dose of drug(P=0.003) but the same result was not observed when comparing the 2 groups. Mood status(calculated by Profile of Mood States) showed no remarkable difference between the 2 groups. CONCLUSION: Melatonin might have a limited benefi t on sleep quality in EM residents working night shifts.

The potential contributions of traditional Chinese medicine to emergency medicine

BACKGROUND:Despite the fact that traditional Chinese medicine(TCM) has been developed and used to treat acute and urgent illness for many thousands of years.TCM has been widely perceived in western societies that TCM may only be effective to treat chronic diseases.The aim of this article is to provide some scientific evidence regarding the application of TCM in emergency medicine and its future potential.METHODS:Multiple databases(PubMed,ProQuest,Academic Search Elite and Science Direct) were searched using the terms:Traditional Chinese Medicine/ Chinese Medicine,Emergency Medicine,China.In addition,three leading TCM Journals in China were searched via Oriprobe Information Services for relevant articles(published from 1990—2012).Particular attention was paid to those articles that are related to TCM treatments or combined medicine in dealing with intensive and critical care.RESULTS:TCM is a systematic traditional macro medicine.The clinical practice of TCM is guided by the TCM theoretical framework- a methodology founded thousands of years ago.As the methodologies between TCM and Biomedicine are significantly different,it provides an opportunity to combine two medicines,in order to achieve clinical efficacy.Nowadays,combined medicine has become a common clinical model particular in TCM hospitals in China.CONCLUSIONS:It is evident that TCM can provide some assistance in emergency although to combine them in practice is still its infant form and is mainly at TCM hospitals in China.The future effort could be put into TCM research,both in laboratories and clinics,with high quality designs,so that TCM could be better understood and then applied in emergency medicine.

German critical incident reporting system database of prehospital emergency medicine: Analysis of reported communication and medication errors between 2005–2015

BACKGROUND: Communication failure in prehospital emergency medicine can affect patient safety as it does in other areas of medicine as well. We analyzed the database of the critical incident reporting system for prehospital emergency medicine in Germany retrospectively regarding communication errors.METHODS: Experts of prehospital emergency medicine and risk management screened the database for verbal communication failure, non-verbal communication failure and missing communication at all.RESULTS: Between 2005 and 2015, 845 reports were analyzed, of which 247 reports were considered to be related to communication failure. An arbitrary classifi cation resulted in six different kinds: 1) no acknowledgement of a suggestion; 2) medication error; 3) miscommunication with dispatcher; 4) utterance heard/understood improperly; 5) missing information transfer between two persons; and 6) other communication failure.CONCLUSION: Communication defi cits can lead to critical incidents in prehospital emergency medicine and are a very important aspect in patient safety.

Perceptions of emergency medicine residents on the quality of residency training in the United States and Saudi Arabia

BACKGROUND: We compare educational environments(i.e. physical, emotional and intellectual experiences) of emergency medicine(EM) residents training in the United States of America(USA) and Saudi Arabia(SA).METHODS: A cross-sectional survey study was conducted using an adapted version of the validated Postgraduate Hospital Educational Environment Measure(PHEEM) survey instrument from April 2015 through June 2016 to compare educational environments in all emergency medicine residency programs in SA and three selected programs in the USA with a history of training Saudi physicians. Overall scores were compared across programs, and for subscales(autonomy, teaching, and social Support), using chi-squared, t-tests, and analysis of variance.RESULTS: A total of 219 surveys were returned for 260 residents across six programs(3 SA, 3 USA), with a response rate of 84%. Program-specific response rates varied from 79%–100%. All six residencies were qualitatively rated as "more positive than negative but room for improvement". Quantitative PHEEM scores for the USA programs were significantly higher: 118.7 compared to 109.9 for SA, P=0.001. In subscales, perceptions of social support were not different between the two countries(P=0.243); however, role autonomy(P<0.001) and teaching(P=0.005) were better in USA programs. There were no significant differences by post-graduate training year.CONCLUSION: EM residents in all three emergency medicine residency programs in SA and the three USA programs studied perceive their training as high quality in general, but with room for improvements. USA residency programs scored higher in overall quality. This was driven by more favorable perceptions of role autonomy and teaching. Understanding how residents perceive their programs may help drive targeted quality improvement efforts.

Emergency medicine in the United States:a systemic review

BACKGROUND:Fifty years of our history in developing and advancing emergency medicine into an independent medical specialty will surely provide emergency medicine colleagues from all over the world with valuable suggestions and guidance.DATA SOURCES:This systemic review is based on the author's extensive experience through active involvement in the national and international development of emergency medicine.RESULTS:Emergency physicians in the U.S.emergency departments and sometimes other settings provide urgent and emergency care to patients of all ages,including definitive diagnosis of emergent conditions,prolonged stabilization of patients when necessary,airway management,and life-saving procedures using rapid sequence intubation and sedation.They use a multitude of diagnostic technologies including laboratory studies,bedside ultrasound and other sophisticated radiology,such as CT scan,and MRI.CONCLUSION:In the U.S.,emergency medicine fits extremely well into the overall medical system,and is clearly the most efficient way to provide emergency patient care.

Multi-formal and Information-based Emergency Resource Reserve System in China

Emergency resources are an important basis of effective emergency response. But there are many disadvantages of the Chinese traditional material reserve method in which the resources are separately reserved in different regions and sections according to the kinds of disasters. So there comes the Multi-formal and Information-based Emergency Resource Reserve System (MIERRS) in China. The reserve body and method change from the single into the multiple forms, that is, the main reserve body changes from the single government agency into the organizations combining with the military, enterprise and society, and the reserve method changes from single material reserve into the reserve combining with market reserve, talents and technology reserve, and production capacity reserve. The content of the reserve change from material to information means to develop the Emergency Resource Management Information System realizing real-time control of resource characteristics and relevant reserve information. The MIERRS leads to a reserve system with rapid response and flexible schedule. It provides a convenient platform for resource sharing, thus avoiding duplication and waste, improving the utilization of resources, reducing the reserve loss and optimizing the structure of resource reserve.

Emergency department operations and management education in emergency medicine training

BACKGROUND:This study was undertaken to examine the current level of operations and management education within US-based Emergency Medicine Residency programs.METHODS:Residency program directors at all US-based Emergency Medicine Residency programs were anonymously surveyed via a web-based instrument.Participants indicated their levels of residency education dedicated to documentation,billing/coding,core measure/quality indicator compliance,and operations management.Data were analyzed using descriptive statistics for the ordinal data/Likert scales.RESULTS:One hundred and six(106)program directors completed the study instrument of one hundred and fifty-six(156)programs(70%).Of these,82.6%indicated emergency department(ED)operations and management education within the training curriculum.Dedicated documentation training was noted in all but 1 program(99%).Program educational offerings also included billing/coding(83%),core measure/quality indicators(78%)and operations management training(71%).In all areas,the most common means of educating came through didactic sessions and direct attending feedback or 69%-94%and 72%-98%respectively.Residency leadership was most confident with resident understanding of quality documentation(80%)and less so with core measures(72%),billing/coding/RVUs(58%),and operations management tools(23%).CONCLUSIONS:While most EM residency programs integrate basic operational education related to documentation and billing/coding,a smaller number provide focused education on the dayto-day management and operations of the ED.Residency leadership perceives graduating resident understanding of operational management tools to be limited.All respondents value further resident curriculum development of ED operations and management.

Emergency Decision-Making Based on q-Rung Orthopair Fuzzy Rough Aggregation Information

With the frequent occurrences of emergency events,emergency decision making(EDM)plays an increasingly significant role in coping with such situations and has become an important and challenging research area in recent times.It is essential for decision makers to make reliable and reasonable emergency decisions within a short span of time,since inappropriate decisions may result in enormous economic losses and social disorder.To handle emergency effectively and quickly,this paper proposes a new EDM method based on the novel concept of q-rung orthopair fuzzy rough(q-ROPR)set.A novel list of q-ROFR aggregation information,detailed description of the fundamental characteristics of the developed aggregation operators and the q-ROFR entropy measure that determine the unknown weight information of decision makers as well as the criteria weights are specified.Further an algorithm is given to tackle the uncertain scenario in emergency to give reliable and reasonable emergency decisions.By using proposed list of q-ROFR aggregation information all emergency alternatives are ranked to get the optimal one.Besides this,the q-ROFR entropy measure method is used to determine criteria and experts’weights objectively in the EDM process.Finally,through an illustrative example of COVID-19 analysis is compared with existing EDM methods.The results verify the effectiveness and practicability of the proposed methodology.

Nursing emergency management practice of COVID-19 in a traditional Chinese medicine hospital

Nursing work is an integral part of hospital work.Under the challenge of the COVID-19 epidemic,it is particularly important to establish a timely and efficient nursing management system.The nursing department of our hospital used the theory and method of feedforward control to formulate the emergency plan for epidemic prevention and control and to conduct drills.The plan includes the establishment of the emergency management system for epidemic nursing and key prevention and control positions,rational allocation of human resources,and strengthening personnel training,so as to ensure the efficient operation of nursing epidemic prevention and control work and provide a reference for nursing management mode during the epidemic.

The use of outcome feedback by emergency medicine physicians: Results of a physician survey

BACKGROUND: Feedback on patient outcomes is invaluable to the practice of emergency medicine but examples of effective forms of feedback have not been well characterized in the literature. We describe one system of emergency department(ED) outcome feedback called the return visit report(RVR) and present the results of a survey assessing physicians' perceptions of this novel form of feedback. METHODS: An Opinio web-based survey was conducted in 81 emergency physicians(EPs) at three EDs.RESULTS: Of the 81 physicians surveyed, 40(49%) responded. Most participants indicated that they frequently review their RVRs(83%), that RVRs are valuable to their practice of medicine(80%), and that RVRs alter their practice in future encounters(57%). Respondents reported seeking other forms of outcome feedback including speaking with other EPs(83%) and reviewing discharge summaries of admitted patients(87%). There was no correlation between demographic data and use of RVRs.CONCLUSION: EPs value RVRs as a form of feedback. RVRs could be improved by reducing the observational interval and optimizing report relevance and differential weighting.

World Journal of Emergency Medicine被SCIE收录

近日,由浙江大学医学院附属第二医院主办的《世界急诊医学杂志》World Journal of Emergency Medicine被汤森路透的Science Citation Index Expanded(SCIE)数据库收录。World Journal of Emergency Medicine创刊于2010年,季刊,报道内容为国内外急诊医学及相关学科的研究报道、最新进展、临床观察与经验总结、病例报告等。期刊网站(http://www. wjem. org)提供全文免费开放获取,欢迎下载阅读。