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.

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.

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.

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.

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.

Development of an intensive simulating training program in emergency medicine for medical students in China

BACKGROUND: A national standardized emergency medicine(EM) curriculum for medical students, including specific competencies in procedural skills, are absent in many countries. The development of an intensive simulating training program in EM, based on a tight schedule, is anticipated to enhance the competency of medical students.METHODS: A 3-day intensive EM training program, consisting of four procedural skills and 8-hour case-based learning(CBL), was developed by experienced physicians from the EM department in Peking Union Medical College Hospital(PUMCH). Medical students from Peking Union Medical College(PUMC) and Tsinghua University(THU) participated in the training. Three written tests were cautiously designed to examine the short-term(immediately after the program) and long-term(6 months after the program) efficacy of the training. After completion of the training program, an online personal appraisal questionnaire was distributed to the students on WeChat(a mobile messaging App commonly used in China) to achieve anonymous self-evaluation.RESULTS: Ninety-seven out of 101 students completed the intensive training and took all required tests. There was a significant increase in the average score after the intensive simulating training program(pre-training 13.84 vs. 15.57 post-training, P<0.001). Compared with the pre-training test, 63(64.9%) students made progress. There was no significant difference in scores between the tests taken immediately after the program and 6 months later(15.57±2.22 vs. 15.38±2.37, P=0.157). Students rated a higher score in all diseases and procedural skills, and felt that their learning was fruitful.CONCLUSIONS: The introduction of a standardized intensive training program in EM focusing on key competencies can improve clinical confidence, knowledge, and skills of medical students toward the specialty. In addition, having such a program can also enhance student’s interest in EM as a career choice which may enhance recruitment into the specialty and workplace planning.

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.

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.

A comparison of perspectives on costs in emergency care among emergency department patients and residents

BACKGROUND: Costs of care are increasingly important in healthcare policy and, more recently, in clinical care in the emergency department(ED). We compare ED resident and patient perspectives surrounding costs in emergency care.METHODS: We conducted a mixed methods study using surveys and qualitative interviews at a single, academic ED in the United States. The two study populations were a convenience sample of adult ED patients(>17 years of age) and ED residents training at the same institution. Participants answered open- and closed-ended questions on costs, medical decision making, cost-related compliance, and communication about costs. Closed-ended data were tabulated and described using standard statistics while open-ended responses were analyzed using grounded theory.RESULTS: Thirty ED patients and 24 ED residents participated in the study. Both patients and residents generally did not have knowledge of medical costs. Patients were comfortable discussing costs while residents were less comfortable. Residents agreed that doctors should consider costs when making medical decisions whereas patients somewhat disagreed. Additionally, residents generally took costs into consideration during clinical decision-making, yet nearly all residents agreed that they had too little education on costs.CONCLUSION: There were several notable differences in ED patient and resident perspectives on costs in this U.S. sample. While patients somewhat disagree that cost should factor into decision making, generally they are comfortable discussing costs yet report having insuf? cient knowledge of what care costs. Conversely, ED residents view costs as important and agree that cost should factor into decision making but lack education on what emergency care costs.

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.

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.

Expert consensus on emergency medicine procedure optimization guided by routine prevention and control strategy for COVID-19

The outbreak of coronavirus disease 2019(COVID-19)was declared a global public health emergency on 31 January 2020.Emergency medicine procedures in Emergency Department should be optimized to cope with the current COVID-19 pandemic by providing subspecialty services,reducing the spread of nosocomial infections,and promoting its capabilities to handle emerging diseases.Thus,the Chinese Society of Emergency Medicine and Wuhan Society of Emergency Medicine drafted this consensus together to address concerns of medical staffs who work in Emergency Department.Based on in-depth review of COVID-19 diagnosis and treatment plans,literatures,as well as management approval,this consensus proposes recommendations for improving the rationalization and efficiency of emergency processes,reducing the risk of nosocomial infections,preventing hospital viral transmission,and ensuring patient safety.

Emergency department approach to monkeypox

BACKGROUND:Monkeypox(mpox) is a viral infection that is primarily endemic to countries in Africa,but large outbreaks outside of Africa have been historically rare.In June 2022,mpox began to spread across Europe and North America,causing the World Health Organization(WHO) to declare mpox a public health emergency of international concern.This article aims to review clinical presentation,diagnosis,and prevention and treatment strategies on mpox,providing the basic knowledge for prevention and control for emergency providers.METHODS:We conducted a review of the literature using PubMed and SCOPUS databases from their beginnings to the end of July 2023.The inclusion criteria were studies on adult patients focusing on emerging infections that described an approach to a public health emergency of international concern,systematic reviews,clinical guidelines,and retrospective studies.Studies that were not published in English were excluded.RESULTS:We included 50 studies in this review.The initial symptoms of mpox are non-specific:fever,malaise,myalgias,and sore throat.Rash,a common presentation of mpox,usually occurs 2–4 weeks after the prodrome,but the presence of lymphadenopathy may distinguish mpox from other infections from the Poxviridae family.Life-threatening complications such as pneumonia,sepsis,encephalitis,myocarditis,and death can occur.There are documented co-occurrences of human immunodeficiency virus(HIV) and other sexually transmitted infections that can worsen morbidity.CONCLUSION:The initial presentation of mpox is non-specific.The preferred treatment included tecovirimat in patients with severe illness or at high risk of developing severe disease and vaccination with two doses of JYNNEOS.However,careful history and physical examination can raise the clinicians’ suspicion and point toward a prompt diagnosis.There are diff erent modalities to prevent and treat mpox infection.

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ESCI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Emerging Sources Citation Index(ESCI)数据库收录。World Journal of Emergency Medicine创刊于2010年,季刊。

World Journal of Emergency Medicine

Aims and Scope World Journal of Emergency Medicine (ISSN 1920-8642, CN 33-1408/R), a quarterly journal,publishes peer-reviewed original research articles,review articles including systematic review and meta-analysis, editorials, commentaries, etc in different fields of emergency medicine. The content of articles could be varied in medical, surgical,

End-tidal capnometry during emergency department procedural sedation and analgesia： a randomized, controlled study

BACKGROUND:This prospective,randomized trial was undertaken to evaluate the utility of adding end-tidal capnometry(ETC)to pulse oximetry(PO)in patients undergoing procedural sedation and analgesia(PSA)in the emergency department(ED).METHODS:The patients were randomized to monitoring with or without ETC in addition to the current standard of care.Primary endpoints included respiratory adverse events,with secondary endpoints of level of sedation,hypotension,other PSA-related adverse events and patient satisfaction.RESULTS:Of 986 patients,501 were randomized to usual care and 485 to additional ETC monitoring.In this series,48%of the patients were female,with a mean age of 46 years.Orthopedic manipulations(71%),cardioversion(12%)and abscess incision and drainage(12%)were the most common procedures,and propofol and fentanyl were the sedative/analgesic combination used for most patients.There was no difference in patients experiencing de-saturation(Sa O2<90%)between the two groups;however,patients in the ETC group were more likely to require airway repositioning(12.9%vs.9.3%,P=0.003).Hypotension(SBP<100 mm Hg or<85 mm Hg if baseline<100 mm Hg)was observed in 16(3.3%)patients in the ETC group and 7(1.4%)in the control group(P=0.048).CONCLUSIONS:The addition of ETC does not appear to change any clinically significant outcomes.We found an increased incidence of the use of airway repositioning maneuvers and hypotension in cases where ETC was used.We do not believe that ETC should be recommended as a standard of care for the monitoring of patients undergoing PSA.

Emergency medicine providers＇ opioid prescribing practices stratified by gender, age, and years in practice

BACKGROUND: Emergency medicine providers(EMPs) prescribe about 25% of opioids, but the effect of EMP risk perception on decisions to prescribe opioids is unknown. This study was undertaken to identify factors that infl uence EMP risk and opioid prescribing practices.METHODS: We distributed an anonymous questionnaire to EMPs at a military trauma and referral center. Response frequencies and distributions were assessed for independence using the Chi-square test.RESULTS: Eighty-nine EMPs completed the questionnaire(100% response). Respondents were primarily younger male physicians(80%) in practice under fi ve years(55%). Male EMPs were more likely to prescribe more opioid tablets than female ones both when and when not concerned for opioid misuse(P<0.001, P<0.007, respectively). Of the providers, 70% stated that patient age would inf luence their prescribing decisions. Hydrocodone and oxycodone were the opioids prescribed most frequently. About 60% of the providers reported changing their prescribing behavior would not prevent opioid misuse. Additionally, 40% of the providers believed at least 10% of patients seen at this military ED misused opioids.CONCLUSION: Female EM providers reported prescribing fewer opioid tablets. Patient age infl uenced prescribing behavior, but the effect is unknown. Finally, EM providers reported that altering their prescribing behavior would not prevent prescription opioid misuse.

Assessment of Weight and Health in the Emergency Department: A Cross-Sectional Study

Introduction: The prevalence of obesity and obesity-related diseases continues to rise. A key aspect of prevention and treatment of these disorders requires clear communication about weight and health between patients and healthcare providers. Objective: We sought to examine the prevalence rate of obesity and associated comorbid illnesses in an emergency department (ED) population. A second aim was to assess patients’ perceptions of their weight and their overall health. Methods: This is a cross-sectional study performed in an academic tertiary-care center using a representative sample of patients (≥18 yr) who presented to the ED. Pregnant patients, patients who were medically unstable, cognitively impaired or who were unable or unwilling to provide informed consent were excluded. Anthropometric measurements were taken which include BMI (the ratio of a patient’s weight and height expressed as kg/m2) and waist circumference. In addition, the prevalence rates of all enrolled patients who 1) feel their health is affecting their weight and 2) who have had or recall discussions about their health and weight with their provider were examined by using a two-question validated survey. Results: The overall prevalence rate of obesity in this study was 38.6%. Only 71.8% (95% CI, 63.2% - 80.6%) of overweight patients (BMI = 25.0 - 29.9) and 28.4% (95% CI, 21.6% - 35.2%) of obese patients (BMI ≥ 30.0) believe their present weight is damaging to their health. Further, only 15.5% (95% CI, 8.5% - 22.6%) and 59.4% (95% CI, 53% - 67%) of those overweight and obese, respectively, recall being informed by their healthcare provider they are overweight. For morbidly obese patients (BMI ≥ 40.0), 79.6% (95% CI, 12.2 - 28.6) feel their weight is damaging their health and 83.7% (95% CI, 9.4 - 23.2) recall having a conversation about weight with their healthcare provider. Conclusion: Many obese and overweight patients believe their weight does not impact their health and have not had discussion about weight and health with their healthcare provider.

A Prospective Review： The Significance of Procalcitonin Levels in the Evaluation of Pediatric Patients Presenting to the Emergency Department with Fever （Pedi-SPEED I）

Purpose： This study was formulated to educate physicians and medical residents on procalcitonin （PCT）. The need for this study is based on lack of information and studies in the United States in the pediatric population regarding PCT, and also due to the lack of awareness by the Baylor Scott ＆ White McLane Children＇s residents in the implications and benefits of PCT. There are several instances where it can be valuable in the diagnosis and treatment of bacterial infections, which in turn, can decrease patient＇s length of stay, hospital costs, and patient exposure to unnecessary antibiotics, without increasing morbidity or mortality. Methods： An educational, qualitative analysis of PCT awareness is assessed utilizing pre and post surveys. These surveys will be given to pediatric and emergency medicine residents on paper before and after an educational presentation about PCT and its importance as a detection method for infection. Surveys consist of six closed-ended questions on the pre-survey and eight open and close-ended questions on the post-survey about PCT, how it works, general use, and how it can be beneficial. Results： Pediatric and emergency medicine residents were asked to participate in this study at a random monthly department meeting, selected by primary investigator and department head. Residents were asked to complete the pre-survey, listened to a short presentation, and completed the post survey. Comparing the pre-survey to post-survey, there was an overall improvement for both groups for questions 1-5 which showed statistical significance （P 〈 0.05）. No statistical difference was found between groups comparing emergency medicine vs. pediatric departments, interns vs. residents and each subgroup pre-survey vs. post-survey for questions 6 and 7. The open-ended post-survey question identified factors for obtaining PCT levels with attending physician＇s preference as the most common response. Conclusions： This prospective study identified gaps in PCT knowledge base, an overall increase in PCT comprehension by pediatric and emergency medicine residents, and identified factors for obtaining PCT levels upon patient admission.