People with advanced cancer at the end of life may visit emergency departments (ED) due to worsening symptoms or unmet needs. The impact of ED-initiated palliative care interventions remains unclear for this population. To synthesize evidence on the impact of ED-initiated palliative care interventions on quality of life and symptom burden, perceptions, and service-related outcomes for people with advanced cancer. Systematic searches were conducted in five databases. Five studies (n = 2,166; two randomized trials) involving interdisciplinary teams including nurses were included. One trial reported improved quality of life at 12 weeks (FACT-G) following an ED-initiated specialist palliative care consultation vs. usual care. In two studies, there were no between-group differences in depressive symptoms. Four studies indicated that ED-initiated referral or screening pathways increased access to palliative care consultations. ED-initiated palliative care may improve quality of life and facilitate access to palliative care but remains underexplored.
Nursing management of peripheral intravenous catheters remains suboptimal and often lacks integration with underpinning theory. Therefore, it is essential to reflect on the persistent gap between theory and practice to enhance patients' outcomes in this area. To conceptually evaluate the integration of Tanner's Clinical Judgment Model using Chinn and Kramer's criteria, and to explore the integration of these two complementary frameworks with Kramer's Ways of Knowing for peripheral intravenous catheter decision-making and patient outcomes improvement in the emergency department. A discussion paper, using Tanner's Clinical Judgment and Chinn & Kramer's Models, to bridge theory and practice, in peripheral intravenous catheter management in the emergency departments, done in October 2024, through consensus among authors, in interactive rounds. According to Chinn and Kramer's model, which advocates evidence-informed and theory-based practice, the absence of theory in nursing education and practice is detrimental to the discipline. Tanner's model supports the integration of evidence into practice, and Chinn and Kramer's framework guides nurses in refining their decisions. In deciding whether to insert a peripheral intravenous catheter, emergency department nurses engage in cognitive and reflective processes, consult evidence-based guidelines, and integrate empirical evidence with personal and ethical considerations to ensure technically sound, empathetic, and ethically grounded patient care. This article analyses and promotes critical reflection on advanced practice nursing decision-making in the emergency department, exemplified by the holistic, evidence-informed processes that nurses use in peripheral intravenous catheter management. Future research is needed to evaluate the effectiveness of these models in education and clinical reasoning in specific emergent situations.
This study aimed to clarify the characteristics of telenursing practices for palliative symptom management in patients with cancer. Participants were recruited using purposive and snowball sampling to identify nurses with experience in providing telenursing for patients with cancer. Semi-structured interviews were conducted face-to-face or online to explore participants' experiences between October 2024 and January 2025, and thematic analysis was then used to analyze the data. Ten participants (mean nursing clinical experience: 16.20 years; standard deviation [SD] = 13.44) were included in this study. Four themes were identified in telenursing practices for symptom relief in patients with advanced cancer: information gathering in telenursing under conditions of uncertainty, clinical reasoning in telenursing, telenursing care practices in non-face-to-face setting, and key elements in telenursing. Information gathering comprised two sub-themes: "Symptom data acquisition via remote devices," and "Addressing inadequate information from remote devices." Clinical reasoning included two sub-themes: "Clinical assessment of non-face-to-face patient data" and "Judgment of urgency." Care practices consisted of five sub-themes: "Strategies for non-face-to-face interactions," "Selecting intervention methods based on patient characteristics," "Practice based on protocols," "Selection of follow-up methods," and "Emergency response." Key elements include two sub-themes: "Safe and versatile telenursing systems" and "Trusting relationships." Telenursing practices for symptom relief in patients with cancer are characterized by adaptations to non-face-to-face care delivery while maintaining core nursing competencies. Notably, establishing trusting relationships remains a critical element of effective telenursing practice.
This article explores the mutual relationship between emergency nursing and ski patrol, highlighting their complementary roles in providing prehospital and hospital-based trauma and medical care. Ski patrols, acting as a crucial first line of medical response personnel in remote, dynamic, and environmentally challenging alpine settings, stabilize patients and manage extrications under the protocols of the National Ski Patrol's Outdoor Emergency Care program. Emergency nurses, in turn, leverage advanced clinical skills and a broader scope of practice within a controlled hospital environment to continue patient care started in the mountain and austere environments. This partnership and collaboration are essential in rural areas where access to advanced life support may be delayed due to severe weather or difficult terrain, necessitating robust on-mountain care. Acknowledging that many ski patrollers already possess emergency medical services training, the relationship emphasizes collaboration and shared expertise rather than a strict division of labor. The synthesis of these two disciplines creates a more seamless continuum of care, improving patient outcomes from the moment of injury on the mountain to definitive treatment in the emergency department.
Artificial intelligence (AI) has advanced rapidly in healthcare; however, its application in emergency nursing remains underexplored. This study aimed to map and synthesise existing evidence to clarify current applications, gaps, and practical implications. A scoping review was conducted using seven databases from inception to 22 November 2024. From 1,885 initial records, 27 studies were included in the final analysis. The review followed the PRISMA-ScR guidelines, with data extracted in standardised formats and analysed using Arksey and O'Malley's framework. The study was conducted across North America, Asia, Europe, the Middle East, and Oceania. A total of 16 studies focused on triage and decision support, while others addressed direct nursing practices or emergency department operations. Evaluation of AI performance was reported in 20 studies, revealing considerable variability across algorithms, models, and metrics, with machine learning being the predominant approach; however, operational ethical aspects were explicitly discussed in just 11 studies. AI demonstrates strong potential for triage, workflow efficiency, and patient safety in emergency nursing but remains poorly integrated into clinical practice. Sustainable progress requires high-quality data, rigorous validation, auditability, and ethical safeguards. Institutional and governmental support, multidisciplinary collaboration, and nurse capacity building are critical for safe, equitable, and scalable implementation.
To explore the expanded roles, task shifting, competency gaps, and adaptive strategies of emergency and intensive care unit nurses in Gaza's government hospitals during armed conflict, and to identify barriers and lessons relevant to international nursing standards. Armed conflicts severely disrupt healthcare systems and demand expanded nursing roles and competencies, especially for emergency and intensive care nurses. A descriptive, qualitative design was used, employing semi-structured key informant interviews and a focus group with senior nurses, supervisors, and academic leaders from all operating governmental hospitals in Gaza. Data were thematically analyzed, following COREQ guidelines and information power principles. Fourteen nurses and ten senior stakeholders participated, offering diverse clinical and academic perspectives. Eight key themes emerged: role expansion, psychological impact, adaptation, core competencies, training, systemic barriers, teamwork, and support systems. Nurses assumed essential and some advanced clinical duties and autonomous decisions in response to staff shortages and resource scarcity. Despite some advanced nursing skills, gaps persisted in pediatric, burn, and mental health care. Solidarity, mentoring, and nongovernmental-supported leadership helped sustain care delivery, revealing both nursing resilience and entrenched system challenges. These findings highlight urgent gaps and opportunities to strengthen nursing competencies, education, and policy to ensure resilient care in conflict-affected settings. Nurses in conflict-affected ICUs and emergency departments demonstrated notable adaptability and role expansion but faced critical gaps in preparedness and institutional support. Their experiences call for enhanced training and clear policy frameworks tailored to conflict settings. The study calls for integrating conflict-nursing skills, ethical decision-making, and psychosocial support into policy and education to build nurse autonomy and conflict-readiness in Palestine and beyond.
Advanced practice providers (APPs), including nurse practitioners (NPs) and physician assistants (PAs), play a vital role in emergency medicine (EM), addressing workforce shortages and enhancing patient care. Despite their growing presence, position statements from the American College of Emergency Physicians (ACEP) and the American Academy of Emergency Medicine (AAEM) challenge APP autonomy and scope of practice. This article critically examines the educational pathways, clinical competencies, and certification standards of APPs, highlighting disparities in recognition and misrepresentation of training. It explores the historical context of EM specialization, the evolution of APP roles, and the impact of restrictive policies-particularly in underserved areas. The authors propose actionable solutions, including standardized credentialing, formal recognition of postgraduate training, and policy reform to support full practice authority. Emphasizing collaboration over division, the article advocates for a team-based approach to emergency care that values the contributions of all provider types and promotes equitable integration.
Emergency department nurses' attitudes toward early disease deterioration affect their assessment behavior and triage ability. A negative attitude delays assessment, impacting patient prognosis. Analyzing attitude characteristics, cultivating positive attitude and enhancing triage abilities are crucial. This study aims to identify distinct profiles of attitudes toward the early recognition of clinical deterioration among emergency department (ED) nurses in China, analyze demographic and statistical factors associated with these profiles, and explore the relationship between these attitude profiles and ED nurses' triage competence. From June to July 2024, a questionnaire survey was conducted among ED nurses from 31 general hospitals across seven provinces and municipalities in China (Anhui Province, Hubei Province, Hunan Province, Henan Province, Zhejiang Province, Jiangsu Province, Shanghai). The Attitudes Toward Recognition of Early Nursing Deterioration (ATREND) questionnaire and the Triage Nurse Professional Competency Questionnaire for Emergency Departments (TNPCQ-ED) were used as research tools. Data were statistically analyzed using SPSS 28.0 and Mplus 8.7. Latent profile analysis was employed to identify attitude characteristics, while multivariate logistic regression was applied to explore influencing factors of attitude profiles and regression analysis was used to examine the relationship between attitude profiles and triage competence. The Chinese versions of the ATREND and TNPCQ-ED questionnaires demonstrated good reliability and validity among ED nurses. A total of 942 valid questionnaires were collected. The overall mean score for the ATREND questionnaire was (39.50 ± 7.34) points. Among its subscales, the Beliefs About Monitoring Importance scored the highest, while the other two subscales followed. The overall mean score for the TNPCQ-ED was (149.19 ± 21.01) points. Among its subscales, the professional commitment dimension had the highest score, followed by the clinical comprehensive capability and psychological empowerment dimensions. Latent profile analysis revealed four distinct attitude profiles: "Skill-Proficient & Belief-Mismatch Profile" (11.25%); "Belief-Dominant & Skill-Developing Profile" (53.72%); "Neutral & Balanced Profile" (15.92%); "Belief-Advanced & Skill-Developing Profile" (19.11%). Univariate analysis showed significant differences in age, years of work experience, job title, trained in triage, years at triage station and hospital level among the four profiles (p < 0.05). Multivariate logistic regression revealed the following: 1. Nurses in the "Belief-Advanced & Skill-Developing Profile" were more likely to have received systematic triage training. 2. Nurses in the "Belief-Dominant & Skill-Developing Profile" were more likely to have <5 years of triage desk experience. 3. The "Belief-Advanced & Skill-Developing Profile" were also more likely to work in provincial tertiary hospitals (p < 0.05). There was a statistically significant association (p < 0.001) between attitude profiles and dimensions of triage competence. ED nurses' attitudes toward early recognition of clinical deterioration can be categorized into four latent profiles: "Skill-Proficient & Belief-Mismatch Profile", "Belief-Dominant & Skill-Developing Profile", "Neutral & Balanced Profile" and "Belief-Advanced & Skill-Developing Profile". Multivariate logistic regression indicated that factors such as systematic triage training, <5 years of triage desk experience, and employment in provincial tertiary hospitals influenced attitude profiles. Moreover, nurses' attitudes significantly impacted their triage competence. Nurse managers should design targeted interventions tailored to the characteristics of these profiles to enhance ED nurses' triage competence and foster positive attitudes toward the early recognition of clinical deterioration. This approach could improve proactive assessment capabilities, prevent further patient deterioration, and ultimately enhance the quality of emergency nursing care.
Bronchiolitis is a leading cause of hospitalisation and paediatric intensive care admissions in infants. Moderate-to-severe cases often require inter-hospital transfer for respiratory support, usually organised by specialised paediatric emergency transport services (PETS). The optimal composition of transport teams, whether nurse-led or medicalised, remains uncertain. To identify predictive factors available during the regulation call that can help determine when an inter-hospital transfer of infants with moderate-to-severe bronchiolitis can be safely conducted by a nurse-led team without a paediatrician, by predicting the need for clinical intervention during transport. A retrospective observational study was conducted from 2021 to 2023 within the PETS of a French University Hospital. Infants under 2 years transferred for moderate-to-severe bronchiolitis were included. The primary outcome was the occurrence of a clinical intervention during transport, defined as any event requiring physician-level management: apnoea requiring manual ventilation, fluid bolus, initiation of two-level non-invasive ventilation or endotracheal intubation. Clinical and paraclinical parameters available at the regulation call-particularly ventilatory support mode, FiO2 and blood gas values-were analysed for their ability to predict the occurrence of such interventions using receiver operating characteristic (ROC) analysis. Among 167 included infants (mean age 157 ± 169 days; weight 5.9 ± 2.7 kg), 20 (12%) required a clinical intervention. Higher FiO2 (51.3% ± 19.3% vs. 34.8% ± 10.2%; p < 0.01), lower pH (7.30 ± 0.08 vs. 7.34 ± 0.07; p = 0.03) and higher pCO2 (62.9 ± 17.9 vs. 49.6 ± 11.2 mmHg; p = 0.01) were associated with interventions. The presence of high-flow nasal cannula (HFNC) with FiO2 > 40%, or continuous positive airway pressure (CPAP) with FiO2 > 35% or pCO2 > 65 mmHg predicted the need for a medicalised team (AUC = 0.83; sensitivity 90%, specificity 78%, negative predictive value 98%). Most inter-hospital transfers of infants with moderate-to-severe bronchiolitis can be safely undertaken by nurse-led teams when predefined respiratory or blood gas thresholds are not exceeded. This study provides objective criteria to guide decision-making regarding team composition during the regulation of inter-hospital transfers for infants with moderate-to-severe bronchiolitis. FiO2 and pCO2 thresholds measured at the initial call can help identify cases requiring physician presence, while allowing most transfers to be safely conducted by nurse-led teams. These results support the development of standardised triage protocols and strengthen the role of advanced paediatric critical care nurses in retrieval medicine. Integrating such evidence-based criteria into practice could optimise human resources, maintain safety and improve response times in paediatric emergency transport systems.
Artificial intelligence (AI) is rapidly transforming healthcare by enabling advanced data analysis, predictive modeling, and intelligent clinical decision support systems. In obstetrics and gynecology (OBG) nursing, AI technologies are increasingly recognized as valuable tools for improving maternal and women's healthcare outcomes. These technologies facilitate early identification of high-risk pregnancies, enhance fetal monitoring accuracy, and support gynecologic cancer screening. This narrative review examines current evidence on the emerging applications of AI in obstetric and gynecologic practice, with particular emphasis on its relevance to nursing roles and responsibilities. A structured search of electronic databases, including PubMed, Scopus, Excerpta Medica Database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science, was conducted for studies published between January 2010 and July 2025. The search yielded 612 records, of which 62 studies met the inclusion criteria and were included in the thematic synthesis. Key domains explored include predictive analytics for maternal risk assessment, AI-assisted clinical decision support systems for labor and emergency management, wearable and remote monitoring technologies for continuous maternal and fetal surveillance, and image-based diagnostic tools used in gynecologic oncology screening and early disease detection. The review also highlights applications of AI in nursing education, including adaptive learning platforms and simulation-based training that enhance clinical reasoning and preparedness for obstetric emergencies. Ethical and implementation challenges, including algorithmic bias, data privacy, transparency, and equitable access, are also discussed. While AI shows promising potential to improve diagnostic accuracy, support evidence-based decision-making, and optimize workflow efficiency, much of the current evidence remains in developmental or pilot phases, with limited large-scale validation. Overall, AI has the potential to strengthen obstetrics and gynecology nursing practice by facilitating proactive, data-driven care while preserving the essential human-centered and compassionate nature of nursing in maternal and women's health.
The authors sought to clarify the difference between evidence-based versus evidence-informed practice by providing historical descriptions and practical applications for Advanced Practice Nurses from the literature. For this review, the database PubMed was searched using the following terms: evidence-based practice, evidence-informed practice, and nursing. Evidence within five years was preferred; however, owing to limitations in the available literature, articles were considered if they had been published post-2000. Twenty-one articles were retrieved using these search terms. The authors present the articles beginning with a historical perspective and a contrast with current practice. This article describes the difference between evidence-based practice, a scientific methodology of applying evidence to practice, and evidence-informed practice, using evidence and clinical judgment in making care decisions, with historical context and relevant examples. This important distinction must be understood by Advanced Practice Registered Nurses to not only advance patient outcomes but to distinguish Advanced Practice Registered Nurses as having expertise in these elements, as implementation science (practice, education, and dissemination) is a core feature of advanced nursing preparation.
Low- and middle- income countries account for 90 % of global trauma-related mortality. Organized prehospital emergency medical services and formal first responder systems are often lacking, contributing to this disproportionate injury burden. Lay first responder training programs have demonstrated effectiveness in addressing gaps in prehospital care. However, the curriculum, skills, and resources required to implement a context-appropriate advanced responder program remains unclear. A three-round modified Delphi consensus was generated at the Masinde Muliro University of Science and Technology (MMUST) in Western Kenya, including paramedics and paramedic lecturers. The 85-item survey consisted of six demographic items, 30 knowledge items, 30 skills items, and 19 resource items. A total of 79 items were included for consensus evaluation. A total of 26 participants were included in the Delphi process, with 100 % retention across three rounds. Participants were primarily male (53.8 %) and practicing paramedics (61.5 %), with a median of seven years of experience (IQR: 4.0, 9.0). 33 of 79 items met consensus, defined as greater than 70 % agreement. This included 11 items in knowledge category, 14 items in skills category, and eight items in resources category. Participants prioritized content related to multi-system integration, respiratory and cardiovascular emergencies, and the female reproductive system. Particular emphasis was placed on airway and dehydration management, hemorrhage control, and emergency labor. Medication overdose and gastrointestinal complications were assigned lower priority. Participants identified the need for additional equipment and trained instructors to effectively implement advanced responder training. This three-round, modified Delphi study in Western Kenya establishes a list of context-appropriate essential knowledge, skills, and resources required for advanced responder training. Consensus was achieved on 33 of 79 items. Similar Delphi-based approaches may help guide the development of advanced responder programs in other resource-limited settings.
This article was written to describe the authors' interprofessional collaboration experience with regard to the clinical translation of evidence-based healthcare. Building upon the spirit of evidence-based medicine invoked at the founding of the Cochrane Centre at Oxford University under the United Kingdom's National Health Service in 1992, our institution recognizes nursing as the core driving force supporting the translation of evidence-based healthcare in clinical settings. Using interdisciplinary collaboration mechanisms, systematic education and training, and knowledge translation strategies, the best research evidence is integrated into clinical decision-making and improving care quality, thus deepening the application of evidence-based clinical healthcare. In clinical care, nursing teams have led multiple evidence-based initiatives targeting patient safety and care quality improvement. Issues addressed have included fall prevention, infection control, nasogastric tube dislodgement prevention, hypothermia interventions to improve neurological outcomes in patients with traumatic brain injury, post-operative positioning adjustments, acute-phase COVID-19 pulmonary rehabilitation, and family-centered interventions in intensive care units to reduce the incidence of delirium. These initiatives have been significantly grounded in the findings of systematic literature reviews and outcome evaluations, with results demonstrating a notable reduction in adverse event rates and significant improvements in functional recovery and quality of life in patients. Nursing personnel play an integrative and leading role in assessment-tool development, care process design, outcome monitoring, and the continuous provision of quality feedback, reflecting their professional autonomy in the clinical application of evidence-based practice. In terms of guideline development, the nursing department has taken the lead in constructing guidelines for cancer symptom management and post-curative follow-up care for patients with liver cancer, advocating for an integrated model centered on holistic care, and collaborating with physicians, pharmacists, and dietitians to jointly establish interdisciplinary care standards. Also, the department has actively mentored advanced practice nurses in writing evidence-based clinical care guidelines at an advanced level, strengthening advanced nursing practice competencies and academic output. With regard to shared decision-making and Choosing Wisely initiatives, nursing staff participate in the development of decision support tools and the application of structured communication models to facilitate patient value clarification and engagement in decision-making, while concurrently enhancing healthcare resource-utilization appropriateness and safety. Overall, within the evidence-based clinical system, the nursing profession fulfills multiple functions in the realms of care practice, research participation, education promotion, and knowledge translation, laying a strong foundation for the sustainable development of evidence-based clinical care. 實證健康照護於臨床轉譯之應用—以跨專業合作經驗為例. 本文旨在闡述實證健康照護於臨床轉譯之跨專業合作經驗。承襲1992年英國國家衛生服務部於牛津大學成立Cochrane Center所揭示之實證醫學精神，本機構以護理專業為核心驅動力量，透過跨領域協作機制、系統化教育訓練與知識轉譯策略，將最佳研究證據整合至臨床決策與品質改進流程中，深化實證導向之臨床健康照護應用。於臨床照護層面，護理團隊主導多項以病人安全與照護品質提升為目標之實證專案，包括跌倒預防、感染控制、鼻胃管滑脫預防、低體溫措施改善創傷性腦損傷病人神經功能、術後姿勢調整、急性期COVID-19肺部復健，以及加護病房家屬介入以降低譫妄發生率等。相關措施多以系統性文獻回顧與成效評估為基礎，結果顯示不良事件發生率明顯下降，病人功能恢復與生活品質顯著改善。護理人員於評估工具建構、照護流程設計、成效監測與持續品質回饋中發揮整合與主導角色，彰顯其於臨床實證應用之專業自主性。在指引發展方面，護理部門主導癌症症狀照護及肝癌治癒後續追蹤指引之建構，倡議以全人照護為核心之整合模式，並協同醫師、藥師與營養師等專業共同制定跨領域照護標準；同時積極輔導專科護理師撰寫進階實證臨床照護指引，強化高階護理實務能力與學術產出。於醫病共享決策與聰明抉擇推動方面，護理人員參與決策輔助工具開發與結構化溝通模式之應用，促進病人價值澄清與參與決策，並提升醫療資源運用之合理性與安全性。整體而言，護理專業於實證臨床體系中兼具照護實踐、研究參與、教育推動與知識轉譯之多重功能，為實證導向臨床照護之永續發展奠定重要基礎。.
To explore advanced-level paramedics' experiences of measuring, interpreting and documenting pediatric vital signs in prehospital care, and to identify contextual factors that influence these practices. We conducted a qualitative cross-sectional descriptive study. Fifty-six advanced-level paramedics were recruited through a national emergency medical services social media forum. Data were collected in February-March 2025 using an online semi-structured questionnaire and analyzed using inductive-deductive content analysis. Measurement practices varied in systematicity and incorporated modified assessment approaches. These were shaped by the child's appearance, symptoms, urgency, paramedic- and child-related factors, caregiver involvement, and equipment-related aspects. Paramedics interpreted pediatric vital signs using assessment tools, physician consultation, and visual impressions of the child's condition, and the process was perceived as time-consuming. Interpretation was influenced by children's emotional and behavioral responses, physiological characteristics, and paramedics' interpretive competence. Electronic documentation was valued for efficiency but reported as posing safety risks, limited pediatric suitability, and insufficient flexibility. Advanced-level paramedics use a variety of approaches when assessing pediatric patients and adapt their practices according to personal and contextual factors. However, variability in practice and limitations in documentation systems may compromise patient safety and quality of care.
The Morse Fall Scale is a widely used fall risk assessment tool. However, limited evidence exists on whether this scale reliably differentiates individuals at high risk for falls in nursing homes. In a sample of nursing home residents, the purpose of this study was to evaluate if the Morse Fall Scale score or any individual scale items differed between residents who did and did not fall. This retrospective cohort study includes data collected from the electronic health record. A fall was defined as the presence of a post-fall progress note. Included individuals who were admitted to a single Community Living Center between June 1, 2022, and May 31, 2024, and had a complete fall risk assessment on admission. Means and frequency counts were used to describe the characteristics of the sample. Differences in characteristics between residents who did and did not fall were evaluated using t tests and χ2 tests. Of the 650 residents included in the analysis, 19% fell. A higher proportion of residents who fell reported a history of falls. No significant differences were found in age, body mass index, sex, marital status, or race between residents who did and did not fall. No significant differences were found in total score, secondary diagnosis, intravenous access, mental status, ambulatory aid, or gait status between residents who did and did not fall. A history of falling was the only item that significantly differed between residents who did and did not fall, suggesting that this piece of historical information is important when considering fall risk. The remaining Morse Fall Scale items did not differentiate well in nursing home residents because of less variation in the characteristics captured by the scale.
Physical and chemical restraints are used in Emergency Departments (EDs) to manage agitation in older people; however their prevalence and impact on clinical outcomes in this specific setting remain under-researched. Therefore, the aim of this study was analyze the prevalence, identify independent predictors, and evaluate the impact on clinical prognosis (mortality, admission, and length of stay) of physical and chemical restraint use in a large cohort of older patients. An observational, analytical, retrospective, multicenter study (EDEN-50 Study) was conducted across 52 Spanish EDs between 1 and 7 April 2019. We consecutively included 25,321 consecutive patients aged 65 years or older. The primary outcome was the need for restraint, subdivided into chemical and physical modalities. Multivariate logistic regression analysis was performed to determine independent predictors, and models were adjusted to quantify the association with adverse outcomes (all-cause mortality, ED and hospital length of stay). Restraint use was recorded in 109 patients (0.43%), with a predominance of chemical (0.35%; n = 89) over physical restraint (0.14%; n = 36), including 16 patients who received both. Restrained patients exhibited a more vulnerable profile: higher median age (86 vs. 78 years; p < 0.001), previous cognitive impairment (54.1% vs. 13.2%; p < 0.001), and nursing home residence (28.4% vs. 6.0%; p < 0.001). Patients presenting with acute confusion or disorientation had the highest risk of restraint (aOR 6.80; 95% CI 4.30-10.76), followed by arrival by ambulance (aOR 3.43; 95% CI 2.08-5.67) and a history of delirium (aOR 3.25; 95% CI 1.96-5.38)). Institutionalization and high comorbidity were associated with physical rather than chemical restraint. Restraint use was independently associated with higher all-cause mortality (aOR 2.14; 95% CI 1.19-3.85) and prolonged ED and hospital length of stay (aOR 2.52; 95% CI 1.61-3.95 and aOR 2.34; 95% CI 1.41-3.88, respectively). The use of restraint in the ED identifies a specific patient phenotype-advanced age, with cognitive impairment and altered mental status upon arrival-and serves as a sentinel marker for imminent mortality and prolonged ED and hospital length of stay.
The recreational use of cannabis is a significant (and growing) contemporary public health issue, confounded by the rapidly changing state and federal marijuana regulation and legislation. As of 2025, 24 states and the District of Columbia have legalized cannabis for medicinal and recreational use, and 39 of the 50 states have legalized it for medicinal use. With the increased use of recreational and medicinal marijuana, there has been an uptick in emergency department (ED) visits for cannabis-related illnesses, including gastrointestinal, cardiac, and mental health disorders. Nausea and vomiting, which are the hallmarks of cannabinoid hyperemesis syndrome (CHS), have been reported as the most common reasons for cannabis-related ED visits in nationwide ED data set analysis. Emergency department staff need to be familiar with CHS, its presentation, pathophysiology, and treatments to quickly recognize, diagnose, and triage/treat patients suffering from this acute cannabis-related GI illness.
Decision making about antithrombotic therapy (ATT) in patients with advanced cancer near the end of life is fraught with clinical uncertainty and can significantly affect care. Despite its importance and complexity, ATT is often deprioritized or guided by legacy prescribing and monitoring patterns. Management spans multiple specialties, with roles and responsibilities frequently blurred. Clinicians' perspectives remain largely underexplored, which are crucial to inform improved care models. This study explores clinicians' experiences of current practice of continuing and deprescribing ATT in patients with advanced cancer at the end of life. Qualitative methodology using semistructured interviews with clinicians involved in ATT management at the end of life, across Denmark, France, Spain, and the United Kingdom. Data were analyzed using Framework Analysis. Eighty clinicians across a range of specialties were interviewed. Two major themes were generated: (1) balancing complexities in ATT management: clinicians reported several challenges, from ambiguity surrounding roles and responsibilities, delicacy around timing, and variance in risk perceptions of ATT, balanced with patient preferences; and (2) culture of continuation: clinicians described a general and ATT-specific culture of continuation and reported a passivity in relation to ATT review. The management of ATT in this context is multifaceted, influenced by many competing factors. These complexities need to be understood and addressed to support decision making related to ATT at the end of life.
Falls are a leading cause of emergency department (ED) visits among older adults, often resulting in fractures. Point-of-care ultrasound (POCUS) has emerged as a valuable diagnostic tool for emergency nurse practitioners (ENPs), offering rapid, radiation-free evaluation of musculoskeletal injuries. This article examines the effectiveness of POCUS in detecting fractures, with evidence demonstrating high sensitivity and specificity, particularly for long-bone injuries. A case study of a patient with a humeral fracture highlights the utility of POCUS in diagnosis and expedited orthopedic referral. The article also discusses ultrasound physics, bone imaging techniques, and transducer selection for musculoskeletal assessments. Beyond clinical accuracy, POCUS use is associated with reduced ED length of stay and healthcare costs. While operator-dependent, structured training models are expanding ENP proficiency in POCUS. Integrating this modality into ED practice enhances timely triage and improves patient outcomes, particularly in resource-limited or high volume settings.
Acute dizziness accounts for approximately 4% of emergency department (ED) visits, with stroke often missed. Current methods for stroke detection in dizzy patients have notable limitations, with vestibular strokes missed in a substantial proportion of ED visits. This study aimed to develop a machine learning (ML) tool to assess stroke risk in patients with acute dizziness. We developed an ensemble model combining four ML algorithms using structured electronic medical record data and unstructured ED physician notes. Model performance was evaluated on a holdout test set and compared with the ABCD2 score using area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis. The ensemble model achieved the highest AUC at 0.880, significantly outperforming the ABCD2 score (AUC 0.673) and individual ML models. The ensemble model demonstrated superior calibration with the lowest Brier score and showed greater clinical utility across different risk thresholds. Features extracted from unstructured clinical text substantially enhanced model performance, with models combining structured and unstructured data consistently outperforming those trained on structured data alone. Our ensemble prediction model effectively stratifies stroke risk in ED patients with acute dizziness. By integrating natural language processing of clinical notes with structured patient data, the model offers a more accurate risk assessment than traditional methods. The implementation of this tool could improve patient outcomes by directing advanced neuroimaging to high-risk patients while avoiding unnecessary testing in low-risk patients, ultimately enhancing patient safety and optimizing resource utilization.