Objective To provide references and recommendations about emergency physician training for our country by analyzing the characteristics of emergency physicians training objective, subject, process, content, appraisal and assessment in the United States, the United Kingdom, Canada and Australia. Methods Such databases as Ovid, Proquest, MDConsoult and relevant websites of national emergency medicine were searched to include literature covering guidelines and documents on emergency education and training in the United States, the United Kingdom, Canada and Australia. According to the evidence-based scientific principles and methods, we graded and analyzed the included information. Results A total of 40 articles were included, covering 12 guidelines and documents, 2 reviews and 26 research documents. Each of the four countries owned a sound emergency specialist training access system especially on how they used competency as the core to design the training content, courses and appraisal and assessment system to improve overall ability and quality of emergency physicians. Conclusion Our country’s emergency physician training certainly has lagged behind those of the developed countries. We should learn from positive experience of the developed countries to standardize emergency physician training, improve the emergency physician training content and curriculum, strengthen access management and the construction of appraisal system, and cultivate the competency of emergency physicians.
Objective To explore the relationship between neurofilament light chain (NfL) level and early neurological deterioration (END) after acute cerebral infarction (ACI). Methods The means of multi-center observational study were adopted to include patients with ACI within 72 hours of onset in 4 hospitals in Deyang between March 31, 2019 and July 31, 2021, to explore the risk factors of END. Results A total of 339 patients with ACI were included in this study, including 131 women and 208 men, aged (68.1±11.6) years. END occurred in 80 patients within 7 days after admission, and the incidence of END was 23.6%. The National Institute of Health Stroke Scale score and NfL level of patients without END were lower than those with END (P<0.05). Cox proportional risk model showed that NfL level [hazard ratio (HR)=1.037, 95% confidence interval (CI) (1.025, 1.050), P<0.001], admission National Institute of Health Stroke Scale score [HR=1.202, 95% CI (1.127, 1.282), P<0.001], initial blood glucose [HR=1.068, 95% CI (1.006, 1.133), P=0.030] were related to the occurrence of END. Conclusion The level of NfL, the severity of stroke, and the bloodglucose at admission are related to the occurrence of END in patients with ACI. Measures can be taken to control the above problems as soon as possible to prevent the occurrence of END.
Objective To explore the correlation between DL-3-n-butylphthalide (NBP) and early neurological deterioration (END) after cerebral infarction in real-world study. Methods A multicenter registry observational study was conducted, enrolling patients with acute cerebral infarction within 72 h of onset from five hospitals in Deyang from March 31st, 2019, to July 31st, 2021. The patients were divided into two groups based on the treatment regimen, whether they received NBP in addition to standard therapy or not. The primary endpoint was END after cerebral infarction, and the secondary endpoint was unfavorable outcome (defined as modified Rankin Scale score of 3 to 6) 90 d after onset. Results A total of 314 patients with cerebral infarction were included in the study, among whom, 126 received standard therapy without NBP treatment (standard treatment group) and 188 received NBP in addition to standard therapy (NBP treatment group). A total of 69 cases occurred END within 10 d after admission. In the NBP treatment group, 32 cases (17.0%) had END within 10 d after admission, while in the standard treatment group, 37 cases (29.4%) occurred END, and the difference between the two groups was statistically significant (P=0.010). Logistic regression analyses showed that the influencing factors related to END included the serum neurofilament light chain level on admission [odds ratio (OR)=1.020, 95% confidence interval (CI) (1.004, 1.035), P=0.013], NBP treatment [OR=0.449, 95%CI (0.253, 0.797), P=0.006], and dual antiplatelet therapy [OR=0.373, 95%CI (0.196, 0.710), P=0.003], and the influencing factors for poor neurological functional prognosis in patients with cerebral infarction included age [OR=1.063, 95%CI (1.024, 1.103), P=0.002], National Institute of Health Stroke Scale score on admission [OR=1.532, 95%CI (1.313, 1.787), P<0.001], NBP treatment [OR=0.375, 95%CI (0.177, 0.794), P=0.010], and END [OR=7.450, 95%CI (3.294, 16.852), P<0.001]. Conclusion The results of our study provide the initial evidence that NBP treatment reduces the occurrence of END, and improves the neurological functional prognosis 90 d after onset in the real world.