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free standing ED

Ara Festekjian, Karen Y Kwan, Todd P Chang, Hollie Lai, Margil Fahit, Danica B Liberman
BACKGROUND: After-hours radiologic interpretation by nonradiology attendings or resident radiologists introduces the risk of discrepancies. Clinical outcomes following radiologic discrepancies among pediatric emergency department (ED) patients are poorly described. In particular, children with special healthcare needs (CSHCN), have more opportunities for discrepancies and potential consequences than non- CSHCN. Our objective was to determine the rates and types of radiologic discrepancies, and to compare CSHCN to non-CSHCN...
December 21, 2017: American Journal of Emergency Medicine
Casey J Allen, Daniel J Baldor, Carl I Schulman, Louis R Pizano, Alan S Livingstone, Nicholas Namias
Florida considers the International Classification Injury Severity Score (ICISS) from hospital discharges within a geographic region in the apportionment of trauma centers (TCs). Patients with an ICISS <0.85 are considered to require triage to a TC, yet many are triaged to an emergency department (ED). We assess outcomes of those with an ICISS <0.85 by the actual triage decision of emergency medical services (EMS). From October 2011 to October 2013, 39,021 consecutive admissions with injury ICD-9 codes were analyzed...
June 1, 2017: American Surgeon
Tom Parkman, Joanne Neale, Ed Day, Colin Drummond
BACKGROUND: Understanding why people repeatedly attend Emergency Departments (EDs) for alcohol-related reasons is an important prerequisite to identifying ways of reducing any unnecessary demands on hospital resources. We use Andersen's Behavioural Model of Health Services Use to explore factors that contributed to repeat ED attendances. METHODS: Qualitative interviews were conducted with 30 people who repeatedly attended EDs for alcohol-related reasons (≥10 attendances in the past 12 months)...
February 16, 2017: BMC Health Services Research
Anup D Patel, Eric G Wood, Daniel M Cohen
BACKGROUND: Epilepsy or seizure care is the most common neurologic condition that presents to an emergency department (ED) and accounts for a large number of annual cases. Our aim was to decrease seizure-related ED visits from our baseline of 17 ED visits per month per 1000 patients to 13.6 ED visits per month per 1000 patients (20%) by July 2014. METHODS: Our strategy was to develop a quality improvement (QI) project utilizing the Institute for Healthcare Improvement model...
February 2017: Pediatrics
Edward R Melnick, Elizabeth G J O'Brien, Olga Kovalerchik, William Fleischman, Arjun K Venkatesh, R Andrew Taylor
BACKGROUND: Variation in emergency physician computed tomography (CT) imaging utilization is well described, but little is known about what drives it. Physician empathy has been proposed as a potential characteristic affecting CT utilization. OBJECTIVES: The objective was to describe empathy in a cohort of emergency physicians and evaluate its association with CT utilization. We also sought to compare emergency physician performance on an empathy psychometric test with performance on other psychometric tests previously proposed as predictors of CT utilization...
August 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Marc H Gorelick, Robert Schremmer, Holly Ruch-Ross, Carrie Radabaugh, Steven Selbst
OBJECTIVES: Changes in health care delivery and graduate medical education have important consequences for the workforce in pediatric emergency medicine (PEM). This study compared career preparation and potential attrition of the PEM workforce with the prior assessment from 1998. METHODS: An e-mail survey was sent to members of the American Academy of Pediatrics (AAP) Section on EM and to non-AAP members board certified in PEM. Information on demographics, practice characteristics and professional activities, career preparation, future plans, and burnout (using two validated screening questions) was analyzed using standard descriptive statistics...
January 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Pavitra Kotini-Shah, Teresa R Camp-Rogers, Robert A Swor, Kelly N Sawyer
Implementation of postarrest care by individual physicians and systems has been slow. Deadoption, or discontinuation of therapeutic hypothermia (TH) treatment targets, after recent prospective study results has not been well reported. This study assesses practices in the early stages of postarrest care across emergency departments (EDs) in Michigan. A 27-question Internet-based survey was distributed to EDs in Michigan in September 2013. To assess changes in practice after publication of Nielsen et al., we sent follow-up questions to all original respondents a year later...
March 2016: Therapeutic Hypothermia and Temperature Management
Robert E Kramer, Michael R Narkewicz
OBJECTIVE: To conduct a comprehensive study of postendoscopic adverse events (AEs) in children, categorizing them by the level of intervention required. BACKGROUND: Previous studies of endoscopic AE in children have focused on intraprocedural and short-term outcomes, such as bleeding, perforation, and infection, and may underestimate the incidence of AEs. DESIGN: Prospective observational study tracking AEs in pediatric patients within 72 hours of an endoscopic procedure...
June 2016: Journal of Pediatric Gastroenterology and Nutrition
K Casey Lion, Julie C Brown, Beth E Ebel, Eileen J Klein, Bonnie Strelitz, Colleen Kays Gutman, Patty Hencz, Juan Fernandez, Rita Mangione-Smith
IMPORTANCE: Consistent professional interpretation improves communication with patients who have limited English proficiency. Remote modalities (telephone and video) have the potential for wide dissemination. OBJECTIVE: To test the effect of telephone vs. video interpretation on communication during pediatric emergency care. DESIGN, SETTING, AND PARTICIPANTS: Randomized trial of telephone vs. video interpretation at a free-standing, university-affiliated pediatric emergency department (ED)...
December 2015: JAMA Pediatrics
Yu-Hsiang Hsieh, David R Holtgrave, Stephen Peterson, Charlotte A Gaydos, Richard E Rothman
High operating costs challenge sustainability of successful US emergency department (ED) HIV screening programs. Free-standing registration kiosks could potentially reduce the marginal costs of ED HIV screening. We investigated incremental cost-effectiveness ratio (CER) per new HIV diagnosis for a kiosk-based approach for offering screening at ED registration versus a testing staff-based approach to offer testing at the bedside. A rapid oral-fluid HIV screening program, instituted in a US ED since 2005, had a rate of new HIV diagnosis 0...
2016: AIDS Care
Avani S Mehta, Monika K Goyal, Nadia Dowshen, Rakesh D Mistry
OBJECTIVE: Limited data exist regarding knowledge of and compliance to the Centers for Disease Control and Prevention's universal adolescent human immunodeficiency virus (HIV) screening recommendations. Our objective was to assess current guideline knowledge, practice, and perceived barriers to emergency department (ED)-based adolescent HIV screening. METHODS: We administered an anonymous Web-based cross-sectional survey from May 1, 2012, to June 30, 2012, to 1073 physicians from the American Academy of Pediatrics Section on Emergency Medicine LISTSERV...
September 2015: Pediatric Emergency Care
Halden F Scott, Sara J Deakyne, Jason M Woods, Lalit Bajaj
OBJECTIVES: This study sought to determine the prevalence, test characteristics, and severity of illness of pediatric patients with systemic inflammatory response syndrome (SIRS) vital signs among pediatric emergency department (ED) visits. METHODS: This was a retrospective descriptive cohort study of all visits to the ED of a tertiary academic free-standing pediatric hospital over 1 year. Visits were included if the patient was <18 years of age and did not leave before full evaluation or against medical advice...
April 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Steven H Saef, Cathy L Melvin, Christine M Carr
INTRODUCTION: Use clinician perceptions to estimate the impact of a health information exchange (HIE) on emergency department (ED) care at four major hospital systems (HS) within a region. Use survey data provided by ED clinicians to estimate reduction in Medicare-allowable reimbursements (MARs) resulting from use of an HIE. METHODS: We conducted the study during a one-year period beginning in February 2012. Study sites included eleven EDs operated by four major HS in the region of a mid-sized Southeastern city, including one academic ED, five community hospital EDs, four free-standing EDs and 1 ED/Chest Pain Center (CPC) all of which participated in an HIE...
November 2014: Western Journal of Emergency Medicine
Susan Wu, Chris Baker, Michael E Lang, Sheree M Schrager, Fasha F Liley, Carmel Papa, Valerie Mira, Ara Balkian, Wilbert H Mason
IMPORTANCE: Bronchiolitis is one of the most common and costly respiratory diseases in infants and young children. Previous studies have shown a potential benefit of nebulized hypertonic saline; however, its effect in the emergency department (ED) setting is unclear. OBJECTIVE: To compare the effect of nebulized 3% hypertonic saline vs 0.9% normal saline on admission rate and length of stay in infants with bronchiolitis. DESIGN, SETTING, AND PARTICIPANTS: We conducted a double-blind, randomized clinical trial during 3 consecutive bronchiolitis seasons from March 1, 2008, through April 30, 2011...
July 2014: JAMA Pediatrics
Aristea Fotopoulou
This article suggests that, in a world emerging in and through mediation, branded sex bloggers and portals become (re)mediators of queer and feminist politics. It examines the websites of two porn production companies, Nofauxxx and Furry Girl, and analyses how they respond to older media forms, re-articulate long-standing debates about pornography in new mediated environments, and re-signify the pornographic object. Key in this process is the circulation of "authenticity," "real bodies," and "diversity" discourses...
2013: Journal of Lesbian Studies
Jessica A Naiditch, Timothy B Lautz, Susan Daley, Mary Clyde Pierce, Marleta Reynolds
OBJECTIVES: The purpose of this study was to determine the fraction of children with acute appendicitis who had recent false-negative diagnoses and to analyze the association of a missed diagnosis of appendicitis with patient outcome. METHODS: The records of all 816 patients who underwent appendectomy for suspected appendicitis at a free-standing children's hospital between 2007 and 2010 were reviewed. A patient admitted or evaluated in the emergency department (ED), discharged without a diagnosis of appendicitis, and then readmitted with histopathologically confirmed appendicitis within 3 days was considered to have a "missed diagnosis...
June 2013: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Roelien Bastiaanse
Many studies have shown that verb inflections are difficult to produce for agrammatic aphasic speakers: they are frequently omitted and substituted. The present article gives an overview of our search to understanding why this is the case. The hypothesis is that grammatical morphology referring to the past is selectively impaired in agrammatic aphasia. That is, verb inflections for past tense and perfect aspect are hard to produce. Furthermore, verb clusters that refer to the past will be affected as well, even if the auxiliary is in present tense, as in he has been writing a letter...
April 2013: Clinical Linguistics & Phonetics
Ming Chien, F Anthony Willyerd, Katherine Mandeville, Mark A Hostetler, Blake Bulloch
BACKGROUND: Standard practice has been to admit children for an observation period after enema-reduced intussusception. However, the utility of such routine practice has not been clearly justified. STUDY OBJECTIVES: The main objective was to determine the rate and timing of recurrent intussusception after successful enema reduction and describe any associated complications. METHODS: The study was a retrospective chart review identifying children with enema-reduced intussusception during a 7-year period from 2002 through 2008...
January 2013: Journal of Emergency Medicine
(no author information available yet)
By empowering front-line staff to come up with some of their own solutions, the ED at Swedish Medical Center in Issaquah, WA, has implemented a no-wait model that eschews traditional triage in favor of a rapid intake process that puts patients in beds immediately and kick-starts the evaluation process. While the approach has proven challenging to implement and maintain, patient satisfaction is greater than 95%. The no-wait model was developed and fine-tuned by the staff at a free-standing ED that preceded the opening of the hospital in Issaquah, WA...
May 2012: ED Management: the Monthly Update on Emergency Department Management
Annalisa Guaragna, Angela Chiaviello, Concetta Paolella, Daniele D'Alonzo, Giuseppe Palumbo, Giovanni Palumbo
The development of tumor-targeting drug delivery systems, able to selectively transport cytotoxic agents into the tumor site by exploiting subtle morphological and physiological differences between healthy and malignant cells, currently stands as one of the most attractive anticancer strategies used to overcome the selectivity problems of conventional chemotherapy. Owing to frequent overexpression of folate receptors (FRs) on the surface of malignant cells, conjugation of cytotoxic agents to folic acid (FA) via suitable linkers have demonstrated to enhance selective drug delivery to the tumor site...
January 18, 2012: Bioconjugate Chemistry
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