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https://www.readbyqxmd.com/read/28338866/the-growing-challenge-of-major-trauma-in-older-people-a-role-for-comprehensive-geriatric-assessment
#1
James Michael Fisher, Charlotte Bates, Jay Banerjee
In this commentary article, we describe the impact that an ageing population is having on the nature of major trauma seen in emergency departments. The proportion of major trauma victims who are older people is rapidly increasing and a fall from standing is now the most common mechanism of injury in major trauma. Potential barriers to effective care of this patient group are highlighted, including: a lack of consensus regarding triage criteria; potentially misleading physiological parameters within triage criteria; non-linear patient presentations and diagnostic nihilism...
March 10, 2017: Age and Ageing
https://www.readbyqxmd.com/read/28329402/novel-orthopoxvirus-infection-in-an-alaska-resident
#2
Yuri P Springer, Christopher H Hsu, Zachary R Werle, Link E Olson, Michael P Cooper, Louisa J Castrodale, Nisha Fowler, Andrea M McCollum, Cynthia S Goldsmith, Ginny L Emerson, Kimberly Wilkins, Jeffrey B Doty, Jillybeth Burgado, JinXin Gao, Nishi Patel, Matthew R Mauldin, Mary G Reynolds, Panayampalli S Satheshkumar, Whitni Davidson, Yu Li, Joseph B McLaughlin
Background.: Human infection by orthopoxviruses is being reported with increasing frequency, attributed in part to the cessation of smallpox vaccination and concomitant waning of population-level immunity. In July 2015, a female resident of interior Alaska, presented to an urgent care clinic with a dermal lesion consistent with poxvirus infection. Laboratory testing of a virus isolated from the lesion confirmed infection by an Orthopoxvirus. Methods.: The virus isolate was characterized by using electron microscopy and nucleic acid sequencing...
March 15, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28328609/evaluation-of-dentoalveolar-trauma-in-children-and-adolescents-a-modified-classification-system-and-surgical-treatment-strategies-for-its-management
#3
Nadia Theologie-Lygidakis, Ourania K Schoinohoriti, Minas Leventis, Ioannis Iatrou
OBJECTIVE: To retrospectively analyze dentoalveolar trauma in pediatric patients, propose a modified classification, and delineate an approach for its urgent care from the surgeon's perspective. PATIENTS AND METHODS: Clinical records of patients, attended at the 'A. and P. Kyriakou' Children's Hospital Department of Oral and Maxillofacial Surgery from 2000 to 2015, were retrieved and data were analyzed. RESULTS: A total of 365 cases of dentoalveolar trauma, affecting 363 children and adolescents (221 males and 142 females), with an age range from 1 to 15 years, were treated in the authors' department...
March 21, 2017: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/28320790/patient-experience-of-different-regional-models-of-urgent-and-emergency-care-a-cross-sectional-survey-study
#4
Conor Foley, Elsa Droog, Maria Boyce, Orla Healy, John Browne
OBJECTIVES: To compare user experiences of 8 regional urgent and emergency care systems in the Republic of Ireland, and explore potential avenues for improvement. DESIGN: A cross-sectional survey. SETTING: Several distinct models of urgent and emergency care operate in Ireland, as system reconfiguration has been implemented in some regions but not others. The Urgent Care System Questionnaire was used to explore service users' experiences with urgent and emergency care...
March 20, 2017: BMJ Open
https://www.readbyqxmd.com/read/28306215/primary-mediastinal-and-retroperitoneal-malignant-germ-cell-tumors-in-children-and-adolescents-results-of-the-tgm95-trial-a-study-of-the-french-society-of-pediatric-oncology-soci%C3%A3-t%C3%A3-fran%C3%A3-aise-des-cancers-de-l-enfant
#5
Hélène Sudour-Bonnange, Cécile Faure-Conter, Hélène Martelli, Frederic Hameury, Brice Fresneau, Daniel Orbach, Cécile Vérité
PURPOSE: To examine the clinical presentation, treatment and results in children and adolescents with primary mediastinal (PM) and retroperitoneal (RP) germ cell tumors (GCTs). METHODS: The TGM95 trial for malignant GCTs was conducted in France between 1995 and 2005 to evaluate a strategy adapted to prognostic factors with cisplatin-based chemotherapy and surgical management. We reviewed patients with TGCTs at PM and RP sites. RESULTS: Among 239 patients, there were 16 patients with PM and 5 with RP tumors, which represent 9% of all patients, highlighting the rarity of these extragonadal locations...
March 17, 2017: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/28303086/anesthesia-provision-in-disasters-and-armed-conflicts
#6
REVIEW
Miguel Trelles Centurion, Rafael Van Den Bergh, Henry Gray
PURPOSE OF REVIEW: Disasters and armed conflicts are characterized by high numbers of trauma cases, and occur mainly in developing countries where the healthcare response is already impaired, resulting in an inadequate response. Aside of the trauma cases, other surgical health conditions are also still present and require urgent care. Surgical care needs are different from context to context and depend on local means and capabilities. RECENT FINDINGS: Doctors without Borders (MSF) has proven that even in precarious situations, safe administration of anesthesia is possible, and the "do no harm" principle can and must be upheld...
2017: Current Anesthesiology Reports
https://www.readbyqxmd.com/read/28302674/urine-culture-follow-up-and-antimicrobial-stewardship-in-a-pediatric-urgent-care-network
#7
Dipanwita Saha, Jimisha Patel, Don Buckingham, David Thornton, Terry Barber, Joshua R Watson
BACKGROUND AND OBJECTIVES: Empiric antibiotic therapy for presumed urinary tract infection (UTI) leads to unnecessary antibiotic exposure in many children whose urine culture results fail to confirm the diagnosis. The objective of this quality improvement study was to improve follow-up management of negative urine culture results in the off-campus urgent care network of Nationwide Children's Hospital to reduce inappropriate antibiotic exposure in children. METHODS: A multidisciplinary task force developed and implemented a protocol for routine nurse and clinician follow-up of urine culture results, discontinuation of unnecessary antibiotics, and documentation in the electronic medical record...
March 16, 2017: Pediatrics
https://www.readbyqxmd.com/read/28296227/health-literacy-in-the-urgent-care-setting-what-factors-impact-consumer-comprehension-of-health-information
#8
Traci L Alberti, Nancy J Morris
BACKGROUND: An increasing number of Americans are using urgent care (UC) clinics due to: improved health insurance coverage, the need to decrease cost, primary care offices with limited appointment availability, and a desire for convenient care. Patients are treated by providers they may not know for episodic illness or injuries while in pain or not feeling well. Treatment instructions and follow-up directions are provided quickly. PURPOSE: To examine health literacy in the adult UC population and identify patient characteristics associated with health literacy risk...
March 10, 2017: Journal of the American Association of Nurse Practitioners
https://www.readbyqxmd.com/read/28282654/approach-to-human-immunodeficiency-virus-sexually-transmitted-infection-testing-for-men-at-an-urban-urgent-care-center
#9
Sarah B Schechter, Dina L Romo, Alwyn T Cohall, Natalie M Neu
BACKGROUND AND OBJECTIVES: Sexually transmitted infection (STI) rates have increased among men. Urgent care centers are increasingly common sites for medical care. The objectives of this study are to describe practices surrounding STI testing at an urban urgent care center. METHODS: Electronic medical record data were analyzed for men ages 20 to 55 years seen at the urgent care center of a large urban hospital from June 7, 2011, to April 30, 2015 (n = 10,983). A subset of charts was reviewed to assess sexual history documentation (n = 906)...
April 2017: Sexually Transmitted Diseases
https://www.readbyqxmd.com/read/28281893/universal-adolescent-suicide-screening-in-a-pediatric-urgent-care-center
#10
Aimy Patel, Catherine Watts, Sheri Shiddell, Karla Couch, Amber M Smith, Michael J Moran, Gregory P Conners
OBJECTIVES: The aim of this article is to describe the implementation of a two-question suicide screening tool in a pediatric urgent care center to identify patients at risk of suicide. METHODS: Adolescents presenting during a 12-month period completed the screening tool. Positive response to either question triggered further social work evaluation, including a Columbia-Suicide Severity Rating Scale. RESULTS: Of 4786 patients screened, 95 (2%) responded positively...
March 10, 2017: Archives of Suicide Research: Official Journal of the International Academy for Suicide Research
https://www.readbyqxmd.com/read/28279116/more-people-accessing-urgent-care-due-to-nhs-111
#11
(no author information available yet)
The NHS's 111 non-emergency phone line is sending a rising number of patients for emergency care, new analysis shows.
March 10, 2017: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
https://www.readbyqxmd.com/read/28273502/ruptured-berry-aneurysm-with-minimal-subarachnoid-hemorrhage
#12
Tyler J Gardner, Joseph A Prahlow
Cerebral artery aneurysm rupture is usually associated with significant subarachnoid hemorrhage; however, there are rare cases where there is a lack of hemorrhage into the subarachnoid space. While subdural hemorrhage can occur with ruptured aneurysms, isolated subdural hemorrhage is more often associated with trauma. In this case, a 51-year-old obese woman, who recently visited an Urgent Care Center for elevated blood pressure, was found dead roughly a month later. She had been complaining of headaches, and received medication for her blood pressure at the visit...
February 28, 2017: Journal of Forensic and Legal Medicine
https://www.readbyqxmd.com/read/28262320/comparing-utilization-and-costs-of-care-in-freestanding-emergency-departments-hospital-emergency-departments-and-urgent-care-centers
#13
Vivian Ho, Leanne Metcalfe, Cedric Dark, Lan Vu, Ellerie Weber, George Shelton, Howard R Underwood
STUDY OBJECTIVE: We compare utilization, price per visit, and the types of care delivered across freestanding emergency departments (EDs), hospital-based EDs, and urgent care centers in Texas. METHODS: We analyzed insurance claims processed by Blue Cross Blue Shield of Texas from 2012 to 2015 for patient visits to freestanding EDs, hospital-based EDs, or urgent care centers in 16 Texas metropolitan statistical areas containing 84.1% of the state's population. We calculated the aggregate number of visits, average price per visit, proportion of price attributable to facility and physician services, and proportion of price billed to Blue Cross Blue Shield of Texas versus out of pocket, by facility type...
February 15, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28255097/patient-and-provider-perspectives-on-the-design-and-implementation-of-an-electronic-consultation-system-for-kidney-care-delivery-in-canada-a-focus-group-study
#14
Aminu K Bello, Anita E Molzahn, Louis P Girard, Mohamed A Osman, Ikechi G Okpechi, Jodi Glassford, Stephanie Thompson, Erin Keely, Clare Liddy, Braden Manns, Kailash Jinda, Scott Klarenbach, Brenda Hemmelgarn, Marcello Tonelli
OBJECTIVES: We assessed stakeholder perceptions on the use of an electronic consultation system (e-Consult) to improve the delivery of kidney care in Alberta. We aim to identify acceptability, barriers and facilitators to the use of an e-Consult system for ambulatory kidney care delivery. METHODS: This was a qualitative focus group study using a thematic analysis design. Eight focus groups were held in four locations in the province of Alberta, Canada. In total, there were 72 participants in two broad stakeholder categories: patients (including patients' relatives) and providers (including primary care physicians, nephrologists, other care providers and policymakers)...
March 2, 2017: BMJ Open
https://www.readbyqxmd.com/read/28245745/atypical-clinical-presentation-of-rapidly-progressing-femoral-head-avascular-necrosis
#15
Joseph A Signorino, Dhinu J Jayaseelan, Kathleen Brindle
A 51-year-old man presented to an urgent care facility 2 weeks after onset of left lateral hip and buttock pain. Radiographs were noncontributory. An orthopaedist referred him to physical therapy, but due to the worsening clinical presentation, he was referred back to the orthopaedist for additional evaluation. Magnetic resonance imaging was ordered and demonstrated abnormal femoral head and acetabular contour, extensive bone marrow edema, and a complex joint effusion. He was diagnosed with femoral head avascular necrosis...
March 2017: Journal of Orthopaedic and Sports Physical Therapy
https://www.readbyqxmd.com/read/28238501/is-tachycardia-at-discharge-from-the-pediatric-emergency-department-a-cause-for-concern-a%C3%A2-nonconcurrent-cohort-study
#16
Paria M Wilson, Todd A Florin, Guixia Huang, Matthew Fenchel, Matthew R Mittiga
STUDY OBJECTIVE: We evaluate the association between discharge tachycardia and (1) emergency department (ED) and urgent care revisit and (2) receipt of clinically important intervention at the revisit. METHODS: The study included a nonconcurrent cohort of children aged 0 to younger than 19 years, discharged from 2 pediatric EDs and 4 pediatric urgent care centers in 2013. The primary exposure was discharge tachycardia (last recorded pulse rate ≥99th percentile for age)...
February 23, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28223112/understanding-and-applying-the-concept-of-value-creation-in-radiology
#17
David B Larson, Daniel J Durand, Daniel S Siegal
The concept of value in radiology has been strongly advocated in recent years as a means of advancing patient care and decreasing waste. This article explores the concept of value creation in radiology and offers a framework for how radiology practices can create value according to the needs of their referring clinicians. Value only exists in the eyes of a customer. We propose that the primary purpose of diagnostic radiology is to answer clinical questions using medical imaging to help guide management of patient care...
February 17, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28222904/the-2016-proposal-for-the-reorganisation-of-urgent-care-provision-in-belgium-a-political-struggle-to-co-locate-primary-care-providers-and-emergency-departments
#18
Koen Van den Heede, Wilm Quentin, Cécile Dubois, Stephan Devriese, Carine Van de Voorde
Internationally the number of emergency department (ED) visits is on the rise while evidence suggests that a substantial proportion of these patients do not require emergency care but primary care. This paper presents the Belgian 2016 proposal for the reorganisation of urgent care provision and places it into its political context. The proposal focused on re-designing patient flow aiming to reduce inappropriate ED visits by improving guidance of patients through the system. Initially policymakers envisaged, as cornerstone of the reform, to roll-out as standard model the co-location of primary care centres and EDs...
February 17, 2017: Health Policy
https://www.readbyqxmd.com/read/28215655/the-caregiver-perspective-on-unscheduled-72-hour-return-visits-to-pediatric-acute-care-sites-a-focus-on-discharge-processes
#19
Nidhya Navanandan, Sarah K Schmidt, Natasha Cabrera, Michael C DiStefano, Rakesh D Mistry
OBJECTIVE: To characterize pediatric caregivers' reasons for 72-hour emergency department (ED) and urgent care (UC) returns. METHODS: A sample of caregivers returning within 72 hours of initial visit to a pediatric ED or affiliated UC site were surveyed from 11/14-6/15; patients evaluated at outside ED/UCs, scheduled for return, or non-English/Spanish speaking were excluded. Caregiver surveys underwent item generation, validation, and pilot testing. Survey items included caregiver reasons for unscheduled returns, with a specific assessment of delivery of key components of discharge instructions (diagnosis, duration of illness, home care, return precautions)...
February 12, 2017: Academic Pediatrics
https://www.readbyqxmd.com/read/28214061/open-physeal-fracture-of-the-distal-phalanx-of-the-hallux-case-study-diagnosis-and-management
#20
Brandon Morris, Scott Mullen, Paul Schroeppel, Bryan Vopat
Open physeal fractures of the distal phalanx of the hallux are the lesser described counterpart to the same fracture of the finger, known by its eponym as a "Seymour fracture". Displaced Salter-Harris phalangeal fractures present with a concomitant nailbed or soft tissue injury. Often these fractures occur in the summer months when open-toe footwear can be worn, however, they may occur indoors as well. Frequently, the injury results from direct axial load of the toe, or "stubbing", which causes the fracture and associated soft tissue injury...
February 6, 2017: American Journal of Emergency Medicine
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