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J de Gelder, J A Lucke, L C Blomaard, A M Booijen, A J Fogteloo, S Anten, E W Steyerberg, J Alsma, S C E Klein Nagelvoort Schuit, A Brink, B de Groot, G J Blauw, S P Mooijaart
INTRODUCTION: Many screening instruments to predict adverse health outcomes in older patients visiting the emergency department (ED) have been developed, but successful implementation has been hampered because they are insufficiently validated or not tailored for the intended use of everyday clinical practice. The present study aims to refine and validate an existing screening instrument (the APOP screener) to predict 90-day functional decline or mortality in older ED patients. METHODS: Consecutive older patients (≥70 years) visiting the EDs of four hospitals were included and prospectively followed...
June 20, 2018: Experimental Gerontology
Fumihito Hirai, Tetsuya Ishida, Fuminao Takeshima, Shojiro Yamamoto, Ichiro Yoshikawa, Shinya Ashizuka, Haruhiko Inatsu, Keiichi Mitsuyama, Suketo Sou, Ryuichi Iwakiri, Ryoichi Nozaki, Hidehisa Ohi, Motohiro Esaki, Mitsuo Iida, Toshiyuki Matsui
BACKGROUND AND AIMS: The aim of this study was to clarify the additional effect of a concomitant elemental diet (ED) for patients with Crohn's disease (CD) on maintenance anti-TNF-alfa antibody (anti-TNF). METHODS: CD patients who received anti-TNF induction therapy were enrolled. Patients who achieved clinical response (defined as delta CDAI>70 and CDAI<200) at 10-14 weeks after the start of infliximab or adalimumab were included. Eligible patients took a tolerability test of ED (900 kcal/day) for 3 days...
June 23, 2018: Journal of Gastroenterology and Hepatology
Linda A Dimeff, David A Jobes, Samantha A Chalker, Brian M Piehl, Leticia Lobo Duvivier, Benjamin C Lok, Mohan S Zalake, Julie Chung, Kelly Koerner
OBJECTIVE: A novel avatar system (Virtual Collaborative Assessment and Management of Suicidality System; V-CAMS) for suicidal patients and medical personnel in emergency departments (EDs) was developed and evaluated. V-CAMS facilitates the delivery of CAMS and other evidence-based interventions to reduce unnecessary hospitalization, readmissions, and suicide following an ED visit. METHOD: Using iterative user-centered design with 24 suicidal patients, an avatar prototype, "Dr...
May 20, 2018: General Hospital Psychiatry
Charles W Hwang, Desmond E Fitzpatrick, Torben K Becker, Jason M Jones
BACKGROUND: Freestanding emergency departments (FSED) are equipped to care for most emergencies, but do not have all the resources that hospital-based emergency departments (ED) offer. As the number of FSEDs grows rapidly, emergency medical services (EMS) must routinely determine whether a FSED is an appropriate destination. Inappropriate triage may delay definitive care, potentially increasing morbidity, mortality, and resource utilization. We sought to evaluate paramedics' ability in determining whether a FSED is the most appropriate destination...
June 12, 2018: American Journal of Emergency Medicine
Susan B Roman, Allison Matthews-Wilson, Patricia Dickinson, Danielle Chenard, Steven C Rogers
Emergency departments (EDs) across North America have become a safety net for patients seeking mental health (MH) services. The prevalence of families seeking treatment of children in MH crisis has become a national emergency. To address MH access and improve quality and efficient management of children with MH conditions, the authors describe ED projects targeting this vulnerable population. Five North American health care systems volunteered to feature projects that seek to reduce ED visits and/or improve the care of MH patients: Allina Health, Nationwide Children's Hospital, Children's Hospital of Eastern Ontario, Connecticut Children's Medical Center, and Rhode Island Hospital...
July 2018: Child and Adolescent Psychiatric Clinics of North America
Johan A Snoek, Thijs M H Eijsvogels, Arnoud W J van 't Hof, Eva Prescott, Maria T Hopman, Evelien Kolkman, Ed P de Kluiver
INTRODUCTION: Although exercise therapy has the potential to improve health outcomes of patients with Chronic Heart Failure (CHF), less than 50% of patients adhere to prescribed physical activity guidelines one year after Cardiac Rehabilitation (CR). We aimed to assess the effects of an extended CR program with 12-months of Graded Exercise Therapy (GET) and resistance exercise training (RT) on exercise capacity and long-term survival in patients with CHF. METHODS: This prospective cohort study included sixty CHF patients between 2009 and 2010...
June 21, 2018: Medicine and Science in Sports and Exercise
Ylenia Nicolini, Antonella Tramacere, Stefano Parmigiani, Harold Dadomo
In this review, we analyze erectile dysfunction (ED) in the context of sexual selection. We highlight that ED is a specific human male characteristic linked to the loss of the baculum or penile bone and results from a range of physical and psychological factors. We discuss evolutionary interpretations that consider dysfunctional penile erection as an honest signal of a low-quality male. We further emphasize the importance of considering psychosocial context and early attachment dynamics for understanding the etiology of some types of ED...
June 22, 2018: Journal of Sex Research
Jessica E Galarraga, William J Frohna, Jesse M Pines
BACKGROUND: In 2014, the state of Maryland moved away from fee-for-service payments and into a global budget revenue (GBR) structure where hospitals have a fixed revenue target, independent of patient volume or services provided. We assess the effects of GBR adoption on emergency department (ED) admission decisions among adult encounters. METHODS: We used hospital medical record and billing data from adult ED encounters from January 1, 2011 through December 31, 2015, with four Maryland (MD) hospitals and two District of Columbia (DC) hospitals within the same health system...
June 22, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Lara Goldstein, Mike Wells, Craig Vincent-Lambert
Objectives: To compare standard emergency department (ED) workflow to a protocolized pathway using upfront point-of-care (POC) tests performed prior to doctor evaluation to determine if this could produce a significant reduction in treatment time. Methods: We performed a prospective, randomized, controlled trial. Patients were randomized to receive the standard of care or one of the enhanced workflow pathways with POC tests. Results: There were 1,044 patients enrolled...
June 19, 2018: American Journal of Clinical Pathology
Ritu R Gill, Beow Y Yeap, Raphael Bueno, William G Richards
Background: Analysis of the International Association for the Study of Lung Cancer (IASLC) Malignant Pleural Mesothelioma (MPM) database revealed that clinical (cTNM) staging minimally stratified survival and was discrepant with pathological (pTNM) staging. To improve prognostic classification of MPM, alternative staging models based on quantitative parameters were explored. Methods: An institutional review board-approved MPM registry was queried to identify patients with available pathological and preoperative imaging data...
March 1, 2018: Journal of the National Cancer Institute
Christine M McDonald, Sarah West, David Dushenski, Stephen E Lapinsky, Christine Soong, Kate van den Broek, Melanie Ashby, Gillian Wilde-Friel, Carrie Kan, Mark McIntyre, Andrew Morris
Objective: To develop a triage-based screening algorithm and treatment order-sets aimed at improving the quality of care of all patients with sepsis presenting to our emergency department (ED). Design: Retrospective cohort study conducted during a pre-intervention period from 1 April 2010 to 31 March 2011 and a post-intervention period from 1 September 2014 to 30 April 2015. Setting: A large teaching hospital located in Toronto, Ontario, Canada with a 35-bed ED...
June 20, 2018: International Journal for Quality in Health Care
Julie Rotival, Youri Yordanov, Pierre-Clément Thiebaud, Nathalie Pelletier-Fleury, Elsa Jacquet, Erwan Debuc, Dominique Pateron, Diane Naouri
Background: Some studies have demonstrated an association between poor continuity of care, high likelihood of 'inappropriate' use of emergency departments (EDs) and avoidable hospitalization. However, we lack data concerning primary care use after an ED visit. Objective: Identify the determinants of a visit to the general practitioner (GP) after an ED visit. Design: Observational study (single-centre cohort). Setting: One emergency department in Paris, France...
June 21, 2018: Family Practice
Ed Madeley, Brett Duane
Data sourcesPubMed, EMBASE, Web of Science, Cochrane library, China Biology Medicine Disc (CBM), China National Knowledge infrastructure (CNKI).Study SelectionThis study included only human randomised controlled trials (RCTs) and clinical controlled trials (CCTs). To be included studies had to include patients prescribed oral anticoagulant therapy (OAT) requiring dental extraction(s). Comparison was made between patients discontinuing OAT for the dental extraction(s) and those continuing with their OAT. The outcome measured was post-operative bleeding identified by clinician or patient...
June 2018: Evidence-based Dentistry
Nicholas R Pettit
CLINICAL INTRODUCTION: A 45-year-old man with no past medical history presents with bilateral lower extremity pain and perineal numbness after walking 10-15 min. The pain starts in his bilateral buttocks and radiates down into his thigh and into his toes. He has no back pain, fever, difficulty urinating or stooling, incontinence or trauma. Social history is positive for smoking. Physical examination was only remarkable for non-dopplerable lower extremity pulses, and he was unable to ambulate down the ED hallway without becoming symptomatic...
July 2018: Emergency Medicine Journal: EMJ
Shannon McConville, Alyssa C Mooney, Brie A Williams, Renee Y Hsia
OBJECTIVE: To assess the patterns of emergency department (ED) utilisation among those with and without criminal justice contact in California in 2014, comparing variation in ED use, visit frequency, diagnoses and insurance coverage. DESIGN: Retrospective, cross-sectional study. SETTING: Analyses included ED visits to all licensed hospitals in California using statewide data on all ED encounters in 2014. PARTICIPANTS: Study participants included 3 757 870 non-elderly adult ED patients who made at least one ED visit in 2014...
June 21, 2018: BMJ Open
Dorothy Stearns, Kanta Sircar
Unintentional non-fire-related (UNFR) carbon monoxide (CO) poisoning is a leading cause of poisoning in the US and a preventable cause of death. We generated national estimates of accidental CO poisoning and characterized the populations most at risk. UNFR CO poisoning cases were assessed using hospitalization and emergency department (ED) data from the Healthcare Costs and Utilization Project National Inpatient Sample and Nationwide Emergency Department Sample databases. We used hospitalization data from 2003 to 2013 and ED data from 2007 to 2013...
June 2, 2018: American Journal of Emergency Medicine
J D Roth, B M Whittam, A E Carroll, K M Szymanski, R Misseri, M P Cain, W E Bennett
INTRODUCTION AND BACKGROUND: Hypospadias is a common birth defect. It is present in about 34.2 in 10,000 live births in North America. However, few studies have evaluated the immediate reoperation and readmission rates following elective repair. OBJECTIVE: This study aimed to define the rates of readmission and reoperation following elective hypospadias repair, to improve pre-operative counseling on risks of the procedure. STUDY DESIGN: The Pediatric Health Information System (PHIS) was interrogated from 2004 to 2015 for all elective hypospadias repairs (ICD-9-CM code 58...
June 6, 2018: Journal of Pediatric Urology
Oscar Thabouillot, Julien Le Coz, Nicolas-Charles Roche
A seven-month-old girl was referred to the emergency department (ED) after a general practitioner suspected Steven-Johnson syndrome. Actually, the diagnosis of bullous pemphigoid (BP) was made based on biopsies; BP is a rare, autoimmune skin disease involving the presence of blisters known as bullae. The child was efficiently treated with topical steroids. This case shows the importance of the ED physician's prior knowledge of BP so that a differential diagnosis with other autoimmune diseases (dermatosis, pemphigus) can be made...
June 22, 2018: Prehospital and Disaster Medicine
Shao Lin, Wayne R Lawrence, Ziqiang Lin, Stephen DiRienzo, Kevin Lipton, Guang-Hui Dong, Ricky Leung, Ursula Lauper, Philip Nasca, Neil Stuart
More extreme cold weather and larger weather variations have raised concerns regarding their effects on public health. Although prior studies assessed the effects of cold air temperature on health, especially mortality, limited studies evaluated wind chill temperatures on morbidity, and health effects under the current cold warning threshold. This study identified the thresholds, lag periods, and best indicators of extreme cold on cardiovascular disease (CVD) by comparing effects of wind chill temperatures and cold air temperatures on CVD emergency department (ED) visits in winter and winter transition months...
October 15, 2018: Science of the Total Environment
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