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"Observation unit"

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https://www.readbyqxmd.com/read/28514641/mapping-workforce-configuration-and-operational-models-in-australian-emergency-departments-a-national-survey
#1
Glenn Gardner, Anne Gardner, Sandy Middleton, Julie Considine, Gerard Fitzgerald, Luke Christofis, Anna Doubrovsky, Margaret Adams, Jane O'Connell
Objective Hospital emergency departments (ED) in Australia and internationally have been experiencing increased demand, resulting in reduced hospital quality, impaired access and adverse health outcomes. Effective evaluation of new ED service models and their effect on outcomes is reliant on baseline measures of the staffing configuration and organisational characteristics of the EDs being studied. The aim of the present study was to comprehensively measure these variables in Australian EDs.Methods Australian hospital EDs with 24-h medical and nursing cover were identified and invited to participate in the study...
May 18, 2017: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/28509704/effectiveness-of-2-hour-troponin-in-high-risk-patients-with-suspected-acute-coronary-syndrome
#2
Joseph Bove, Steven Hochman, Jacob Miller, Stephen Artim
BACKGROUND: Research has shown the safety and effectiveness of drawing a standard troponin level at presentation and again at 2 hours in only low-risk patients. Because high-sensitivity troponins are not currently approved in the United States, we studied the utility of a standard troponin that is presently in use. Our goal was to determine if 2-hour standard troponin would be safe and effective in the evaluation of a high-risk cohort of patients never studied previously. METHODS: We conducted a single-center prospective observational study of adult patients presenting to the emergency department with signs and symptoms suggestive of acute coronary syndrome...
June 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28506591/early-echocardiography-has-a-low-yield-in-patients-with-transient-ischemic-attack
#3
Elie Harmouche, Ghada A Mahmoud, Michael Ross, Jason Hockenberry, Robin Dharia, Fadi Nahab
STUDY OBJECTIVE: Current guidelines recommend patients presenting with transient ischemic attack (TIA) undergo echocardiography to evaluate for a cardiac source. However, echocardiography is not available daily at many centers. We assessed the yield from early transthoracic echocardiography (TTE) in consecutive patients with TIA evaluated in an emergency department observation unit (EDOU) protocol. METHODS: This observational cohort study took place in an academic medical center from January 1, 2011 to July 31, 2013...
May 11, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28505059/creation-of-an-adult-observation-unit-improving-outcomes
#4
Joy M Plamann, Judith Zedreck-Gonzalez, Laura Fennimore
A growing segment of patients in hospitals are considered outpatients, classified as observation. These patients neither have the severity of illness nor the intensity of service to qualify as inpatients, yet are not well enough to be discharged. Hospitals have created observation units to address the clinical needs of this growing patient type to provide care in the right setting by managing emergency department throughput and utilizing the most efficient staffing resources. This article describes the change processes and improvements in quality, length of stay, and patient satisfaction, which occurred following the implementation of an adult observation unit...
May 12, 2017: Journal of Nursing Care Quality
https://www.readbyqxmd.com/read/28480251/real-world-effectiveness-of-simeprevir-containing-regimens-among-patients-with-chronic-hepatitis-c-virus-the-sonet-study
#5
Imtiaz Alam, Kimberley Brown, Cynthia Donovan, Jamie Forlenza, Kris Lauwers, Mitchell A Mah'moud, Richard Manch, Smruti R Mohanty, Avinash Prabhakar, Robert Reindollar, Ralph DeMasi, Jihad Slim, Neeta Tandon, Shirley Villadiego, Susanna Naggie
BACKGROUND: The Simeprevir ObservatioNal Effectiveness across practice seTtings (SONET) study evaluated the real-world effectiveness of simeprevir-based treatment for hepatitis C virus (HCV) infection. METHODS: The SONET study was a phase 4, prospective, observational, United States-based study enrolling patients ≥18 years of age with chronic genotype 1 HCV infection. The primary endpoint was the proportion of patients who achieved sustained virologic response 12 weeks after the end of treatment (SVR12), defined as HCV ribonucleic acid undetectable ≥12 weeks after the end of all HCV treatments...
2017: Open Forum Infectious Diseases
https://www.readbyqxmd.com/read/28402053/pseudoreplication-and-the-usage-of-biomarkers-in-ecotoxicological-bioassays
#6
Flávio H Tincani, Grabrieli L Galvan, Antonio E M L Marques, Gustavo S Santos, Letícia S Pereira, Thiago A da Silva, Helena C Silva de Assis, Ronilson V Barbosa, Marta M Cestari
Pseudoreplication is a widely discussed topic in the scientific community. Its principal critique concerns the lack of independence in flawed experimental designs and the use of inferential statistics to test the hypothesis of such experiments. Thirty years after its appearance, it remains misunderstood by many researchers, including ecotoxicologists. In this work, we will try to clarify some of its concepts by filling in what seems to be a gap in the terminology of manipulative experiments. We propose the term experimental medium to refer strictly to the relevant spatial scale of the experiment, in order to preserve the specificity of the experimental and observational units, and to display pseudoreplication as a kind of misinterpretation and/or misanalysis of inferential statistics...
April 12, 2017: Environmental Toxicology and Chemistry
https://www.readbyqxmd.com/read/28386813/simultaneous-component-analysis-by-means-of-tucker3
#7
Alwin Stegeman
A new model for simultaneous component analysis (SCA) is introduced that contains the existing SCA models with common loading matrix as special cases. The new SCA-T3 model is a multi-set generalization of the Tucker3 model for component analysis of three-way data. For each mode (observational units, variables, sets) a different number of components can be chosen and the obtained solution can be rotated without loss of fit to facilitate interpretation. SCA-T3 can be fitted on centered multi-set data and also on the corresponding covariance matrices...
April 6, 2017: Psychometrika
https://www.readbyqxmd.com/read/28370979/cohort-study-on-emergency-general-surgery-patients-and-an-observation-unit
#8
Marilla Dickfos, Hany Ibrahim, Andrew Evans, Robert Franz
BACKGROUND: Medium-sized, non-trauma hospitals experience many of the same difficulties as tertiary centres do when it comes to managing emergency general surgery patients. However, acute surgical units are not a financially viable option in these hospitals. To improve the care of emergency general surgery patients at one such hospital, a Rapid Assessment Medical Surgical (RAMS) unit was developed to decrease the time to review and increase the efficiency in caring for these patients...
March 30, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/28285117/acute-heart-failure-alternatives-to-hospitalization
#9
REVIEW
Reka Zsilinszka, Robert J Mentz, Adam D DeVore, Zubin J Eapen, Peter S Pang, Adrian F Hernandez
Acute heart failure (HF) is a major public health problem with substantial associated economic costs. Because most patients who present to hospitals are admitted irrespective of their level of risk, novel approaches to manage acute HF are needed, such as the use of same-day access clinics for outpatient diuresis and observation units from the emergency department. Current published data lacks a comprehensive overview of the present state of acute HF management in various clinical settings. This review summarizes the strengths and limitations of acute HF care in the outpatient and emergency department settings...
May 2017: JACC. Heart Failure
https://www.readbyqxmd.com/read/28257538/multidisciplinary-approach-to-complicated-pregnancy
#10
Josip Andelo Borovac, Josko Bozic, Tina Ticinovic Kurir, Nikola Zaja, Kresimir Kolic, Vedran Hrboka
A nulliparous pregnant woman in her mid-20s and in the 32nd week of gestation presented to the emergency department with severe headache and vomiting. She had an uneventful medical history; however, the physical examination upon hospital admission revealed a hypertensive emergency, papilledema, and 2+ dipstick proteinuria. Upon establishing the diagnosis of preeclampsia, aggressive therapy with corticosteroids, antihypertensive medication, and seizure prophylaxis was initiated. Hemodynamic stability was achieved within 24 hours and the patient remained in the observation unit located within the gynecology clinic...
March 2017: Southern Medical Journal
https://www.readbyqxmd.com/read/28243009/predictors-for-critical-care-admission-among-children-presenting-to-emergency-department-with-recurrent-wheezing
#11
Aman Saini, Jaya Shankar Kaushik, Vandana Arya, Geeta Gathwala
CONTEXT: Children with recurrent wheezing contribute to a significant burden of inpatient hospital admission in developing countries. However, many patients could be managed at home following a short observation period in emergency unit. AIM: This study aimed to determine the predictors of critical care admission in a population of children aged 6 months to 2 years attending pediatric emergency department (ED) for recurrent wheezing. SETTING AND DESIGN: This is a case-control study conducted in pediatric ED of a tertiary care center in North India...
January 2017: Journal of Emergencies, Trauma, and Shock
https://www.readbyqxmd.com/read/28236513/remote-management-of-low-to-intermediate-risk-chest-pain-a-case-series
#12
Alexander Chiu, Kathleen Shumaker, Christopher Del Corral, Blessy George, Michael Kasper, Marie-Carmelle Elie, Preeti Jois, Daniel Dipsia, Adam Ash
We report a case series of three low to intermediate risk chest pain patients who presented to the emergency department and were managed as outpatients via the Cellular Outpatient Twelve-Lead Telemetry with Emergency Response (COTTER™). This technology allows for certain chest pain patients to be managed remotely via telemedicine while receiving care comparable to that which would be available in a hospital or chest pain observation unit.
February 16, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28212168/implementation-of-interdisciplinary-rapid-rounds-in-observation-units
#13
Lindsey Ryan, Stephanie Scott, Willa Fields
Lack of collaboration and communication can lead to medical errors, increased length of stay, and diminished patient satisfaction. The purpose of this project was to improve nurse efficiency, interdisciplinary communication and collaboration, and patient satisfaction with the discharge process through Rapid Rounds. The results demonstrated that interdisciplinary communication and collaboration improved coordination of care, as evidenced by improved Press Ganey percentile rankings for readiness for discharge and speed of the discharge process, increased pharmaceutical interventions, and fewer phone calls to physicians...
February 16, 2017: Journal of Nursing Care Quality
https://www.readbyqxmd.com/read/28211087/semiparametric-pseudoscore-for-regression-with-multidimensional-but-incompletely-observed-regressor
#14
Zonghui Hu, Jing Qin, Dean Follmann
We study the regression fβ (Y|X,Z), where Y is the response, Z∈Rd is a vector of fully observed regressors and X is the regressor with incomplete observation. To handle missing data, maximum likelihood estimation via expectation-maximisation (EM) is the most efficient but is sensitive to the specification of the distribution of X. Under a missing at random assumption, we propose an EM-type estimation via a semiparametric pseudoscore. Like in EM, we derive the conditional expectation of the score function given Y and Z, or the mean score, over the incompletely observed units under a postulated distribution of X...
February 16, 2017: Statistics in Medicine
https://www.readbyqxmd.com/read/28210350/use-of-physician-in-triage-model-in-the-management-of-abdominal-pain-in-an-emergency-department-observation-unit
#15
John R Marshall, Robert Katzer, Shahram Lotfipour, Bharath Chakravarthy, Siri Shastry, Jessica Andrusaitis, Craig L Anderson, Erik D Barton
INTRODUCTION: Given the nationwide increase in emergency department (ED) visits it is of paramount importance for hospitals to find efficient ways to manage patient flow. The purpose of this study was to determine whether there is a significant difference in success rates, length of stay (LOS), and other demographic factors in two cohorts of patients admitted directly to an ED observation unit (EDOU) under an abdominal pain protocol by a physician in triage (bypassing the main ED) versus those admitted via the traditional pathway (evaluated and treated in the main ED prior to EDOU admission)...
February 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28195938/low-adverse-event-rates-but-high-emergency-department-utilization-in-chest-pain-patients-treated-in-an-emergency-department-observation-unit
#16
Anthony M Napoli, Janette Baird, Steven Tran, Jing Wang
OBJECTIVES: Nearly 40% of all previously admitted chest pain patients re-present to the emergency department (ED) within 1 year regardless of stress testing, and nearly 5% of patients return with a major adverse cardiac event (MACE). The primary objective of this study was to determine the prevalence of return visits to the ED among patients previously admitted to an ED chest pain observation unit (CPU). We also identified the patient characteristics and health risk factors associated with these return ED visits...
March 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/27935745/does-abnormal-laboratory-results-notification-with-the-short-message-service-shorten-length-of-stay-in-the-pediatric-emergency-department-observation-unit
#17
Ibrahim Hakan Bucak, Habip Almis
BACKGROUND: A new age in communications began with the entry into use of cell phones and their applications. Cell phones and their various applications must be actively used in patient monitoring in the healthcare system. INTRODUCTION: The purpose of this study was to determine the length of stay in the pediatric emergency department observation unit (PEDOU) based upon the notification of abnormal laboratory results (ALRs) via the short message service (SMS). MATERIALS AND METHODS: Patients with ALRs notified through the SMS (April-May-June 2015: study period) were evaluated retrospectively, and those admitted to hospital after such notification were enrolled as the study group (SG)...
December 9, 2016: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/27919865/shared-decision-making-in-patients-with-low-risk-chest-pain-prospective-randomized-pragmatic-trial
#18
RANDOMIZED CONTROLLED TRIAL
Erik P Hess, Judd E Hollander, Jason T Schaffer, Jeffrey A Kline, Carlos A Torres, Deborah B Diercks, Russell Jones, Kelly P Owen, Zachary F Meisel, Michel Demers, Annie Leblanc, Nilay D Shah, Jonathan Inselman, Jeph Herrin, Ana Castaneda-Guarderas, Victor M Montori
OBJECTIVE:  To compare the effectiveness of shared decision making with usual care in choice of admission for observation and further cardiac testing or for referral for outpatient evaluation in patients with possible acute coronary syndrome. DESIGN:  Multicenter pragmatic parallel randomized controlled trial. SETTING:  Six emergency departments in the United States. PARTICIPANTS:  898 adults (aged >17 years) with a primary complaint of chest pain who were being considered for admission to an observation unit for cardiac testing (451 were allocated to the decision aid and 447 to usual care), and 361 emergency clinicians (emergency physicians, nurse practitioners, and physician assistants) caring for patients with chest pain...
December 5, 2016: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/27918377/utility-of-emergency-department-observation-units-for-neurologically-intact-children-with-head-ct-abnormalities-secondary-to-acute-closed-head-injury
#19
Roxanna Lefort, Jill V Hunter, Andrea T Cruz, A Chantal Caviness, Thomas G Luerssen, Aderonke Adekunle-Ojo
OBJECTIVE: The aim of the study was to evaluate the utility of the emergency department observation unit (EDOU) for neurologically intact children with closed head injuries (CHIs) and computed tomography (CT) abnormalities. METHODS: A retrospective cohort study of children aged 0 to 18 years with acute CHI, abnormal head CT, and a Glasgow Coma Scales score of 14 or higher admitted to the EDOU of a tertiary care children's hospital from 2007 to 2010. Children with multisystem trauma, nonaccidental trauma, and previous neurosurgical or coagulopathic conditions were excluded...
March 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27902667/managing-skin-and-soft-tissue-infections-in-the-emergency-department-observation-unit
#20
Shabana Yusuf, Joseph L Hagan, Aderonke O Adekunle-Ojo
BACKGROUND: Skin and soft tissue infections (SSTIs) are a common reason for presentation to the emergency department (ED) and account for 3% of ED visits. Patients with a diagnosis of cellulitis requiring intravenous (IV) antibiotics have traditionally been admitted to the hospital. In our institution, these patients are placed in the ED Observation Unit (EDOU) for IV antibiotics. OBJECTIVES: The purpose of this study is to determine if 3 doses of IV antibiotics are adequate to document clinical improvement in children with uncomplicated SSTI...
December 2, 2016: Pediatric Emergency Care
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