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https://www.readbyqxmd.com/read/28811209/prevalence-of-pulmonary-embolism-in-patients-presenting-to-the-emergency-department-with-syncope
#1
Alison Frizell, Nicole Fogel, Jacob Steenblik, Margaret Carlson, Joseph Bledsoe, Troy Madsen
OBJECTIVES: A recent study reported a high prevalence of pulmonary embolism (PE) among patients admitted with syncope. We sought to determine whether these findings were validated in our patient population. METHODS: We performed a retrospective, secondary analysis of prospectively gathered data from patients presenting with syncope to an academic emergency department (ED) from July 2010 to December 2015. We analyzed baseline information from the time of the ED visit, recorded outcomes during the hospital stay, and contacted patients by phone at least 30days after the ED visit...
July 31, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28768699/use-of-a-23-hour-emergency-department-observation-unit-for-the-management-of-patients-with-toxic-exposures
#2
Rupeng Mong, Gabriel Joseph Arciaga, Hock Heng Tan
BACKGROUND: A significant proportion of patients with toxic exposures presenting to the ED require admission. However, most will improve within 24 hours, and so could potentially be managed in a short-stay observation unit. We describe the management and outcomes of these patients in a 23-hour ED observation unit (EDOU). METHODS: A retrospective chart review of all patients with toxic exposures admitted to the EDOU in Singapore between 1 April 2013 and 31 March 2015 was performed...
August 2, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28748625/multiple-risk-factor-counseling-to-promote-heart-healthy-lifestyles-in-the-chest-pain-observation-unit-pilot-randomized-controlled-trial
#3
David A Katz, Mark Graber, Patricia Lounsbury, Mark W Vander Weg, Emily K Phillips, Christina Clair, Phillip A Horwitz, Xueya Cai, Alan J Christensen
OBJECTIVE: Admission to the chest pain observation unit (CPOU) may be an advantageous time for patients to consider heart-healthy lifestyle changes while undergoing diagnostic evaluation to rule out myocardial ischemia. The aim of this pragmatic trial was to assess the effectiveness of a multiple risk factor intervention in changing CPOU patients' health beliefs and readiness to change health behaviors. A secondary aim was to obtain preliminary estimates of the intervention's effect on diet, physical activity, and smoking...
July 27, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28742647/the-dis-utility-of-a-change-in-troponin-i-for-diagnosis-of-non-st-segment-elevation-myocardial-infarction-in-an-observation-unit
#4
Iani Patsias, Benjamin Swanson, Michael Hudson, Sachin Parikh, Khaled Nour, Gordon Jacobsen, James McCord
BACKGROUND: Observation units (OUs) may be an efficient and effective setting to diagnose and risk stratify patients with coronary ischemia and myocardial infarction (MI). Given improved cardiac troponin I (cTnI) assays and expanded utilization of OUs, it is not uncommon for patients with mildly elevated cTnI to be evaluated in OUs. We investigated the serial cTnI results in OU patients to determine whether absolute or relative cTnI changes were useful for the diagnosis of MI. METHODS: This was a retrospective study of 260 patients placed in the OU from a single center in 2007, with an initial cTnI in the indeterminate range of 0...
September 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28711132/additional-conditions-amenable-to-observation-care
#5
REVIEW
Matthew A Wheatley
ED observation units (EDOUs) are designed for patients who require diagnostics or therapeutics beyond the initial ED visit to determine the need for hospital admission. Best evidence is that this care be delivered via ordersets or protocols. Occasionally, patients present with conditions that are amenable to EDOU care but fall outside the commonly used protocols. This article details a few of these conditions: abnormal uterine bleeding, allergic reaction, alcohol intoxication, acetaminophen overdose and sickle cell vaso-occlusive crisis...
August 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28711131/care-of-special-populations-in-an-observation-unit-pediatrics-and-geriatrics
#6
REVIEW
Sharon E Mace
Infants and children and the elderly comprise a large and growing (especially the elderly) segment of the US population. The benefits of observation medicine have been documented in these two age groups: Based on the success of observation medicine, and recognizing the growth of these special populations, it is likely that observation medicine will be expanding in the future, especially within the pediatric and geriatric populations. Future studies should be able to provide further evidence regarding the value of observation medicine in these two diverse population age groups...
August 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28711130/care-of-traumatic-conditions-in-an-observation-unit
#7
REVIEW
Christopher G Caspers
Patients presenting to the emergency department with certain traumatic conditions can be managed in observation units. The evidence base supporting the use of observation units to manage injured patients is smaller than the evidence base supporting the management of medical conditions in observation units. The conditions that are eligible for management in an observation unit are not limited to those described in this article, and investigators should continue to identify types of conditions that may benefit from this type of health care delivery...
August 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28711129/care-of-infectious-conditions-in-an-observation-unit
#8
REVIEW
Pawan Suri, Taruna K Aurora
Infectious conditions such as skin and soft tissue infections (SSTIs), Urogenital infections and peritonsillar abscesses frequently require care beyond emergency stabilization and are well-suited for short term care in an observation unit. SSTIs are a growing problem, partly due to emergence of strains of methicillin-resistant S. aureus (MRSA). Antibiotic choice is guided by the presence of purulence and site of infection. Purulent cellulitis is much more likely to be associated with MRSA. Radiographic imaging should be considered to aid in management in patients who are immunosuppressed, have persistent symptoms despite antibiotic therapy, recurrent infections, sepsis or diabetes...
August 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28711128/care-of-respiratory-conditions-in-an-observation-unit
#9
REVIEW
Margarita E Pena, Viviane M Kazan, Michael N Helmreich, Sharon E Mace
In adults, respiratory disorders are the second most frequent diagnoses treated in emergency department observation units (EDOUs) and account for the most frequent indication for placement of pediatric patients into an EDOU. With appropriate patient selection, chronic obstructive pulmonary disease exacerbations, and community-acquired pneumonia can be managed in the EDOU. EDOU management results in equivalent or better outcomes than inpatient care with decreased length of stay, increased patient satisfaction, lower cost and in some studies decreased mortality...
August 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28711127/care-of-neurologic-conditions-in-an-observation-unit
#10
REVIEW
Matthew A Wheatley, Michael A Ross
As a group, neurologic conditions represent a substantial portion of emergency department (ED) visits. Cerebrovascular disease, headache, vertigo and seizures are all common reasons for patients to seek care in the ED. Patients being treated for each of these conditions are amenable to care in an ED observation unit (EDOU) if they require further diagnostic or therapeutic interventions beyond their ED stay. EDOUs are the ideal setting for patients who require advanced imaging such as MRIs, frequent neuro checks or specialist consultation in order to determine if they require admission or can be discharged home...
August 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28711126/care-of-metabolic-and-endocrine-conditions-in-the-observation-unit
#11
REVIEW
Anwar Dayan Osborne
Accelerated therapeutic protocols targeting metabolic conditions are ideal for observation unit care. Because many conditions, such as hypokalemia and hyperglycemia, have little to no diagnostic uncertainty, the care in the unit is often straightforward. Additionally, some components of care for the endocrine condition may exhaust services, such as phlebotomy. Hence, this discussion focuses resource utilization and management considerations for the purposes of matching the level of care to the severity of the conditions...
August 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28711125/care-of-acute-gastrointestinal-conditions-in-the-observation-unit
#12
REVIEW
Jason J Ham, Edgar Ordonez, R Gentry Wilkerson
The Emergency Department Observation Unit (EDOU) provides a viable alternative to inpatient admission for the management of many acute gastrointestinal conditions with additional opportunities of reducing resource utilization and reducing radiation exposure. Using available evidence-based criteria to determine appropriate patient selection, evaluation, and treatment provides higher-quality medical care and improved patient satisfaction. Discussions of factors involved in creating an EDOU capable of caring for acute gastrointestinal conditions and clinical protocol examples of acute appendicitis, gastrointestinal hemorrhage, and acute pancreatitis provide a framework from which a successful EDOU can be built...
August 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28711124/cardiovascular-conditions-in-the-observation-unit-beyond-chest-pain
#13
REVIEW
Jeremiah D Gaddy, Kathleen T P Davenport, Brian C Hiestand
The first emergency department observation units (EDOUs) focused on chest pain and potential acute coronary syndromes. However, most EDOUs now cover multiple other conditions that lend themselves to protocolized, aggressive diagnostic and therapeutic regimens. In this article, the authors discuss the management of 4 cardiovascular conditions that have been successfully deployed in EDOUs around the country.
August 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28711123/care-of-the-patient-with-chest-pain-in-the-observation-unit
#14
REVIEW
Joseph B Borawski, Louis G Graff, Alexander T Limkakeng
Care of the patient presenting to an emergency department (ED) with chest pain remains a common yet challenging aspect of emergency medicine. Acute coronary syndrome presents in nonspecific fashion. The development and evolution of the ED-based observation unit has helped to safely assess and diagnose those most at risk for an adverse cardiac event. Furthermore, there are several provocative testing modalities to help assess for coronary artery disease. This article serves to describe and discuss the modern ED-based observation unit approach to patients with chest pain and/or angina equivalents presenting to an ED...
August 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28711122/the-establishment-and-management-of-an-observation-unit
#15
REVIEW
Jared Conley, J Stephen Bohan, Christopher W Baugh
The current health care landscape and evidence support the establishment of observation units (OUs) for safe and efficient care for observation patients. Careful attention is required in the design of OU process, location, and layout to enable optimal care and finances. Developing and maintaining protocols to guide patient selection and clinical care are critical. OU management requires a strong, collaborative leadership model, appropriate staffing, and a robust monitoring system for quality, safety, and finances...
August 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28711121/history-principles-and-policies-of-observation-medicine
#16
REVIEW
Michael A Ross, Michael Granovsky
The history of observation medicine has paralleled the rise of emergency medicine over the past 50 years to meet the needs of patients, emergency departments, hospitals, and the US health care system. Just as emergency departments are the safety net of the health system, observation units are the safety net of emergency departments. The growth of observation medicine has been driven by innovations in health care, an ongoing shift of patients from inpatient to outpatient settings, and changes in health policy...
August 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28705743/the-influence-of-crowding-on-clinical-practice-in-the-emergency-department
#17
I-Min Chiu, Yan-Ren Lin, Yuan-Jhen Syue, Chia-Te Kung, Kuan-Han Wu, Chao-Jui Li
BACKGROUND: This study aimed to clarify the association between the crowding and clinical practice in the emergency department (ED). METHODS: This 1-year retrospective cohort study conducted in two EDs in Taiwan included 70,222 adult non-trauma visits during the day shift between July 1, 2011, and June 30, 2012. The ED occupancy status, determined by the number of patients staying during their time of visit, was used to measure crowding, grouped into four quartiles, and analyzed in reference to the clinical practice...
July 4, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28702257/the-relationship-between-diabetes-mellitus-and-30-day-readmission-rates
#18
Stephanie Ostling, Jennifer Wyckoff, Scott L Ciarkowski, Chih-Wen Pai, Hae Mi Choe, Vinita Bahl, Roma Gianchandani
BACKGROUND: It is estimated that 9.3% of the population in the United States have diabetes mellitus (DM), 28% of which are undiagnosed. The high prevalence of DM makes it a common comorbid condition in hospitalized patients. In recent years, government agencies and healthcare systems have increasingly focused on 30-day readmission rates to determine the complexity of their patient populations and to improve quality. Thirty-day readmission rates for hospitalized patients with DM are reported to be between 14...
2017: Clinical Diabetes and Endocrinology
https://www.readbyqxmd.com/read/28682895/acute-decompensated-heart-failure-in-the-emergency-department-identification-of-early-predictors-of-outcome
#19
Luigi Mario Castello, Luca Molinari, Alessandra Renghi, Elena Peruzzi, Andrea Capponi, Gian Carlo Avanzi, Mario Pirisi
Identification of clinical factors that can predict mortality and hospital early readmission in acute decompensated heart failure (ADHF) patients can help emergency department (ED) physician optimize the care-path and resource utilization.We conducted a retrospective observational study of 530 ADHF patients evaluated in the ED of an Italian academic hospital in 2013.Median age was 82 years, females were 55%; 31.1% of patients were discharged directly from the ED (12.5% after short staying in the observation unit), while 68...
July 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28616766/-knowledge-and-information-sources-of-parents-of-3%C3%A2-to-6%C3%A2-year-old-children-concerning-skin-cancer-risk-factors
#20
Wolfgang Uter, Cornelia Fießler, Olaf Gefeller, Annette Pfahlberg
BACKGROUND: The dissemination of knowledge on risk factors and preventive strategies is a core element of skin cancer prevention. However, little is known about the information channels utilised by the population for this purpose. OBJECTIVES: Descriptive analysis of information sources used by parents of 3‑ to 6‑year-old children as a particularly relevant target group and analysis of association patterns between socio-demographic factors, types of information sources and acquired knowledge...
August 2017: Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
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