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https://www.readbyqxmd.com/read/29444751/management-of-dyspepsia-the-role-of-the-emergency-department-observation-unit-to-optimize-patient-outcomes
#1
Wei Ping Daniel Chor, Pei Xian Lorraine Yong, Li Lin Lim, Chew Yian Chai, Tiong Beng Sim, Win Sen Kuan
BACKGROUND: Dyspepsia is a common complaint that can confer significant burden on one's quality of life and may also be associated with serious underlying conditions. The objective of this study was to determine if patients admitted to the emergency department observation unit (EDOU) for severe or persistent dyspepsia would have cost effective management in terms of investigations performed, length and cost of hospital stay. The secondary objective was to determine if any patient characteristics could predict a need for admission to the inpatient unit...
February 3, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29365040/adjusting-for-unmeasured-spatial-confounding-with-distance-adjusted-propensity-score-matching
#2
Georgia Papadogeorgou, Christine Choirat, Corwin M Zigler
Propensity score matching is a common tool for adjusting for observed confounding in observational studies, but is known to have limitations in the presence of unmeasured confounding. In many settings, researchers are confronted with spatially-indexed data where the relative locations of the observational units may serve as a useful proxy for unmeasured confounding that varies according to a spatial pattern. We develop a new method, termed distance adjusted propensity score matching (DAPSm) that incorporates information on units' spatial proximity into a propensity score matching procedure...
January 20, 2018: Biostatistics
https://www.readbyqxmd.com/read/29351781/mindmap-establishing-an-integrated-database-infrastructure-for-research-in-ageing-mental-well-being-and-the-urban-environment
#3
Mariëlle A Beenackers, Dany Doiron, Isabel Fortier, J Mark Noordzij, Erica Reinhard, Emilie Courtin, Martin Bobak, Basile Chaix, Giuseppe Costa, Ulrike Dapp, Ana V Diez Roux, Martijn Huisman, Emily M Grundy, Steinar Krokstad, Pekka Martikainen, Parminder Raina, Mauricio Avendano, Frank J van Lenthe
BACKGROUND: Urbanization and ageing have important implications for public mental health and well-being. Cities pose major challenges for older citizens, but also offer opportunities to develop, test, and implement policies, services, infrastructure, and interventions that promote mental well-being. The MINDMAP project aims to identify the opportunities and challenges posed by urban environmental characteristics for the promotion and management of mental well-being and cognitive function of older individuals...
January 19, 2018: BMC Public Health
https://www.readbyqxmd.com/read/29336989/are-geriatric-patients-placed-in-an-emergency-department-observation-unit-on-a-chest-pain-pathway-more-likely-than-non-geriatric-patients-to-re-present-to-the-hospital-within-30%C3%A2-days
#4
Christopher C Gruenberg, Alan H Breaud, James H Liu, Patricia M Mitchell, James A Feldman, Kerrie P Nelson, Joseph H Kahn
BACKGROUND: Emergency department observation units (EDOUs) are used frequently for low-risk chest pain evaluations. OBJECTIVE: The purpose of this study was to determine whether geriatric compared to non-geriatric patients evaluated in an EDOU for chest pain have differences in unscheduled 30-day re-presentation, length of stay (LOS), and use of stress testing. METHODS: We conducted an exploratory, retrospective, cohort study at a single academic, urban ED of all adult patients placed in an EDOU chest pain protocol from June 1, 2014 to May 31, 2015...
January 11, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29321107/can-i-send-this-patient-with-stroke-home-strategies-managing-transient-ischemic-attack-and-minor-stroke-in-the-emergency-department
#5
Bernard P Chang, Sara Rostanski, Joshua Willey, Benjamin Kummer, Eliza Miller, Mitchell Elkind
BACKGROUND: While transient ischemic attack and minor stroke (TIAMS) are common conditions evaluated in the emergency department (ED), there is controversy regarding the most effective and efficient strategies for managing them in the ED. Some patients are discharged after evaluation in the ED and cared for in the outpatient setting, while others remain in an observation unit without being admitted or discharged, and others experience prolonged and potentially costly inpatient admissions...
January 8, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29306267/role-of-emergency-department-observation-units-in-the-management-of-patients-with-unexplained-syncope-a-critical-review-and-meta-analysis
#6
REVIEW
Filippo Numeroso, Gianluigi Mossini, Giuseppe Lippi, Gianfranco Cervellin
This meta-analysis aimed to establish the role of standardized emergency department (ED) observation protocols in the management of syncopal patients as an alternative to ordinary admission. A systematic electronic literature search was performed to identify randomized controlled trials or observational studies evaluating syncopal patients managed in ED observation units. Data regarding mean length of stay, rate of etiological diagnosis, admission rate, and incidence of short-term serious outcomes were extracted...
December 2017: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/29274930/immediate-stress-echocardiography-for-low-risk-chest-pain-patients-in-the-emergency-department-a-prospective-observational-cohort-study
#7
Gregory Jasani, Mia Papas, Avkash J Patel, Neil Jasani, Brian Levine, Yuanyuan Zhang, Erik S Marshall
BACKGROUND: Evaluation and disposition of low-risk chest pain (CP) patients in the emergency department (ED) is time consuming and expensive. Low-risk CP often results in hospital admission to rule out myocardial infarction, which leads to additional costs and delays. OBJECTIVE: Our aim was to assess whether an immediate exercise stress echocardiogram (IESE) in the ED will allow safe, efficient, and cost-effective evaluation and discharge of patients with low-risk CP...
December 20, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29237710/short-term-outcomes-and-factors-associated-with-adverse-events-among-adults-discharged-from-the-emergency-department-after-treatment-for-acute-heart-failure
#8
MULTICENTER STUDY
Dana R Sax, Dustin G Mark, Renee Y Hsia, Thida C Tan, Grace H Tabada, Alan S Go
BACKGROUND: Although 80% of patients with heart failure seen in the emergency department (ED) are admitted, less is known about short-term outcomes and demand for services among discharged patients. METHODS AND RESULTS: We examined adult members of a large integrated delivery system who visited an ED for acute heart failure and were discharged from January 1, 2013, through September 30, 2014. The primary outcome was a composite of repeat ED visit, hospital admission, or death within 7 days of discharge...
December 2017: Circulation. Heart Failure
https://www.readbyqxmd.com/read/29218817/impact-of-a-shared-decision-making-intervention-on-health-care-utilization-a-secondary-analysis-of-the-chest-pain-choice-multicenter-randomized-trial
#9
Jason T Schaffer, Erik P Hess, Judd E Hollander, Jeffrey A Kline, Carlos A Torres, Deborah B Diercks, Russell Jones, Kelly P Owen, Zachary F Meisel, Michel Demers, Annie Leblanc, Jonathan Inselman, Jeph Herrin, Victor M Montori, Nilay D Shah
BACKGROUND: Patients at low risk for acute coronary syndrome are frequently admitted for observation and cardiac testing, resulting in substantial burden and cost to the patient and the health care system. OBJECTIVES: The purpose of this investigation was to measure the effect of the Chest Pain Choice (CPC) decision aid on overall health care utilization as well as utilization of specific services both during the index emergency department (ED) visit and in the subsequent 45 days...
December 8, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29189590/management-of-pediatric-isolated-skull-fractures-a-decision-tree-and-cost-analysis-on-emergency-department-disposition-strategies
#10
Daniel C Williams, W Scott Russell, Annie L Andrews, Kit N Simpson, William T Basco, Ronald J Teufel
OBJECTIVE: Pediatric isolated skull fractures (ISFs) are common injuries that represent challenging disposition decisions for clinicians. The purpose of this study is to use a decision analysis to compare the clinical and cost-effectiveness of 3 emergency department (ED)-based disposition scenarios for a pediatric patient presenting with ISF. METHODS: We conducted a cost-effectiveness analysis comparing ED disposition scenarios that included current practice, increased at-home surveillance, and observation unit utilization...
November 20, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29159958/evaluation-of-a-low-risk-mild-traumatic-brain-injury-and-intracranial-hemorrhage-emergency-department-observation-protocol
#11
Brian J Yun, Pierre Borczuk, Lulu Wang, Stephen Dorner, Benjamin A White, Ali S Raja
OBJECTIVES: Among emergency physicians, there is wide variation in admitting practices for patients who suffered a mild traumatic brain injury (TBI) with an intracranial hemorrhage (ICH). The purpose of this study was to evaluate the effects of implementing a protocol in the emergency department (ED) observation unit for patients with mild TBI and ICH. METHODS: This retrospective cohort study was approved by the institutional review board. Study subjects were patients ≥ 18 years of age with an International Classification of Diseases code corresponding to a traumatic ICH and admitted to an ED observation unit (EDOU) of an urban, academic Level I trauma center between February 1, 2015, and January 31, 2017...
November 20, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29135623/patient-ethnicity-predicts-poor-health-access-and-gaps-in-perception-of-personal-cardiovascular-risk-factors
#12
Yeunjung Kim, Kathryn Hogan, Gail D'Onofrio, Sharon Chekijian, Basmah Safdar
BACKGROUND: Focus of health literacy campaigns has centered around raising awareness. It is unknown whether awareness of coronary artery disease risk factors accurately reflects personalization of one's own cardiovascular risk. METHODS: A cross-sectional survey was performed in consecutive patients presenting with chest pain admitted to an observation unit of a tertiary care hospital. A 32-item questionnaire in English or Spanish examined knowledge of coronary artery disease risk factors...
December 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/29135621/efficacy-of-implementation-of-a-chest-pain-center-at-a-community-hospital
#13
Alexandra Davis, Jason Chiu, Stanley K Lau, Yih Jen Kok, Jonathan Y H Wu
INTRODUCTION: Chest pain is the second leading cause for emergency department (ED) visits in the United States; however, <20% of the patients have acute coronary syndrome that require immediate attention. The HEART score is designed for rapid risk stratification of ED chest pain patients using the following criteria: history, electrocardiogram, age, risk factors, and troponin. It has been shown to be superior in identifying patients with low (HEART score 0-3) and high (7-10) risk of major adverse cardiac events, who can then be rapidly discharged or admitted for intervention...
December 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/29079375/allergic-like-contrast-reactions-in-the-ed-incidence-management-and-impact-on-patient-disposition
#14
Ravi V Gottumukkala, McKinley Glover, Brian J Yun, Jonathan D Sonis, Mannudeep K Kalra, Alexi Otrakji, Ali S Raja, Anand M Prabhakar
PURPOSE: Determine the incidence, management, and impact on patient disposition of allergic-like contrast reactions (ALCR) to intravenous iodinated contrast in the emergency department (ED). METHODS: All ED patients who developed an ALCR following contrast-enhanced CT (CECT) from June 2011-December 2016 were retrospectively identified. Medical records were reviewed and reaction severity, management, and disposition were quantified using descriptive statistics. The total number of consecutive CECTs performed in the ED were available from June 2011-March 2016 and were used to derive ALCR incidence over that time period...
October 12, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29023942/a-review-of-tensor-based-methods-and-their-application-to-hospital-care-data
#15
Paolo Giordani, Henk A L Kiers
In many situations, a researcher is interested in the analysis of the scores of a set of observation units on a set of variables. However, in medicine, it is very frequent that the information is replicated at different occasions. The occasions can be time-varying or refer to different conditions. In such cases, the data can be stored in a 3-way array or tensor. The Candecomp/Parafac and Tucker3 methods represent the most common methods for analyzing 3-way tensors. In this work, a review of these methods is provided, and then this class of methods is applied to a 3-way data set concerning hospital care data for a hospital in Rome (Italy) during 15 years distinguished in 3 groups of consecutive years (1892-1896, 1940-1944, 1968-1972)...
October 10, 2017: Statistics in Medicine
https://www.readbyqxmd.com/read/28982749/a-population-based-assessment-of-emergency-department-observation-status-for-older-adults-with-cancer
#16
Allison Lipitz-Snyderman, Adam Klotz, Renee L Gennarelli, Jeffrey Groeger
Background: Hospitals' use of observation status for patients with cancer presenting to the emergency department (ED) is not well understood. This model of care delivery may be a viable alternative to inpatient admission for patients with cancer presenting with certain conditions. Our objective was to assess the use of observation status among Medicare beneficiaries with and without cancer. Methods: Population-based SEER-Medicare data were used to assess differences in the use of observation status between Medicare beneficiaries aged ≥66 years with and without cancer using a matched analysis (n=151,183 per cohort)...
October 2017: Journal of the National Comprehensive Cancer Network: JNCCN
https://www.readbyqxmd.com/read/28975679/an-emergency-department-observation-unit-is-a-feasible-setting-for-multidisciplinary-geriatric-assessments-in-compliance-with-the-geriatric-emergency-department-guidelines
#17
Lauren T Southerland, Anthony J Vargas, Lalitha Nagaraj, Tanya R Gure, Jeffery M Caterino
BACKGROUND: The Geriatric Emergency Department (ED) Guidelines recommend providing multidisciplinary geriatric assessment in the ED, but these assessments can be difficult to coordinate and may prolong length of stay. Patients who need longer than a typical ED stay can be placed in an ED observation unit (Obs Unit). We investigated the effects of offering multidisciplinary assessments for ED patients in an Obs Unit. METHODS: Evaluation by a geriatric hospital consultation team, physical therapist, case manager, and/or pharmacist was made available to all Obs Unit patients...
October 4, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28954802/henry-ford-heart-score-randomized-trial-rapid-discharge-of-patients-evaluated-for-possible-myocardial-infarction
#18
Tiberio M Frisoli, Richard Nowak, Kaleigh L Evans, Michael Harrison, Maath Alani, Saira Varghese, Mehnaz Rahman, Samantha Noll, Katherine R Flannery, Alex Michaels, Mishel Tabaku, Gordon Jacobsen, James McCord
BACKGROUND: Hospital evaluation of patients with chest pain is common and costly. The HEART score risk stratification tool that merges troponin testing into a clinical risk model for evaluation emergency department patients with possible acute myocardial infarction (AMI) has been shown to effectively identify a substantial low-risk subset of patients possibly safe for early discharge without stress testing, a strategy that could have tremendous healthcare savings implications. METHOD AND RESULTS: A total of 105 patients evaluated for AMI in the emergency departments of 2 teaching hospitals in the Henry Ford Health System (Detroit and West Bloomfield, MI), between February 2014 and May 2015, with a modified HEART score ≤3 (which includes cardiac troponin I <0...
October 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28925925/entrustable-professional-activities-for-residency-training-in-physical-medicine-and-rehabilitation
#19
Michael Mallow, Heather Baer, Alex Moroz, Vu Q C Nguyen
Entrustable professional activities are observable units of professional practice that can potentially provide a link between competency-based medical education and clinical practice. The authors, part of a subcommittee of the Association of Academic Physiatrists Education Committee, identified a set of entrustable professional activities that would serve residency training programs in the specialty of physical medicine and rehabilitation. Using a modified Delphi process, residency program directors in the field reviewed and validated a set of entrustable professional activities...
October 2017: American Journal of Physical Medicine & Rehabilitation
https://www.readbyqxmd.com/read/28876570/cohort-study-on-emergency-general-surgery-patients-and-an-observation-unit
#20
M Dickfos, H Ibrahim, A Evans, R 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...
September 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
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