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https://www.readbyqxmd.com/read/29661692/hospital-ambulatory-medicine-a-leading-strategy-for-internal-medicine-in-europe
#1
Xavier Corbella, Vasco Barreto, Stefano Bassetti, Monica Bivol, Pietro Castellino, Evert-Jan de Kruijf, Francesco Dentali, Mine Durusu-Tanriöver, Carmen Fierbinţeanu-Braticevici, Thomas Hanslik, Radovan Hojs, Soňa Kiňová, Leonid Lazebnik, Evija Livčāne, Matthias Raspe, Luis Campos
Addressing the current collision course between growing healthcare demands, rising costs and limited resources is an extremely complex challenge for most healthcare systems worldwide. Given the consensus that this critical reality is unsustainable from staff, consumer, and financial perspectives, our aim was to describe the official position and approach of the Working Group on Professional Issues and Quality of Care of the European Federation of Internal Medicine (EFIM), for encouraging internists to lead a thorough reengineering of hospital operational procedures by the implementation of innovative hospital ambulatory care strategies...
April 13, 2018: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/29619807/-recommendations-for-the-care-of-patients-with-community-acquired-pneumonia-in-the-emergency-department
#2
A Julián-Jiménez, I Adán Valero, A Beteta López, L M Cano Martín, O Fernández Rodríguez, R Rubio Díaz, M A Sepúlveda Berrocal, J González Del Castillo, F J Candel González
The incidence of community-acquired pneumonia (CAP) ranges from 2-15 cases / 1,000 inhabitants / year, being higher in those older than 65 years and in patients with high co-morbidity. Around 75% of all CAP diagnosed are treated in the Emergency Department (ED). The CAP represents the main cause for sepsis and septic shock in ED, and the most frequent cause of death and admission to the Intensive Care Unit (ICU) due to infectious disease. Overall mortality is 10-14% according to age and associated risk factors...
April 2018: Revista Española de Quimioterapia: Publicación Oficial de la Sociedad Española de Quimioterapia
https://www.readbyqxmd.com/read/29617358/what-exactly-is-n-in-cell-culture-and-animal-experiments
#3
Stanley E Lazic, Charlie J Clarke-Williams, Marcus R Munafò
Biologists determine experimental effects by perturbing biological entities or units. When done appropriately, independent replication of the entity-intervention pair contributes to the sample size (N) and forms the basis of statistical inference. If the wrong entity-intervention pair is chosen, an experiment cannot address the question of interest. We surveyed a random sample of published animal experiments from 2011 to 2016 where interventions were applied to parents and effects examined in the offspring, as regulatory authorities provide clear guidelines on replication with such designs...
April 4, 2018: PLoS Biology
https://www.readbyqxmd.com/read/29560059/emergency-department-ed-ed-observation-day-hospital-and-hospital-admissions-for-adults-with-sickle-cell-disease
#4
David M Cline, Susan Silva, Caroline E Freiermuth, Victoria Thornton, Paula Tanabe
Introduction: Use of alternative venues to manage uncomplicated vaso-occlusive crisis (VOC), such as a day hospital (DH) or ED observation unit, for patients with sickle cell anemia, may significantly reduce admission rates, which may subsequently reduce 30-day readmission rates. Methods: In the context of a two-institution quality improvement project to implement best practices for management of patients with sickle cell disease (SCD) VOC, we prospectively compared acute care encounters for utilization of 1) emergency department (ED); 2) ED observation unit; 3) DH, and 4) hospital admission, of two different patient cohorts with SCD presenting to our two study sites...
March 2018: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29560046/implementation-of-a-rapid-protocol-based-tia-management-pathway
#5
Susann J Jarhult, Melissa L Howell, Isabelle Barnaure-Nachbar, Yuchiao Chang, Benjamin A White, Mary Amatangelo, David F Brown, Aneesh B Singhal, Lee H Schwamm, Scott B Silverman, Joshua N Goldstein
Introduction: Our goal was to assess whether use of a standardized clinical protocol improves efficiency for patients who present to the emergency department (ED) with symptoms of transient ischemic attack (TIA). Methods: We performed a structured, retrospective, cohort study at a large, urban, tertiary care academic center. In July 2012 this hospital implemented a standardized protocol for patients with suspected TIA. The protocol selected high-risk patients for admission and low/intermediate-risk patients to an ED observation unit for workup...
March 2018: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29550098/evaluating-the-emergency-department-observation-unit-for-the-management-of-hyperglycemia-in-adults
#6
Colin J Crilly, Amy J Allen, Teresa M Amato, Allison Tiberio, Rifka C Schulman, Robert A Silverman
OBJECTIVE: To determine whether hyperglycemic patients can be successfully managed in the Emergency Department Observation Unit (EDOU), as determined by the frequency of inpatient admission following their EDOU stay. METHODS: This was a retrospective chart review of patients≥18years presenting to an academic tertiary care ED between May 1, 2014 and May 31, 2016, found to have a glucose≥300mg/dL, and selected for EDOU admission. Patient demographic information, lab results including an HbA1c, disposition, and hospital revisits within 30days of discharge were recorded...
February 27, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29548339/population-aging-and-migration-history-and-un-forecasts-in-the-eu-28-and-its-east-and-south-near-neighborhood-one-century-perspective-1950-2050
#7
Mihajlo Michael Jakovljevic, Yael Netz, Sandra C Buttigieg, Roza Adany, Ulrich Laaser, Mirjana Varjacic
BACKGROUND: There is a gap in knowledge on long term pace of population aging acceleration and related net-migration rate changes in WHO European Region and its adjacent MENA countries. We decided to compare European Union (EU-28) region with the EU Near Neighborhood Policy Region East and EU Near Neighborhood Policy Region South in terms of these two essential features of third demographic transition. One century long perspective dating back to both historical data and towards reliable future forecasts was observed...
March 16, 2018: Globalization and Health
https://www.readbyqxmd.com/read/29524340/creation-and-implementation-of-an-outpatient-pathway-for-atrial-fibrillation-in-the-emergency-department-setting-results-of-an-expert-panel
#8
Christopher W Baugh, Carol L Clark, Jason W Wilson, Ian G Stiell, Abraham G Kocheril, Krista K Luck, Troy D Myers, Charles V Pollack, Steven K Roumpf, Gery F Tomassoni, James M Williams, Brian B Patel, Fred Wu, Jesse M Pines
Atrial fibrillation and flutter (AF) is a common condition among emergency department (ED) patients in the United States (US). Traditionally, ED care for primary complaints related to AF focus on rate control, and patients are often admitted to an inpatient setting for further care. Inpatient care may include further telemetry monitoring and diagnostic testing, rhythm control, a search for identification of AF etiology, and stroke prophylaxis. However, many patients are eligible for safe and effective outpatient management pathways...
March 10, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29507899/exploring-opportunities-to-prevent-cirrhosis-admissions-in-the-emergency-department-a-multicenter-multidisciplinary-survey
#9
Shazia Mehmood Siddique, Meghan Lane-Fall, Matthew J McConnell, Neha Jakhete, James Crismale, Stefanie Porges, Vandana Khungar, Shivan J Mehta, David Goldberg, Zhiping Li, Thomas Schiano, Linda Regan, Clinton Orloski, Judy A Shea
Patients with cirrhosis have high admission and readmission rates, and it is estimated that a quarter are potentially preventable. Little data are available regarding nonmedical factors impacting triage decisions in this patient population. This study sought to explore such factors as well as to determine provider perspectives on low-acuity clinical presentations to the emergency department, including ascites and hepatic encephalopathy. A survey was distributed in four liver transplant centers to both emergency medicine and hepatology providers, who included attending physicians, house staff, and advanced practitioners; 196 surveys were returned (estimated response rate 50...
March 2018: Hepatology communications
https://www.readbyqxmd.com/read/29501340/invited-review-learning-from-the-future-a-vision-for-dairy-farms-and-cows-in-2067
#10
J H Britt, R A Cushman, C D Dechow, H Dobson, P Humblot, M F Hutjens, G A Jones, P S Ruegg, I M Sheldon, J S Stevenson
The worldwide population in 2067 will reach 10.4 billion with 81% residing in Africa or Asia. Arable land available for food production will decrease to 0.15 ha per person. Temperature will increase in tropical and temperate zones, especially in the Northern Hemisphere, and this will push growing seasons and dairy farming away from arid areas and into more northern latitudes. Dairy consumption will increase because it provides essential nutrients more efficiently than many other agricultural systems. Dairy farming will become modernized in developing countries and milk production per cow will increase, doubling in countries with advanced dairying systems...
February 28, 2018: Journal of Dairy Science
https://www.readbyqxmd.com/read/29488003/can-an-emergency-department-observation-unit-reduce-hospital-admissions-for-copd-exacerbation
#11
Julia Budde, Parul Agarwal, Madhu Mazumdar, Jonathan Yeo, Sidney S Braman
Studies on observation unit (OU) use to avoid a hospital admission from the emergency department (ED) have found variable effects on health care resource utilization, and these effects have not been studied in acute exacerbation of chronic obstruction pulmonary disease (AECOPD). We retrospectively collected data for all AECOPD-related ED visits (age > 40) to an urban, academic medical center between February 2013 and April 2017. We examined the total proportion of visits admitted to the hospital before and after availability of an OU and the proportion of visits discharged directly from the ED using segmented regression analysis...
February 27, 2018: Lung
https://www.readbyqxmd.com/read/29453874/outcomes-of-early-dermatology-consultation-for-inpatients-diagnosed-with-cellulitis
#12
David G Li, Fan Di Xia, Hasan Khosravi, Anna K Dewan, Daniel J Pallin, Christopher W Baugh, Karl Laskowski, Cara Joyce, Arash Mostaghimi
Importance: Many inflammatory skin dermatoses mimic cellulitis (pseudocellulitis) and are treated with antibiotics and/or hospitalization, leading to unnecessary patient morbidity and substantial health care spending. Objective: To evaluate the impact of early dermatology consultation on clinical and economic outcomes associated with misdiagnosed cellulitis. Design, Setting, and Participants: This prospective cohort study enrolled patients with presumed diagnosis of cellulitis in the emergency department, in the emergency department observation unit, or within 24 hours of admission to an inpatient unit of a large urban teaching hospital between February and September 2017...
February 16, 2018: JAMA Dermatology
https://www.readbyqxmd.com/read/29444751/management-of-dyspepsia-the-role-of-the-emergency-department-observation-unit-to-optimize-patient-outcomes
#13
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
#14
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
#15
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-days
#16
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...
March 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
#17
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
#18
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
#19
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...
February 2018: 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
#20
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
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