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"Observation unit"

Elena Antonelli, Laura Vagnoli, Enrica Ciucci, Chiara Vernucci, Federica Lachi, Andrea Messeri
OBJECTIVES: The majority of children and adolescents presenting to the emergency department are in pain and require painful procedures. This randomized study was to investigate the efficacy of 3 different nonpharmacologic interventions (clowns, dogs, and musicians) to reduce pain and analyze the perception of positive and negative affects after the presence of these activities in a short-stay observation unit (SSOU). METHODS: Participants were composed of 105 children (54 boys and 51 girls; aged 3-16 years) assigned randomly to an experimental group (N = 57) that was composed of patients who were present in the SSOU...
October 4, 2016: Pediatric Emergency Care
M Fernanda Bellolio, Lindsey R Sangaralingham, Stephanie R Schilz, Claire M Noel-Miller, Keith D Lind, Pamela Morin, Peter A Noseworthy, Nilay D Shah, Erik P Hess
OBJECTIVES: To compare healthcare utilization including coronary angiography, percutaneous coronary intervention (PCI), rehospitalization, and rate of subsequent acute myocardial infarction (AMI) within 30-days, among patients presenting to the Emergency Department (ED) with chest pain admitted as short-term inpatient (≤2 days) versus observation (in ED observation units combined with in-hospital observation). METHODS: We identified adults diagnosed with acute chest pain in the ED from 2010-2014 using administrative claims from privately insured and Medicare Advantage...
October 14, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Jared Conley, Colin W O'Brien, Bruce A Leff, Shari Bolen, Donna Zulman
Importance: Determining innovative approaches that better align health needs to the appropriate setting of care remains a key priority for the transformation of US health care; however, to our knowledge, no comprehensive assessment exists of alternative management strategies to hospital admission for acute medical conditions. Objective: To examine the effectiveness, safety, and cost of managing acute medical conditions in settings outside of a hospital inpatient unit...
October 3, 2016: JAMA Internal Medicine
Amy H Y Cheng, Neil G Barclay, Riyad B Abu-Laban
BACKGROUND: Observation units (OUs) have been shown to reduce emergency department (ED) lengths of stay (LOS) and admissions. Most published studies have been on OUs managing single complaints. OBJECTIVE: Our aim was to determine whether an OU reduces ED LOS and hospital admission rates for adults with a variety of presenting complaints. METHODS: We comparatively evaluated two hospitals in British Columbia, Canada (hereafter ED A and ED B) using a pre-post design...
September 26, 2016: Journal of Emergency Medicine
Troy Madsen, Cameron Smyres, Talmage Wood, Tamara Moores, Matthew Fuller, Virgil Davis, Kurt Bernhisel
BACKGROUND: In evaluating patients with chest pain, emergency department observation units (EDOUs) may use a staffing model in which emergency physicians determine patient testing (EP model) or a model similar to a chest pain unit (CPU) in which cardiologists determine provocative testing (CPU model). METHODS: We performed a prospective study with 30-day telephone follow-up for all chest pain patients placed in our EDOU. Halfway through the study period, our EDOU transitioned from an EP model to a CPU model...
September 17, 2016: American Journal of Emergency Medicine
John A Bosso, Anthony M Casapao, Jonathan Edwards, Kenneth Klinker, Christopher McCoy, David P Nicolau, Katherine K Perez, Andrew Marcarelli, Deeksha Dua
This article was written with the aim to establish a consensus clinical pathway for long-acting lipoglycopeptide antibiotics such as oritavancin (Orbactiv®) and dalbavancin (Dalvance®) for the treatment of acute bacterial skin and skin structure infections (ABSSSI). Seven infectious diseases pharmacy specialists from a variety of facilities across the United States (US) participated in a roundtable discussion to consider the use of newer single-dose long-acting lipoglycopeptides, and integrate them into clinical pathways for ABSSSI...
October 2016: Hospital Practice (Minneapolis)
Brandon Garcia, Carlos Guzman, Christopher Johnson, Nicholas J Hellenthal, Daphne Monie, Jose Raul Monzon
BACKGROUND: Studies suggest increased lymph node excision in patients with colon cancer portends improved survival. Guidelines recommend excising 12 or more lymph nodes during colectomy. There is an inverse correlation between the positive lymph node ratio and survival in patients of these patients. OBJECTIVE: We sought to determine whether colon cancer patients have adequate lymph node excision and whether positive lymph node ratio can be used as a guiding factor for their treatment plan...
September 2016: Surgical Oncology
Hideto Yasuda, Yusuke Hagiwara, Hiroko Watase, Kohei Hasegawa
OBJECTIVES: We sought to compare the characteristics of patients with asthma presenting to the emergency department (ED) during the night-time with those of patients presenting at other times of the day, and to determine whether the time of ED presentation is associated with the risk of hospitalisation. DESIGN AND SETTING: A multicentre chart review study of 23 EDs across Japan. PARTICIPANTS: Patients aged 18-54 years with a history of physician-diagnosed asthma, presented to the ED between January 2009 and December 2011 OUTCOME MEASURES: The outcome of interest was hospitalisation, including admissions to an observation unit, inpatient unit and intensive care unit...
2016: BMJ Open
Andrew A Gonzalez
No abstract text is available yet for this article.
August 4, 2016: New England Journal of Medicine
Steffie Woolhandler, David U Himmelstein
No abstract text is available yet for this article.
August 4, 2016: New England Journal of Medicine
Rachael B Zuckerman, Steven H Sheingold, Arnold M Epstein
No abstract text is available yet for this article.
August 4, 2016: New England Journal of Medicine
Hiroaki Shimizu, Soichiro Matsunaga, Taro Yamada, Toshihide Kobayashi, Maki Kawai
The molecular arrangement of phospholipid molecules was investigated on a hydrophilically modified gold surface within an aqueous solution by scanning tunneling microscopy. By suspending phospholipid (1-palmitoyl-2-oleoyl-sn-glycero-3-phosphocholine, POPC) nanoparticles in the aqueous electrolyte surrounding a hydrophilically modified gold (111) substrate with 3-mercaptopropionic acid (SH-C2H4-COOH, 3-MPA), well-ordered adlattices of POPC were observed. Traces of particle fusion were visualized before formation of the adlattice...
August 23, 2016: ACS Nano
Phayvanh P Sjogren, David E Skarda, Albert H Park
OBJECTIVES: To describe the clinical presentations and management of detergent pod ingestion at a tertiary children's hospital. STUDY DESIGN: Case series. METHODS: A retrospective chart review of children diagnosed with detergent pod ingestion from June 2010 and March 2015. RESULTS: Nine cases of detergent pod ingestion were included over a 5-year period. The average age was 26.3 months (range, 11-43 months). Eight (89%) of the cases were female...
July 28, 2016: Laryngoscope
Aakash Kaushik Shah, Andrey Bilko, James Kimo Takayesu
BACKGROUND: Epidural steroid injections are frequently used to treat back and extremity pain. The procedure is generally safe, with a low rate of adverse events, including intrathecal entry, pneumocephalus, and chemical meningitis. CASE REPORT: We report a case of a 45-year-old woman who presented to the emergency department (ED) with headache, nausea, vomiting, and photophobia after a lumbar epidural steroid injection. She was afebrile and had an elevated white blood cell count...
September 2016: Journal of Emergency Medicine
Danielle Gabele, Charlene Bugais, Joanne Laguna
OBJECTIVE: The aim of this study was to identify whether observation status patients placed in a dedicated unit would decompress the emergency department (ED) more than observation patients who were admitted to other available beds. BACKGROUND: An urban quaternary hospital has a high volume of patients with average daily census of 95% capacity. A medical observation unit (MOU) was created to improve patient throughput. METHODS: In phase 1, the MOU charge nurse reviewed the ED patients to be admitted and selected appropriate patients based on unit inclusion criteria...
July 2016: Journal of Nursing Administration
Rodney C Sena, Samuel Eldrich, Richard M Pescatore, Anthony Mazzarelli, Richard G Byrne
BACKGROUND: Current guidelines for the treatment of adult patients in cardiac arrest are supplied by the American Heart Association through basic life support and advanced cardiovascular life support (ACLS) provider courses. When treatments defined by the ACLS guidelines are unsuccessful in terminating a lethal dysrhythmia, the use of alternative strategies may prove useful. In this case, two defibrillators were used to deliver a greater than normal energy waveform over an extended time interval to return a patient to a normal sinus rhythm...
September 2016: Journal of Emergency Medicine
Hyung J Cho, Neil Desai, Angelita Florendo, Christine Marshall, Jaime Michalski, Nathan Lee, Andrew Dunn
Short stay admissions that are outside of observation unit models hold challenges for throughput and decreasing length of stay (LOS). In our institution at Mount Sinai Hospital in New York City, United States, we noticed a lack of communication about potential next-day discharges from the day and night admission teams to the inpatient teams. Our hospitalist division started the Early Discharge Initiation Project (E-DIP), a system of flagging and communicating potential discharges to improve this problem. We used a multidisciplinary approach with PDSA cycles, engaging members of all teams involved in this process, including the nocturnists...
2016: BMJ Quality Improvement Reports
Bereket P Kindo, Hao Wang, Edsel A Peña
This article proposes multinomial probit Bayesian additive regression trees (MPBART) as a multinomial probit extension of BART - Bayesian additive regression trees. MPBART is flexible to allow inclusion of predictors that describe the observed units as well as the available choice alternatives. Through two simulation studies and four real data examples, we show that MPBART exhibits very good predictive performance in comparison to other discrete choice and multiclass classification methods. To implement MPBART, the R package mpbart is freely available from CRAN repositories...
2016: Stat: the ISI's Journal for Rapid Dissemination of Statistics Research
J P Haran, G Wu, V Bucci, A Fischer, L Keang, E W Boyer, P L Hibberd
Clostridium difficile diarrhoea is an urgent threat to patients, but little is known about the role of antibiotic administration that starts in emergency department observation units (EDOUs). We studied risk factors for antibiotic-associated diarrhoea (AAD) and C. difficile infection (CDI) in EDOU patients. This prospective cohort study enrolled adult patients discharged after EDOU antibiotic treatment between January 2013 and 2014. We obtained medical histories, EDOU treatment and occurrence of AAD and CDI over 28 days after discharge...
July 2016: Epidemiology and Infection
(no author information available yet)
A one-page tool has shown promise for facilitating shared decision-making between clinicians and patients who present to the ED with low-risk chest pain. The tool, dubbed Chest Pain Choice, was developed by researchers at the Mayo Clinic. It is designed to more effectively communicate risk to patients so that they can make more informed decisions with their providers regarding treatment options. Investigators devised a study involving 898 low-risk chest pain patients in six EDs in five states. Half the patients were randomized to standard physician consultations and half received consultations facilitated by the Chest Pain Choice tool...
June 2016: ED Management: the Monthly Update on Emergency Department Management
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