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https://www.readbyqxmd.com/read/27902667/managing-skin-and-soft-tissue-infections-in-the-emergency-department-observation-unit
#1
Shabana Yusuf, Joseph L Hagan, Aderonke O Adenkule-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...
November 29, 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27876328/best-clinical-practice-controversies-in-transient-ischemic-attack-evaluation-and-disposition-in-the-emergency-department
#2
Brit Long, Alex Koyfman
BACKGROUND: Transient ischemic attack (TIA) affects over 200,000 patients annually in the United States, and it precedes approximately 14% to 23% of strokes. Patients are typically admitted for evaluation and management. OBJECTIVE: This review investigates the controversies of emergency department (ED) evaluation of TIA, including imaging, clinical risk scores, rapid diagnostic protocols, and disposition. DISCUSSION: TIA is a common condition, with over 200,000 patients affected annually, and is associated with risk of stroke...
November 19, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27849505/a-prospective-observation-study-of-medical-toxicology-consultation-in-a-u-s-combat-theater
#3
Joseph K Maddry, Patrick C Ng, Daniel Sessions, Vikhyat S Bebarta
OBJECTIVES: Since 2001, U.S. military personnel and active duty, uniformed physicians providing medical support have been deployed to Afghanistan. Medical toxicologists are among the physicians deployed. There is a paucity of information present in the literature that has documented cases treated by toxicologists in theater. This prospective observational study describes 15 male patients treated in theater by a military medical toxicologist. METHODS: We performed a prospective observational study in which a medical toxicologist consulted and reported on deployed toxicology cases occurring during a 5-month deployment to Bagram, Afghanistan...
November 2016: Military Medicine
https://www.readbyqxmd.com/read/27846006/chest-pain-risk-scores-can-reduce-emergent-cardiac-imaging-test-needs-with-low-major-adverse-cardiac-events-occurrence-in-an-emergency-department-observation-unit
#4
Hao Wang, Katherine Watson, Richard D Robinson, Kristina H Domanski, Johnbosco Umejiego, Layton Hamblin, Sterling E Overstreet, Amanda M Akin, Steven Hoang, Meena Shrivastav, Michael Collyer, Ryan N Krech, Chet D Schrader, Nestor R Zenarosa
OBJECTIVE: To compare and evaluate the performance of the HEART, Global Registry of Acute Coronary Events (GRACE), and Thrombolysis in Myocardial Infarction (TIMI) scores to predict major adverse cardiac event (MACE) rates after index placement in an emergency department observation unit (EDOU) and to determine the need for observation unit initiation of emergent cardiac imaging tests, that is, noninvasive cardiac stress tests and invasive coronary angiography. METHODS: A prospective observational single center study was conducted from January 2014 through June 2015...
December 2016: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/27830996/permanent-emergency-inequality-in-access-to-hospitalisation-among-urban-elderly-chinese
#5
Tim F Liao, Cuntong Wang
The phenomenon of elderly patients staying in hospital emergency department observation units for extended time in urban China poses a challenge to China's healthcare system and presents a social problem of inequality. In this paper, we analyse statistics collected from 16 major public hospitals in Beijing to assess the extent and intensity of the problem and examine interviews of medical professionals to understand the mechanisms linking the issue to the Chinese healthcare system. We study the issue with the literature on market transition theory and on China's recent healthcare reforms and view this age-based inequality as an outcome of the economic and social transformations in China...
November 10, 2016: Global Public Health
https://www.readbyqxmd.com/read/27797873/skin-and-soft-tissue-infection-management-failure-in-the-emergency-department-observation-unit-a-systematic-review
#6
Jeremy W Abetz, Nicholas G Adams, Biswadev Mitra
INTRODUCTION: Skin and soft tissue infections (SSTIs) are commonly treated in ED observation units (EDOUs). The management failure rate in this setting is high, as evidenced by a large proportion of patients requiring inpatient admission. This systematic review sought to quantify the management failure rate and identify risk factors associated with management failure. METHODS: Searches of six databases and grey literature were conducted with no limits on publication year or language...
October 25, 2016: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/27796127/-impact-of-reorganization-of-the-hungarian-system-of-intensive-care-units-in-2012
#7
Miklós Gresz
INTRODUCTION: In 2012, the Hungarian system of intensive care units was reorganized. During this process, multidisciplinary units were separated from observation units. AIM: The author analysed certain indicators of the remaining intensive care units. METHOD: The study was based on reports of National Health Insurance Fund between 2000 and 2015. RESULTS: After reorganization the number of the multidisciplinary intensive care units decreased by 20% and the number of beds decreased by 10%...
October 2016: Orvosi Hetilap
https://www.readbyqxmd.com/read/27749803/a-comparison-of-nonpharmacologic-interventions-on-the-emotional-state-of-children-in-the-emergency-department
#8
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
https://www.readbyqxmd.com/read/27739128/observation-or-inpatient-impact-of-patient-disposition-on-outcomes-and-utilization-among-emergency-department-patients-with-chest-pain
#9
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
https://www.readbyqxmd.com/read/27695822/alternative-strategies-to-inpatient-hospitalization-for-acute-medical-conditions-a-systematic-review
#10
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
https://www.readbyqxmd.com/read/27687168/effect-of-a-multi-diagnosis-observation-unit-on-emergency-department-length-of-stay-and-inpatient-admission-rate-at-two%C3%A2-canadian-hospitals
#11
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...
December 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27687049/cardiology-consultation-reduces-provocative-testing-rates-in-an-ed-observation-unit
#12
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
https://www.readbyqxmd.com/read/27598313/clinical-pathway-for-moderate-to-severe-acute-bacterial-skin-and-skin-structure-infections-from-a-us-perspective-a-roundtable-discussion
#13
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)
https://www.readbyqxmd.com/read/27566017/trends-in-lymph-node-excision-and-impact-of-positive-lymph-node-ratio-in-patients-with-colectomy-for-primary-colon-adenocarcinoma-population-based-study-1988-to-2011
#14
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
https://www.readbyqxmd.com/read/27519919/nocturnal-emergency-department-visits-duration-of-symptoms-and-risk-of-hospitalisation-among-adults-with-asthma-exacerbations-a-multicentre-observational-study
#15
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
https://www.readbyqxmd.com/read/27518685/the-hospital-readmissions-reduction-program
#16
LETTER
Andrew A Gonzalez
No abstract text is available yet for this article.
August 4, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27518684/the-hospital-readmissions-reduction-program
#17
LETTER
Steffie Woolhandler, David U Himmelstein
No abstract text is available yet for this article.
August 4, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27518683/the-hospital-readmissions-reduction-program
#18
LETTER
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
https://www.readbyqxmd.com/read/27494363/formation-of-ordered-phospholipid-monolayer-on-a-hydrophilically-modified-au-111-substrate
#19
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
https://www.readbyqxmd.com/read/27470579/upper-aerodigestive-injuries-from-detergent-ingestion-in-children
#20
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
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