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https://www.readbyqxmd.com/read/28810931/a-comprehensive-regional-clinical-and-educational-ecpr-protocol-decreases-time-to-ecmo-in-patients-with-refractory-out-of-hospital-cardiac-arrest
#1
Brian Grunau, Sarah Carrier, Jamil Bashir, William Dick, Luke Harris, Robert Boone, Dan Kalla, Frank Scheuermeyer, Brian Twaites, Ron Straight, James Abel, Ken McDonald, Ruth MacRedmond, David Agulnik, Joe Finkler, Jeanne MacLeod, Jim Christenson, Anson Cheung
OBJECTIVE: Extracorporeal membrane oxygenation within CPR (ECPR) may improve survival for refractory out-of-hospital cardiac arrest (OHCA). We developed a prehospital, emergency department (ED), and hospital-based clinical and educational protocol to improve the key variable of time-to-ECPR (TTE). METHODS: In a single urban health region we involved key prehospital, clinical, and administrative stakeholders over a 2-year period, to develop a regional ECPR program with destination to a single urban tertiary care hospital...
August 16, 2017: CJEM
https://www.readbyqxmd.com/read/28807069/a-pilot-project-demonstrating-that-combat-medics-can-safely-administer-parenteral-medications-in-the-emergency-department
#2
Steven G Schauer, Cord W Cunningham, Andrew D Fisher, Robert A DeLorenzo
Introduction Select units in the military have improved combat medic training by integrating their functions into routine clinical care activities with measurable improvements in battlefield care. This level of integration is currently limited to special operations units. It is unknown if regular Army units and combat medics can emulate these successes. The goal of this project was to determine whether US Army combat medics can be integrated into routine emergency department (ED) clinical care, specifically medication administration...
August 15, 2017: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/28806373/patient-aligned-care-team-engagement-to-connect-veterans-experiencing-homelessness-with-appropriate-health-care
#3
Adi V Gundlapalli, Andrew Redd, Daniel Bolton, Megan E Vanneman, Marjorie E Carter, Erin Johnson, Matthew H Samore, Jamison D Fargo, Thomas P O'Toole
BACKGROUND: Veterans experiencing homelessness frequently use emergency and urgent care (ED). OBJECTIVE: To examine the effect of a Patient-aligned Care Team (PACT) model tailored to the unique needs of Veterans experiencing homelessness (H-PACT) on frequency and type of ED visits in Veterans Health Administration (VHA) medical facilities. RESEARCH DESIGN: During a 12-month period, ED visits for 3981 homeless Veterans enrolled in (1) H-PACT at 20 VHA medical centers (enrolled) were compared with those of (2) 24,363 homeless Veterans not enrolled in H-PACT at the same sites (nonenrolled), and (3) 23,542 homeless Veterans at 12 non-H-PACT sites (usual care) using a difference-in-differences approach...
September 2017: Medical Care
https://www.readbyqxmd.com/read/28805423/patterns-of-psychiatric-emergency-department-utilization-among-community-dwelling-medicare-beneficiaries-under-65
#4
Jingjing Qian, Saranrat Wittayanukorn, Richard A Hansen
This study estimated patterns and trends in all-cause (any reason, including psychiatry related) and psychiatric emergency department (ED) utilization among Medicare beneficiaries under 65 who were residing in community settings (i.e., noninstitutionalized or in their own homes). Medicare beneficiaries under the age of 65 enrolled in Medicare for Social Security Disability Insurance (SSDI) due to permanent physical or mental disabilities are a population with poor health conditions and high utilization of health services; however, this vulnerable population has received limited attention from researchers and policymakers compared to the Medicare beneficiaries 65 years and older...
August 2017: Psychological Services
https://www.readbyqxmd.com/read/28802082/ketamine-or-ketofol-do-we-have-enough-evidence-to-know-which-one-to-use
#5
James Miner
Ketamine and propofol are both commonly used emergency department (ED) procedural sedation agents. Their concurrent administration, often referred to as "ketofol", is widely used for procedural sedation. A simple google search can lead to a lot of opinions on why we should use propofol, ketamine, or ketofol in a given situation for moderate or deep procedural sedation in the ED, but finding evidence that supports differences these opinions assume is much harder to come by. This article is protected by copyright...
August 12, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28793910/the-prevalence-of-non-cardiac-chest-pain-nccp-using-emergency-department-ed-data-a-northern-ireland-based-study
#6
Orla McDevitt-Petrovic, Karen Kirby, Mark Shevlin
BACKGROUND: The aim of this study was to assess the frequency of chest pain presentations and the subsequent non-cardiac chest pain diagnoses in an emergency department (ED) over a 3 year period. METHODS: Administrative data on ED attendances to an urban general hospital in Northern Ireland between March 2013 and March 2016 were used. Data were coded and analysed to estimate frequencies of 'chest pain' presentation and the subsequent diagnoses for each year. RESULTS: Both chest pain presentations and chest pain presentations with a subsequent diagnosis of unknown cause increased each year...
August 9, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28793374/pain-assessment-by-emergency-nurses-at-triage-in-the-emergency-department-a-qualitative-study
#7
Marilène Vuille, Maryline Foerster, Eliane Foucault, Olivier Hugli
AIM: To investigate the assessment of pain intensity in the specific context of triage. BACKGROUND: Acute pain affects most patients admitted in emergency departments (ED) but pain relief in this setting remains insufficient. Evaluation of pain and its treatment at the time of patient triage expedites the administration of analgesia, but may be awkward at this time-pressured moment. The assessment of pain intensity by a validated pain scale is a critical initial step, and a patient's self-reporting is widely considered as the key to effective pain management...
August 9, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28792258/utilization-of-intravenous-catheters-by-prehospital-providers-during-pediatric-transports
#8
Timothy VanderKooy, Kelsey Spaur, Lina Brou, Sean Caffrey, Kathleen M Adelgais
INTRODUCTION: Prehospital intravenous (IV) access in children may be difficult and time-consuming. Emergency Medical Service (EMS) protocols often dictate IV placement; however, some IV catheters may not be needed. The scene and transport time associated with attempting IV access in children is unknown. The objective of this study is to examine differences in scene and transport times associated with prehospital IV catheter attempt and utilization patterns of these catheters during pediatric prehospital encounters...
August 9, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28791775/maintenance-of-oxygenation-during-rapid-sequence-intubation-in-the-emergency-department
#9
John C Sakles
Rapid sequence intubation (RSI) is the most common method of airway control in the emergency department (ED).(1,2) Administration of an anesthetic agent and a neuromuscular blocking agent (NMBA) optimizes conditions for tracheal intubation and is thought to minimize the risk of aspiration.(3-10) Evidence suggests that RSI improves first pass success and reduces complications in the critically ill.(11-14) This article is protected by copyright. All rights reserved.
August 9, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28774769/predictors-for-under-prescribing-antibiotics-in-children-with-respiratory-infections-requiring-antibiotics
#10
Aaron E Kornblith, Jahan Fahimi, Hemal Kanzaria, Ralph C Wang
BACKGROUND/OBJECTIVE: Previous studies showed variability in the use of diagnostic and therapeutic resources for children with febrile acute respiratory tract infections (ARTI), including antibiotics. Unnecessary antibiotic use has important public and individual health outcomes, but missed antibiotic prescribing also has important consequences. We sought to determine factors associated with antibiotic prescribing in pediatric ARTI, specifically those with pneumonia. METHODS: We assessed national trends in the evaluation and treatment of ARTI for pediatric emergency department (ED) patients by analyzing the National Hospital Ambulatory Medical Care Survey from 2002 to 2013...
July 28, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28765247/a-longitudinal-study-of-ambulatory-physician-encounters-emergency-room-visits-and-hospitalizations-by-patients-with-rheumatoid-arthritis-a-13-year-population-health-study
#11
John G Hanly, Kara Thompson, Chris Skedgel
OBJECTIVE: To determine total physician encounters, emergency room (ER) visits, and hospitalizations in an incident cohort of rheumatoid arthritis (RA) cases and matched control patients over 13 years. METHODS: A retrospective cohort study was performed using administrative healthcare data from about 1 million people with access to universal healthcare. Using the International Classification of Diseases, 9th ed (ICD-9) and ICD-10 diagnostic codes, 7 RA case definitions were used...
August 1, 2017: Journal of Rheumatology
https://www.readbyqxmd.com/read/28759405/outcomes-of-nonoperative-management-of-uncomplicated-appendicitis
#12
Richard G Bachur, Susan C Lipsett, Michael C Monuteaux
BACKGROUND AND OBJECTIVES: Nonoperative management (NOM) of uncomplicated pediatric appendicitis has promise but remains poorly studied. NOM may lead to an increase in resource utilization. Our objective was to investigate the trends in NOM for uncomplicated appendicitis and study the relevant clinical outcomes including subsequent appendectomy, complications, and resource utilization. METHODS: Retrospective analysis of administrative data from 45 US pediatric hospitals...
July 2017: Pediatrics
https://www.readbyqxmd.com/read/28759282/adolescent-risk-screening-instruments-for-primary-care-an-integrative-review-utilizing-the-donabedian-framework
#13
Deanna B Hiott, Shannon Phillips, Elaine Amella
Adolescent risk-taking behavior choices can affect future health outcomes. The purpose of this integrative literature review is to evaluate adolescent risk screening instruments available to primary care providers in the United States using the Donabedian Framework of structure, process, and outcome. To examine the literature concerning multidimensional adolescent risk screening instruments available in the United States for use in the primary care setting, library searches, ancestry searches, and Internet searches were conducted...
July 31, 2017: Compr Child Adolesc Nurs
https://www.readbyqxmd.com/read/28756081/temporal-trends-in-epinephrine-dispensing-and-allergy-immunology-follow-up-among-emergency-department-anaphylaxis-patients-in-the-united-states-2005-2014
#14
Megan S Motosue, M Fernanda Bellolio, Holly K Van Houten, Nilay D Shah, Venkatesh R Bellamkonda, David M Nestler, Ronna L Campbell
BACKGROUND: Anaphylaxis is a potentially life-threatening allergic reaction; measures including prescription of an epinephrine autoinjector (EAI) and allergy/immunology (A/I) follow-up may prevent future morbidity. OBJECTIVE: The objective of this study was to evaluate trends in outpatient management of anaphylaxis by studying EAI dispensing and A/I follow-up among patients seen in the emergency department (ED) for anaphylaxis from 2005 through 2014. METHODS: We analyzed administrative claims data from the OptumLabs Data Warehouse database using an expanded International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code algorithm...
July 26, 2017: Journal of Allergy and Clinical Immunology in Practice
https://www.readbyqxmd.com/read/28754601/magnesium-sulfate-infusion-for-acute-asthma-in-the-emergency-department
#15
REVIEW
Jose Enrique Irazuzta, Nicolas Chiriboga
OBJECTIVES: To describe the role of intravenous magnesium sulfate (MgSO4) as therapy for acute severe asthma in the pediatric emergency department (ED). SOURCE: Publications were searched in the PubMed and Cochrane databases using the following keywords: magnesium AND asthma AND children AND clinical trial. A total of 53 publications were retrieved using this criteria. References of relevant articles were also screened. The authors included the summary of relevant publications where intravenous magnesium sulfate was studied in children (age <18 years) with acute asthma...
July 26, 2017: Jornal de Pediatria
https://www.readbyqxmd.com/read/28748654/review-article-does-acupuncture-have-a-role-in-providing-analgesia-in-the-emergency-setting-a-systematic-review-and-meta-analysis
#16
REVIEW
Andrew L Jan, Emogene S Aldridge, Ian R Rogers, Eric J Visser, Max K Bulsara, Richard C Niemtzow
Acupuncture might offer a novel approach to improve ED pain management. Our primary aim was to assess the efficacy of acupuncture in the emergency setting while secondary objectives were to explore its suitability through its side-effect profile, patient satisfaction, cost, administration time and points used. Seven databases and Google Scholar were searched up to 31 July 2016 using MeSH descriptors for three overarching themes concerning acupuncture, pain management and emergency medicine. Meta-analysis was performed on randomised trials for three comparator groups: acupuncture versus sham, acupuncture versus standard analgesia care and acupuncture-as-an-adjunct to standard care, to calculate the standardised mean difference and weighted mean difference for pain scores out of 10...
July 26, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28744454/staff-perspectives-on-a-tablet-based-intervention-to-increase-hiv-testing-in-a-high-volume-urban-emergency-department
#17
Ian David Aronson, Honoria Guarino, Alexander S Bennett, Lisa A Marsch, Marya Gwadz, Charles M Cleland, Laura Damschroder, Theodore C Bania
Emergency departments (EDs) frequently serve people who have limited, if any, additional interactions with health care, yet many ED patients are not offered HIV testing, and those who are frequently decline. ED staff (n = 13) at a high volume urban ED (technicians, nurses, physicians, and administrators) were interviewed to elicit their perspectives on the feasibility and acceptability of a tablet-based intervention designed to increase HIV test rates among patients who initially decline testing. Content-based thematic analysis of semi-structured interviews indicated overall support for interventions to increase HIV testing, but a lack of available staff resources emerged as a potential barrier to widespread implementation...
2017: Frontiers in Public Health
https://www.readbyqxmd.com/read/28738685/assessing-the-effect-of-the-vha-pcmh-model-on-utilization-patterns-among-veterans-with-ptsd
#18
Ian Randall, Charles Maynard, Gary Chan, Beth Devine, Chris Johnson
OBJECTIVES: The Veterans Health Administration (VHA) implemented a patient-centered medical home (PCMH)-based Patient Aligned Care Teams (PACT) model in 2010. We examined its effects on the utilization of health services among US veterans with posttraumatic stress disorder (PTSD). STUDY DESIGN: We analyzed VHA clinical and administrative data to conduct an interrupted time series study. Encounter-level data were obtained for the period of April 1, 2005, through March 31, 2014...
May 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28728807/the-impact-of-team-based-primary-care-on-health-care-services-utilization-and-costs-quebec-s-family-medicine-groups
#19
Erin Strumpf, Mehdi Ammi, Mamadou Diop, Julie Fiset-Laniel, Pierre Tousignant
We investigate the effects on health care costs and utilization of team-based primary care delivery: Quebec's Family Medicine Groups (FMGs). FMGs include extended hours, patient enrolment and multidisciplinary teams, but they maintain the same remuneration scheme (fee-for-service) as outside FMGs. In contrast to previous studies, we examine the impacts of organizational changes in primary care settings in the absence of changes to provider payment and outside integrated care systems. We built a panel of administrative data of the population of elderly and chronically ill patients, characterizing all individuals as FMG enrollees or not...
July 1, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28723915/key-findings-from-a-prospective-trauma-registry-at-a-regional-hospital-in-southwest-cameroon
#20
Alain Chichom-Mefire, Obieze C Nwanna-Nzewunwa, Vincent Verla Siysi, Isabelle Feldhaus, Rochelle Dicker, Catherine Juillard
INTRODUCTION: Trauma is a leading cause of morbidity and mortality worldwide. Data characterizing the burden of trauma in Cameroon is limited. Regular, prospective injury surveillance can address the shortcomings of existing hospital administrative logs and medical records. This study aims to characterize trauma as seen at the emergency department (ED) of Limbe Regional Hospital (LRH) and assess the completeness of data obtained by a trauma registry. METHODS AND FINDINGS: From January 2008 to October 2013, we prospectively captured data on injured patients using a strategically designed, context-relevant trauma registry instrument...
2017: PloS One
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