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Emergency Department Safety

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https://www.readbyqxmd.com/read/28437795/effect-of-using-the-heart-score-in-patients-with-chest-pain-in-the-emergency-department-a-stepped-wedge-cluster-randomized-trial
#1
Judith M Poldervaart, Johannes B Reitsma, Barbra E Backus, Hendrik Koffijberg, Rolf F Veldkamp, Monique E Ten Haaf, Yolande Appelman, Herman F J Mannaerts, Jan-Melle van Dantzig, Madelon van den Heuvel, Mohamed El Farissi, Bernard J W M Rensing, Nicolette M S K J Ernst, Ineke M C Dekker, Frank R den Hartog, Thomas Oosterhof, Ghizelda R Lagerweij, Eugene M Buijs, Maarten W J van Hessen, Marcel A J Landman, Roland R J van Kimmenade, Luc Cozijnsen, Jeroen J J Bucx, Clara E E van Ofwegen-Hanekamp, Maarten-Jan Cramer, A Jacob Six, Pieter A Doevendans, Arno W Hoes
Background: The HEART (History, Electrocardiogram, Age, Risk factors, and initial Troponin) score is an easy-to-apply instrument to stratify patients with chest pain according to their short-term risk for major adverse cardiac events (MACEs), but its effect on daily practice is unknown. Objective: To measure the effect of use of the HEART score on patient outcomes and use of health care resources. Design: Stepped-wedge, cluster randomized trial...
April 25, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28433247/outpatient-laparoscopic-appendectomy-feasible-in-a-public-county-hospital
#2
David R Rosen, Kenji Inaba, Paul J Oh, Adam C Gutierrez, Aaron M Strumwasser, Subarna Biswas, Melody Cala, Glenn T Ault
BACKGROUND: Outpatient laparoscopic appendectomy is being used increasingly as a treatment option for acute, uncomplicated appendicitis. This was a prospective validation study in a large, urban, public safety-net hospital. STUDY DESIGN: From 2014 to 2016, all patients undergoing laparoscopic appendectomy for acute, uncomplicated appendicitis were enrolled in a prospective observational trial. Standard baseline perioperative practice (control group) was documented for 1 year...
March 13, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28432613/pediatric-tonsillectomy-is-a-resource-intensive-procedure-a-study-of-canadian-health-administrative-data
#3
Kimmo T T Murto, Sherri L Katz, Daniel I McIsaac, Matthew A Bromwich, Régis Vaillancourt, Carl van Walraven
BACKGROUND: The majority of pediatric surgeries are performed in a day surgery setting. The rate of adverse postoperative outcomes and the factors that influence them are poorly described in the Canadian setting. Concerns about the safety of adenotonsillectomy (AT) have been raised. The objective of this Ontario-based study was to determine the rates and risks of hospital readmission, emergency department (ED) visits, or deaths within 30 days following common pediatric surgeries, with an emphasis on AT...
April 21, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28431426/anesthesiologists-and-disaster-medicine-a-needs-assessment-for-education-and-training-and-reported-willingness-to-respond
#4
Heather K Hayanga, Daniel J Barnett, Natasha R Shallow, Michael Roberts, Carol B Thompson, Itay Bentov, Gozde Demiralp, Bradford D Winters, Deborah A Schwengel
BACKGROUND: Anesthesiologists provide comprehensive health care across the emergency department, operating room, and intensive care unit. To date, anesthesiologists' perspectives regarding disaster medicine and public health preparedness have not been described. METHODS: Anesthesiologists' thoughts and attitudes were assessed via a Web-based survey at 3 major academic institutions. Frequencies, percentages, and odds ratios (ORs) were used to assess self-reported perceptions of knowledge and skills, as well as attitudes and beliefs regarding education and training, employee development, professional obligation, safety, psychological readiness, efficacy, personal preparedness, and willingness to respond (WTR)...
May 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28431130/safety-concerns-with-thoracoabdominal-acupuncture-experience-at-a-tertiary-care-emergency-department
#5
Hak Jin Lee, Youn-Jung Kim, Won Young Kim
Objective.:  To evaluate serious complications caused by acupuncture treatment and to increase awareness of this complication. Design.:  A retrospective observational study. Setting. : At the emergency department of a tertiary hospital in an urban area during a five-year period (2010-2014) in Seoul, Korea. Subjects.:  Patients with postacupuncture mechanical complications in the thoracoabdominal region. Methods...
April 19, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28430713/a-national-survey-of-neonatologists-barriers-and-prerequisites-to-introduce-point-of-care-ultrasound-in-neonatal-icus
#6
Hussnain S Mirza, Gregory Logsdon, Anoop Pulickal, Mark Stephens, Rajan Wadhawan
Point-of-care (POC) ultrasound refers to the use of portable imaging. Although POC ultrasound is widely available to the neonatologists in Australia and Europe, neonatologists in the United States report limited availability. Our objective was to seek the US neonatologists' perception of barriers and prerequisites in adopting POC ultrasound in neonatal intensive care units. An online survey link was sent via e-mail to 3000 neonatologists included in the database maintained by the American Academy of Pediatrics...
April 20, 2017: Ultrasound Quarterly
https://www.readbyqxmd.com/read/28424134/six-year-experience-of-outpatient-total-and-completion-thyroidectomy-at-a-single-academic-institution
#7
Ethan Frank, Joshua Park, Alfred Simental, Christopher Vuong, Steve Lee, Pedro Andrade Filho, Daniel Kwon, Yuan Liu
Outpatient thyroidectomy has become slowly accepted with various published reports predominantly examining partial or subtotal thyroidectomy. Concerns regarding the safety of outpatient total and completion thyroidectomy remain, especially with regard to vocal fold paralysis, hypocalcemia, and catastrophic hematoma. We aimed to evaluate the safety of outpatient thyroid surgery in a large cohort by retrospectively comparing outcomes in those who underwent outpatient (n = 251) versus inpatient (n = 291) completion or total thyroidectomy between February 2009 and February 2015...
April 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28422839/unexpected-side-effect-in-mcrc-a-care-compliant-case-report-of-regorafenib-induced-hyperammonemic-encephalopathy
#8
Michela Quirino, Sabrina Rossi, Giovanni Schinzari, Michele Basso, Antonia Strippoli, Alessandra Cassano, Carlo Barone
RATIONALE: Regorafenib represents a treatment option in heavily pretreated patients affected by metastatic colorectal cancer (mCRC). Its safety profile is typical of small-molecule tyrosine-kinase inhibitors (TKIs) and most adverse events are manageable. PATIENT CONCERNS: A 56 years-old Caucasian man affected by mCRC with normal hepatic reserve was treated with regorafenib as second-line treatment. After only 2 days of therapy, the patient presented to the emergency department due to impairment of both spatial and temporal orientation and motor function with bradylalia...
April 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28422834/feasibility-and-safety-of-emergency-laparoscopic-partial-splenectomy-a-retrospective-analysis
#9
Hongyu Li, Yonggang Wei, Bing Peng, Bo Li, Fei Liu
The increased awareness of asplenia-related life-threatening complications has led to the development of parenchyma sparing splenic resections in past few years. The aim of this study is to retrospectively analyze the feasibility and safety of laparoscopic partial splenectomy (LPS) in selected emergency patients.From January 2013 to December 2015, there were 46 emergency patients, diagnosed with splenic rupture, admitted in our department. Selection criteria for LPS: (1) Preoperative CT scan revealed single pole rupture without spleen pedicle injury; (2) BP>90/60 mm Hg and heart rates <120 bpm; (3) No sigh of multiple organ injury...
April 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28420688/can-a-partnership-between-general-practitioners-and-ambulance-services-reduce-conveyance-to-emergency-care
#10
Manuel Villarreal, Jonathan Leach, Kandala Ngianga-Bakwin, Jeremy Dale
BACKGROUND: Emergency services are facing increasing workload pressures, and new models of care are needed. We evaluate the impact of a service development involving a partnership between emergency ambulance crews and general practitioners (GPs) on reducing conveyance rates to the Hospital Emergency Department (ED). METHODS: The service model was implemented in the West Midlands of England. Call handlers identified patients with needs that could be addressed by a GP using locally agreed criteria...
April 18, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28419011/establishing-a-dedicated-difficult-vascular-access-team-in-the-emergency-department-a-needs-assessment
#11
Madeleine Whalen, Barbara Maliszewski, Diana-Lyn Baptiste
Peripheral vascular access is one of the most common procedures performed in emergency departments across the United States. Successful venipuncture is critical in providing timely diagnosis and treatments for patients. The aim of this article is to describe a needs assessment performed in a level-one academic emergency department to establish the need for a dedicated team for patients with difficult vascular access. Results from this assessment suggest that difficult vascular access represents tangible threats to patient safety and increased use of resources...
May 2017: Journal of Infusion Nursing: the Official Publication of the Infusion Nurses Society
https://www.readbyqxmd.com/read/28414102/parental-knowledge-of-trampoline-safety-in-children
#12
S Beno, A Ackery, K Colaco, K Boutis
OBJECTIVES: Recreational trampoline use is increasing in popularity, with a resulting increase in significant trampoline-related injuries in children. Parents are the best advocates for the safety of their children during recreational trampoline use. Our primary objective was to determine the proportion of parents who were aware of five key recommendations for safer recreational trampoline use in children. METHODS: This was a cross-sectional survey of parents whose children presented to a tertiary care pediatric emergency department (ED) with an extremity injury...
April 13, 2017: Academic Pediatrics
https://www.readbyqxmd.com/read/28412951/understanding-discharge-communication-behaviours-in-a-pediatric-emergency-care-context-a-mixed-methods-observation-study-protocol
#13
Janet A Curran, Andrea Bishop, Amy Plint, Shannon MacPhee, Roger Zemek, Jill Chorney, Mona Jabbour, Stephen Porter, Scott Sawyer
BACKGROUND: One of the most important transitions in the continuum of care for children is discharge to home. Optimal discharge communication between healthcare providers and caregivers (e.g., parents or other guardians) who present to the emergency department (ED) with their children is not well understood. The lack of policies and considerable variation in practice regarding discharge communication in pediatric EDs pose a quality and safety risk for children and their parents. METHODS: The aim of this mixed methods study is to better understand the process and structure of discharge communication in a pediatric ED context to contribute to the design and development of discharge communication interventions...
April 17, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28409062/improved-availability-and-quality-of-care-with-epilepsy-nurse-practitioners
#14
Chloe E Hill, Bethany Thomas, Kimberly Sansalone, Kathryn A Davis, Judy A Shea, Brian Litt, Nabila Dahodwala
BACKGROUND: This study investigated the quality of care delivered by nurse practitioner (NP)-physician teams employed to expand clinic appointment availability for patients with epilepsy. METHODS: We performed a retrospective observational cohort study of patients with epilepsy presenting to the Penn Epilepsy Center for a new patient appointment in 2014. During this time, patients were seen either by an NP-physician team care model or a more traditional physician-only care model...
April 2017: Neurology. Clinical Practice
https://www.readbyqxmd.com/read/28407212/reduced-healthcare-use-and-apparent-savings-with-passive-home-monitoring-technology-a-pilot-study
#15
Michael Finch, Kristen Griffin, James T Pacala
OBJECTIVES: To conduct a cost analysis of ambient assisted living technology, which is promising for improving the ability of individuals and care providers to monitor daily activities and gain better awareness through proactive management of health and safety. DESIGN: Three-arm cohort study. SETTING: Homes of enrollees of a state-based healthcare plan for older adults. PARTICIPANTS: Enrollees dually eligible for Medicare and Medicaid (N = 268)...
April 13, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28402017/asthma-education-for-school-staff
#16
REVIEW
Kayleigh M Kew, Robin Carr, Tim Donovan, Morris Gordon
BACKGROUND: Teachers and school staff should be competent in managing asthma in schools. Demonstrated low levels of asthma knowledge mean that staff may not know how best to protect a child with asthma in their care, or may fail to take appropriate action in the event of a serious attack. Education about asthma could help to improve this knowledge and lead to better asthma outcomes for children. OBJECTIVES: To assess the effectiveness and safety of asthma education programmes for school staff, and to identify content and attributes underpinning them...
April 12, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28400902/a-novel-neuroscience-intermediate-level-care-unit-model-retrospective-analysis-of-impact-on-patient-flow-and-safety
#17
Alexandra E Quimby, Michel C F Shamy, Deanna M Rothwell, Erin Y Liu, Dar Dowlatshahi, Grant Stotts
BACKGROUND AND PURPOSE: Neurointensive care units have been shown to improve patient outcomes across a variety of neurological and neurosurgical conditions. However, the efficacy of less resource-intensive intermediate-level care units to deliver similar care has not been well studied. The purpose of this study is to evaluate the impact of neurocritical specialist comanagement on patient flow and safety in a neuroscience intermediate-level care unit. METHODS: Our intervention consisted of the addition of a physician with critical care experience as well as training in neurology, anesthesiology, or intensive care to a neuroscience intermediate-level care unit to comanage patients alongside neurology and neurosurgery staff during weekday daytime hours...
April 2017: Neurohospitalist
https://www.readbyqxmd.com/read/28400068/intracranial-complications-after-minor-head-injury-mhi-in-patients-taking-vitamin-k-antagonists-vka-or-direct-oral-anticoagulants-doacs
#18
Alessandro Riccardi, Beatrice Spinola, Pierangela Minuto, Maria Ghinatti, Grazia Guiddo, Michele Malerba, Roberto Lerza
INTRODUCTION: The correlation between chronic direct oral anticoagulants (DOACs) intake and the incidence of intracranial complications after minor head injury (MHI) is still not well defined. This study examined the incidence of complications in patients receiving vitamin K antagonists (VKA) or DOACs observed in the emergency department (ED) for MHI. METHODS: Two hundred twenty-five patients affected by MHI and receiving oral anticoagulants were recorded between January and December 2016, distinguishing those treated with VKA (118) from those receiving DOACs (107)...
April 1, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28399647/%C3%AE-blockers-cocaine-and-the-unopposed-%C3%AE-stimulation-phenomenon
#19
John R Richards, Judd E Hollander, Edward A Ramoska, Fareed N Fareed, I Charles Sand, María Manuela Izquierdo Gómez, Richard A Lange
Cocaine abuse remains a significant worldwide health problem. Patients with cardiovascular toxicity from cocaine abuse frequently present to the emergency department for treatment. These patients may be tachycardic, hypertensive, agitated, and have chest pain. Several pharmacological options exist for treatment of cocaine-induced cardiovascular toxicity. For the past 3 decades, the phenomenon of unopposed α-stimulation after β-blocker use in cocaine-positive patients has been cited as an absolute contraindication, despite limited and inconsistent clinical evidence...
May 2017: Journal of Cardiovascular Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28396187/collaborative-interventions-reduce-time-to-thrombolysis-for-acute-ischemic-stroke-in-a-public-safety-net-hospital
#20
Zachary D Threlkeld, Benjamin Kozak, David McCoy, Sara Cole, Christine Martin, Vineeta Singh
BACKGROUND AND PURPOSE: Shorter time-to-thrombolysis in acute ischemic stroke (AIS) is associated with improved functional outcome and reduced morbidity. We evaluate the effect of several interventions to reduce time-to-thrombolysis at an urban, public safety net hospital. METHODS: All patients treated with tissue plasminogen activator for AIS at our institution between 2008 and 2015 were included in a retrospective analysis of door-to-needle (DTN) time and associated factors...
April 7, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
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