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Emergency care

Poul Jennum, Anne Sabers, Jakob Christensen, Rikke Ibsen, Jakob Kjellberg
PURPOSE: Epilepsy surgery has been a standard treatment for refractory epilepsies that cannot be controlled by standard medical treatment. We aimed to evaluate the health and social consequences of resective surgery relative to controls from a study of national data. METHODS: Using the Danish National Patient Registry we identified all subjects with an epilepsy diagnosis between 1996 and 2009 and compared them with a group of patients with an epilepsy diagnosis who had had neither epilepsy surgery nor a vagus stimulation diagnosis by the index date, and who were matched by gender, index year for epilepsy diagnosis, and index year for epilepsy surgery...
October 6, 2016: Seizure: the Journal of the British Epilepsy Association
Rocío Carmona, Cristina Linares, Cristina Ortiz, Blanca Vázquez, Julio Díaz
BACKGROUND: Although the effects of noise on population morbidity and mortality have been observed both in the short and long term, the morbidity and mortality indicators used to date have not enabled information on such health effects to be accessed in real time. At an international level, there are relatively few studies, mostly recent, which have considered an alternative indicator, such as the demand for medical attention provided by emergency services, taking into account environmental factors other than noise...
October 19, 2016: Environmental Research
S Tatishvili, M Sinitsa, R Jorbendaze, G Kavtaradze
Severe infarction or its consequences are considered as triggering factors of incidental depression. The aim of our study was to reveal factors associated with depressive episode in patients hospitalized with acute coronary syndrome (acute myocardial infarction, unstable angina). The Beck Depression inventory (BDI) was used for assessment of depressive symptoms in patients with coronary disease in Emergency Cardiology Clinic Tbilisi, Georgia. The study sample included 84 patients. The clinical Information was collected from hospital recordings...
September 2016: Georgian Medical News
Marleen Kunneman, Victor M Montori, Ana Castaneda-Guarderas, Erik P Hess
Both the practice of medicine and the expectations of patients regarding their care are changing. A point of confluence is in the need for medicine to be more patient centered, and in the need for patients to be more involved in their care.(1,2) This confluence is particularly pertinent when more than one reasonable approach is available to manage the patient's situation, and when those approaches differ in ways that matter to patients.(3) In shared decision-making (SDM), clinicians and patients work together to understand the patient's situation and to determine how best to address it...
October 21, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Sathyaseelan Subramaniam, Jacqueline Bober, Jennifer Chao, Shahriar Zehtabchi
BACKGROUND: Traditionally, emergency department (ED) physicians rely on their clinical examination to differentiate between cellulitis and abscess when evaluating skin and soft tissue infections (SSTI). Management of an abscess requires incision and drainage, whereas cellulitis generally requires a course of antibiotics. Misdiagnosis often results in unnecessary invasive procedures, sedations (for incision and drainage in pediatric patients), or a return ED visit for failed antibiotic therapy...
October 21, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Riikka Homanen
This article discusses practices of parental support in the maternity healthcare provided by the welfare state. Drawing on ethnographic material from clinics in Finland, I discuss maternity healthcare practices and processes as the specific contexts of subjectification to parenthood in the Nordic welfare state. The analysis shows that in both nurses' (work) experience-based knowledge and population-statistical knowledge, parental competence is achieved largely through the 'natural' process of experiencing pregnant life...
October 22, 2016: Sociology of Health & Illness
Andrew S Hwang, Steven J Atlas, Johan Hong, Jeffrey M Ashburner, Adrian H Zai, Richard W Grant, Clemens S Hong
BACKGROUND: A better understanding of the attributes of patients who require more effort to manage may improve risk adjustment approaches and lead to more efficient resource allocation, improved patient care and health outcomes, and reduced burnout in primary care clinicians. OBJECTIVE: To identify and characterize high-effort patients from the physician's perspective. DESIGN: Cohort study. PARTICIPANTS: Ninety-nine primary care physicians in an academic primary care network...
October 21, 2016: Journal of General Internal Medicine
Hisham Hussan, Peter P Stanich, Darrell M Gray, Somashekar G Krishna, Kyle Porter, Darwin L Conwell, Steven K Clinton
BACKGROUND: Morbid obesity is associated with worse colorectal cancer (CRC) perioperative outcomes. The impact of bariatric surgery on these outcomes is unknown. METHODS: The National Inpatient Sample Database (2006-2012) was used to identify adults with prior bariatric surgery (divided into BMI ≤35 kg/m(2) and BMI >35 kg/m(2)) or morbid obesity that underwent CRC surgery. Main outcomes were mortality, surgical complications and health care utilization. RESULTS: There were 1813 patients with prior bariatric surgery and 22,552 morbidly obese patients that underwent CRC surgery between 2006 and 2012...
October 21, 2016: Obesity Surgery
Jason Mackey, Jane C Khoury, Kathleen Alwell, Charles J Moomaw, Brett M Kissela, Matthew L Flaherty, Opeolu Adeoye, Daniel Woo, Simona Ferioli, Felipe De Los Rios La Rosa, Sharyl Martini, Pooja Khatri, Joseph P Broderick, Mario Zuccarello, Dawn Kleindorfer
OBJECTIVE: To characterize temporal trends in subarachnoid hemorrhage (SAH) incidence and outcomes over 5 time periods in a large population-based stroke study in the United States. METHODS: All SAHs among residents of the Greater Cincinnati/Northern Kentucky region at least 20 years of age were identified and verified via study physician review in 5 distinct year-long study periods between 1988 and 2010. We abstracted demographics, care patterns, and outcomes, and we compared incidence and case-fatality rates across the study periods...
October 21, 2016: Neurology
Jennifer C Cook, Richard H Tran, J Herbert Patterson, Jo E Rodgers
PURPOSE: The pharmacology, clinical efficacy, and safety profiles of evolving therapies for the management of chronic heart failure (HF) and acute decompensated heart failure (ADHF) are described. SUMMARY: HF confers a significant financial burden despite the widespread use of traditional guideline-directed medical therapies such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, and aldosterone receptor antagonists, and the rates of HF-related mortality and hospitalization have remained unacceptably high...
November 1, 2016: American Journal of Health-system Pharmacy: AJHP
Nicole M Orr, Rebecca S Boxer, Mary A Dolansky, Larry A Allen, Daniel E Forman
Skilled nursing facilities (SNF) have emerged as an integral component of care for older adults with heart failure (HF). Despite their prominent role, poor clinical outcomes for the medically complex patients with HF managed in SNFs are common. Barriers to providing quality care include poor transitional care during hospital-to-SNF and SNF-to-community discharges, lack of HF training among SNF staff, and a lack of a standardized care process among SNF facilities. While no evidence-based practice standards have been established, various measures and tools designed to improve HF management in SNFs are being investigated...
October 18, 2016: Journal of Cardiac Failure
Magaly Rodriguez de Bittner, Viktor V Chirikov, Ian M Breunig, Roxanne W Zaghab, Fadia Tohme Shaya
OBJECTIVE: To determine the effectiveness and cost savings of a real-world, continuous, pharmacist-delivered service with an employed patient population with diabetes over a 5-year period. SETTING: The Patients, Pharmacists Partnerships (P(3) Program) was offered as an "opt-in" benefit to employees of 6 public and private self-insured employers in Maryland and Virginia. Care was provided in ZIP code-matched locations and at 2 employers' worksites. PRACTICE DESCRIPTION: Six hundred two enrolled patients with type 1 and 2 diabetes were studied between July 2006 and May 2012 with an average follow-up of 2...
October 18, 2016: Journal of the American Pharmacists Association: JAPhA
Elizabeth A Sternke, Kathleen Abrahamson, Matthew J Bair
Clinician empathy is a well-documented component of effective patient/provider communication. Evidence surrounding the association between patient perspectives on clinician empathy and perception of pain management is currently limited, particularly among patients with chronic pain and depression. The aim of this study was to analyze patients' perspectives on the emergent theme of empathy and describe how patients construct their experiences and expectations surrounding empathic interactions. A secondary analysis of focus group data was designed using grounded theory methodology...
October 18, 2016: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
Dr Gian Domenico Giusti, Dr Cecilia Rogari, Dr Alessio Gili, Dr Fulvio Nisi
BACKGROUND: Endotracheal intubation (ETI) for mechanical ventilation has a central role in the Intensive Care Unit (ICU). ETI is one of the main risk factors for the development of ventilator-associated pneumonia (VAP) as its presence reduces the natural defences of the upper airway and allows the micro-suction of secretions in the airways. In order to minimise such complications, it is fundamental to maintain a suitable pressure inside the tube cuff. AIM AND SCOPE: The main objective of the present study is to evaluate the effectiveness and reliability of palpation method, performed with the operators fingers, for detecting the tube cuff pressure...
October 18, 2016: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
María Isabel Fernández-Cano, Xavier Espada-Trespalacios, Azahara Reyes-Lacalle, Josep Maria Manresa Domínguez, Lluís Armadans-Gil, Magda Campins-Martí, Gemma Falguera-Puig, Pere Toran Monserrat
INTRODUCTION: The re-emergence of pertussis and the severity of its complications in infants younger than 3 months, were determining factors for starting a vaccination program for pregnant women in the third trimester of gestation in Catalonia in February 2014. This was the first autonomous community to introduce it in Spain. The aim of the study was to estimate the coverage of the program in its first year of implementation. METHODS: A retrospective analysis was performed on the data from the Primary Care Centre computerised medical records of pregnant women attending Sexual and Reproductive Health Care centres of the Metropolitan Nord area of the province of Barcelona, part of the Catalan Institute of Health...
October 18, 2016: Enfermedades Infecciosas y Microbiología Clínica
Kristy Bultema, Sara Fowler, Melissa Drum, Al Reader, John Nusstein, Mike Beck
INTRODUCTION: In the treatment of patients with symptomatic irreversible pulpitis, endodontic debridement is a predictable method to relieve pain. However, there are clinical situations in which emergency care cannot be provided immediately. An unexplored treatment option in these cases may be the use of a long-acting anesthetic to reduce pain in untreated irreversible pulpitis. Some medical studies have shown potential for infiltrations of liposomal bupivacaine (Exparel; Pacira Pharmaceuticals, San Diego, CA) to prolong pain relief and reduce opioid use postoperatively...
October 18, 2016: Journal of Endodontics
Michael Y Woo, Nathan Hecht, Bernard Hurley, David Stitt, Venkatesh Thiruganasambandamoorthy
OBJECTIVES: The objective of this study was to determine the test characteristics of point-of-care ultrasonography (POCUS) for the diagnosis of retinal tear (RT), retinal detachment (RD), posterior vitreous detachment (PVD), and vitreous hemorrhage (VH). DESIGN: A prospective observation study on a convenience sample of patients presenting to a tertiary care emergency general ophthalmology clinic was performed. PARTICIPANTS: Adult patients with acute flashes/floaters or new visual field defects were included (n = 62)...
October 2016: Canadian Journal of Ophthalmology. Journal Canadien D'ophtalmologie
Suwanna Chaorattanakawee, Chanthap Lon, Krisada Jongsakul, Jariyanart Gawee, Somethy Sok, Siratchana Sundrakes, Nareth Kong, Chatchadaporn Thamnurak, Soklyda Chann, Sorayut Chattrakarn, Chantida Praditpol, Nillawan Buathong, Nichapat Uthaimongkol, Philip Smith, Narongrid Sirisopana, Rekol Huy, Satharath Prom, Mark M Fukuda, Delia Bethell, Douglas S Walsh, Charlotte Lanteri, David Saunders
BACKGROUND: The recent dramatic decline in dihydroartemisinin-piperaquine (DHA-PPQ) efficacy in northwestern Cambodia has raised concerns about the rapid spread of piperaquine resistance just as DHA-PPQ is being introduced as first-line therapy in neighbouring countries. METHODS: Ex vivo parasite susceptibilities were tracked to determine the rate of progression of DHA, PPQ and mefloquine (MQ) resistance from sentinel sites on the Thai-Cambodian and Thai-Myanmar borders from 2010 to 2015...
October 21, 2016: Malaria Journal
Pierre Cornillon, Sébastien Loiseau, Bruno Aublet-Cuvelier, Virginie Guastella
BACKGROUND: Patients under palliative care and in hospital-at-home services are frequently transferred to emergency departments. We set out to identify the reasons for these presentations to determine the proportion that might be avoidable. METHODS: We conducted a retrospective study by assessment of patient files. We studied admissions to four emergency departments in an area of France (Puy-de-Dôme) between September 2011 and August 2013. Reasons for transfer and diagnostic conclusion by emergency doctors were noted...
October 21, 2016: BMC Palliative Care
Paibul Suriyawongpaisal, Wichai Aekplakorn, Samrit Srithamrongsawat, Chaisit Srithongchai, Orawan Prasitsiriphon, Rassamee Tansirisithikul
BACKGROUND: Although bodies of evidence on copayment effects on access to care and quality of care in general have not been conclusive, allowing copayment in the case of emergency medical conditions might pose a high risk of delayed treatment leading to avoidable disability or death. METHODS: Using mixed-methods approach to draw evidence from multiple sources (over 40,000 records of administrative dataset of Thai emergency medical services, in-depth interviews, telephone survey of users and documentary review), we are were able to shed light on the existence of copayment and its related factors in the Thai healthcare system despite the presence of universal health coverage since 2001...
October 21, 2016: BMC Health Services Research
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