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Pre-hospital emergency care

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https://www.readbyqxmd.com/read/28073292/health-care-utilization-after-hospice-enrollment-in-patients-with-heart-failure-and-cancer
#1
Meredith A MacKenzie, Alexandra Hanlon
This study aimed to examine the role of diagnosis in health-care utilization patterns after hospice enrollment. Using 2007 National Home and Hospice Care Survey data from hospice patients with heart failure (n = 311) and cancer (n = 946), we analyzed emergency service use and discharge to hospital via logistic regression pre- and postpropensity score matching. Prematching, patients with heart failure had twice the odds of emergency services use than patients with cancer ( P < .001) and twice the odds of discharge to hospital ( P = ...
January 1, 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/28070029/the-relationship-between-scores-and-outcomes-for-polytrauma-patients-in-the-emergency-department-a-case-study
#2
Maria Gioffre-Florio, Letizia Maria Murabito, Carmela Visalli, Alessandra Villari, Floriana Lauritano, Carla Bramanti, Fausto Fama
AIM: Traumas are one of the most relevant pathological events in health care, because of clinical and prognostic relevance. Morbidity and mortality rates are strongly affected by the timely and correct approach to the patient (golden hour). The objective of this study was to investigate the possible influence of the diagnostic time and of the Injury Severity Score (ISS) on outcomes in trauma patients. MATERIAL OF STUDY: Out of a total of 240,833 emergency patients, we observed, 447 polytrauma...
December 29, 2016: Annali Italiani di Chirurgia
https://www.readbyqxmd.com/read/28062529/a-mixed-reality-simulator-concept-for-future-medical-emergency-response-team-training
#3
Robert J Stone, R Guest, P Mahoney, D Lamb, C Gibson
The UK Defence Medical Service's Pre-Hospital Emergency Care (PHEC) capability includes rapid-deployment Medical Emergency Response Teams (MERTs) comprising tri-service trauma consultants, paramedics and specialised nurses, all of whom are qualified to administer emergency care under extreme conditions to improve the survival prospects of combat casualties. The pre-deployment training of MERT personnel is designed to foster individual knowledge, skills and abilities in PHEC and in small team performance and cohesion in 'mission-specific' contexts...
January 6, 2017: Journal of the Royal Army Medical Corps
https://www.readbyqxmd.com/read/28050802/the-effectiveness-of-apneic-oxygenation-during-tracheal-intubation-in-various-clinical-settings-a-narrative-review
#4
David T Wong, Amanda J Yee, Siaw May Leong, Frances Chung
PURPOSE: During the process of tracheal intubation, patients are apneic or hypoventilating and are at risk of becoming hypoxemic. This risk is especially high in patients with acute or chronic respiratory failure and accompanying compromised respiratory reserve. To address this concern, apneic oxygenation can be administered during tracheal intubation to aid in maintaining arterial oxygen saturation. The objective of this narrative review is to examine the utilization of apneic oxygenation within the operating room, intensive care unit (ICU), emergency department, and pre-hospital settings and to determine its efficacy compared with controls...
January 3, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28045940/applying-the-integrated-practice-unit-concept-to-a-modified-virtual-ward-model-of-care-for-patients-at-highest-risk-of-readmission-a-randomized-controlled-trial
#5
Lian Leng Low, Shu Yun Tan, Matthew Joo Ming Ng, Wei Yi Tay, Lee Beng Ng, Kanchana Balasubramaniam, Rachel Marie Towle, Kheng Hock Lee
BACKGROUND: Emerging evidence from the virtual ward care model showed that multidisciplinary case management are inadequate to reduce readmissions or death for high risk patients. There is consensus that interventions should encompass both pre-hospital discharge and post-discharge transitional care to be effective. Integrated practice units (IPU) had been proposed as an approach of restructuring the organization and work processes of multidisciplinary teams to achieve value in healthcare...
2017: PloS One
https://www.readbyqxmd.com/read/28030458/interorganizational-collaboration-in-emergency-cardiovascular-care
#6
James R Langabeer, Tiffany Champagne-Langabeer, Jeffrey R Helton, Wendy Segrest, Bita Kash, Jami DelliFraine, Raymond Fowler
BACKGROUND: Interorganizational collaboration management theory contends that cooperation between distinct but related organizations can yield innovation and competitive advantage to the participating organization. Yet, it is unclear if a multi-institutional collaborative can improve quality outcomes across communities. METHODS: We developed a large regional collaborative network of 15 hospitals and 24 emergency medical service agencies surrounding Dallas, Texas, and collected patient-level data on treatment times for acute myocardial infarctions...
January 2017: Quality Management in Health Care
https://www.readbyqxmd.com/read/28029501/declining-mortality-due-to-severe-sepsis-and-septic-shock-in-spanish-intensive-care-units-a-two-cohort-study-in-2005-and-2011
#7
B Sánchez, R Ferrer, D Suarez, E Romay, E Piacentini, G Gomà, M L Martínez, A Artigas
OBJECTIVE: To analyze the evolution of sepsis-related mortality in Spanish Intensive Care Units (ICUs) following introduction of the Surviving Sepsis Campaign (SSC) guidelines and the relationship with sepsis process-of-care. DESIGN: A prospective cohort study was carried out, with the inclusion of all consecutive patients presenting severe sepsis or septic shock admitted to 41 Spanish ICUs during two time periods: 2005 (Edusepsis study pre-intervention group) and 2011 (ABISS-Edusepsis study pre-intervention group)...
October 28, 2016: Medicina Intensiva
https://www.readbyqxmd.com/read/28013559/key-factors-influencing-the-incidence-of-hemolysis-a-critical-appraisal-of-current-evidence
#8
Euan James McCaughey, Elia Vecellio, Rebecca Lake, Ling Li, Leslie Burnett, Douglas Chesher, Stephen Braye, Mark Mackay, Stephanie Gay, Tony Badrick, Johanna Westbrook, Andrew Georgiou
Hemolysis is a leading cause of pre-analytical laboratory errors. The identification of contributing factors is an important step towards the development of effective practices to reduce and prevent hemolysis. We performed a review of PUBMED, Embase, Medline and CINAHL to identify articles published between January 2000 and August 2016 that identified factors influencing in vitro hemolysis rates. The 40 studies included in this review provide excellent evidence that hemolysis rates are higher in Emergency Departments (EDs), for non-antecubital draws, for specimens drawn using an intravenous catheter compared to venipuncture and for samples transported by pneumatic tube compared to by hand...
December 26, 2016: Critical Reviews in Clinical Laboratory Sciences
https://www.readbyqxmd.com/read/28009334/challenges-successes-and-opportunities-for-reducing-readmissions-in-a%C3%A2-referral-based-children-s-hospital-nicu
#9
R Bapat, R McClead, E Shepherd, G Ryshen, T Bartman
AIM: To evaluate readmission data in a level IV neonatal intensive care unit (NICU) to identify patient characteristics and process failures which serve as drivers for readmission. METHODS: Our center is a primary referral center in Central and Southeast Ohio, providing us a unique opportunity to evaluate readmissions. We studied our current discharge process, caregiver perception of discharge readiness, parental comfort and the pre-discharge and post-discharge characteristics of infants...
2016: Journal of Neonatal-perinatal Medicine
https://www.readbyqxmd.com/read/28007319/nasal-flaring-as-a-clinical-sign-of-respiratory-acidosis-in-patients-with-dyspnea
#10
José Gregorio Zorrilla-Riveiro, Anna Arnau-Bartés, Ramón Rafat-Sellarés, Dolors García-Pérez, Arantxa Mas-Serra, Rafael Fernández-Fernández
OBJECTIVE: To determine whether the presence of nasal flaring is a clinical sign of respiratory acidosis in patients attending emergency departments for acute dyspnea. METHODS: Single-center, prospective, observational study of patients aged over 15 requiring urgent attention for dyspnea, classified as level II or III according to the Andorran Triage Program and who underwent arterial blood gas test on arrival at the emergency department. The presence of nasal flaring was evaluated by two observers...
December 10, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28007227/the-perioperative-surgical-home-model-facilitates-change-implementation-in-anesthetic-technique-within-a-clinical-pathway-for-total-knee-arthroplasty
#11
Seshadri C Mudumbai, Tessa L Walters, Steven K Howard, T Edward Kim, Gregory Milo Lochbaum, Stavros G Memtsoudis, Zeev N Kain, Alex Kou, Robert King, Edward R Mariano
BACKGROUND: The challenge of knowledge translation in medical settings is well known, and implementing change in clinical practice can take years. For the increasing number total knee arthroplasty (TKA) patients annually, there is ample evidence to endorse neuraxial anesthesia over general anesthesia. The rate of adoption of this practice, however, is slow at the current time. We hypothesized that a Perioperative Surgical Home (PSH) model facilitates rapid change implementation in anesthesia...
December 2016: Healthcare
https://www.readbyqxmd.com/read/28005272/prophylactic-versus-selective-blood-transfusion-for-sickle-cell-disease-in-pregnancy
#12
REVIEW
Babasola O Okusanya, Olufemi T Oladapo
BACKGROUND: Pregnant women with sickle cell disease (HbSS, HbSC and HbSβThal) may require blood transfusion to prevent severe anaemia or to manage potential medical complications. Preventive blood transfusion in the absence of complications starting from the early weeks of pregnancy or blood transfusion only for medical or obstetric indications have been used as management policies. There is currently no consensus on the blood transfusion policy that guarantees optimal clinical benefits with minimal risks for such women and their babies...
22, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28005173/diabetes-education-of-patients-and-their-entourage-out-of-hospital-national-study-educated-2
#13
Frédéric Lapostolle, Nadia Hamdi, Majed Barghout, Louis Soulat, Anna Faucher, Yves Lambert, Nicolas Peschanski, Agnès Ricard-Hibon, Carine Chassery, Maryline Roti, Vincent Bounes, Guillaume Debaty, Tarak Mokni, Gérald Egmann, Pierre-Arnaud Fort, Karim Boudenia, Laurent Alayrac, Mohamed Safraou, Michel Galinski, Frédéric Adnet
AIMS: To determine the contributing factors in the successful diabetes education of patients and their entourage. METHODS: Prospective observational study conducted in a pre-hospital setting by 17 emergency services across France (September 2009-January 2011) included all insulin-treated patients (≥18 years) provided that at least one family member was present on scene. Data were collected from patients and their entourage: (1) personal details including language proficiency and educational attainment, (2) treatments, (3) diabetes-related data (log sheets, glucose meter, glucagon, glycated hemoglobin, prior hypoglycemic episodes); (4) care by diabetologist, general practitioner and/or visiting nurse...
December 22, 2016: Acta Diabetologica
https://www.readbyqxmd.com/read/27995016/new-hospital-structure-in-the-twenty-first-century-the-position-of-level-iii-tertiary-neurological-and-stroke-care-in-a-changing-healthcare-system
#14
Tamás Szentes, László Kovács, Csaba Óváry
AIM: The determination of the necessary capacity and number of neurology wards of level III progressivity that can be defined in the system of criteria detailed in this article and which possess optimal operating conditions in Hungarian terms. METHODS: We used the National Health Insurance Company's database to calculate case numbers and capacity for different levels of neurological and stroke care. We also revised the allocation of advanced diagnostic and therapeutic technologies, and proposed changes, based on health insurance data...
2016: SpringerPlus
https://www.readbyqxmd.com/read/27992988/-risk-factors-for-methicillin-resistant-staphylococcus-aureus-bacteremia-a-multicenter-matched-case-control-study
#15
Paola Mariana Arias-Ortiz, Libia Del Pilar Calderón, Juan Sebastián Castillo, José Moreno, Aura Lucía Leal, Jorge Alberto Cortés, Carlos Arturo Álvarez, Grupo Grebo
INTRODUCTION: Methicillin-resistant Staphylococcus aureus is a frequent pathogen at critical care services. Its presence leads to increased hospital stays and mortality risk in patients with bacteremia. However, the etiology of this resistance marker has not been fully studied. OBJECTIVE: To identify risk factors associated with the emergence of methicillin-resistant S. aureus bacteremia in critically ill patients treated at intensive care units in Bogotá, Colombia...
December 1, 2016: Biomédica: Revista del Instituto Nacional de Salud
https://www.readbyqxmd.com/read/27982326/analysis-of-the-revised-trauma-score-rts-in-200-victims-of-different-trauma-mechanisms
#16
Bruno Durante Alvarez, Danilo Mardegam Razente, Daniel Augusto Mauad Lacerda, Nicole Silveira Lother, Luiz Carlos VON-Bahten, Carla Martinez Menini Stahlschmidt
Objective: to analyze the epidemiological profile and mortality associated with the Revised Trauma Score (RTS) in trauma victims treated at a university hospital. Methods: we conducted a descriptive, cross-sectional study of trauma protocols (prospectively collected) from December 2013 to February 2014, including trauma victims admitted in the emergency room of the Cajuru University Hospital. We set up three groups: (G1) penetrating trauma to the abdomen and chest, (G2) blunt trauma to the abdomen and chest, and (G3) traumatic brain injury...
September 2016: Revista do Colégio Brasileiro de Cirurgiões
https://www.readbyqxmd.com/read/27979598/how-successful-is-the-transition-to-adult-urology-care-in-spina-bifida-a-single-center-7-year-experience
#17
Konrad M Szymanski, Mark P Cain, Thomas J Hardacker, Rosalia Misseri
INTRODUCTION: Rates of successful transition from adolescent to adult spina bifida (SB) care are unknown. OBJECTIVE: We aimed to assess rates and predictors of successful transition from a multidisciplinary SB clinic to a transitional urology clinic (TUC), or a pediatric or adult urologist. STUDY DESIGN: We retrospectively reviewed patients discharged from a multidisciplinary SB clinic (2006-2012), collecting demographic and clinical data...
November 9, 2016: Journal of Pediatric Urology
https://www.readbyqxmd.com/read/27968771/treatment-of-acute-cardiac-failure-in-the-emergency-department-improve-our-practices-data-from-the-resurcor-network
#18
L Belle, G Courtiol, L Lamboley, P Debax, P Pili, G Deschane, M Latappy, J Oberlin, A Drouet, C Ricard, C Morvan, F-X Ageron
BACKGROUND: In 2015, the European Society of cardiology published guidelines on the pre-hospital and early hospital management of acute cardiac failure (ACF), which included: - use of intravenous vasodilators (nitrates) when systolic blood pressure is>110mmHg; - non-invasive ventilation if oxygen saturation is<90% and/or respiratory rate is>25/min despite nasal oxygen; - using a reduced dose of intravenous furosemide (20-40mg or equivalent of the oral morning dose if already on chronic diuretic therapy) and; - early performance of echocardiography...
November 2016: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/27955855/-analysis-of-population-characteristics-of-infants-affected-by-necrotizing-enterocolitis-in-a-tertiary-centre-in-the-last-12-years
#19
Miriam García-González, Salvador Pita-Fernández, Jesús Caramés-Bouzán
BACKGROUND: Necrotizing enterocolitis is the most lethal gastrointestinal emergency in the neonatal period. Incidence and mortality have remained stable in recent years despite advances in neonatal intensive care. The aim of this study is to show the general characteristics of patients diagnosed with necrotizing enterocolitis at Teresa Herrera's Hospital (La Coruna, Spain) in the last 12years. MATERIAL AND METHODS: This study makes a retrospective and prospective descriptive analysis, evaluating the medical records and collecting radiological demographic variables, gestational data, perinatal history, clinical, analytical and perinatal therapeutic management and events in patients diagnosed with and treated for necrotizing enterocolitis between 2003 and 2015...
December 9, 2016: Cirugia y Cirujanos
https://www.readbyqxmd.com/read/27942002/the-impact-of-adding-a-physician-assistant-to-a-critical-care-outreach-team
#20
Hayley B Gershengorn, Yunchao Xu, Carri W Chan, Mor Armony, Michelle N Gong
RATIONALE: Hospitals are increasingly using critical care outreach teams (CCOTs) to respond to patients deteriorating outside intensive care units (ICUs). CCOT staffing is variable across hospitals and optimal team composition is unknown. OBJECTIVES: To assess whether adding a critical care medicine trained physician assistant (CCM-PA) to a critical care outreach team (CCOT) impacts clinical and process outcomes. METHODS: We performed a retrospective study of two cohorts-one with a CCM-PA added to the CCOT (intervention hospital) and one with no staffing change (control hospital)-at two facilities in the same system...
2016: PloS One
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