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Pre-hospital emergency care

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https://www.readbyqxmd.com/read/29236303/impact-of-antimicrobial-stewardship-program-on-hospitalized-patients-at-the-intensive-care-unit-a-prospective-audit-and-feedback-study
#1
Maher R Khdour, Hussein O Hallak, Mamoon Al-Deyab, Mowafq A Nasif, Aliaa M Khalili, Ahamad A Dallashi, Mohammad B Khofash, Michael G Scott
AIMS: Inappropriate use of antibiotics is one of the most important factors contributing to the emergence of drug resistant pathogens. The purpose of this study was to measure the clinical impact of Antimicrobial Stewardship Program (ASP) interventions on hospitalized patients at the Intensive care unit at Palestinian Medical Complex. METHODS: A prospective audit with intervention and feedback by ASP team within 48-72h of antibiotic administration began in Sep, 2015...
December 13, 2017: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29228010/nasal-carriage-of-methicillin-resistant-staphylococcus-aureus-mrsa-at-a-palliative-care-unit-a-prospective-single-service-analysis
#2
Maria Heckel, Walter Geißdörfer, Franziska A Herbst, Stephanie Stiel, Christoph Ostgathe, Christian Bogdan
BACKGROUND: The emergence of multidrug-resistant bacterial microorganisms is a particular challenge for the health care systems. Little is known about the occurrence of methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant Gram-negative bacteria (MDRGNB) in patients of palliative care units (PCU). AIM: The primary aim of this study was to determine the carriage of MRSA among patients of a PCU at a German University Hospital and to assess whether the positive cases would have been detected by a risk-factor-based screening-approach...
2017: PloS One
https://www.readbyqxmd.com/read/29226815/integrative-assessment-of-congestion-in%C3%A2-heart-failure-throughout-the-patient%C3%A2-journey
#3
REVIEW
Nicolas Girerd, Marie-France Seronde, Stefano Coiro, Tahar Chouihed, Pascal Bilbault, François Braun, David Kenizou, Bruno Maillier, Pierre Nazeyrollas, Gérard Roul, Ludivine Fillieux, William T Abraham, James Januzzi, Laurent Sebbag, Faiez Zannad, Alexandre Mebazaa, Patrick Rossignol
Congestion is one of the main predictors of poor patient outcome in patients with heart failure. However, congestion is difficult to assess, especially when symptoms are mild. Although numerous clinical scores, imaging tools, and biological tests are available to assist physicians in ascertaining and quantifying congestion, not all are appropriate for use in all stages of patient management. In recent years, multidisciplinary management in the community has become increasingly important to prevent heart failure hospitalizations...
November 27, 2017: JACC. Heart Failure
https://www.readbyqxmd.com/read/29224789/pediatric-surgical-capacity-building-a-pathway-to-improving-access-to-pediatric-surgical-care-in-haiti
#4
Neema Kaseje, Hillary Jenny, Andre Patrick Jeudy, Jean Louis MacLee, John G Meara, Henri R Ford
PURPOSE: Lack of human resources is a major barrier to accessing pediatric surgical care globally. Our aim was to establish a model for pediatric surgical training of general surgery residents in a resource constrained region. MATERIALS/METHODS: A pediatric surgical program with a pediatric surgical rotation for general surgery residents in a tertiary hospital in Haiti in 2015 was established. We conducted twice daily patient rounds, ran an outpatient clinic, and provided emergent and elective pediatric surgical care, with tasks progressively given to residents until they could run clinic and perform the most common elective and emergent procedures...
November 16, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29218822/european-academy-of-neurology-european-stroke-organisation-consensus-statement-and-practical-guidance-for-pre-hospital-management-of-stroke
#5
A Kobayashi, A Czlonkowska, G A Ford, A C Fonseca, G J Luijckx, J Korv, N Pérez de la Ossa, C Price, D Russell, A Tsiskaridze, M Messmer-Wullen, J De Keyser
Reduction of delay between onset and hospital arrival and adequate pre-hospital care of persons with acute stroke are important for improving chances of a favorable outcome. The objective is to recommend evidence-based practices for the management of patients with suspected stroke in the pre-hospital setting. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to define the key clinical questions. An expert panel then reviewed the literature, established the quality of the evidence, and made recommendations...
December 7, 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/29215499/post-operative-emergency-department-utilization-and-hospital-readmission-after-cervical-spine-arthrodesis-rates-trends-causes-and-risk-factors
#6
Peter B Derman, Lukas P Lampe, Ting Jung Pan, Stephan N Salzmann, Janina Kueper, Federico P Girardi, Stephen Lyman, Alexander P Hughes
STUDY DESIGN: Retrospective state database analysis. OBJECTIVE: To quantify the 30-day and 90-day emergency department (ED) utilization and inpatient readmission rates after primary cervical arthrodesis, to stratify these findings by surgical approach and to describe risk factors and conditions precipitating these events. SUMMARY OF BACKGROUND DATA: Limited data exist on ED utilization and hospital readmission rates after cervical spine arthrodesis...
December 5, 2017: Spine
https://www.readbyqxmd.com/read/29212683/-hot-joints-infection-protocol-reduces-unnecessary-post-operative-re-admissions-following-total-hip-and-knee-arthroplasty
#7
J Dattilo, D Gittings, M Sloan, R Charette, E Hume, G-C Lee
AIMS: To evaluate the effectiveness of an institutionally developed algorithm for evaluation and diagnosis of prosthetic joint injection and to determine the impact of this protocol on overall hospital re-admissions.p PATIENTS AND METHODS: We retrospectively evaluated 2685 total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients prior to (1263) and following (1422) the introduction of an infection detection protocol. The protocol used conservative thresholds for C-reactive protein to direct the medical attendant to aspirate the joint...
December 2017: Bone & Joint Journal
https://www.readbyqxmd.com/read/29212452/the-effectiveness-of-physiologically-based-early-warning-or-track-and-trigger-systems-after-triage-in-adult-patients-presenting-to-emergency-departments-a-systematic-review
#8
Francesca Wuytack, Pauline Meskell, Aislinn Conway, Fiona McDaid, Nancy Santesso, Fergal G Hickey, Paddy Gillespie, Adam J N Raymakers, Valerie Smith, Declan Devane
BACKGROUND: Changes to physiological parameters precede deterioration of ill patients. Early warning and track and trigger systems (TTS) use routine physiological measurements with pre-specified thresholds to identify deteriorating patients and trigger appropriate and timely escalation of care. Patients presenting to the emergency department (ED) are undiagnosed, undifferentiated and of varying acuity, yet the effectiveness and cost-effectiveness of using early warning systems and TTS in this setting is unclear...
December 6, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/29211225/off-pump-versus-on-pump-coronary-artery-bypass-grafting-in-frail-patients-study-protocol-for-the-fragile-multicenter-randomized-controlled-trial
#9
Omar Asdrúbal Vilca Mejía, Michel Pompeu Barros Oliveira Sá, Maurilio Onofre Deininger, Luís Roberto Palma Dallan, Rodrigo Coelho Segalote, Marco Antonio Praça de Oliveira, Fernando Antibas Atik, Magaly Arrais Dos Santos, Pedro Gabriel Melo de Barros E Silva, Rodrigo Mussi Milani, Alexandre Ciappina Hueb, Rosangela Monteiro, Ricardo Carvalho Lima, Luiz Augusto Ferreira Lisboa, Luís Alberto Oliveira Dallan, John Puskas, Fabio Biscegli Jatene
INTRODUCTION: Advances in modern medicine have led to people living longer and healthier lives. Frailty is an emerging concept in medicine yet to be explored as a risk factor in cardiac surgery. When it comes to CABG surgery, randomized controlled clinical trials have primarily focused on low-risk (ROOBY, CORONARY), elevated-risk (GOPCABE) or high-risk patients (BBS), but not on frail patients. Therefore, we believe that off-pump CABG could be an important technique in patients with limited functional capacity to respond to surgical stress...
September 2017: Brazilian Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/29207756/intravenous-fluid-administration-and-the-survival-of-pre-hospital-resuscitated-out-of-hospital-cardiac-arrest-patients-in-thailand
#10
Phichet Nongchang, Wongsa Laohasiri Wong, Somsak Pitaksanurat, Pairoj Boonsirik Amchai
Introduction: Out of Hospital Cardiac Arrest (OHCA) is a leading cause of death worldwide. The Emergency Medical Service (EMS) provides early care to critical OHCA patients. Pre hospital intervention has been improving OHCA survival rate, however it is still unclear for the recommendation of routine infusion of Intravenous (IV) fluids during cardiac arrest resuscitation. Aim: This study aimed to determine whether IV fluid administration was associated with increasing survival of resuscitated OHCA patients and to assess the survival rate of resuscitated OHCA patients...
September 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/29203501/effect-of-a-newly-designed-observation-response-and-discharge-chart-in-the-post-anaesthesia-care-unit-on-patient-outcomes-a-quasi-expermental-study-in-australia
#11
Maryann Street, Nicole M Phillips, Mohammadreza Mohebbi, Bridie Kent
OBJECTIVES: This study aimed to evaluate whether use of a discharge criteria tool for nursing assessment of patients in Post Anaesthesia Care Unit (PACU) would enhance nurses' recognition and response to patients at-risk of deterioration and improve patient outcomes. METHODS: A prospective non-randomised pre-post intervention study was conducted in three hospitals in Australia. Participants were adults undergoing elective surgery before (n=723) and after (n=694) implementation of the Post-Anaesthetic Care Tool (PACT)...
December 3, 2017: BMJ Open
https://www.readbyqxmd.com/read/29193548/rephill-protocol-for-a-randomised-controlled-trial-of-pre-hospital-blood-product-resuscitation-for-trauma
#12
I M Smith, N Crombie, J R Bishop, A McLaughlin, D N Naumann, M Herbert, J M Hancox, G Slinn, N Ives, M Grant, G D Perkins, H Doughty, M J Midwinter
OBJECTIVES: To describe the 'Resuscitation with Pre-HospItaL bLood products' trial (RePHILL) - a multi-centre randomised controlled trial of pre-hospital blood product (PHBP) administration vs standard care for traumatic haemorrhage. BACKGROUND: PHBP are increasingly used for pre-hospital trauma resuscitation despite a lack of robust evidence demonstrating superiority over crystalloids. Provision of PHBP carries additional logistical and regulatory implications, and requires a sustainable supply of universal blood components...
November 28, 2017: Transfusion Medicine
https://www.readbyqxmd.com/read/29191378/patients-with-head-trauma-a-study-on-initial-prehospital-assessment-and-care
#13
Rebecka Rubenson Wahlin, Veronica Lindström, Sari Ponzer, Veronica Vicente
BACKGROUND: Best evidence guidelines are intended to standardise assessment and treatment of patients with head trauma and improve outcomes for TBI patients. The primary aim was to explore pre-hospital emergency care nurses' (PECNs') documented assessment and care of patients with head trauma and the secondary aim to study gender differences in the documented care and interventions given by the PECNs. METHODS: A retrospective observational study was conducted by evaluating 2750 prehospital medical records...
November 27, 2017: International Emergency Nursing
https://www.readbyqxmd.com/read/29190808/the-validity-of-linear-and-non-linear-heart-rate-metrics-as-workload-indicators-of-emergency-physicians
#14
Frederick Schneider, Jan Martin, Alexander Hapfelmeier, Denis Jordan, Gerhard Schneider, Christian M Schulz
BACKGROUND: It has been shown that linear and non-linear heart rate variability (HRV) metrics are suitable to assess workload of anesthetists administering anesthesia. In pre-hospital emergency care, these parameters have not yet been evaluated. We hypothesized that heart rate (HR) and HRV metrics discriminate between differing workload levels of an emergency physician. METHODS: Electrocardiograms were obtained from 13 emergency physicians. Mean HR, ten linear and seven non-linear HRV metrics were analyzed...
2017: PloS One
https://www.readbyqxmd.com/read/29182358/diabetes-care-improvement-in-pharmacist-versus-nurse-supported-patient-centered-medical-homes
#15
Lillian Min, Christine T Cigolle, Steven J Bernstein, Kathleen Ward, Tisha L Moore, Jinkyung Ha, Caroline S Blaum
OBJECTIVES: In 2009 and 2010, 17 primary care sites within 1 healthcare system became patient-centered medical homes (PCMHs), but the sites trained different personnel (pharmacists vs nurses) to improve diabetes care using self-management support (SMS). We report the challenges and successes of our efforts to: 1) assemble a new multipayer (Medicare, Medicaid, commercial) claims dataset linked to a clinical registry and 2) use the new dataset to perform comparative effectiveness research on implementation of the 2 SMS models...
November 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29175877/the-feasibility-of-an-interactive-voice-response-system-ivrs-for-monitoring-patient-safety-after-discharge-from-the-ed
#16
Lisa A Calder, A Adam Cwinn, Mathieu Gatien, Andrew Gee, Natasha Larocque, Samantha Calder-Sprackman, Ria De Gorter, Jennifer Zlepnig, Ian G Stiell, Alan J Forster
BACKGROUND: Return ED visits are frequent and may be due to adverse events: adverse outcomes related to healthcare received. An interactive voice response system (IVRS) is a technology that translates human telephone input into digital data. Use of IVRS has been explored in many healthcare settings but to a limited extent in the ED. We determined the feasibility of using an IVRS to assess for adverse events after ED discharge. METHODS: This before and after study assessed detection of adverse events among consecutive high-acuity patients discharged from a tertiary care ED pre-IVRS and post-IVRS over two 2-week periods...
November 24, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29170314/17%C3%A2-exploring-ambulance-conveyances-to-the-emergency-department-a-descriptive-analysis-of-non-urgent-transports
#17
Jamie Miles, Colin O'Keeffe, Richard Jacques, Tony Stone, Suzanne Mason
OBJECTIVES: An NHS England report highlighted key issues in how patients were initially navigating access to healthcare. This has manifested in increased pressure on ambulance services and emergency departments (EDs) to provide high quality, safe and efficient services to manage this demand. This study aims to identify non-urgent conveyances by ambulance services to the ED that would be suitable for care at scene or an alternative response. DESIGN: A retrospective analysis of emergency department data linked to initial pre-hospital call data (either '111' or '999') in 2014 in Yorkshire and Humber...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29169818/introduction-of-a-horizontal-and-vertical-split-flow-model-of-emergency-department-patients-as-a-response-to-overcrowding
#18
Gregory Wallingford, Nikita Joshi, Patrice Callagy, Jamie Stone, Ian Brown, Sam Shen
INTRODUCTION: ED overcrowding is an issue that is affecting every emergency department and every hospital. The inability to maintain patient flow into and out of the emergency department paralyzes the ability to provide effective and timely patient care. Many solutions have been proposed on how to mitigate the effects of ED overcrowding. Solutions involve either hospital-wide initiatives or ED-based solutions. In this article, the authors seek to describe and provide metrics for a patient flow methodology that targets ESI 3 patients in a vertical flow model...
November 20, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/29168319/hospital-based-routine-hiv-testing-in-high-income-countries-a-systematic-literature-review
#19
A Elgalib, S Fidler, K Sabapathy
OBJECTIVES: To produce a summary of the published evidence of the barriers and facilitators for hospital-based routine HIV testing in high-income countries. METHODS: Electronic databases were searched for studies, which described the offer of HIV testing to adults attending emergency departments (EDs) and acute medical units (AMUs) in the UK and US, published between 2006 and 2015. Other high-income countries were not included, as their guidelines do not recommend routine testing for HIV...
November 23, 2017: HIV Medicine
https://www.readbyqxmd.com/read/29166783/improving-asthma-related-outcomes-among-children-participating-in-the-head-off-environmental-asthma-in-louisiana-heal-phase-ii-study
#20
Kristi Isaac Rapp, Leonard Jack, Candice Wilson, Sandra Carr Hayes, Robert Post, Ellen McKnight, Floyd Malveaux
PURPOSE: Pediatric asthma disproportionately affects low-income and minority children. The HEAL (Head-Off Environmental Asthma in Louisiana), Phase II Project was a collaborative effort with a primary focus to improve pediatric asthma management in New Orleans, Louisiana. The purpose of this article is to report clinical outcomes captured at baseline and 12-month follow-up. METHOD: HEAL (Head-off Environmental Asthma in Louisiana), Phase II was a pre-post intervention study that enrolled children ages 2 to 18 years of age with a diagnosis of asthma to receive asthma education within the clinic setting...
November 1, 2017: Health Promotion Practice
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