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https://www.readbyqxmd.com/read/28650904/pediatric-procedural-sedation-using-the-combination-of-ketamine-and-propofol-outside-of-the-emergency-department-a-report-from-the-pediatric-sedation-research-consortium
#1
Jocelyn R Grunwell, Curtis Travers, Anne G Stormorken, Patricia D Scherrer, Corrie E Chumpitazi, Jana A Stockwell, Mark G Roback, Joseph Cravero, Pradip P Kamat
OBJECTIVES: Outcomes associated with a sedative regimen comprised ketamine + propofol for pediatric procedural sedation outside of both the pediatric emergency department and operating room are underreported. We used the Pediatric Sedation Research Consortium database to describe a multicenter experience with ketamine + propofol by pediatric sedation providers. DESIGN: Prospective observational study of children receiving IV ketamine + propofol for procedural sedation outside of the operating room and emergency department using data abstracted from the Pediatric Sedation Research Consortium during 2007-2015...
August 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28637569/assessing-field-triage-decisions-and-the-international-classification-injury-severity-score-iciss-at-predicting-outcomes-of-trauma-patients
#2
Casey J Allen, Daniel J Baldor, Carl I Schulman, Louis R Pizano, Alan S Livingstone, Nicholas Namias
Florida considers the International Classification Injury Severity Score (ICISS) from hospital discharges within a geographic region in the apportionment of trauma centers (TCs). Patients with an ICISS <0.85 are considered to require triage to a TC, yet many are triaged to an emergency department (ED). We assess outcomes of those with an ICISS <0.85 by the actual triage decision of emergency medical services (EMS). From October 2011 to October 2013, 39,021 consecutive admissions with injury ICD-9 codes were analyzed...
June 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28209195/qualitative-exploration-of-why-people-repeatedly-attend-emergency-departments-for-alcohol-related-reasons
#3
Tom Parkman, Joanne Neale, Ed Day, Colin Drummond
BACKGROUND: Understanding why people repeatedly attend Emergency Departments (EDs) for alcohol-related reasons is an important prerequisite to identifying ways of reducing any unnecessary demands on hospital resources. We use Andersen's Behavioural Model of Health Services Use to explore factors that contributed to repeat ED attendances. METHODS: Qualitative interviews were conducted with 30 people who repeatedly attended EDs for alcohol-related reasons (≥10 attendances in the past 12 months)...
February 16, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28108581/reduced-emergency-department-utilization-by-patients-with-epilepsy-using-qi-methodology
#4
Anup D Patel, Eric G Wood, Daniel M Cohen
BACKGROUND: Epilepsy or seizure care is the most common neurologic condition that presents to an emergency department (ED) and accounts for a large number of annual cases. Our aim was to decrease seizure-related ED visits from our baseline of 17 ED visits per month per 1000 patients to 13.6 ED visits per month per 1000 patients (20%) by July 2014. METHODS: Our strategy was to develop a quality improvement (QI) project utilizing the Institute for Healthcare Improvement model...
February 2017: Pediatrics
https://www.readbyqxmd.com/read/27908594/rucaparib-in-relapsed-platinum-sensitive-high-grade-ovarian-carcinoma-ariel2-part-1-an-international-multicentre-open-label-phase-2-trial
#5
MULTICENTER STUDY
Elizabeth M Swisher, Kevin K Lin, Amit M Oza, Clare L Scott, Heidi Giordano, James Sun, Gottfried E Konecny, Robert L Coleman, Anna V Tinker, David M O'Malley, Rebecca S Kristeleit, Ling Ma, Katherine M Bell-McGuinn, James D Brenton, Janiel M Cragun, Ana Oaknin, Isabelle Ray-Coquard, Maria I Harrell, Elaina Mann, Scott H Kaufmann, Anne Floquet, Alexandra Leary, Thomas C Harding, Sandra Goble, Lara Maloney, Jeff Isaacson, Andrew R Allen, Lindsey Rolfe, Roman Yelensky, Mitch Raponi, Iain A McNeish
BACKGROUND: Poly(ADP-ribose) polymerase (PARP) inhibitors have activity in ovarian carcinomas with homologous recombination deficiency. Along with BRCA1 and BRCA2 (BRCA) mutations genomic loss of heterozygosity (LOH) might also represent homologous recombination deficiency. In ARIEL2, we assessed the ability of tumour genomic LOH, quantified with a next-generation sequencing assay, to predict response to rucaparib, an oral PARP inhibitor. METHODS: ARIEL2 is an international, multicentre, two-part, phase 2, open-label study done at 49 hospitals and cancer centres in Australia, Canada, France, Spain, the UK, and the USA...
January 2017: Lancet Oncology
https://www.readbyqxmd.com/read/27505716/procedural-sedation-outside-of-the-operating-room-using-ketamine-in-22-645-children-a-report-from-the-pediatric-sedation-research-consortium
#6
Jocelyn R Grunwell, Curtis Travers, Courtney E McCracken, Patricia D Scherrer, Anne G Stormorken, Corrie E Chumpitazi, Mark G Roback, Jana A Stockwell, Pradip P Kamat
OBJECTIVE: Most studies of ketamine administered to children for procedural sedation are limited to emergency department use. The objective of this study was to describe the practice of ketamine procedural sedation outside of the operating room and identify risk factors for adverse events. DESIGN: Observational cohort review of data prospectively collected from 2007 to 2015 from the multicenter Pediatric Sedation Research Consortium. SETTING: Sedation services from academic, community, free-standing children's hospitals and pediatric wards within general hospitals...
December 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27503190/a-survey-of-graduates-of-combined-emergency-medicine-pediatrics-residency-programs-an-update
#7
Ashley M Strobel, Rose M Chasm, Dale P Woolridge
BACKGROUND: In 1998, emergency medicine-pediatrics (EM-PEDS) graduates were no longer eligible for the pediatric emergency medicine (PEM) sub-board certification examination. There is a paucity of guidance regarding the various training options for medical students who are interested in PEM. OBJECTIVES: We sought to to determine attitudes and personal satisfaction of graduates from EM-PEDS combined training programs. METHODS: We surveyed 71 graduates from three EM-PEDS residences in the United States...
October 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27343485/the-association-between-physician-empathy-and-variation-in-imaging-use
#8
Edward R Melnick, Elizabeth G J O'Brien, Olga Kovalerchik, William Fleischman, Arjun K Venkatesh, R Andrew Taylor
BACKGROUND: Variation in emergency physician computed tomography (CT) imaging utilization is well described, but little is known about what drives it. Physician empathy has been proposed as a potential characteristic affecting CT utilization. OBJECTIVES: The objective was to describe empathy in a cohort of emergency physicians and evaluate its association with CT utilization. We also sought to compare emergency physician performance on an empathy psychometric test with performance on other psychometric tests previously proposed as predictors of CT utilization...
August 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27279218/strongly-correlated-perovskite-fuel-cells
#9
You Zhou, Xiaofei Guan, Hua Zhou, Koushik Ramadoss, Suhare Adam, Huajun Liu, Sungsik Lee, Jian Shi, Masaru Tsuchiya, Dillon D Fong, Shriram Ramanathan
Fuel cells convert chemical energy directly into electrical energy with high efficiencies and environmental benefits, as compared with traditional heat engines. Yttria-stabilized zirconia is perhaps the material with the most potential as an electrolyte in solid oxide fuel cells (SOFCs), owing to its stability and near-unity ionic transference number. Although there exist materials with superior ionic conductivity, they are often limited by their ability to suppress electronic leakage when exposed to the reducing environment at the fuel interface...
June 9, 2016: Nature
https://www.readbyqxmd.com/read/27111928/analysis-of-the-community-benefit-standard-in-texas-hospitals
#10
James Corbett Worthy, Cheryl L Anderson
The federal government provides special tax-exemption status, known as the community benefit standard, to some nonprofit hospitals. It is not known if hospitals that claim the community benefit standard provide more or different services from those provided by hospitals that do not claim the community benefit status. Guided by the socioecological model, this quantitative study investigated 95 hospitals serving 52 counties in South Texas--43 that claimed a community benefit and 52 that did not. The independent variables were hospitals that claimed the community benefit standard versus hospitals that did not...
March 2016: Journal of Healthcare Management / American College of Healthcare Executives
https://www.readbyqxmd.com/read/27043094/use-of-simulation-to-gauge-preparedness-for-ebola-at-a-free-standing-children-s-hospital
#11
Elizabeth A Biddell, Brian L Vandersall, Stephanie A Bailes, Stephanie A Estephan, Lori A Ferrara, Kristine M Nagy, Joyce L O'Connell, Mary D Patterson
On October 10, 2014, a health care worker exposed to Ebola traveled to Akron, OH, where she became symptomatic. The resulting local public health agencies and health care organization response was unequalled in our region. The day this information was announced, the emergency disaster response was activated at our hospital. The simulation center had 12 hours to prepare simulations to evaluate hospital preparedness should a patient screen positive for Ebola exposure. The team developed hybrid simulation scenarios using standardized patients, mannequin simulators, and task trainers to assess hospital preparedness in the emergency department, transport team, pediatric intensive care unit, and for interdepartmental transfers...
April 2016: Simulation in Healthcare: Journal of the Society for Simulation in Healthcare
https://www.readbyqxmd.com/read/26915058/postoperative-complications-in-pediatric-tonsillectomy-and-adenoidectomy-in-ambulatory-vs-inpatient-settings
#12
MULTICENTER STUDY
Misha Amoils, Kay W Chang, Olga Saynina, Paul H Wise, Anita Honkanen
IMPORTANCE: A large-scale review is needed to characterize the rates of airway, respiratory, and cardiovascular complications after pediatric tonsillectomy and adenoidectomy (T&A) for inpatient and ambulatory cohorts. OBJECTIVE: To identify risk factors for postoperative complications stratified by age and operative facility type among children undergoing T&A. DESIGN, SETTING, AND PARTICIPANTS: This retrospective review included 115,214 children undergoing T&A in hospitals, hospital-based facilities (HBF), and free-standing facilities (FSF) in California from January 1, 2005, to December 31, 2010...
April 2016: JAMA Otolaryngology—Head & Neck Surgery
https://www.readbyqxmd.com/read/26709584/the-relationship-between-sleep-wake-cycle-disturbance-and-trajectory-of-cognitive-recovery-during-acute-traumatic-brain-injury
#13
Erin M Holcomb, Stephanie Towns, Joel E Kamper, Scott D Barnett, Mark Sherer, Clea Evans, Risa Nakase-Richardson
OBJECTIVE: Following traumatic brain injury, both sleep dysfunction and cognitive impairment are common. Unfortunately, little is known regarding the potential associations between these 2 symptoms during acute recovery. This study sought to prospectively examine the relationship between ratings of sleep dysfunction and serial cognitive assessments among traumatic brain injury acute neurorehabilitation admissions. METHODS: Participants were consecutive admissions to a free-standing rehabilitation hospital following moderate to severe traumatic brain injury (Median Emergency Department Glasgow Coma Scale = 7)...
March 2016: Journal of Head Trauma Rehabilitation
https://www.readbyqxmd.com/read/26654317/an-assessment-of-emergency-department-post-cardiac-arrest-care-variation-in-michigan
#14
Pavitra Kotini-Shah, Teresa R Camp-Rogers, Robert A Swor, Kelly N Sawyer
Implementation of postarrest care by individual physicians and systems has been slow. Deadoption, or discontinuation of therapeutic hypothermia (TH) treatment targets, after recent prospective study results has not been well reported. This study assesses practices in the early stages of postarrest care across emergency departments (EDs) in Michigan. A 27-question Internet-based survey was distributed to EDs in Michigan in September 2013. To assess changes in practice after publication of Nielsen et al., we sent follow-up questions to all original respondents a year later...
March 2016: Therapeutic Hypothermia and Temperature Management
https://www.readbyqxmd.com/read/26477440/novel-emergency-department-registration-kiosk-for-hiv-screening-is-cost-effective
#15
Yu-Hsiang Hsieh, David R Holtgrave, Stephen Peterson, Charlotte A Gaydos, Richard E Rothman
High operating costs challenge sustainability of successful US emergency department (ED) HIV screening programs. Free-standing registration kiosks could potentially reduce the marginal costs of ED HIV screening. We investigated incremental cost-effectiveness ratio (CER) per new HIV diagnosis for a kiosk-based approach for offering screening at ED registration versus a testing staff-based approach to offer testing at the bedside. A rapid oral-fluid HIV screening program, instituted in a US ED since 2005, had a rate of new HIV diagnosis 0...
2016: AIDS Care
https://www.readbyqxmd.com/read/26452704/variability-in-the-structure-and-care-processes-for-critically-injured-children-a-multicenter-survey-of-trauma-bay-and-intensive-care-units
#16
MULTICENTER STUDY
Katherine T Flynn-O'Brien, Leah L Thompson, Christine M Gall, Mary E Fallat, Tom B Rice, Frederick P Rivara
PURPOSE: Evaluate national variation in structure and care processes for critically injured children. METHODS: Institutions with pediatric intensive care units (PICUs) that treat trauma patients were identified through the Virtual Pediatric Systems (n=72). Prospective survey data were obtained from PICU and Trauma Directors (n=69, 96% response). Inquiries related to structure and care processes in the PICU and emergency department included infrastructure, physician staffing, team composition, decision making, and protocol/checklist use...
March 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/26221786/using-a-multimedia-presentation-to-enhance-informed-consent-in-a-pediatric-emergency-department
#17
RANDOMIZED CONTROLLED TRIAL
Sandra P Spencer, Michael J Stoner, Kelly Kelleher, Daniel M Cohen
BACKGROUND: Informed consent is an ethical process for ensuring patient autonomy. Multimedia presentations (MMPs) often aid the informed consent process for research studies. Thus, it follows that MMPs would improve informed consent in clinical settings. OBJECTIVE: The aim of this study was to determine if an MMP for the informed consent process for ketamine sedation improves parental satisfaction and comprehension as compared with standard practice. METHODS: This 2-phase study compared 2 methods of informed consent for ketamine sedation of pediatric patients...
August 2015: Pediatric Emergency Care
https://www.readbyqxmd.com/read/25834965/practices-beliefs-and-perceived-barriers-to-adolescent-human-immunodeficiency-virus-screening-in-the-emergency-department
#18
Avani S Mehta, Monika K Goyal, Nadia Dowshen, Rakesh D Mistry
OBJECTIVE: Limited data exist regarding knowledge of and compliance to the Centers for Disease Control and Prevention's universal adolescent human immunodeficiency virus (HIV) screening recommendations. Our objective was to assess current guideline knowledge, practice, and perceived barriers to emergency department (ED)-based adolescent HIV screening. METHODS: We administered an anonymous Web-based cross-sectional survey from May 1, 2012, to June 30, 2012, to 1073 physicians from the American Academy of Pediatrics Section on Emergency Medicine LISTSERV...
September 2015: Pediatric Emergency Care
https://www.readbyqxmd.com/read/25778743/the-prevalence-and-diagnostic-utility-of-systemic-inflammatory-response-syndrome-vital-signs-in-a-pediatric-emergency-department
#19
Halden F Scott, Sara J Deakyne, Jason M Woods, Lalit Bajaj
OBJECTIVES: This study sought to determine the prevalence, test characteristics, and severity of illness of pediatric patients with systemic inflammatory response syndrome (SIRS) vital signs among pediatric emergency department (ED) visits. METHODS: This was a retrospective descriptive cohort study of all visits to the ED of a tertiary academic free-standing pediatric hospital over 1 year. Visits were included if the patient was <18 years of age and did not leave before full evaluation or against medical advice...
April 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/25755175/observation-status-patients-in-children-s-hospitals-with-and-without-dedicated-observation-units-in-2011
#20
Michelle L Macy, Matthew Hall, Elizabeth R Alpern, Evan S Fieldston, Leticia A Shanley, Carla Hronek, Paul D Hain, Samir S Shah
BACKGROUND: Pediatric observation units (OUs) have demonstrated reductions in lengths of stay (LOS) and costs of care. Hospital-level outcomes across all observation-status stays have not been evaluated in relation to the presence of a dedicated OU in the hospital. OBJECTIVE: To compare observation-status stay outcomes in hospitals with and without a dedicated OU. DESIGN: Cross-sectional analysis of hospital administrative data. METHODS: Observation-status stay outcomes were compared in hospitals with and without a dedicated OU across 4 categories: (1) LOS, (2) standardized costs, (3) conversion to inpatient status, and (4) return care...
June 2015: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
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