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Emergency department observation unit

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https://www.readbyqxmd.com/read/28330420/arthroplasty-treatment-of-proximal-humerus-fractures-14-year-trends-in-the-united-states
#1
William W Schairer, Benedict U Nwachukwu, Stephen Lyman, Lawrence V Gulotta
OBJECTIVES: Proximal humerus fractures are a common injury in the elderly population that can usually be managed non-operatively. However, arthroplasty has become increasingly utilized for complex fractures and poor bone quality. We evaluated national trends in treatment, specifically looking at the adoption of reverse total shoulder arthroplasty. METHODS: The incidence of proximal humerus fractures was calculated from the Nationwide Emergency Department Database (NEDD) from 2006-2012...
March 22, 2017: Physician and Sportsmedicine
https://www.readbyqxmd.com/read/28321299/successful-emergency-department-interventions-that-reduce-time-to-antibiotics-in-febrile-pediatric-cancer-patients
#2
Sandra Spencer, MIchele Nypaver, Katherine Hebert, Christopher Benner, Rachel Stanley, Daniel Cohen, Alexander Rogers, Jason Goldstick, Prashant Mahajan
Children with cancer and fever are at high risk for sepsis related death. Rapid antibiotic delivery (< 60 minutes) has been shown to reduce mortality. We compared patient outcomes and describe interventions from three separate quality improvement (QI) projects conducted in three United States (US) tertiary care pediatric emergency departments (EDs) with the shared aim to reduce time to antibiotic (TTA) to < 60 minutes in febrile pediatric oncology patients (Temperature > 38.0 C). A secondary objective was to identify interventions amenable to translation to other centers...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28319006/high-rates-of-severe-hypoglycemia-among-african-american-patients-with-diabetes-the-surveillance-prevention-and-management-of-diabetes-mellitus-supreme-dm-network
#3
Andrew J Karter, Kasia J Lipska, Patrick J O'Connor, Jennifer Y Liu, Howard H Moffet, Emily B Schroeder, Jean M Lawrence, Gregory A Nichols, Katherine M Newton, Ram D Pathak, Jay Desai, Beth Waitzfelder, Melissa G Butler, Abraham Thomas, John F Steiner
AIMS: Seven-year surveillance study (2005-2011) to evaluate race/ethnic differences in the trends in rates of severe hypoglycemia (SH) in a population of insured, at-risk adults with diabetes. METHODS: SH events were identified via any primary or principal diagnosis from emergency department or inpatient encounters among African American, Asian, Latino and White adult diabetes patients treated with insulin or secretagogues (Sulfonylureas or Meglitinides), receiving care from integrated healthcare delivery systems across the United States...
February 21, 2017: Journal of Diabetes and its Complications
https://www.readbyqxmd.com/read/28314685/association-of-psoriasis-and-psoriatic-arthritis-with-osteoporosis-and-pathological-fractures
#4
Parul Kathuria, Kenneth B Gordon, Jonathan I Silverberg
BACKGROUND: Previous studies examining the relationship between psoriasis (Pso), osteoporosis, and pathological fractures found conflicting results. OBJECTIVE: To determine whether Pso and psoriatic arthritis (PsA) are associated with osteoporosis and fractures in US adults. METHODS: Cross-sectional study of 198,102,435 children and adults, including 183,725 with Pso and 28,765 with PsA from the 2006-2012 National Emergency Department Sample, including 20% of the emergency care visits throughout the United States...
March 14, 2017: Journal of the American Academy of Dermatology
https://www.readbyqxmd.com/read/28301451/traumatic-brain-injury-related-emergency-department-visits-hospitalizations-and-deaths-united-states-2007-and-2013
#5
Christopher A Taylor, Jeneita M Bell, Matthew J Breiding, Likang Xu
PROBLEM/CONDITION: Traumatic brain injury (TBI) has short- and long-term adverse clinical outcomes, including death and disability. TBI can be caused by a number of principal mechanisms, including motor-vehicle crashes, falls, and assaults. This report describes the estimated incidence of TBI-related emergency department (ED) visits, hospitalizations, and deaths during 2013 and makes comparisons to similar estimates from 2007. REPORTING PERIOD: 2007 and 2013. DESCRIPTION OF SYSTEM: State-based administrative health care data were used to calculate estimates of TBI-related ED visits and hospitalizations by principal mechanism of injury, age group, sex, and injury intent...
March 17, 2017: MMWR. Surveillance Summaries: Morbidity and Mortality Weekly Report. Surveillance Summaries
https://www.readbyqxmd.com/read/28293768/the-utility-of-a-medical-admissions-pharmacist-in-a-hospital-in-australia
#6
Sally B Marotti, Rachael May Theng Cheh, Anne Ponniah, Helen Phuong
Background Medication-related hospital admissions in Australia have previously been estimated to account for approximately 3% of all hospital admissions, with hospital entry points being a point of vulnerability. The timely medication review and reconciliation by a pharmacist at the early stage of an admission for patients admitted to the Acute Medical Unit (AMU) would be beneficial. Setting The Emergency Department (ED) and AMU in a 300 bed tertiary teaching hospital, in South Australia. Objective To investigate the impact of a Medical Admissions (MA) pharmacist on the proportion of AMU patients who receive a complete and accurate medication history by a pharmacist prior to admission and within 4 h of presentation...
March 15, 2017: International Journal of Clinical Pharmacy
https://www.readbyqxmd.com/read/28290956/multidisciplinary-in-situ-simulation-based-training-as-a-postpartum-hemorrhage-quality-improvement-project
#7
Monica A Lutgendorf, Carmen Spalding, Elizabeth Drake, Dennis Spence, Jason O Heaton, Kristina V Morocco
BACKGROUND: Postpartum hemorrhage is a common obstetric emergency affecting 3 to 5% of deliveries, with significant maternal morbidity and mortality. Effective management of postpartum hemorrhage requires strong teamwork and collaboration. We completed a multidisciplinary in situ postpartum hemorrhage simulation training exercise with structured team debriefing to evaluate hospital protocols, team performance, operational readiness, and real-time identification of system improvements...
March 2017: Military Medicine
https://www.readbyqxmd.com/read/28285117/acute-heart-failure-alternatives-to-hospitalization
#8
REVIEW
Reka Zsilinszka, Robert J Mentz, Adam D DeVore, Zubin J Eapen, Peter S Pang, Adrian F Hernandez
Acute heart failure (HF) is a major public health problem with substantial associated economic costs. Because most patients who present to hospitals are admitted irrespective of their level of risk, novel approaches to manage acute HF are needed, such as the use of same-day access clinics for outpatient diuresis and observation units from the emergency department. Current published data lacks a comprehensive overview of the present state of acute HF management in various clinical settings. This review summarizes the strengths and limitations of acute HF care in the outpatient and emergency department settings...
March 4, 2017: JACC. Heart Failure
https://www.readbyqxmd.com/read/28285032/the-association-between-physician-turnover-the-july-effect-and-survival-after-in-hospital-cardiac-arrest
#9
Laura Myers, Bassem Mikhael, Paul Currier, Katherine Berg, Anupam Jena, Michael Donnino, Lars W Andersen
IMPORTANCE: The July Effect refers to adverse outcomes that occur as a result of turnover of the physician workforce in teaching hospitals during the month of June. OBJECTIVE: As a surrogate for physician turnover, we used a multivariable difference-in-difference approach to determine if there was a difference in outcomes between May and July in teaching versus non-teaching hospitals. DESIGN: We used prospectively collected observational data from United States hospitals participating in the Get With The Guidelines(®)-Resuscitation registry...
March 8, 2017: Resuscitation
https://www.readbyqxmd.com/read/28265287/pernicious-anemia-associated-cobalamin-deficiency-and-thrombotic-microangiopathy-case-report-and-review-of-the-literature
#10
Farhanah Yousaf, Bruce Spinowitz, Chaim Charytan, Marilyn Galler
A 43-year-old Hispanic male without significant previous medical history was brought to emergency department for syncope following a blood draw to investigate a 40 lbs weight loss during the past 6 months associated with decreased appetite and progressive fatigue. The patient also reported a 1-month history of jaundice. On examination, he was hemodynamically stable and afebrile with pallor and diffuse jaundice but without skin rash or palpable purpura. Normal sensations and power in all extremities were evident on neurological exam...
2017: Case Reports in Medicine
https://www.readbyqxmd.com/read/28261908/acute-coronary-syndrome-screening-and-diagnostic-practice-variation
#11
Maame Yaa A B Maya Yiadom, Xulei Liu, Conor M McWade, Dandan Liu, Alan B Storrow
BACKGROUND: In the absence of the existing acute coronary syndrome guidelines directing the clinical practice implementation of ED screening and diagnosis, there is variable screening and diagnostic clinical practice across ED facilities. This practice diversity may be warranted. Understanding the variability may identify opportunities for more consistent practice. METHODS: This is a cross-sectional clinical practice epidemiology study with the emergency department (ED) as the unit of analysis characterizing variability in the acute coronary syndrome (ACS) evaluation across 62 diverse EDs...
March 6, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28257538/multidisciplinary-approach-to-complicated-pregnancy
#12
Josip Andelo Borovac, Josko Bozic, Tina Ticinovic Kurir, Nikola Zaja, Kresimir Kolic, Vedran Hrboka
A nulliparous pregnant woman in her mid-20s and in the 32nd week of gestation presented to the emergency department with severe headache and vomiting. She had an uneventful medical history; however, the physical examination upon hospital admission revealed a hypertensive emergency, papilledema, and 2+ dipstick proteinuria. Upon establishing the diagnosis of preeclampsia, aggressive therapy with corticosteroids, antihypertensive medication, and seizure prophylaxis was initiated. Hemodynamic stability was achieved within 24 hours and the patient remained in the observation unit located within the gynecology clinic...
March 2017: Southern Medical Journal
https://www.readbyqxmd.com/read/28257335/serial-procalcitonin-predicts-mortality-in-severe-sepsis-patients-results-from-the-multicenter-procalcitonin-monitoring-sepsis-moses-study
#13
Philipp Schuetz, Robert Birkhahn, Robert Sherwin, Alan E Jones, Adam Singer, Jeffrey A Kline, Michael S Runyon, Wesley H Self, D Mark Courtney, Richard M Nowak, David F Gaieski, Stefan Ebmeyer, Sascha Johannes, Jan C Wiemer, Andrej Schwabe, Nathan I Shapiro
OBJECTIVES: To prospectively validate that the inability to decrease procalcitonin levels by more than 80% between baseline and day 4 is associated with increased 28-day all-cause mortality in a large sepsis patient population recruited across the United States. DESIGN: Blinded, prospective multicenter observational clinical trial following an Food and Drug Administration-approved protocol. SETTING: Thirteen U.S.-based emergency departments and ICUs...
March 2, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28243009/predictors-for-critical-care-admission-among-children-presenting-to-emergency-department-with-recurrent-wheezing
#14
Aman Saini, Jaya Shankar Kaushik, Vandana Arya, Geeta Gathwala
CONTEXT: Children with recurrent wheezing contribute to a significant burden of inpatient hospital admission in developing countries. However, many patients could be managed at home following a short observation period in emergency unit. AIM: This study aimed to determine the predictors of critical care admission in a population of children aged 6 months to 2 years attending pediatric emergency department (ED) for recurrent wheezing. SETTING AND DESIGN: This is a case-control study conducted in pediatric ED of a tertiary care center in North India...
January 2017: Journal of Emergencies, Trauma, and Shock
https://www.readbyqxmd.com/read/28241903/adult-epiglottitis-a-case-series
#15
Benjamin Lindquist, Sybil Zachariah, Anita Kulkarni
INTRODUCTION: Emergency Departments are inundated by patients with respiratory illness during the winter months. Emergency physicians are required to quickly identify critically ill patients among the large volume of patients with mild upper respiratory illness. Among these life-threatening conditions is acute epiglottitis. CASE PRESENTATION: We report a rare series of four adult patients who presented to our Emergency Department during a period of only one week in April 2015 and were ultimately diagnosed with acute epiglottitis...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28236513/remote-management-of-low-to-intermediate-risk-chest-pain-a-case-series
#16
Alexander Chiu, Kathleen Shumaker, Christopher Del Corral, Blessy George, Michael Kasper, Marie-Carmelle Elie, Preeti Jois, Daniel Dipsia, Adam Ash
We report a case series of three low to intermediate risk chest pain patients who presented to the emergency department and were managed as outpatients via the Cellular Outpatient Twelve-Lead Telemetry with Emergency Response (COTTER™). This technology allows for certain chest pain patients to be managed remotely via telemedicine while receiving care comparable to that which would be available in a hospital or chest pain observation unit.
February 16, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28225541/perceived-barriers-to-adherence-to-tuberculosis-infection-control-measures-among-health-care-workers-in-the-dominican-republic
#17
Helena J Chapman, Bienvenido A Veras-Estévez, Jamie L Pomeranz, Eddy N Pérez-Then, Belkys Marcelino, Michael Lauzardo
INTRODUCTION Health care workers have an increased risk of infection due to occupational Mycobacterium tuberculosis exposure, including multidrug-resistant strains. Health care workers' risk of developing tuberculosis is greater than that of the general population, whether in low-, intermediate- or high-incidence countries. Adherence to infection control measures (administrative controls, environmental controls, and personal respiratory protection) is essential to reduce risk of disease transmission between suspected tuberculosis patients and health care workers, but for different reasons, both objective and subjective, adherence is low...
January 2017: MEDICC Review
https://www.readbyqxmd.com/read/28211266/-non-febrile-syndromes-in-the-traveler-returning-from-tropical-regions-admitted-in-a-monographic-unit
#18
A Anula-Morales, B Martin-Giner, M Hernández-Cabrera, C Carranza-Rodríguez, E Pisos-Álamo, N Jaén-Sánchez, J L Pérez-Arellano
OBJECTIVE: The aim was to analyse those syndromes without fever in travellers who return from tropical regions evaluated at our Department of Infectology and Tropical Medicine. Clarifying these conditions intends to reach earlier diagnoses and, perhaps, to avoid the emergence and spread of imported diseases, as well as to establish appropriate preventive measures. METHODS: An observational descriptive transversal study was performed, selecting those patients who returned from tropical regions without fever (n = 281), amongst all travellers evaluated in our department between 1998 and 2013...
February 17, 2017: Revista Española de Quimioterapia: Publicación Oficial de la Sociedad Española de Quimioterapia
https://www.readbyqxmd.com/read/28210835/a-10-year-review-of-cannabis-exposure-in-children-under-3-years-of-age-do-we-need-a-more-global-approach
#19
Isabelle Claudet, Mathilde Le Breton, Camille Bréhin, Nicolas Franchitto
Pediatricians working in an emergency environment are confronted with children admitted to emergency departments for intoxication on a daily basis. We carried out a retrospective cohort study of children admitted to a pediatric emergency department due to unintentional cannabis exposure over a 10-year period from 2004 to 2014. Twenty-nine children under the age of 3 were admitted with a positive cannabis urine test. Eighty-seven percent of intoxications occurred at the family home. Resin was the main form of ingested cannabis (69%)...
April 2017: European Journal of Pediatrics
https://www.readbyqxmd.com/read/28210350/use-of-physician-in-triage-model-in-the-management-of-abdominal-pain-in-an-emergency-department-observation-unit
#20
John R Marshall, Robert Katzer, Shahram Lotfipour, Bharath Chakravarthy, Siri Shastry, Jessica Andrusaitis, Craig L Anderson, Erik D Barton
INTRODUCTION: Given the nationwide increase in emergency department (ED) visits it is of paramount importance for hospitals to find efficient ways to manage patient flow. The purpose of this study was to determine whether there is a significant difference in success rates, length of stay (LOS), and other demographic factors in two cohorts of patients admitted directly to an ED observation unit (EDOU) under an abdominal pain protocol by a physician in triage (bypassing the main ED) versus those admitted via the traditional pathway (evaluated and treated in the main ED prior to EDOU admission)...
February 2017: Western Journal of Emergency Medicine
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