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Emerency Medical Services

Richard H Lee, Richard Sloane, Carl Pieper, Kenneth W Lyles, Robert A Adler, Courtney Van Houtven, Joanne LaFleur, Cathleen Colón-Emeric
Introduction: Type 2 diabetes mellitus among older women has been associated with increased bone mineral density, but paradoxically with increased fracture risk. Findings among older men have varied, and potential mechanisms have not been fully elucidated. Methods: A retrospective study of male veterans 65 to 99 years of age who received primary care in the Veterans Health Administration from 2000 to 2010, using administrative data from all 146 Veterans Health Administration medical centers linked to Centers for Medicare and Medicaid Services Medicare fee-for-service data...
January 1, 2018: Journal of Clinical Endocrinology and Metabolism
Derek Stewart, Breda Anthony, Clare Morrison, Yvonne MacRae, Lucy Dixon, Emer Friel, Evelyn Yoong, Scott Cunningham, Katie MacLure
Background: The Highlands and the Western Isles are the two most remote and rural areas of Scotland, with many medical practices in areas where pharmacies would not be viable. Recent regulations state that that dispensing medical practices in these areas must receive pharmacist support for patients who would benefit. Objective: This study aimed to evaluate pilot services, which centred on the provision of patient centred pharmaceutical care. Methods: A realist type evaluation was conducted by an independent research team comprising collecting quantitative data around what occurred during the consultation followed by interviews with purposive samples of staff (n = 14) and patients (n = 18)...
August 1, 2017: Family Practice
Padraig E Hawkins, Jamshed Alam, Timothy J McDonnell, Emer Kelly
Chronic obstructive pulmonary disease is a very common disease often punctuated by intermittent episodes of exacerbation. These exacerbations affect the natural history of the disease, accelerating a decline in lung function. They affect the individual in many ways and affect the health service caring for these patients. The definition of exacerbation varies and lacks clarity. The definitions used most are either symptom based, for example, breathlessness, sputum production and sputum purulence, or event driven, for example, an event causing a patient to seek healthcare input or change to medications...
June 2015: Expert Review of Respiratory Medicine
Andrea Piccin, Marina Cronin, Róisín Brady, Jackie Sweeney, Luigi Marcheselli, Emer Lawlor
BACKGROUND: Transfusion-associated circulatory overload (TACO) is an increasingly reported condition but symptoms and signs are still unrecognized. We present a review of the incidence and clinical features of TACO reported to the National Haemovigilance Office at the Irish Blood Transfusion Service. STUDY DESIGN AND METHODS: Between 2000 and 2010, a total of 1071 cases of serious transfusion-related reactions were reported, of which 221 (21%) cases were TACO. RESULTS: A total of 2,000,684 blood components were issued, with a TACO incidence of one in 9177...
June 2015: Transfusion
Huifeng Yun, Elizabeth Delzell, Kenneth G Saag, Meredith L Kilgore, Michael A Morrisey, Paul Muntner, Robert Matthews, Lingli Guo, Nicole Wright, Wilson Smith, Cathleen Colón-Emeric, Christopher M O'Connor, Kenneth W Lyles, Jeffrey R Curtis
OBJECTIVES: Few studies have assessed the effectiveness of different drugs for osteoporosis (OP). We aimed to determine if fracture and mortality rates vary among patients initiating different OP medications. METHODS: We used the Medicare 5% sample to identify new users of intravenous (IV) zoledronic acid (n=1.674), oral bisphosphonates (n=32.626), IV ibandronate (n=492), calcitonin (n=2.606), raloxifene (n=1.950), or parathyroid hormone (n=549). We included beneficiaries who were ≥65 years of age, were continuously enrolled in fee-for-service Medicare and initiated therapy during 2007-2009...
May 2015: Clinical and Experimental Rheumatology
Richard H Lee, Kenneth W Lyles, Megan Pearson, Karen Barnard, Cathleen Colón-Emeric
Fewer than 24% of Veterans received appropriate evaluation and/or treatment for osteoporosis within 6 months of an index fracture. An electronic consult (E-consult) service was implemented at three Veterans Affairs Medical Centers to facilitate the identification of and recommend management for patients with recent fracture. The E-consult service used clinical encounter data based on ICD9 diagnosis codes to prospectively identify patients with potential osteoporotic fractures. Eligible patients' medical records were reviewed by a metabolic bone specialist, and an E-consult note was sent to the patient's primary provider with specific recommendations for further management...
June 2014: Calcified Tissue International
Cristín Ryan, Denis O'Mahony, Dónal Óg O'Donovan, Emer O'Grady, Peter Weedle, Julia Kennedy, Stephen Byrne
BACKGROUND: A European screening tool (STOPP/START) has been formulated to identify the prescribing of potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs). Pharmacists working in community pharmacies could use STOPP/START as a guide to conducting medication use reviews; however, community pharmacists do not routinely have access to patients' clinical records. OBJECTIVE: To compare the PIM and PPO detection rates from application of the STOPP/START criteria to patients' medication details alone with the detection rates from application of STOPP/START to information on patients' medications combined with clinical information...
April 2013: International Journal of Clinical Pharmacy
Thomas Saïas, Emilie Lerner, Tim Greacen, Elodie Simon-Vernier, Alessandra Emer, Eléonore Pintaux, Antoine Guédeney, Romain Dugravier, Susana Tereno, Bruno Falissard, Florence Tubach, Anne Revah-Levy
OBJECTIVE: Implementation fidelity is a key issue in home-visiting programs as it determines a program's effectiveness in accomplishing its original goals. This paper seeks to evaluate fidelity in a 27-month program addressing maternal and child health which took place in France between 2006 and 2011. METHOD: To evaluate implementation fidelity, home visit case notes were analyzed using thematic qualitative and computer-assisted linguistic analyses. RESULTS: During the prenatal period, home visitors focused on the social components of the program...
2012: PloS One
Anne Hickey, Deirdre Holly, Hannah McGee, Ronan Conroy, Emer Shelley
BACKGROUND: Inability to recognize stroke warning signs and delay in seeking medical attention for recognized symptoms contribute to treatment delay, thus limiting the potential for intervention and impacting negatively on potential stroke outcome. AIM: To examine knowledge of stroke risk factors and warning signs in the adult population in Ireland. METHODS: In 2009, 1000 members of the general public were interviewed by telephone using quota-based population sampling of adults (≥18 years)...
June 2012: International Journal of Stroke: Official Journal of the International Stroke Society
Frances Horgan, Hannah McGee, Anne Hickey, David L Whitford, Sean Murphy, Maeve Royston, Seamus Cowman, Emer Shelley, Ronan M Conroy, Miriam Wiley, Desmond O'Neill
BACKGROUND: Many countries are developing national audits of stroke care. However, these typically focus on stroke care from acute event to hospital discharge rather than the full spectrum from prevention to long-term care. We report on a comprehensive national audit of stroke care in the community and hospitals in the Republic of Ireland. The findings provide insights into the wider needs of people with stroke and their families, a basis for developing stroke-appropriate health strategies, and a global model for the evaluation of stroke services...
2011: Cerebrovascular Diseases
Stela Nazareth Meneghel, Fernanda Bairros, Betânia Mueller, Débora Monteiro, Lidiane Pellenz de Oliveira, Marceli Emer Collaziol
This qualitative study aims to describe the trajectories of female victims of gender violence in Porto Alegre, Rio Grande do Sul State, Brazil. The methodology included in-depth interviews with women and staff, attempting to map the critical paths of women when they made the decision to seek professional help. We interviewed 21 women victims of gender violence and 25 professionals, including law enforcement officials, health and social workers, and nongovernmental organizations. The women's trajectories in the services were mapped, identifying facilitating factors and obstacles in the process of breaking with gender violence...
April 2011: Cadernos de Saúde Pública
Ruairi Brugha, Myles Balfe, Isabelle Jeffares, Ronán M Conroy, Eric Clarke, Margaret Fitzgerald, Emer O'Connell, Deirdre Vaughan, Claire Coleman, H McGee, P Gillespie, Diarmuid O'Donovan
BACKGROUND: This study measured the acceptability of urine-based chlamydia screening to young adults, where young adults wanted opportunistic chlamydia screening services to be located, and by whom they wanted to be offered screening. METHODS: A cross-sectional survey of 5685 university students and 400 young adult healthcares setting attendees (age: 18-29 years). RESULTS: Ninety-six percent of males and 93% of females said that they would find it acceptable to be offered chlamydia screening...
December 2011: Journal of Public Health
Deirdre Vaughan, Emer O'Connell, Martin Cormican, Ruairi Brugha, Colette Faherty, Myles Balfe, Diarmuid O'Donovan
BACKGROUND: The aim of the study was to explore the acceptability and uptake of on-campus screening using a youth friendly approach in two Third Level higher education institutions (HEIs). This study is part of wider research exploring the optimal setting for chlamydia screening in Ireland. METHODS: Male and female students were given the opportunity to take a free anonymous test for chlamydia during a one week programme of "pee-in-a-pot" days at two HEI campuses in the West of Ireland...
2010: BMC Infectious Diseases
Jeffrey R Curtis, Tarun Arora, Robert S Matthews, Allison Taylor, David J Becker, Cathleen Colon-Emeric, Meredith L Kilgore, Michael A Morrisey, Kenneth G Saag, Monika M Safford, Amy Warriner, Elizabeth Delzell
INTRODUCTION: Undertreatment of osteoporosis is common, even for high-risk patients. Among the reasons for undertreatment may be a clinician's perception of a lack of treatment benefit, particularly in light of patients' expected future mortality. Among US Medicare beneficiaries, we evaluated the risk for second fracture versus death in the 5 years following a hip, clinical vertebral, and wrist/forearm fracture. METHODS: Using data from 1999 to 2006 for a random 5% sample of US Medicare beneficiaries, we identified individuals who experienced an incident hip, clinical vertebral, or wrist/forearm fracture in 2000 or 2001...
October 2010: Journal of the American Medical Directors Association
Kathleen Tschantz Unroe, Trista Pfeiffenberger, Sarah Riegelhaupt, Jennifer Jastrzembski, Yuliya Lokhnygina, Cathleen Colón-Emeric
BACKGROUND: Medication discrepancies are unintended differences between medication regimens (ie, between a patient's home regimen and medications prescribed on admission to the hospital). OBJECTIVE: The goal of this study was to describe the incidence, drug classes, and probable importance of hospital admission medication discrepancies and discharge regimen differences, and to determine whether factors such as age and specific hospital services were associated with greater frequency of medication discrepancies and differences...
April 2010: American Journal of Geriatric Pharmacotherapy
Karen Morgan, Hannah McGee, Emer Shelley
The increasing prevalence and poor prognosis associated with heart failure have prompted research to focus on improving quality of life (QoL) for heart failure patients. Research from 1996-2005 was systematically reviewed to identify randomized controlled trials that assessed QoL in heart failure. In 120 studies, 44 were medication trials; 19 surgical/procedural interventions; and 57 patient care/service delivery interventions. Studies were summarized in terms of aim, population, QoL measures used and QoL findings...
October 2007: European Journal of Cardiovascular Prevention and Rehabilitation
Deborah A Levine, Kenneth G Saag, Linda L Casebeer, Cathleen Colon-Emeric, Kenneth W Lyles, Richard M Shewchuk
BACKGROUND: Barriers prevent osteoporosis care in nursing homes. Successful interventions designed to circumvent these barriers benefit from target recipient input during development. OBJECTIVE: To elicit suggestions for an osteoporosis quality improvement intervention designed for use by nursing home health care professionals. DESIGN: Modified nominal group technique. SETTING: Convenience sample of Alabama nursing home directors...
September 2006: Journal of the American Medical Directors Association
Garret Cullen, Emer Kelly, Frank E Murray
AIMS: Adverse drug reactions (ADRs) account for 3.2-7% of acute hospital admissions. The aim of this study was to assess prospectively knowledge of ADRs in patients admitted through the emergency department of a teaching hospital. METHODS: Three hundred and ninety-nine patients were admitted on acute medical call during study periods in September 2002 and May 2003. One hundred gave their perception of the risk of ADRs using visual analogue scales, where 0 indicates minimum and 10 maximum risk...
August 2006: British Journal of Clinical Pharmacology
Hannah M McGee, Frank Doyle, Ronán M Conroy, Davida De La Harpe, Emer Shelley
BACKGROUND: Patients with acute coronary syndromes (ACS) are at increased risk of further acute cardiac events. Secondary prevention aims to decrease morbidity and mortality post-ACS. Depression is related to increased risk in this population, and to poorer secondary prevention activities. However, lengthy depression assessment techniques preclude depression assessment in routine care. The present study investigated the relationship of briefly-assessed depression with secondary prevention outcomes one year post-ACS...
2006: BMC Health Services Research
Cathleen S Colón-Emeric, Linda Casebeer, Kenneth Saag, Jeroan Allison, Deborah Levine, Theodore T Suh, Kenneth W Lyles
OBJECTIVES: The objectives of this study were to identify the barriers to osteoporosis clinical practice guideline use perceived by Medical Directors (MED DIR) and Directors of Nursing (DON) in skilled nursing facilities; and to describe differences in the perceptions of MED DIRs and DONs. DESIGN: The authors conducted a cross-sectional national survey. PARTICIPANTS: This study consisted of a random national sample of MED DIRs (n = 1300) and DONs (n = 1300) belonging to the American Medical Directors Association or the National Association of Directors of Nursing Administration in Long-term Care...
May 2005: Journal of the American Medical Directors Association
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