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return visits

Sathyaseelan Subramaniam, Jacqueline Bober, Jennifer Chao, Shahriar Zehtabchi
BACKGROUND: Traditionally, emergency department (ED) physicians rely on their clinical examination to differentiate between cellulitis and abscess when evaluating skin and soft tissue infections (SSTI). Management of an abscess requires incision and drainage, whereas cellulitis generally requires a course of antibiotics. Misdiagnosis often results in unnecessary invasive procedures, sedations (for incision and drainage in pediatric patients), or a return ED visit for failed antibiotic therapy...
October 21, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Pierre Cornillon, Sébastien Loiseau, Bruno Aublet-Cuvelier, Virginie Guastella
BACKGROUND: Patients under palliative care and in hospital-at-home services are frequently transferred to emergency departments. We set out to identify the reasons for these presentations to determine the proportion that might be avoidable. METHODS: We conducted a retrospective study by assessment of patient files. We studied admissions to four emergency departments in an area of France (Puy-de-Dôme) between September 2011 and August 2013. Reasons for transfer and diagnostic conclusion by emergency doctors were noted...
October 21, 2016: BMC Palliative Care
Yu-Li Huang, Sarah M Bach
BACKGROUND: Patient access to care has been a known and continuing struggle for many health care providers. In spite of appointment lead time policies set by government or clinics, the problem persists. Justification for how lead time policies are determined is lacking. OBJECTIVES: This paper proposed a data-driven approach for how to best set feasible appointment target lead times given a clinic's capacity and appointment requests. METHODS: The proposed approach reallocates patient visits to minimize the deviation between actual appointment lead time and a feasible target lead time...
October 19, 2016: Applied Clinical Informatics
David J Berkoff, Kamesh Krishnamurthy, Jennifer Hopp, Laura Stanley, Ken Spores, David Braunreiter
BACKGROUND AND PURPOSE: The accurate performance of physical therapy exercises can be difficult. In this evolving healthcare climate it is important to continually look for better methods to educate patients. The use of handouts, in-person demonstration, and video instruction are all potential avenues used to teach proper exercise form. The purpose of this study was to examine if a corrected error video (CEV) would be as effective as a single visit with a physical therapist (PT) to teach healthy subjects how to properly perform four different shoulder rehabilitation exercises...
October 2016: International Journal of Sports Physical Therapy
Kimberly A Randell, Danica Harris, Jennifer Stallbaumer-Rouyer
Childhood exposure to intimate partner violence (IPV) results in numerous, lifelong, negative health outcomes, underscoring the American Academy of Pediatrics' recommendation for IPV screening and intervention in the pediatric health care setting. We report a case in which a mother denied IPV during routine IPV screening in a pediatric emergency department (ED). However, subsequent discussion with health care providers during the ED visit revealed IPV. The mother declined to meet with an IPV advocate because the abuser was texting repeatedly to ask about the duration of the ED visit...
October 4, 2016: Pediatric Emergency Care
Charles H Tegeler, Catherine L Tegeler, Jared F Cook, Sung W Lee, Lee Gerdes, Hossam A Shaltout, Christopher M Miles, Sean L Simpson
BACKGROUND: Effective interventions are needed for individuals with persisting post-concussion symptoms. High-resolution, relational, resonance-based, electroencephalic mirroring (HIRREM®) is an allostatic, closed-loop, acoustic stimulation neurotechnology, designed to facilitate relaxation and self-optimization of neural oscillations. METHODS: Fifteen athletes (seven females, mean age 18.1 years, SD 2.6) with persisting post-concussion symptoms received 18.7 (SD 6...
December 2016: Sports Medicine—Open
Kimona Issa, Todd P Pierce, Steven F Harwin, Anthony J Scillia, Anthony Festa, Michael A Mont
BACKGROUND: HIV is prevalent worldwide and numerous patients with this diagnosis ultimately may become candidates for TKA. Although some studies have suggested that complications are more common in patients with HIV who undergo TKA, these studies largely were done before the contemporary era of HIV management; moreover, it is unclear whether patients with HIV achieve lower patient-reported outcome scores or inferior implant survivorship. QUESTIONS/PURPOSES: We asked whether there were any differences in the outcomes of patients with HIV without hemophilia who undergo TKA compared with a matched control cohort in terms of: (1) patient-reported outcomes; (2) implant survivorship; and (3) complication rates...
October 14, 2016: Clinical Orthopaedics and related Research
Ilaria Bergese, Simona Frigerio, Marco Clari, Emanuele Castagno, Antonietta De Clemente, Elena Ponticelli, Enrica Scavino, Paola Berchialla
OBJECTIVES: Return visit (RV) to the emergency department (ED) is considered a benchmarking clinical indicator for health care quality. The purpose of this study was to develop a predictive model for early readmission risk in pediatric EDs comparing the performances of 2 learning machine algorithms. METHODS: A retrospective study based on all children younger than 15 years spontaneously returning within 120 hours after discharge was conducted in an Italian university children's hospital between October 2012 and April 2013...
October 6, 2016: Pediatric Emergency Care
Luis Gerardo Natera Cisneros, Juan Sarasquete Reiriz
INTRODUCTION: Surgical indication for acromioclavicular joint (ACJ) injuries still represents a reason for shoulder and trauma debate. In high-grade injuries, surgery is advocated because some of the non-operatively managed patients may have persistent shoulder pain that could make them unable to return to their previous activity. It has been shown that many of the patients with high-grade ACJ injuries that are managed non-operatively involve the development of scapular dyskinesis, situation that may result in loss of strength and weakness...
October 12, 2016: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Andrea K Boggild, Jennifer Geduld, Michael Libman, Cedric P Yansouni, Anne E McCarthy, Jan Hajek, Wayne Ghesquiere, Jean Vincelette, Susan Kuhn, David O Freedman, Kevin C Kain
BACKGROUND: Malaria remains the most common specific cause of fever in returned travellers and can be life-threatening. We examined demographic and travel correlates of malaria among Canadian travellers and immigrants to identify groups for targeted pretravel intervention. METHODS: Descriptive data on ill returned Canadian travellers and immigrants presenting to a CanTravNet site between 2004 and 2014 with a diagnosis of malaria were analyzed. Data were collected using the GeoSentinel data platform...
July 2016: CMAJ Open
Chang Ho Hwang, Dong Jin Park, Gyu Yeol Kim
A 58-year-old woman, who had undergone total gastrectomy for early gastric cancer 9 years previously, visited the outpatient clinic complaining of progressive difficulty in walking for 15 d. Laboratory examinations showed macrocytic anemia and a decreased serum vitamin B12 concentration and increased serum concentrations of folate, vitamin E and copper. Magnetic resonance imaging showed multifocal high signal intensities along the posterior column of the cervical and thoracic spinal cord. Treatment consisted of intramuscular injections of vitamin B12 for 7 d, which increased her serum level of vitamin B12 to normal...
October 7, 2016: World Journal of Gastroenterology: WJG
Oriana Ciani, Nicola Antonio Pascarelli, Chiara Giannitti, Mauro Galeazzi, Michela Meregaglia, Giovanni Fattore, Antonella Fioravanti
OBJECTIVE: To perform a cost-effectiveness analysis of mud-bath therapy (MBT) in addition to usual treatment compared to usual treatment alone in patients with bilateral knee osteoarthritis (OA). METHODS: An economic evaluation alongside a randomized controlled trial was conducted. Patients were randomly assigned to receive either a 2 weeks cycle of MBT in addition to their usual treatment or to continue routine care alone. The European Quality-of-Life Questionnaire-5 Dimensions (EQ-5D) questionnaire was administered at baseline, 2 weeks, 3, 6, 9, and 12 months...
October 9, 2016: Arthritis Care & Research
Hanan H Balkhy, Aiman El-Saed, Faisal M Sanai, Mohammad Alqahtani, Mashael Alonaizi, Nermeen Niazy, Abdulrahman Aljumah
BACKGROUND: Non-adherence with recommended follow-up visits is a major barrier for completing treatment of viral hepatitis and is consequently associated with unfavorable outcomes of health services. OBJECTIVES: To estimate the magnitude and identify perceived reasons and patient characteristics associated with loss to follow-up in a tertiary care setting. METHODS: A two-step cross-sectional study design was used, including a chart review (2011) followed by phone survey (2012)...
October 6, 2016: Journal of Infection and Public Health
Sarah Svenningsen, Fumin Guo, David G McCormack, Grace Parraga
RATIONALE AND OBJECTIVES: Evidence-based treatment and management for patients with bronchiectasis remain challenging. There is a need for regional disease measurements as focal distribution of disease is common. Our objective was to evaluate the ability of magnetic resonance imaging (MRI) to detect regional ventilation impairment and response to airway clearance therapy (ACT) in patients with noncystic fibrosis (CF) bronchiectasis, providing a new way to objectively and regionally evaluate response to therapy...
October 4, 2016: Academic Radiology
Jennifer A Price, Ana I F Sousa Soares, Augustine D Asante, Joao S Martins, Kate Williams, Virginia L Wiseman
BACKGROUND: Despite public health care being free at the point of delivery in Timor-Leste, wealthier patients access hospital care at nearly twice the rate of poorer patients. This study seeks to understand the barriers driving inequitable utilisation of hospital services in Timor-Leste from the perspective of community members and health care managers. METHODS: This multisite qualitative study in Timor-Leste conducted gender segregated focus groups (n = 8) in eight districts, with 59 adults in urban and rural settings, and in-depth interviews (n = 8) with the Director of community health centres...
September 30, 2016: BMC Health Services Research
Elizabeth D Ballard, Mary Cwik, Kathryn Van Eck, Mitchell Goldstein, Clarissa Alfes, Mary Ellen Wilson, Jane M Virden, Lisa M Horowitz, Holly C Wilcox
The pediatric emergency department (ED) is a critical location for the identification of children and adolescents at risk for suicide. Screening instruments that can be easily incorporated into clinical practice in EDs to identify and intervene with patients at increased suicide risk is a promising suicide prevention strategy and patient safety objective. This study is a retrospective review of the implementation of a brief suicide screen for pediatric psychiatric ED patients as standard of care. The Ask Suicide Screening Questions (ASQ) was implemented in an urban pediatric ED for patients with psychiatric presenting complaints...
September 27, 2016: Prevention Science: the Official Journal of the Society for Prevention Research
Cui-Lan Li, Li-Ping Song, Shi-Yan Tang, Lee Jaden Gil Yu-Kang Zhou, Hong He, Xue-Tang Mo, Yi-Ming Liao
The aim of this study was to investigate the efficacy, safety, and acceptability of low-dose mifepristone combined with self-administered misoprostol for ultra-early medical abortion. A total of 744 women with ultra-early pregnancy (amenorrhea ≤35 days) who fulfilled the inclusion criteria were enrolled in the study. Equal numbers of participants were allocated randomly to the hospital administration and self-administration groups. All participants took 75 mg mifepristone at the initial visit and 400 µg oral misoprostol 24 hours later in the hospital or by self-administration...
September 27, 2016: Reproductive Sciences
Alberto Jiménez-Puente, José Del Río-Mata, José Luís Arjona-Huertas, Begoña Mora-Ordóñez, Alfonso Martínez-Reina, Miguel Martínez Del Campo, Lourdes Nieto-de Haro, Antonio Lara-Blanquer
BACKGROUND: The rate of unscheduled return visits is often used as a quality-of-care indicator in EDs, although its validity is not yet fully established. Our aim was to identify the characteristics of return visits that may be attributed to problems in quality of care. METHODS: Retrospective paired review of medical charts in a random sample of return visits during the 72 hours following discharge from the ED in three hospitals of Andalusia, Spain in 2013. Charts were reviewed by senior medical physicians to determine which return visits reflected quality-of-care problems...
September 26, 2016: Emergency Medicine Journal: EMJ
P Chasserant, M Gosgnach
AIM OF THE STUDY: Outpatient left colectomy has been described in several small series or case reports. We conducted a prospective study to determine whether an optimized management approach could allow performance of this procedure in a broader patient population. PATIENTS AND METHODS: Between December 2014 and December 2015, all eligible patients were prospectively and consecutively included in this study. They all underwent surgery following the same outpatient management protocol...
September 23, 2016: Journal of Visceral Surgery
Nguyen X Thanh, Anderson W Chuck, Tracy Wasylak, Jeannette Lawrence, Peter Faris, Olle Ljungqvist, Gregg Nelson, Leah M Gramlich
BACKGROUND: In February 2013, Alberta Health Services established an Enhanced Recovery After Surgery (ERAS) implementation program for adopting the ERAS Society colorectal guidelines into 6 sites (initial phase) that perform more than 75% of all colorectal surgeries in the province. We conducted an economic evaluation of this initiative to not only determine its cost-effectiveness, but also to inform strategy for the spread and scale of ERAS to other surgical protocols and sites. METHODS: We assessed the impact of ERAS on patients' health services utilization (HSU; length of stay [LOS], readmissions, emergency department visits, general practitioner and specialist visits) within 30 days of discharge by comparing pre- and post-ERAS groups using multilevel negative binomial regressions...
October 1, 2016: Canadian Journal of Surgery. Journal Canadien de Chirurgie
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