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Emergency room care

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https://www.readbyqxmd.com/read/28818435/a-parent-reveals-the-biases-that-she-faced-to-get-care-for-her-daughter
#1
Sosha Chaney, John D Lantos
A poor, African-American mother describes the difficulties that she has in getting a comprehensive medical evaluation for her child in an Emergency Room. Eventually, she finds the care and the caring that she needs at a medical clinic in a community health center.
August 14, 2017: Current Problems in Pediatric and Adolescent Health Care
https://www.readbyqxmd.com/read/28818179/multiple-trauma-and-emergency-room-management
#2
Michael Frink, Philipp Lechler, Florian Debus, Steffen Ruchholtz
BACKGROUND: The care of severely injured patients remains a challenge. Their initial treatment in the emergency room is the essential link between first aid in the field and definitive in-hospital treatment. METHODS: We present important elements of the initial in-hospital care of severely injured patients on the basis of pertinent publications retrieved by a selective search in PubMed and the current German S3 guideline on the care of severely and multiply traumatized patients, which was last updated in 2016...
July 24, 2017: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/28817783/the-association-between-insurance-type-and-cost-related-delay-in-care-a-survey
#3
Sora Al Rowas, Michael B Rothberg, Benjamin Johnson, Joel Miller, Mohanad AlMahmoud, Jennifer Friderici, Sarah L Goff, Tara Lagu
OBJECTIVES: Massachusetts has insurance rates similar to those projected under the Affordable Care Act, but many of the state's patients are insured through private insurance plans with high out-of-pocket costs. We aimed to explore the relationship between insurance type (private vs public) and delays in care due to cost, stratified by income. STUDY DESIGN: Cross-sectional study. METHODS: We conducted a study of English-speaking adults recruited from the waiting rooms of the emergency department or outpatient clinics of a large healthcare system in western Massachusetts...
July 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28815823/ten-years-of-simulation-based-training-in-pediatric-anesthesia-the-inception-evolution-and-dissemination-of-the-managing-emergencies-in-paediatric-anaesthesia-mepa-course
#4
Tobias C Everett, Ralph MacKinnon, David de Beer, Matthew Taylor, Matthew Dylan Bould
2016 marked the 10-year anniversary of the inception of the Managing Emergencies in Paediatric Anaesthesia (MEPA) course. This simulation-based program was originally created to allow trainees in pediatric anesthesia to experience operating room emergencies which although infrequent, would be considered key competencies for any practicing anesthetist with responsibility for providing care to children. Since its original manifestation, the course has evolved in content, scope, and worldwide availability, such that it is now available at over 60 locations on five continents...
August 17, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28814943/comparison-of-different-laboratory-tests-in-the-evaluation-of-hemorrhagic-risk-of-patients-using-rivaroxaban-in-the-critical-care-setting-diagnostic-accuracy-study
#5
Marjorie Paris Colombini, Priscilla Bento Matos Cruz Derogis, Valdir Fernandes de Aranda, João Carlos de Campos Guerra, Nelson Hamerschlak, Cristóvão Luis Pitangueiras Mangueira
BACKGROUND: Rivaroxaban is a direct oral anticoagulant designed to dispense with the necessity of laboratory monitoring. However, monitoring rivaroxaban levels is necessary in certain clinical conditions, especially in the critical care setting. METHODS: This is a diagnostic accuracy study evaluating sensitivity and specificity of prothrombin time (PT), activated partial thromboplastin time (aPTT), and Dilute Russell viper venom time (dRVVT), to evaluate the hemorrhagic risk in patients taking rivaroxaban...
2017: Thrombosis Journal
https://www.readbyqxmd.com/read/28814705/-spontaneous-subcapsular-renal-hemorrhage-of-papillary-renal-cell-carcinoma
#6
Masatsugu Miyashita, Tsuyoshi Iwata, Hiroyuki Nakanishi, Jintetsu Soh
A 75-year-old man with a history of chronic kidney disease (CKD) visited our emergency room after the sudden onset of severe right lower abdominal pain and nausea. Computed tomography (CT) showed right perirenal hematoma and renal tumor, which was diagnosed as a spontaneous rupture of the right renal tumor. It was difficult to correctly diagnose the tumor as benign or malignant with magnetic resonance imaging (MRI). Because of CKD, a shunt was implanted, and dynamic enhanced CT was performed. Dynamic enhanced CT showed a slightly enhanced area of the tumor, and it was diagnosed as renal cell carcinoma (RCC)...
July 2017: Hinyokika Kiyo. Acta Urologica Japonica
https://www.readbyqxmd.com/read/28813753/pre-guideline-trends-associated-with-chest-radiograph-usage-for-pediatric-community-acquired-pneumonia-in-emergency-department-settings
#7
Eric W Jones, Benjamin Meyer, Aaron M Berg, Benson S Hsu
BACKGROUND: Health care spending in the U.S. totaled $3 trillion in 2014 and continues to increase rapidly. Minimizing waste through clinical guidelines is a promising strategy to reduce spending without compromising patient care. In 2011, clinical guidelines recommended against the use of chest X-ray (CXR) for diagnosis of community-acquired pneumonia (CAP) in pediatric ambulatory settings. However, use of CXR has not changed post-guideline. Thus, understanding the drivers of CXR utilization prior to guideline implementation could improve guideline adherence...
May 2017: South Dakota Medicine: the Journal of the South Dakota State Medical Association
https://www.readbyqxmd.com/read/28807523/multidisciplinary-heart-failure-clinics-are-associated-with-lower-heart-failure-hospitalization-and-mortality-systematic-review-and-meta-analysis
#8
REVIEW
Sumeet Gandhi, Wassim Mosleh, Umesh C Sharma, Catherine Demers, Michael E Farkouh, Jon-David Schwalm
BACKGROUND: Heart failure (HF) clinics (HFCs) are an integral aspect of the strategy for community HF care. METHODS: A systematic search was conducted to retrieve studies. We searched for candidate articles in the PubMed, EMBASE, and Cochrane databases from 1990 to January 2017. RESULTS: We included 16 randomized controlled trials in the meta-analysis with 3999 patients. The HFC group had a lower incidence of the primary composite end point of HF hospitalization and all-cause mortality (odds ratio [OR], 0...
May 24, 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28801131/health-care-demand-elasticities-by-type-of-service
#9
Randall P Ellis, Bruno Martins, Wenjia Zhu
We estimate within-year price elasticities of demand for detailed health care services using an instrumental variable strategy, in which individual monthly cost shares are instrumented by employer-year-plan-month average cost shares. A specification using backward myopic prices gives more plausible and stable results than using forward myopic prices. Using 171 million person-months spanning 73 employers from 2008 to 2014, we estimate that the overall demand elasticity by backward myopic consumers is -0.44, with higher elasticities of demand for pharmaceuticals (-0...
July 29, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28801040/extracorporeal-cardiopulmonary-resuscitation-for-blunt-cardiac-rupture-a-case-report
#10
Shunsuke Kudo, Keiji Tanaka, Kunihiko Okada, Takahiro Takemura
Extracorporeal cardiopulmonary resuscitation (ECPR) followed by operating room sternotomy, rather than resuscitative thoracotomy, might be life-saving for patients with blunt cardiac rupture and cardiac arrest who do not have multiple severe traumatic injuries. A 49-year-old man was injured in a vehicle crash and transferred to the emergency department. On admission, he was hemodynamically stable, but a plain chest radiograph revealed a widened mediastinum, and echocardiography revealed hemopericardium. A computed tomography scan revealed hemopericardium and mediastinal hematoma, without other severe traumatic injuries...
August 5, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28800812/highlight-in-telepsychiatry-and-behavioral-health-emergencies
#11
REVIEW
James Rachal, Wayne Sparks, Christine Zazzaro, Terri Blackwell
Carolinas HealthCare System is one of the largest freestanding psychiatric emergency departments in the country. It has grown from a small community mental health center in the 1930s, to one of the largest providers of emergency mental health services in the country. It offers services in person and via telepsychiatry to other emergency departments and primary care clinics. It decreased emergency room wait times and revolutionized where and how patients get their care. This has been the work of several groups from many disciplines...
September 2017: Psychiatric Clinics of North America
https://www.readbyqxmd.com/read/28799206/the-incidence-and-characteristics-of-3-month-mortality-after-intraoperative-cardiac-arrest-in-adults
#12
M Hur, H-C Lee, K H Lee, J-T Kim, C-W Jung, H-P Park
BACKGROUND: There is little information about clinical outcomes after intraoperative cardiac arrest (IOCA). We determined the incidence and characteristics of 3-month mortality after IOCA. METHODS: The electronic medical records of 238,648 adult surgical patients from January 2005 to December 2014 were reviewed retrospectively. Characteristics of IOCA were documented using the Utstein reporting template. RESULTS: IOCA occurred in 50 patients (21/100,000 surgeries)...
August 11, 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28799158/-the-impact-of-immigrant-status-on-the-mode-of-hospital-referral-impression-of-disease-severity-and-length-of-stay-in-inpatient-general-pediatric-care
#13
Sebastian Ullrich, Yuriy Nesterko, Diana Briel, Andreas Hiemisch, Elmar Brähler, Heide Glaesmer
Background National as well as international research often shows differences in health and health behavior between children and youth with and without migration background. It is also noted that there are differences in the use of health services depending on the migration background. Patients and Methods Data from 266 pediatric patients, regarding their hospitalization, general impression of health status and length of stay in a hospital, were analyzed depending on the migration background. Information on migration background and treatment-related data were obtained from the parents of the patient or from the hospital information system (SAP)...
August 10, 2017: Das Gesundheitswesen
https://www.readbyqxmd.com/read/28798146/bloody-stools-in-a-3-day-old-term-infant
#14
Amelia Bray-Aschenbrenner, L Richard Feldenberg, Amelia Kirby, Colleen M Fitzpatrick, Justin B Josephsen
A 3-day-old term, male infant presented to the emergency department for evaluation of bloody stools. The infant was born after an uncomplicated pregnancy followed by a normal spontaneous vaginal delivery. The mother was group B Streptococcus colonized, and received antenatal penicillin prophylaxis. The infant received routine delivery room care, and was given ophthalmic erythromycin and intramuscular vitamin K. Circumcision was performed without bleeding and he was discharged from the newborn nursery and the hospital after 48 hours...
August 10, 2017: Pediatrics
https://www.readbyqxmd.com/read/28797911/a-prospective-evaluation-of-radiation-free-direct-solitary-cholangioscopy-for-the-management-of-choledocholithiasis
#15
Monique T Barakat, Mohit Girotra, Abhishek Choudhary, Robert J Huang, Saurabh Sethi, Subhas Banerjee
BACKGROUND AND AIMS: Endoscopy has replaced many radiological studies for the GI tract. However, ERCP remains a hybrid endoscopic-fluoroscopic procedure, which limits its portable delivery, creates delays due to fluoroscopy room unavailability and exposes patients/providers to radiation. We evaluated fluoroscopy/radiation-free management of patients with non-complex choledocholithiasis using direct solitary cholangioscopy (DSC). METHODS: Patients underwent fluoroscopy-free biliary cannulation, sphincterotomy then cholangioscopy to establish location, number/size of stones and document distance from ampulla to bifurcation to guide balloon advancement...
August 7, 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/28797858/comparative-effectiveness-of-usual-source-of-care-approaches-to-improve-end-of-life-outcomes-for-children-with-intellectual-disability
#16
Lisa C Lindley, Melanie J Cozad
CONTEXT: Children with intellectual disability (ID) are at risk for adverse end-of-life outcomes including high emergency room utilization and hospital readmissions, along with low hospice enrollment. OBJECTIVES: The objective of this study was to compare the effectiveness of usual source of care approaches to improve end-of-life outcomes for children with ID. METHODS: We used longitudinal California Medicaid claims data. We included children who were less than 21 years with fee-for-service Medicaid claims, died between January 1, 2007 and December 31, 2010, and had a moderate to profound ID diagnosis...
August 7, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28794966/synthetic-cannabinoid-induced-acute-respiratory-depression-case-series-and-literature-review
#17
Mark Henry Alon, Margaret Olibrice Saint-Fleur
Synthetic Cannabinoids are a street drug that is widely attainable and cheap compared to natural cannabis, and has variable potency and unpredictable effects with no commercially available diagnostic test to confirm its presence. Similar to natural cannabis, Synthetic Cannabinoid intoxication can present in several ways with the most common emergency room presentations to be of neurologic and psychiatric manifestation. The respiratory depressive effect of Synthetic Cannabinoids has not been well documented in medical literature...
2017: Respiratory Medicine Case Reports
https://www.readbyqxmd.com/read/28794620/spreading-improvements-for-advanced-copd-care-through-a-canadian-collaborative
#18
Graeme M Rocker, Claudia Amar, Wendy L Laframboise, Jane Burns, Jennifer Y Verma
BACKGROUND: A year-long pan-Canadian quality improvement collaborative (QIC) led by the Canadian Foundation for Healthcare Improvement (CFHI) supported the spread of the successful Halifax, Nova Scotia-based INSPIRED COPD Outreach Program™ to 19 teams in the 10 Canadian provinces. We describe QIC results, addressing two main questions: 1) Can the results of the Nova Scotia INSPIRED model be replicated elsewhere in Canada? 2) How did the teams implement and evaluate their versions of the INSPIRED program? METHODS: Collaborative faculty selected measures that were evidence-based, relatively simple to collect, and relevant to local context...
2017: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/28794524/an-analysis-of-the-predictors-of-mortality-and-morbidity-in-patients-admitted-after-suicidal-hanging-to-an-indian-multidisciplinary-intensive-care-unit
#19
M K Renuka, M S Kalaiselvan, A S Arunkumar
BACKGROUND AND AIMS: Hanging is a frequently used method to attempt suicide in India. There is a lack of data in the Indian population regarding clinical features and outcomes of suicidal hanging. The purpose of this study was to evaluate the factors affecting mortality and morbidity in patients admitted with suicidal hanging to the Intensive Care Unit (ICU). METHODS: A 6-year retrospective study of adult patients admitted to the ICU with suicidal hanging was analysed for demographics, mode of hanging, lead time to emergency room (ER) admission, clinical presentation, Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, admission Glasgow coma scale (GCS) and neurological outcomes...
July 2017: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/28793840/inadequate-visits-to-the-emergency-department-by-pregnant-women
#20
Elena Ferriols Pérez, Nadwa Kanjou Augé, Jordi Genovés González, Andrea Burón Prust, Antonio Payà Panadés, Ramón Carreras Collado
Inadequate emergency visits, which could be resolved in primary care, are an unnecessary expense for the healthcare service. We did a review of all gynaecology and obstetrics emergency visits by pregnant or postpartum women during 2010 and 2011 in order to describe the adequacy of the visits by pregnant women to the emergency service. We defined three levels of adequacy: adequate, moderately adequate, and inadequate. One thousand seven hundred and forty-three visits to the emergency room of gynaecology and obstetrics were studied...
August 9, 2017: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
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