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Point-of-care systems and emergency medicine

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https://www.readbyqxmd.com/read/29016516/barriers-to-effective-teamwork-relating-to-pediatric-resuscitations-perceptions-of-pediatric-emergency-medicine-staff
#1
Joshua M Sherman, Todd P Chang, Nurit Ziv, Alan L Nager
BACKGROUND: In the pediatric emergency department (PED), resuscitations require medical teams form ad hoc, rarely communicating beforehand. Literature has shown that the medical community has deficiencies in communication and teamwork. However, we as medical providers do not know or understand the perceived barriers of our colleagues. Physicians may perceive a barrier that is different from nurses, respiratory therapists, pharmacists, or technicians. Perhaps we do not know in which area of teamwork and communication we are deficient...
October 9, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28963294/new-criteria-for-sepsis-induced-coagulopathy-sic-following-the-revised-sepsis-definition-a-retrospective-analysis-of-a-nationwide-survey
#2
Toshiaki Iba, Marcello Di Nisio, Jerrold H Levy, Naoya Kitamura, Jecko Thachil
OBJECTIVE: Recent clinical studies have shown that anticoagulant therapy might be effective only in specific at-risk subgroups of patients with sepsis and coagulation dysfunction. The definition of sepsis was recently modified, and as such, old scoring systems may no longer be appropriate for the diagnosis of sepsis-associated coagulopathy. The aim of this study was to evaluate prognostic factors in patients diagnosed with sepsis and coagulopathy according to the new sepsis definition and assess their accuracy in comparison with existing models...
September 27, 2017: BMJ Open
https://www.readbyqxmd.com/read/28934995/quality-improvement-primer-part-2-executing-a-quality-improvement-project-in-the-emergency-department
#3
Lucas B Chartier, Antonia S Stang, Samuel Vaillancourt, Amy H Y Cheng
The topics of quality improvement (QI) and patient safety have become important themes in health care in recent years, particularly in the emergency department setting, which is a frequent point of contact with the health care system for patients. In the first of three articles in this series meant as a QI primer for emergency medicine clinicians, we introduced the strategic planning required to develop an effective QI project using a fictional case study as an example. In this second article we continue with our example of improving time to antibiotics for patients with sepsis, and introduce the Model for Improvement...
September 22, 2017: CJEM
https://www.readbyqxmd.com/read/28780235/dilated-right-coronary-sinus-identified-on-point-of-care-ultrasound
#4
Damali Nakitende, Michael Gottlieb
Point-of-care cardiac ultrasound (POCUS) is a common application in Emergency Medicine. Here we present a case of an incidentally discovered dilated right coronary sinus on ultrasound. This case involved a 55-year-old female who presented with chest pain, shortness of breath, and lightheadedness. Her initial presentation was concerning for congestive heart failure (CHF) exacerbation. A bedside ultrasound was performed to assess cardiac function, where a dilated right coronary sinus was discovered. The right coronary sinus is the vein that serves as the venous return for the coronary system...
October 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28765464/the-effect-of-new-oral-care-technologies-on-the-need-for-dentists-in-2040
#5
Peter M Milgrom, Jeremy A Horst
This article addresses changes in technology of oral self-care or professional care that may increase or decrease the demand for dentists by 2040. The focus is on dental caries, periodontitis, and temporomandibular joint disorders (TMD), as the first two are the main areas of current practice and because TMD is an area for growth. To address this question, the authors examined the scientific literature and government registries to identify recent or soon-to-be-available technologies. They also examined the state of translational efficiency, dissemination, and adoption of advances into dental practice...
August 2017: Journal of Dental Education
https://www.readbyqxmd.com/read/28751837/anmco-sic-consensus-document-cardiology-networks-for-outpatient-heart-failure-care
#6
Nadia Aspromonte, Michele Massimo Gulizia, Andrea Di Lenarda, Andrea Mortara, Ilaria Battistoni, Renata De Maria, Michele Gabriele, Massimo Iacoviello, Alessandro Navazio, Daniela Pini, Giuseppe Di Tano, Marco Marini, Renato Pietro Ricci, Gianfranco Alunni, Donatella Radini, Marco Metra, Francesco Romeo
Changing demographics and an increasing burden of multiple chronic comorbidities in Western countries dictate refocusing of heart failure (HF) services from acute in-hospital care to better support the long inter-critical out-of- hospital phases of HF. In Italy, as well as in other countries, needs of the HF population are not adequately addressed by current HF outpatient services, as documented by differences in age, gender, comorbidities and recommended therapies between patients discharged for acute hospitalized HF and those followed-up at HF clinics...
May 2017: European Heart Journal Supplements: Journal of the European Society of Cardiology
https://www.readbyqxmd.com/read/28646595/point-of-care-ultrasound-work-flow-innovation-impact-on-documentation-and-billing
#7
Matthew J Flannigan, Srikar Adhikari
OBJECTIVES: To evaluate the impact that an innovative automated ultrasound (US) work flow, which allows for bedside performance of examination documentation and order placement, has on point-of-care US billing compared to ordering US examinations through an electronic medical record. METHODS: We conducted a retrospective review of point-of-care US billing data (March 2014-February 2016) for adult and pediatric emergency departments with an emergency medicine residency and a US fellowship...
June 24, 2017: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/28632011/essential-public-health-competencies-for-medical-students-establishing-a-consensus-in-family-medicine
#8
Christopher P Morley, Scott R Rosas, Ranit Mishori, William Jordan, Yumi Shitama Jarris, Family Medicine/Public Health Competencies Work Group, Jacob Prunuske
Phenomenon: The integration of public health (PH) competency training into medical education, and further integration of PH and primary care, has been urged by the U.S. Institute of Medicine. However, PH competencies are numerous, and no consensus exists over which competencies are most important for adoption by current trainees. Our objective was to conduct a group concept mapping exercise with stakeholders identifying the most important and feasible PH skills to incorporate in medical and residency curricula...
July 2017: Teaching and Learning in Medicine
https://www.readbyqxmd.com/read/28561658/more-medicine-fewer-clicks-how-informatics-can-actually-help-your-practice
#9
Debra A Patt, Elmer V Bernstam, Joshua C Mandel, David A Kreda, Jeremy L Warner
In the information age, we expect data systems to make us more effective and efficient-not to make our lives more difficult! In this article, we discuss how we are using data systems, such as electronic health records (EHRs), to improve care delivery. We illustrate how US Oncology is beginning to use real-world evidence to facilitate trial accrual by automatic identification of eligible patients and how big data and predictive analytics will transform the field of oncology. Some information systems are already being used at the point of care and are already empowering clinicians to improve the care of their patients in real time...
2017: American Society of Clinical Oncology Educational Book
https://www.readbyqxmd.com/read/28526675/iterative-user-interface-design-for-automated-sequential-organ-failure-assessment-score-calculator-in-sepsis-detection
#10
Christopher Ansel Aakre, Jaben E Kitson, Man Li, Vitaly Herasevich
BACKGROUND: The new sepsis definition has increased the need for frequent sequential organ failure assessment (SOFA) score recalculation and the clerical burden of information retrieval makes this score ideal for automated calculation. OBJECTIVE: The aim of this study was to (1) estimate the clerical workload of manual SOFA score calculation through a time-motion analysis and (2) describe a user-centered design process for an electronic medical record (EMR) integrated, automated SOFA score calculator with subsequent usability evaluation study...
May 18, 2017: JMIR Human Factors
https://www.readbyqxmd.com/read/28443278/saliva-liquid-biopsy-for-point-of-care-applications
#11
REVIEW
Katri Aro, Fang Wei, David T Wong, Michael Tu
Saliva is a non-invasive biofluid, which is easy to collect, transport, and store. Because of its accessibility and connection to systemic diseases, saliva is one of the best candidates for the advancement of point-of-care medicine, where individuals are able to easily monitor their health status by using portable convenient tools such as smartphones. There are a variety of scenarios with which saliva can be used: studies have been conducted on using saliva to measure stress hormones, enzyme levels, developmental disease biomarkers, and even cancer mutations...
2017: Frontiers in Public Health
https://www.readbyqxmd.com/read/28351067/do-medical-students-narrative-representations-of-the-good-doctor-change-over-time-comparing-humanism-essays-from-a-national-contest-in-1999-and-2013
#12
Pooja C Rutberg, Brandy King, Elizabeth Gaufberg, Pamela Brett-MacLean, Perry Dinardo, Richard M Frankel
PURPOSE: To explore medical students' conceptions of "the good doctor" at two points in time separated by 14 years. METHOD: The authors conducted qualitative analysis of narrative-based essays. Following a constant comparative method, an emergent relational coding scheme was developed which the authors used to characterize 110 essays submitted to the Arnold P. Gold Foundation Humanism in Medicine Essay Contest in 1999 (n = 50) and 2013 (n = 60) in response to the prompt, "Who is the good doctor?" RESULTS: The authors identified five relational themes as guiding the day-to-day work and lives of physicians: doctor-patient, doctor-self, doctor-learner, doctor-colleague, and doctor-system/society/profession...
April 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28341085/faculty-evaluations-correlate-poorly-with-medical-student-examination-performance-in-a-fourth-year-emergency-medicine-clerkship
#13
Nicole M Dubosh, Jonathan Fisher, Jason Lewis, Edward A Ullman
BACKGROUND: Clerkship directors routinely evaluate medical students using multiple modalities, including faculty assessment of clinical performance and written examinations. Both forms of evaluation often play a prominent role in final clerkship grade. The degree to which these modalities correlate in an emergency medicine (EM) clerkship is unclear. OBJECTIVE: We sought to correlate faculty clinical evaluations with medical student performance on a written, standardized EM examination of medical knowledge...
March 21, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28302636/pharmacist-provided-medicines-reconciliation-within-24%C3%A2-hours-of-admission-and-on-discharge-a-randomised-controlled-pilot-study
#14
Brit Cadman, David Wright, Amanda Bale, Garry Barton, James Desborough, Eman A Hammad, Richard Holland, Helen Howe, Ian Nunney, Lisa Irvine
BACKGROUND: The UK government currently recommends that all patients receive medicines reconciliation (MR) from a member of the pharmacy team within 24 hours of admission and subsequent discharge. The cost-effectiveness of this intervention is unknown. A pilot study to inform the design of a future randomised controlled trial to determine effectiveness and cost-effectiveness of a pharmacist-delivered service was undertaken. METHOD: Patients were recruited 7 days a week from 5 adult medical wards in 1 hospital over a 9 month period and randomised using an automated system to intervention (MR within 24 hours of admission and at discharge) or usual care which may include MR (control)...
March 16, 2017: BMJ Open
https://www.readbyqxmd.com/read/28294582/pioneering-medical-advances-through-nanofluidic-implantable-technologies
#15
REVIEW
R Lyle Hood, Gold Darr Hood, Mauro Ferrari, Alessandro Grattoni
Nanofluidic implantables represent a recent advance in a broad effort for developing personalized, point-of-care medical technologies. Such systems have unprecedented potential when matched with the newest developments in robotics, microprocessing, and tissue engineering. In this review, we present their emergence in medicine within the fields of diagnostics, biosensing, therapeutics, and theranostics. Discussion includes current limitations and future directions for these systems, as commensurate advances in power density and electronic processing are continually redefining the possible...
September 2017: Wiley Interdisciplinary Reviews. Nanomedicine and Nanobiotechnology
https://www.readbyqxmd.com/read/28290956/multidisciplinary-in-situ-simulation-based-training-as-a-postpartum-hemorrhage-quality-improvement-project
#16
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/28274964/predicting-aki-in-emergency-admissions-an-external-validation-study-of-the-acute-kidney-injury-prediction-score-aps
#17
L E Hodgson, B D Dimitrov, P J Roderick, R Venn, L G Forni
OBJECTIVES: Hospital-acquired acute kidney injury (HA-AKI) is associated with a high risk of mortality. Prediction models or rules may identify those most at risk of HA-AKI. This study externally validated one of the few clinical prediction rules (CPRs) derived in a general medicine cohort using clinical information and data from an acute hospitals electronic system on admission: the acute kidney injury prediction score (APS). DESIGN, SETTING AND PARTICIPANTS: External validation in a single UK non-specialist acute hospital (2013-2015, 12 554 episodes); four cohorts: adult medical and general surgical populations, with and without a known preadmission baseline serum creatinine (SCr)...
March 8, 2017: BMJ Open
https://www.readbyqxmd.com/read/28257405/the-mecklenburg-county-interlocal-agreement-an-18-year-collaboration-between-medicine-and-public-health
#18
Crystal N Piper, Marcus Plescia, Stephen R Keener, Mark DeHaven
CONTEXT: Better integration of public health and medical services has been a long-standing goal in the United States and has been widely discussed in the scientific literature. OBJECTIVE: To identify key lessons and outcomes of the Mecklenburg County Interlocal Agreement, one of the longest running efforts integrating health care delivery and public health services in a major metropolitan area. DESIGN: In-depth key informant interviews and brief questionnaires of leaders involved in the Mecklenburg County Interlocal Agreement...
March 1, 2017: Journal of Public Health Management and Practice: JPHMP
https://www.readbyqxmd.com/read/28222830/impact-of-early-vasopressor-administration-on-neurological-outcomes-after-prolonged-out-of-hospital-cardiac-arrest
#19
Michael W Hubble, Clark Tyson
Introduction Vasopressors are associated with return of spontaneous circulation (ROSC), but no long-term benefit has been demonstrated in randomized trials. However, these trials did not control for the timing of vasopressor administration which may influence outcomes. Consequently, the objective of this study was to develop a model describing the likelihood of favorable neurological outcome (cerebral performance category [CPC] 1 or 2) as a function of the public safety answering point call receipt (PSAP)-to-pressor-interval (PPI) in prolonged out-of-hospital cardiac arrest...
February 22, 2017: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/28192937/amplification-and-quantification-of-an-antisense-oligonucleotide-from-target-microrna-using-programmable-dna-and-a-biological-nanopore
#20
Moe Hiratani, Masayuki Ohara, Ryuji Kawano
This paper describes a strategy for autonomous diagnoses of cancers using microRNA (miRNA) and therapy for tumor cells by DNA computing techniques and nanopore measurement. Theranostics, which involves the combination of diagnosis and therapy, has emerged as an approach for personalized medicine or point-of-care cancer diagnostics. DNA computing will become a potent tool for theranostics because it functions completely autonomously without the need for external regulations. However, conventional theranostics using DNA computing involves a one-to-one reaction in which a single input molecule generates a single output molecule; the concentration of the antisense drug is insufficient for the therapy in this type of reaction...
February 9, 2017: Analytical Chemistry
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