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https://www.readbyqxmd.com/read/28637110/guidelines-for-cauda-equina-syndrome-red-flags-and-white-flags-systematic-review-and-implications-for-triage
#1
Nicholas V Todd
INTRODUCTION: Patients with cauda equina syndrome (CES) are frequently referred late when neurological damage cannot be reversed. National Guidelines for emergency referral, imaging and treatment of CES contain symptoms and/or signs that are those of late often, irreversible CES. Referral at this stage may be too late for that patient. METHODS: Seven sources were reviewed. Advice re emergency referral/imaging/treatment were reviewed. Symptoms/signs were compared with a standard classification of CES...
March 2, 2017: British Journal of Neurosurgery
https://www.readbyqxmd.com/read/28632578/acute-abdominal-pain-recognition-and-management-of-constipation-in-the-emergency-department
#2
Stefania Norbedo, Giulia Bassanese, Francesca Barbieri, Egidio Barbi
OBJECTIVE: The main aim of the study was to investigate the incidence and the clinically relevant features of functional constipation in patients evaluated for acute abdominal pain in a tertiary care pediatric emergency department. METHODS: This is a retrospective study. We analyzed 4394 medical records and recorded the information (demographics, triage code, symptoms, medical history, physical evaluation, laboratory tests, radiological studies, procedures, and treatments) of all patients admitted for acute abdominal pain to the emergency department of the IRCCS Burlo Garofolo, Trieste, during 2010 to 2013...
June 20, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28630565/efficacy-of-various-scoring-systems-for-predicting-the-28-day-survival-rate-among-patients-with-acute-exacerbation-of-chronic-obstructive-pulmonary-disease-requiring-emergency-intensive-care
#3
Zhihong Feng, Tao Wang, Ping Liu, Sipeng Chen, Han Xiao, Ning Xia, Zhiming Luo, Bing Wei, Xiuhong Nie
We aimed to investigate the efficacy of four severity-of-disease scoring systems in predicting the 28-day survival rate among patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) requiring emergency care. Clinical data of patients with AECOPD who required emergency care were recorded over 2 years. APACHE II, SAPS II, SOFA, and MEDS scores were calculated from severity-of-disease indicators recorded at admission and compared between patients who died within 28 days of admission (death group; 46 patients) and those who did not (survival group; 336 patients)...
2017: Canadian Respiratory Journal: Journal of the Canadian Thoracic Society
https://www.readbyqxmd.com/read/28628525/assessing-sensitivity-and-specificity-of-the-manchester-triage-system-in-the-evaluation-of-acute-coronary-syndrome-in-adult-patients-in-emergency-care-a-systematic-review
#4
Fernanda Ayache Nishi, Flávia de Oliveira Motta Maia, Itamar de Souza Santos, Dina de Almeida Lopes Monteiro da Cruz
BACKGROUND: Triage is the first assessment and sorting process used to prioritize patients arriving in the emergency department (ED). As a triage tool, the Manchester Triage System (MTS) must have a high sensitivity to minimize the occurrence of under-triage, but must not compromise specificity to avoid the occurrence of overtriage. Sensitivity and specificity of the MTS can be calculated using the frequency of appropriately assigned clinical priority levels for patients presenting to the ED...
June 2017: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/28625711/why-parents-seek-care-for-acute-illness-in-the-clinic-or-the-ed-the-role-of-health-literacy
#5
Meghan May, David C Brousseau, David A Nelson, Kathryn E Flynn, Michael S Wolf, Bryn Lepley, Andrea K Morrison
OBJECTIVE: To explore the decision to seek care and decision-making regarding location of care among parents with low and adequate health literacy. METHODS: Parents of children ≤ 8 years old presenting for 'sick child' visits at a clinic or a non-urgent ED visit (triage level 5) were interviewed. The Newest Vital Sign (NVS) categorized parental health literacy. Interviewers followed a semi-structured interview guide to understand 1) care-seeking for current illness and 2) choice of clinic or ED...
June 15, 2017: Academic Pediatrics
https://www.readbyqxmd.com/read/28623183/phone-based-interventions-in-adolescent-psychiatry-a-perspective-and-proof-of-concept-pilot-study-with-a-focus-on-depression-and-autism
#6
Robert Yuzen Chen, Jordan Robert Feltes, William Shun Tzeng, Zoe Yunzhu Lu, Michael Pan, Nan Zhao, Rebecca Talkin, Kavon Javaherian, Anne Glowinski, Will Ross
BACKGROUND: Telemedicine has emerged as an innovative platform to diagnose and treat psychiatric disorders in a cost-effective fashion. Previous studies have laid the functional framework for monitoring and treating child psychiatric disorders electronically using videoconferencing, mobile phones (smartphones), and Web-based apps. However, phone call and text message (short message service, SMS) interventions in adolescent psychiatry are less studied than other electronic platforms. Further investigations on the development of these interventions are needed...
June 16, 2017: JMIR Research Protocols
https://www.readbyqxmd.com/read/28611876/effectiveness-of-resident-physicians-as-triage-liaison-providers-in-an-academic-emergency-department
#7
Victoria Weston, Sushil K Jain, Michael Gottlieb, Amer Aldeen, Stephanie Gravenor, Michael J Schmidt, Sanjeev Malik
INTRODUCTION: Emergency department (ED) crowding is associated with detrimental effects on ED quality of care. Triage liaison providers (TLP) have been used to mitigate the effects of crowding. Prior studies have evaluated attending physicians and advanced practice providers as TLPs, with limited data evaluating resident physicians as TLPs. This study compares operational performance outcomes between resident and attending physicians as TLPs. METHODS: This retrospective cohort study compared aggregate operational performance at an urban, academic ED during pre- and post-TLP periods...
June 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28607677/design-and-implementation-of-a-trauma-care-bundle-at-a-community-hospital
#8
Ryan Andres, Elan Hahn, Steffen de Kok, Rafi Setrak, Jeffrey Doyle, Allison Brown
The Niagara Health System (NHS) in Ontario, Canada is comprised of three non-designated trauma center (NTC) hospitals which provide primary care to approximately 100 trauma patients annually. NTCs often lack standardized resources such as trauma surgeons, trauma-trained emergency room physicians, Advanced Trauma Life Support certified staff, trauma protocols, and other resources commonly found at designated trauma centers. Studies indicate that these differences contribute to poorer outcomes for trauma patients treated at community hospitals in Ontario, including the NTC hospitals of the NHS...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28607213/consensus-guidelines-on-evaluation-and-management-of-the-febrile-child-presenting-to-the-emergency-department-in-india
#9
Prashant Mahajan, Prerna Batra, Neha Thakur, Reena Patel, Narendra Rai, Nitin Trivedi, Bernhard Fassl, Binita Shah, Marie Lozon, Rockerfeller A Oteng, Abhijeet Saha, Dheeraj Shah, Sagar Galwankar
JUSTIFICATION: No country-specific, evidence-based, consensus approach for the emergency department (ED) evaluation and management of the febrile child exist in India. PROCESS: We held two consensus meetings, performed an exhaustive literature review, and held ongoing web-based based discussions to arrive at a formal consensus on the proposed evaluation and management algorithm. The first meeting was held in Delhi in October 2015, under the auspices of Pediatric Emergency Medicine (PEM) Section of Academic College of Emergency Experts in India (ACEE-INDIA); and the second meeting was conducted at Pune during Emergency Medical Pediatrics and Recent Trends (EMPART 2016) in March 2016...
June 4, 2017: Indian Pediatrics
https://www.readbyqxmd.com/read/28603651/endobronchial-ultrasound-guided-transbronchial-needle-aspiration-ebus-tbna-from-morphology-to-molecular-testing
#10
REVIEW
Luisella Righi, Francesca Franzi, Francesca Montarolo, Gaia Gatti, Massimo Bongiovanni, Fausto Sessa, Stefano La Rosa
In recent years, endobronchial ultrasound-guided TBNA (EBUS-TBNA) has emerged as an innovative technique for diagnosis and staging of lung cancer and has been successfully introduced into daily clinical practice with several advantages including minimally invasive approach, safe, cost-effective, real time image guidance, broad sampling capability, and rapid on-site evaluation (ROSE). Both cytological and histological approach could be useful to have material for diagnosis, immunohistochemical and molecular analyses which may be very important for targeted therapy with successful rate ranging from 89% to 98%...
May 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28601795/the-role-of-nurses-clinical-impression-in-the-first-assessment-of-children-at-the-emergency-department
#11
Joany M Zachariasse, Dominique van der Lee, Nienke Seiger, Evelien de Vos-Kerkhof, Rianne Oostenbrink, Henriëtte A Moll
OBJECTIVE: To assess the diagnostic value and determinants of nurses' clinical impression for the recognition of children with a serious illness on presentation to the emergency department (ED). DESIGN: Secondary analysis of a prospective cohort. SETTING AND PATIENTS: 6390 consecutive children <16 years of age presenting to a paediatric ED with a non-surgical chief complaint and complete data available. MAIN OUTCOME MEASURES: Diagnostic accuracy of nurses' clinical impression for the prediction of serious illness, defined by intensive care unit (ICU) and hospital admission...
June 10, 2017: Archives of Disease in Childhood
https://www.readbyqxmd.com/read/28601333/variability-in-ct-imaging-of-blunt-trauma-among-ed-physicians-surgical-residents-and-trauma-surgeons
#12
Melissa K James, Shi-Wen Lee, Jennifer A Minneman, Maureen D Moore, Taylor R Klein, R Jonathan Robitsek, Phillip S Barie, Sebastian D Schubl
BACKGROUND: Trauma triage decisions can be influenced by both knowledge and experience. Consequently, there may be substantial variability in computed tomography (CT) scans desired by emergency medicine physicians, surgical chief residents, and attending trauma surgeons. We quantified this difference and studied the effects of each group's decisions on missed injuries, cost, and radiation exposure. METHODS: All blunt trauma activations at an urban level 1 trauma center were studied over a 6-mo period...
June 1, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28601203/the-care-of-thermally-injured-patients-in-operational-austere-and-mass-casualty-situations
#13
REVIEW
Booker T King, Wylan C Peterson
Burn injury affects a half million people in the United States annually. The severe thermal injury can have long-term debilitating effects. The management of burn patients in austere and operational environments is more complex. Mass casualty incidents can result in a large number of patients with multiple traumatic injuries, which often include burn injury. Appropriate triage of casualties is essential. Severely burned patients should be evacuated to a burn center if possible. Airway management and fluid resuscitation of burn patients present unique challenges...
June 2017: Wilderness & Environmental Medicine
https://www.readbyqxmd.com/read/28599661/poor-performance-of-quick-sofa-qsofa-score-in-predicting-severe-sepsis-and-mortality-a-prospective-study-of-patients-admitted-with-infection-to-the-emergency-department
#14
Åsa Askim, Florentin Moser, Lise T Gustad, Helga Stene, Maren Gundersen, Bjørn Olav Åsvold, Jostein Dale, Lars Petter Bjørnsen, Jan Kristian Damås, Erik Solligård
BACKGROUND: We aimed to evaluate the clinical usefulness of qSOFA as a risk stratification tool for patients admitted with infection compared to traditional SIRS criteria or our triage system; the Rapid Emergency Triage and Treatment System (RETTS). METHODS: The study was an observational cohort study performed at one Emergency Department (ED) in an urban university teaching hospital in Norway, with approximately 20,000 visits per year. All patients >16 years presenting with symptoms or clinical signs suggesting an infection (n = 1535) were prospectively included in the study from January 1 to December 31, 2012...
June 9, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28593802/the-effect-on-the-patient-flow-in-a-local-health-care-after-implementing-reverse-triage-in-a-primary-care-emergency-department-a-longitudinal-follow-up-study
#15
Timo Kauppila, Katri Seppänen, Juho Mattila, Johanna Kaartinen
OBJECTIVE: Reverse triage means that patients who are not considered to be in need of medical services are not placed on the doctor's list in an emergency department (ED) but are sent, after face-to-face evaluation by a triage nurse, to a more appropriate health care unit. It is not known how an abrupt application of such reverse triage in a combined primary care ED alters the demand for doctors' services in collaborative parts of the health care system. DESIGN: An observational study...
June 8, 2017: Scandinavian Journal of Primary Health Care
https://www.readbyqxmd.com/read/28588290/comparative-epidemiology-of-middle-east-respiratory-syndrome-coronavirus-mers-cov-in-saudi-arabia-and-south-korea
#16
Xin Chen, Abrar Ahmad Chughtai, Amalie Dyda, Chandini Raina MacIntyre
MERS-CoV infection emerged in the Kingdom of Saudi Arabia (KSA) in 2012 and has spread to 26 countries. However, 80% of all cases have occurred in KSA. The largest outbreak outside KSA occurred in South Korea (SK) in 2015. In this report, we describe an epidemiological comparison of the two outbreaks. Data from 1299 cases in KSA (2012-2015) and 186 cases in SK (2015) were collected from publicly available resources, including FluTrackers, the World Health Organization (WHO) outbreak news and the Saudi MOH (MOH)...
June 7, 2017: Emerging Microbes & Infections
https://www.readbyqxmd.com/read/28588013/building-a-visual-aid-for-a-triage-tool-in-a-developing-health-service
#17
Mir Saaduddin Ahmad, Darryl R Wood
Resources in the modern day emergency department are often stretched, and this holds true more so in developing services. With limited manpower, it is essential that efficient tools are created so that processes can be run safely. Here we pilot the use of a vital signs matrix in a medical camp in Dhaka to screen patients at triage. We further modified this matrix to include the National Early Warning Score as our recording of the NEWS have remained poor in triage. A trial and validation study for the use of this matrix in an NHS setting is currently underway...
June 6, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28580508/economics-of-early-warning-scores-for-identifying-clinical-deterioration-a-systematic-review
#18
A Murphy, J Cronin, R Whelan, F J Drummond, E Savage, J Hegarty
AIM: In 2013, a National Early Warning System (EWS) was implemented in Ireland. Whilst evidence exists to support the clinical effectiveness of EWS in the acute health care setting, there is a paucity of information on their cost and cost effectiveness. The objective of this systematic literature review was to critically evaluate the economic literature on the use of EWS in adult patients in acute health care settings for the timely detection of physiological deterioration. METHODS: A systematic literature review was conducted to accumulate the economic evidence on the use of EWS in adult patients in acute health care settings...
June 3, 2017: Irish Journal of Medical Science
https://www.readbyqxmd.com/read/28580202/the-empty-chairs-approach-to-learning-simulation-based-train-the-trainer-program-in-mzuzu-malawi
#19
Elaine Sigalet, Ian Wishart, Norman Lufesi, Faizal Haji, Adam Dubrowski
Together, a group of Canadian colleagues from St. John's, Newfoundland, Calgary, Alberta (some via Doha) and London, Ontario introduced the first Train the Trainer in Simulation-Based Learning (TTT-SBL) program in Mzuzu Central Hospital and Mzuzu University in Malawi. The team led by Elaine Sigalet (Doha) and consisting of Ian Wishart (Calgary), Faizal Haji (London) and Adam Dubrowski (St. John's) was invited to Malawi by Norman Lufesi to conduct a two-day TTT-SBL course for facilitators who teach an Emergency Triage, Assessment and Treatment (ETAT) plus Trauma course...
May 1, 2017: Curēus
https://www.readbyqxmd.com/read/28579532/dashboard-visualizations-supporting-real-time-throughput-decision-making
#20
Amy Franklin, Swaroop Gantela, Salsawit Shifarraw, Todd R Johnson, David J Robinson, Brent R King, Amit M Mehta, Charles L Maddow, Nathan R Hoot, Vickie Nguyen, Adriana Stanley, Jiajie Zhang, Nnaemeka G Okafor
Providing timely and effective care in the emergency department (ED) requires the management of individual patients as well as the flow and demands of the entire department. Strategic changes to work processes, such as adding a flow coordination nurse or a physician in triage, have demonstrated improvements in throughput times. However, such global strategic changes do not address the real-time, often opportunistic workflow decisions of individual clinicians in the ED. We believe that real-time representation of the status of the entire emergency department and each patient within it through information visualizations will better support clinical decision-making in-the-moment and provide for rapid intervention to improve ED flow...
June 1, 2017: Journal of Biomedical Informatics
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