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ED Observation unit

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https://www.readbyqxmd.com/read/28096032/creation-of-an-intensive-care-unit-and-organizational-changes-in-an-adult-emergency-department-impact-on-acute-stroke-management
#1
Laurent Puy, Chantal Lamy, Sandrine Canaple, Audrey Arnoux, Nicolas Laine, Ella Iacob, Jean-Marc Constans, Olivier Godefroy
BACKGROUND AND PURPOSE: Following the reorganization of a University Medical Center onto a single campus, an Intensive Care Unit was created within the adult Emergency Department (ED ICU). We assessed the effects of these organizational changes on acute stroke management and the intravenous administration of recombinant tissue plasminogen activator (IV rtPA), as characterized by the thrombolysis rate, door-to-needle time (DNT) and outcome at 3months. METHODS: Between October 2013 and September 2015, we performed a retrospective, observational, single-center, comparative study of patients admitted for ischemic stroke and treated with IV rtPA during two 321-day periods (before and after the creation of the ED ICU)...
January 10, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28062816/primary-care-clinic-re-design-for-prescription-opioid-management
#2
Michael L Parchman, Michael Von Korff, Laura-Mae Baldwin, Mark Stephens, Brooke Ike, DeAnn Cromp, Clarissa Hsu, Ed H Wagner
BACKGROUND: The challenge of responding to prescription opioid overuse within the United States has fallen disproportionately on the primary care clinic setting. Here we describe a framework comprised of 6 Building Blocks to guide efforts within this setting to address the use of opioids for chronic pain. METHODS: Investigators conducted site visits to thirty primary care clinics across the United States selected for their use of team-based workforce innovations...
January 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28053364/use-of-antibiotics-in-children-younger-than-two-years-in-eight-countries-a-prospective-cohort-study
#3
Elizabeth T Rogawski, James A Platts-Mills, Jessica C Seidman, Sushil John, Mustafa Mahfuz, Manjeswori Ulak, Sanjaya K Shrestha, Sajid Bashir Soofi, Pablo Penataro Yori, Estomih Mduma, Erling Svensen, Tahmeed Ahmed, Aldo Am Lima, Zulfiqar A Bhutta, Margaret N Kosek, Dennis R Lang, Michael Gottlieb, Anita Km Zaidi, Gagandeep Kang, Pascal O Bessong, Eric R Houpt, Richard L Guerrant
OBJECTIVE: To describe the frequency and factors associated with antibiotic use in early childhood, and estimate the proportion of diarrhoea and respiratory illnesses episodes treated with antibiotics. METHODS: Between 2009 and 2014, we followed 2134 children from eight sites in Bangladesh, Brazil, India, Nepal, Pakistan, Peru, South Africa and the United Republic of Tanzania, enrolled in the MAL-ED birth cohort study. We documented all antibiotic use from mothers' reports at twice-weekly visits over the children's first two years of life...
January 1, 2017: Bulletin of the World Health Organization
https://www.readbyqxmd.com/read/28046080/the-annual-burden-of-seasonal-influenza-in-the-us-veterans-affairs-population
#4
Yinong Young-Xu, Robertus van Aalst, Ellyn Russo, Jason K H Lee, Ayman Chit
Seasonal influenza epidemics have a substantial public health and economic burden in the United States (US). On average, over 200,000 people are hospitalized and an estimated 23,000 people die from respiratory and circulatory complications associated with seasonal influenza virus infections each year. Annual direct medical costs and indirect productivity costs across the US have been found to average respectively at $10.4 billion and $16.3 billion. The objective of this study was to estimate the economic impact of severe influenza-induced illness on the US Veterans Affairs population...
2017: PloS One
https://www.readbyqxmd.com/read/28040411/emergency-department-critical-care-unit-for-critically-ill-cardiovascular-patients-an-observation-study
#5
Ken-Hui Fu, Yin-Ru Chen, Ju-Shin Fan, Yen-Chia Chen, Hsien-Hao Huang, Chorng-Kuang How, David Hung-Tsang Yen, Si-An Chen, Mu-Shun Huang
BACKGROUND: We investigated an intensive care model for acute critically cardiovascular emergency patients in the emergency department (ED) as compared with those in the coronary care unit (CCU) after ED visits. METHODS: We performed a retrospective cohort analysis of patients with acute cardiovascular emergency admitted to the intensive care unit in the ED (EICU) or CCU from January 1, 2010 to March 31, 2011 in an university-affiliated medical center. All clinical characteristics or predictors possibly related to in-hospital mortality were documented, completed, and measured via electronic medical records review...
December 28, 2016: Journal of the Chinese Medical Association: JCMA
https://www.readbyqxmd.com/read/28005916/the-triage-proadm-score-for-an-early-risk-stratification-of-medical-patients-in-the-emergency-department-development-based-on-a-multi-national-prospective-observational-study
#6
Alexander Kutz, Pierre Hausfater, Devendra Amin, Adina Amin, Pauline Canavaggio, Gabrielle Sauvin, Maguy Bernard, Antoinette Conca, Sebastian Haubitz, Tristan Struja, Andreas Huber, Beat Mueller, Philipp Schuetz
INTRODUCTION: The inflammatory biomarker pro-adrenomedullin (ProADM) provides additional prognostic information for the risk stratification of general medical emergency department (ED) patients. The aim of this analysis was to develop a triage algorithm for improved prognostication and later use in an interventional trial. METHODS: We used data from the multi-national, prospective, observational TRIAGE trial including consecutive medical ED patients from Switzerland, France and the United States...
2016: PloS One
https://www.readbyqxmd.com/read/28003301/safety-and-feasibility-of-sublingual-microcirculation-assessment-in-the-emergency-department-for-civilian-and-military-patients-with-traumatic-haemorrhagic-shock-a-prospective-cohort-study
#7
David N Naumann, Clare Mellis, Iain M Smith, Jasna Mamuza, Imogen Skene, Tim Harris, Mark J Midwinter, Sam D Hutchings
OBJECTIVES: Sublingual microcirculatory monitoring for traumatic haemorrhagic shock (THS) may predict clinical outcomes better than traditional blood pressure and cardiac output, but is not usually performed until the patient reaches the intensive care unit (ICU), missing earlier data of potential importance. This pilot study assessed for the first time the feasibility and safety of sublingual video-microscopy for THS in the emergency department (ED), and whether it yields useable data for analysis...
December 21, 2016: BMJ Open
https://www.readbyqxmd.com/read/27976497/prospective-and-explicit-clinical-validation-of-the-ottawa-heart-failure-risk-scale-with-and-without-use-of-quantitative-nt-probnp
#8
Ian G Stiell, Jeffrey J Perry, Catherine M Clement, Robert J Brison, Brian H Rowe, Shawn D Aaron, Andrew McRae, Bjug Borgundvaag, Lisa A Calder, Alan J Forster, George A Wells
OBJECTIVES: We previously developed the Ottawa Heart Failure Risk Scale (OHFRS) to assist with disposition decisions for acute heart failure patients in the emergency department (ED). We sought to prospectively evaluate the accuracy, acceptability, and potential impact of OHFRS. METHODS: This prospective observational cohort study was conducted at six tertiary hospital EDs. Patients with acute heart failure were evaluated by ED physicians for the 10 OHFRS criteria and then followed for 30 days...
December 15, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27974919/brief-report-serial-capillary-lactate-measurement-predict-the-evolution-of-early-sepsis
#9
REVIEW
A Purcarea, A Bourgarit, A Sovaila, C Ghiura, P Diemunsch, E Andres
OBJECTIVE: In intensive care settings, blood lactate level measurement proved to be an excellent predictor of outcomes. In patients requiring less urgent treatment, the arterial blood lactate is less sensitive and its usefulness remains to be proven. Capillary blood lactate dosing, an emergent point-of-care technique readily available should be more sensitive to changes in these settings. METHOD: prospective, observational, monocentric study conducted in a polyvalent internal medicine ward in a French University Hospital...
January 2016: Journal of Medicine and Life
https://www.readbyqxmd.com/read/27974226/adverse-event-and-error-of-unexpected-life-threatening-events-within-24h-of-emergency-department-admission
#10
Ewai Zhang, Shih-Chiang Hung, Chien-Hung Wu, Ling-Ling Chen, Ming-Ta Tsai, Wen-Huei Lee
OBJECTIVES: Errors and adverse events associated with unexpected life-threatening events including unplanned transfer to the intensive care unit (ICU) and unexpected death after emergency department (ED) hospitalization are not well characterized. We performed this study to investigate the role of unexpected life-threatening events as a trigger to capture errors and adverse events for ED patient safety. METHODS: This prospective observational study enrolled adult non-trauma patients with unexpected life-threatening events within 24h of general ward admission from the ED of a medical center in Taiwan...
November 30, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27942517/troubleshooting-an-isolate-prolongation-of-activated-partial-thromboplastin-time-in-a-patient-with-acute-myocardial-infarction-a-paradigmatic-case-report
#11
Giovanni Poli, Piero Castiglioni, Martina Montagnana, Emmanuel J Favaloro, Giuseppe Lippi
We describe here the case of a 46-year-old man admitted to the emergency department (ED) and diagnosed with a non-ST elevation myocardial infarction. Before referring the patient to the coronary care unit and initiating antiplatelet and anticoagulant therapy, a highly prolonged activated partial thromboplastin time (APTT) was observed among results of laboratory testing. Results of mixing test showed complete correction of APTT, thus ruling out the presence of inhibitors of blood coagulation. On the following day, second line coagulation testing revealed normal activity of all clotting factors except factor XII, the concentration of which was found to be 1...
November 2016: Annals of Translational Medicine
https://www.readbyqxmd.com/read/27938373/pre-hospital-transfusion-of-plasma-in-hemorrhaging-trauma-patients-independently-improves-hemostatic-competence-and-acidosis
#12
Hanne H Henriksen, Elaheh Rahbar, Lisa A Baer, John B Holcomb, Bryan A Cotton, Jacob Steinmetz, Sisse R Ostrowski, Jakob Stensballe, Pär I Johansson, Charles E Wade
BACKGROUND: The early use of blood products has been associated with improved patient outcomes following severe hemorrhage or traumatic injury. We aimed to investigate the influence of pre-hospital blood products (i.e. plasma and/or RBCs) on admission hemostatic properties and patient outcomes. We hypothesized that pre-hospital plasma would improve hemostatic function as evaluated by rapid thrombelastography (rTEG). METHODS: We conducted a prospective observational study recruiting 257 trauma patients admitted to a Level I trauma center having received either blood products pre-hospital or in-hospital within 6 hours of admission...
December 9, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/27931303/a-comparison-of-seasonal-trends-in-asthma-exacerbations-among-children-from-geographic-regions-with-different-climates
#13
Julia A Wisniewski, Anne P McLaughlin, Philip J Stenger, James Patrie, Mark A Brown, Jane M El-Dahr, Thomas A E Platts-Mills, Nora J Byrd, Peter W Heymann
BACKGROUND: The fall peak in childhood asthma exacerbations is thought to be related to an increase in viral infections and allergen exposure when children return to school. Whether the seasonality of asthma attacks among children from different geographic regions follows similar trends is unclear. OBJECTIVE: To compare seasonal trends in asthma exacerbations among school-age children who lived in different geographic locations, with different climates, within the United States...
November 2016: Allergy and Asthma Proceedings:
https://www.readbyqxmd.com/read/27923148/patient-and-clinician-reported-outcome-in-eating-disorders
#14
Laura Al-Dakhiel Winkler, Jacob Stampe Frølich, Claire Gudex, Kirsten Hørder, Niels Bilenberg, René Klinkby Støving
Patient-reported outcome is increasingly applied in health sciences. Patients with eating disorders (EDs) characteristically have a different opinion of their needs to that of the health professionals, which can lead to ambivalence towards treatment and immense compliance difficulties. This cross-sectional study compared data assessed by the clinician to patient-reported measures in patients with a history of EDs. We included data from a cohort of patients with EDs (n=544) referred to a specialized ED unit in Denmark...
January 2017: Psychiatry Research
https://www.readbyqxmd.com/read/27918377/utility-of-emergency-department-observation-units-for-neurologically-intact-children-with-head-ct-abnormalities-secondary-to-acute-closed-head-injury
#15
Roxanna Lefort, Jill V Hunter, Andrea T Cruz, A Chantal Caviness, Thomas G Luerssen, Aderonke Adekunle-Ojo
OBJECTIVE: The aim of the study was to evaluate the utility of the emergency department observation unit (EDOU) for neurologically intact children with closed head injuries (CHIs) and computed tomography (CT) abnormalities. METHODS: A retrospective cohort study of children aged 0 to 18 years with acute CHI, abnormal head CT, and a Glasgow Coma Scales score of 14 or higher admitted to the EDOU of a tertiary care children's hospital from 2007 to 2010. Children with multisystem trauma, nonaccidental trauma, and previous neurosurgical or coagulopathic conditions were excluded...
December 1, 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27914661/statin-discontinuation-and-mortality-in-an-older-adult-population-with-traumatic-brain-injury-a-four-year-multi-centre-observational-cohort-study
#16
Alessandro Orlando, Christine Thomas, Matthew Carrick, D Sue Slone, Charles W Mains, David Bar-Or
INTRODUCTION: Statin discontinuation has been investigated in a wide range of diseases and injuries, but there is a paucity of data in the older adult population with traumatic brain injury (TBI). The purpose of this study was to re-examine the extent to which early discontinuation of pre-injury statin (PIS) therapy increases the risk of poor patient outcomes in older adult patients suffering a TBI. METHODS: This was a retrospective observational cohort study of adult trauma patients with a blunt TBI across three trauma centres over four years...
November 25, 2016: Injury
https://www.readbyqxmd.com/read/27903209/incidence-and-cost-of-stress-ulcer-prophylaxis-after-discharge-from-the-intensive-care-unit-a-retrospective-study
#17
Benedict Tan, Richard Norman, Ed Litton, Chloe Heath, David J Hawkins, Ravi Krishnamurthy, Ravikiran Sonawane, Matthew H Anstey
OBJECTIVE: To describe current patterns in initiation and cessation of proton pump inhibitors (PPIs) for stress ulcer prophylaxis (SUP) in intensive care units, and to assess the costs associated with inappropriate (non-evidence-based) SUP. DESIGN, SETTING AND PARTICIPANTS: Retrospective observational study in five ICUs in Western Australia. We assessed the medical records of consecutive patients admitted to the ICUs between September 2013 and January 2015. Patients aged < 18 years were excluded...
December 2016: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/27902667/managing-skin-and-soft-tissue-infections-in-the-emergency-department-observation-unit
#18
Shabana Yusuf, Joseph L Hagan, Aderonke O Adekunle-Ojo
BACKGROUND: Skin and soft tissue infections (SSTIs) are a common reason for presentation to the emergency department (ED) and account for 3% of ED visits. Patients with a diagnosis of cellulitis requiring intravenous (IV) antibiotics have traditionally been admitted to the hospital. In our institution, these patients are placed in the ED Observation Unit (EDOU) for IV antibiotics. OBJECTIVES: The purpose of this study is to determine if 3 doses of IV antibiotics are adequate to document clinical improvement in children with uncomplicated SSTI...
December 2, 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27896320/influences-of-do-not-resuscitate-order-prohibition-on-cpr-outcomes
#19
Umut Gulacti, Ugur Lok
OBJECTIVES: The aim of the study is to determine factors affecting the return of spontaneous circulation (ROSC) ratios, neurological outcomes at discharge, the ratio of living patients discharged from the hospital and due to Do not attempt resuscitation (DNAR) prohibition. MATERIAL AND METHODS: This is a retrospective observational study conducted on patients of cardiopulmonary resuscitation (CPR) performed in emergency department (ED) and intensive care units between February 2010 and February 2012...
June 2016: Turkish Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27876328/best-clinical-practice-controversies-in-transient-ischemic-attack-evaluation-and-disposition-in-the-emergency-department
#20
Brit Long, Alex Koyfman
BACKGROUND: Transient ischemic attack (TIA) affects over 200,000 patients annually in the United States, and it precedes approximately 14% to 23% of strokes. Patients are typically admitted for evaluation and management. OBJECTIVE: This review investigates the controversies of emergency department (ED) evaluation of TIA, including imaging, clinical risk scores, rapid diagnostic protocols, and disposition. DISCUSSION: TIA is a common condition, with over 200,000 patients affected annually, and is associated with risk of stroke...
November 19, 2016: Journal of Emergency Medicine
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