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https://www.readbyqxmd.com/read/28214722/when-high-pressure-system-constraints-and-a-social-justice-mission-collide-a-socio-structural-analysis-of-emergency-department-social-work-services
#1
Megan Moore, Margaret Cristofalo, Danae Dotolo, Nicole Torres, Alexandra Lahdya, Leyna Ho, Mia Vogel, Mollie Forrester, Bonnie Conley, Susan Fouts
The emergency department (ED) can be a critical intervention point for many patients with multifaceted needs. Social workers have long been part of interdisciplinary ED teams. This study aimed to contribute to the limited understanding of social worker-patient interactions and factors influencing social work services in this setting. This paper reports a qualitative content analysis of social work medical record notes (N = 1509) of services provided to trauma patients in an urban, public, level 1 trauma center and an in-depth analysis of semi-structured interviews with ED social workers (N = 10)...
February 11, 2017: Social Science & Medicine
https://www.readbyqxmd.com/read/28214474/emergency-department-utilisation-by-older-people-in-metropolitan-melbourne-2008-12-findings-from-the-reducing-older-patient
#2
Danielle Mazza, Christopher Pearce, Angela Joe, Lyle R Turner, Bianca Brijnath, Colette Browning, Marianne Shearer, Judy Lowthian
Objective Older patients are over-represented in emergency departments (ED), with many presenting for conditions that could potentially be managed in general practice. The aims of the present study were to examine the characteristics of ED presentations by older patients and to identify patient factors contributing to potentially avoidable general practitioner (PAGP)-type presentations.Methods A retrospective analysis was performed of routinely collected data comprising ED presentations by patients aged ≥70 years at public hospitals across metropolitan Melbourne from January 2008 to December 2012...
February 20, 2017: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/28213342/virtual-visits-for-acute-nonurgent-care-a-claims-analysis-of-episode-level-utilization
#3
Aliza S Gordon, Wallace C Adamson, Andrea R DeVries
BACKGROUND: Expansion of virtual health care-real-time video consultation with a physician via the Internet-will continue as use of mobile devices and patient demand for immediate, convenient access to care grow. OBJECTIVE: The objective of the study is to analyze the care provided and the cost of virtual visits over a 3-week episode compared with in-person visits to retail health clinics (RHC), urgent care centers (UCC), emergency departments (ED), or primary care physicians (PCP) for acute, nonurgent conditions...
February 17, 2017: Journal of Medical Internet Research
https://www.readbyqxmd.com/read/28210363/using-the-electronic-medical-record-to-reduce-unnecessary-ordering-of-coagulation-studies-for-patients-with-chest-pain
#4
Jeremiah S Hinson, Binoy Mistry, Yu-Hsiang Hsieh, Nicholas Risko, David Scordino, Karolina Paziana, Susan Peterson, Rodney Omron
INTRODUCTION: Our goal was to reduce ordering of coagulation studies in the emergency department (ED) that have no added value for patients presenting with chest pain. We hypothesized this could be achieved via implementation of a stopgap measure in the electronic medical record (EMR). METHODS: We used a pre and post quasi-experimental study design to evaluate the impact of an EMR-based intervention on coagulation study ordering for patients with chest pain. A simple interactive prompt was incorporated into the EMR of our ED that required clinicians to indicate whether patients were on anticoagulation therapy prior to completion of orders for coagulation studies...
February 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28210361/estimating-the-cost-of-care-for-emergency-department-syncope-patients-comparison-of-three-models
#5
Marc A Probst, John K McConnell, Robert E Weiss, Amber L Laurie, Annick N Yagapen, Michelle P Lin, Jeffrey M Caterino, Manish N Shah, Benjamin C Sun
INTRODUCTION: We sought to compare three hospital cost-estimation models for patients undergoing evaluation for unexplained syncope using hospital cost data. Developing such a model would allow researchers to assess the value of novel clinical algorithms for syncope management. METHODS: We collected complete health services data, including disposition, testing, and length of stay (LOS), on 67 adult patients (age 60 years and older) who presented to the emergency department (ED) with syncope at a single hospital...
February 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28210358/american-association-for-emergency-psychiatry-task-force-on-medical-clearance-of-adults-part-i-introduction-review-and-evidence-based-guidelines
#6
REVIEW
Eric L Anderson, Kimberly Nordstrom, Michael P Wilson, Jennifer M Peltzer-Jones, Leslie Zun, Anthony Ng, Michael H Allen
INTRODUCTION: In the United States, the number of patients presenting to the emergency department (ED) for a mental health concern is significant and expected to grow. The breadth of the medical evaluation of these patients is controversial. Attempts have been made to establish a standard evaluation for these patients, but to date no nationally accepted standards exist. A task force of the American Association of Emergency Psychiatry, consisting of physicians from emergency medicine and psychiatry, and a psychologist was convened to form consensus recommendations on the medical evaluation of psychiatric patients presenting to EDs...
February 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28210353/prevalence-of-horizontal-violence-among-emergency-attending-physicians-residents-and-physician-assistants
#7
Nico B Volz, Ryan Fringer, Bradford Walters, Terry Kowalenko
INTRODUCTION: Horizontal violence (HV) is malicious behavior perpetrated by healthcare workers against each other. These include bullying, verbal or physical threats, purposeful disruptive behavior, and other malicious behaviors. This pilot study investigates the prevalence of HV among emergency department (ED) attending physicians, residents, and mid-level providers (MLPs). METHODS: We sent an electronic survey to emergency medicine attending physicians (n=67), residents (n=25), and MLPs (n=24) in three unique EDs within a single multi-hospital medical system...
February 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28210351/cross-continuum-tool-is-associated-with-reduced-utilization-and-cost-for-frequent-high-need-users
#8
Lauran Hardin, Adam Kilian, Leslie Muller, Kevin Callison, Michael Olgren
INTRODUCTION: High-need, high-cost (HNHC) patients can over-use acute care services, a pattern of behavior associated with many poor outcomes that disproportionately contributes to increased U.S. healthcare cost. Our objective was to reduce healthcare cost and improve outcomes by optimizing the system of care. We targeted HNHC patients and identified root causes of frequent healthcare utilization. We developed a cross-continuum intervention process and a succinct tool called a Complex Care Map (CCM)© that addresses fragmentation in the system and links providers to a comprehensive individualized analysis of the patient story and causes for frequent access to health services...
February 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28208056/oral-rehabilitation-of-a-patient-with-ectodermal-dysplasia-treated-with-fresh-frozen-bone-allografts-and-computer-guided-implant-placement-a-clinical-case-report
#9
Carlo Maiorana, Pier Paolo Poli, Carlo Poggio, Paola Barbieri, Mario Beretta
Ectodermal dysplasia (ED) is an inherited disorder characterized by abnormality of ectodermally derived structures. A recurrent oral finding is oligodontia, which in turn leads to a severely hypotrophic alveolar process with typical knife-edge morphology and adverse ridge contours. This unfavorable anatomy can seriously hamper proper implant placement. Fresh-frozen bone (FFB) allografts recently have been proposed to augment the residual bone volume for implant placement purposes; however, scientific evidence concerning the use of FFB to treat ED patients is absent...
January 20, 2017: Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/28207996/the-use-of-a-contextual-modal-and-psychological-classification-of-medication-errors-in-the-emergency-department-a-retrospective-descriptive-study
#10
C J Cabilan, J A Hughes, C Shannon
BACKGROUND: The causes of medication errors are unique in every clinical setting; hence error minimisation strategies are not always effective. For this reason, it is fundamental to understand the causes specific to the emergency department so that targeted strategies can be implemented. OBJECTIVES: To describe the contextual, modal, and psychological classification of medication errors in the emergency department to know the factors associated with the reported medication errors...
February 16, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28205446/intramuscular-ziprasidone-dosing-for-acute-agitation-in-the-pediatric-emergency-department
#11
Tammy Nguyen, Jillian Stanton, Robin Foster
BACKGROUND: Intramuscular (IM) ziprasidone is often used to manage acute agitation. Limited data exist on the pediatric dosing of ziprasidone in the emergency department (ED). OBJECTIVE: To characterize the mg/kg dosing differences between pediatric ED patients who respond to an initial dose of ziprasidone versus patients who do not. METHODS: This was a retrospective, observational study of 5- to 18-year-old patients who were treated with IM ziprasidone in the pediatric ED from 2007 to 2015...
January 1, 2017: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/28197017/characterization-and-therapeutic-application-of-canine-adipose-mesenchymal-stem-cells-to-treat-elbow-osteoarthritis
#12
Éva Kriston-Pál, Ágnes Czibula, Zoltán Gyuris, Gyula Balka, Antal Seregi, Farkas Sükösd, Miklós Süth, Endre Kiss-Tóth, Lajos Haracska, Ferenc Uher, Éva Monostori
Visceral adipose tissue (AT) obtained from surgical waste during routine ovariectomies was used as a source for isolating canine mesenchymal stem cells (MSCs). As determined by cytofluorimetry, passage 2 cells expressed MSC markers CD44 and CD90 and were negative for lineage-specific markers CD34 and CD45. The cells differentiated toward osteogenic, adipogenic, and chondrogenic directions. With therapeutic aims, 30 dogs (39 joints) suffering from elbow dysplasia (ED) and osteoarthritis (OA) were intra-articularly transplanted with allogeneic MSCs suspended in 0...
January 2017: Canadian Journal of Veterinary Research, Revue Canadienne de Recherche Vétérinaire
https://www.readbyqxmd.com/read/28196949/referral-pathways-for-patients-with-tia-avoiding-hospital-admission-a-scoping-review
#13
Bridie Angela Evans, Khalid Ali, Jenna Bulger, Gary A Ford, Matthew Jones, Chris Moore, Alison Porter, Alan David Pryce, Tom Quinn, Anne C Seagrove, Helen Snooks, Shirley Whitman, Nigel Rees
OBJECTIVE: To identify the features and effects of a pathway for emergency assessment and referral of patients with suspected transient ischaemic attack (TIA) in order to avoid admission to hospital. DESIGN: Scoping review. DATA SOURCES: PubMed, CINAHL Web of Science, Scopus. STUDY SELECTION: Reports of primary research on referral of patients with suspected TIA directly to specialist outpatient services. DATA EXTRACTION: We screened studies for eligibility and extracted data from relevant studies...
February 14, 2017: BMJ Open
https://www.readbyqxmd.com/read/28196608/management-of-major-bleeding-events-in-patients-treated-with-dabigatran-for-nonvalvular-atrial-fibrillation-a-retrospective-multicenter-review
#14
Truman J Milling, Christian Fromm, Michael Ganetsky, Daniel J Pallin, Julie Cong, Adam J Singer
STUDY OBJECTIVE: There are limited data on the clinical presentations and management of dabigatran-associated major bleeding outside the clinical trial setting. The aim of this study is to describe clinical characteristics, interventions, and outcomes in patients with dabigatran-associated major bleeding who present to the emergency department (ED). METHODS: We performed a retrospective observational chart review study of dabigatran-treated patients with nonvalvular atrial fibrillation who presented with acute major bleeding to the ED...
February 3, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28196544/diagnostic-error-in-the-emergency-department-follow-up-of-patients-with-minor-trauma-in-the-outpatient-clinic
#15
Pieter-Jan Moonen, Luc Mercelina, Willem Boer, Tom Fret
BACKGROUND: The Emergency Department (ED) is prone to diagnostic error. Most frequent diagnostic errors involved "minor" trauma. Our goal was to determine how frequently a missed diagnosis was detected during follow up and to determine the frequency and causes of primary missed diagnosis and diagnostic error. METHODS: A retrospective single centre study review, during 6 months including all patients presenting to the outpatient clinic after ED admission with a minor trauma...
February 14, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28195938/low-adverse-event-rates-but-high-emergency-department-utilization-in-chest-pain-patients-treated-in-an-emergency-department-observation-unit
#16
Anthony M Napoli, Janette Baird, Steven Tran, Jing Wang
OBJECTIVES: Nearly 40% of all previously admitted chest pain patients re-present to the emergency department (ED) within 1 year regardless of stress testing, and nearly 5% of patients return with a major adverse cardiac event (MACE). The primary objective of this study was to determine the prevalence of return visits to the ED among patients previously admitted to an ED chest pain observation unit (CPU). We also identified the patient characteristics and health risk factors associated with these return ED visits...
March 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28195435/why-do-children-present-to-emergency-departments-exploring-motivators-and-measures-of-presentation-appropriateness-for-children-presenting-to-a-paediatric-emergency-department
#17
John A Cheek, George Braitberg, Simon Craig, Adam West
AIM: To compare the parental motivators and referring general practitioner's (GP's) reasons for advising emergency department (ED) attendance with the assessment of ED medical staff. To compare ED clinician opinion with other published methods that have attempted to define 'primary care suitable' presentations to the ED. METHODS: A prospective observational study and series of surveys regarding the attendance of children presenting to a single tertiary paediatric ED...
February 14, 2017: Journal of Paediatrics and Child Health
https://www.readbyqxmd.com/read/28190665/intranasal-fentanyl-and-inhaled-nitrous-oxide-for-fracture-reduction-the-fan-observational-study
#18
J Hoeffe, E Doyon Trottier, B Bailey, D Shellshear, M Lagacé, C Sutter, G Grimard, R Cook, F E Babl
INTRODUCTION: Procedural sedation and analgesia (PSA) are frequently used for fracture reduction in pediatric emergency departments (ED). Combining intranasal (IN) fentanyl with inhalation of nitrous oxide (N2O) allow for short recovery time and obviates painful and time-consuming IV access insertions. METHODS: We performed a bicentric, prospective, observational cohort study. Patients aged 4-18years were included if they received combined PSA with IN fentanyl and N2O for the reduction of mildly/moderately displaced fracture or of dislocation...
January 5, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28190453/an-empirical-vs-risk-based-approach-algorithm-to-intracavernosal-injection-therapy-a-prospective-study
#19
Helen Levey Bernie, Robert Segal, Brian Le, Arthur Burnett, Trinity J Bivalacqua
INTRODUCTION: Intracavernosal injection (ICI) therapy is widely used for the treatment of erectile dysfunction (ED). Its use in practice is largely empirical and has not been validated with evidence-based approaches. AIM: To compare two strategies for ICI, specifically a risk-based approach and an empiric-based approach, and assess the efficacy, patient satisfaction, and complication rates of the two treatment approaches. METHODS: After obtaining approval from the institutional review board, a prospective database of patients enrolled in the ICI program at the Johns Hopkins Hospital (Baltimore, MD, USA) from May 2012 through May 2014 was amassed...
March 2017: Sexual Medicine
https://www.readbyqxmd.com/read/28190410/the-effect-of-older-age-on-ems-use-for-transportation-to-an-emergency-department
#20
Courtney M C Jones, Erin B Wasserman, Timmy Li, Ashley Amidon, Marissa Abbott, Manish N Shah
: Introduction Previous studies have found that older adults are more likely to use Emergency Medical Services (EMS) than younger adults, but the reasons for this remain understudied. Hypothesis/Problem This study aimed to determine if older age is associated with using EMS for transportation to an emergency department (ED) after controlling for confounding variables. METHODS: A cross-sectional survey study was conducted at a large academic medical center. Data on previous medical history, chief complaint, self-perceived illness severity, demographic information, and mode of arrival to the ED were collected on all subjects...
February 13, 2017: Prehospital and Disaster Medicine
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