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https://www.readbyqxmd.com/read/29330584/a-dedicated-neurologist-at-the-emergency-department-during-out-of-office-hours-decreases-patients-length-of-stay-and-admission-percentages
#1
M Christien van der Linden, Crispijn L van den Brand, Ido R van den Wijngaard, Roeline A Y de Beaufort, Naomi van der Linden, Korné Jellema
BACKGROUND: Emergency departments (EDs) worldwide face crowding, which hampers patient flow. In this study, the impact of a dedicated neurologist present at the ED on patient flow during out-of-office hours was assessed. METHODS: A cross-sectional, mixed methods study was undertaken at a Dutch ED, including a pre-post analysis of data of patients who had a primary neurological disease (n = 458) and staff surveys (n = 152). Descriptive statistics and content analysis were used for analyses...
January 12, 2018: Journal of Neurology
https://www.readbyqxmd.com/read/29329727/parent-activation-in-the-pediatric-emergency-department-theory-vs-reality
#2
Danica B Liberman, Phung K Pham
OBJECTIVE: To measure parent activation and test for its associations with sociodemographics, clinical factors, and short-term outcomes. METHODS: By convenience sampling, 246 parents of children treated in an emergency department (ED) of a children's hospital completed the Parent-Patient Activation Measure (P-PAM) and answered sociodemographic questions. Clinical information was abstracted from medical records. Phone calls to parents and primary care physician offices were conducted within one-month post-ED visit for information about short-term outcomes...
January 8, 2018: Patient Education and Counseling
https://www.readbyqxmd.com/read/29328792/identification-and-management-of-nontraumatic-splenic-rupture
#3
Samanthi De Silva
A 43-year old previously fit and well gentleman presented to the emergency department (ED) with a two day history of worsening epigastric pain. He had had coryzal symptoms the preceding week but had no other past medical history. He was haemodynamically stable at presentation and an ultrasound scan (US) performed in the ED could not definitively rule out intra-abdominal fluid. In view of his tender abdomen on examination and a haemoglobin level of 9.2g/dL, a computerised tomography (CT) scan was performed and revealed extensive high-density fluid within the peritoneal cavity, raising the possibility of a concealed bleed but no obvious source was identified by the scan...
December 2017: Journal of Perioperative Practice
https://www.readbyqxmd.com/read/29328745/airway-safety-in-a-patient-with-submandibular-swelling
#4
Samanthi De Silva
A fifty-eight year old gentleman (CH) with a five-day history of toothache presented to the emergency department (ED) with increasing pain with associated submandibular swelling over the last 24-hours. He was an unkempt gentleman who had not consulted his general practitioner or dentist in many years, was unaware of any significant past medical history and was not on any regular medication. He was an obese gentleman with a BMI of 56.
March 2017: Journal of Perioperative Practice
https://www.readbyqxmd.com/read/29324631/pediatric-appendicitis-association-of-chief-complaint-with-missed-appendicitis
#5
Zachary Drapkin, Jennifer Dunnick, Troy E Madsen, Matthew Bryce, Jeff E Schunk
OBJECTIVES: We evaluated the association between the emergency department (ED) triage chief complaint and rate of missed appendicitis in children. METHODS: We performed a retrospective chart review of patients who presented to a pediatric ED and were diagnosed with appendicitis over 5 years (July 1, 2009 to June 30, 2014). We reviewed the medical record for any additional ED visits in the 7 days preceding the diagnosis of appendicitis. Triage chief complaints were classified as "suggestive of appendicitis" (abdominal pain, right lower quadrant pain, or rule out appendicitis) or "nonspecific" (fever, vomiting, dehydration, etc)...
January 11, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29321226/the-association-of-neurologists-with-headache-health-care-utilization-and-costs
#6
Brian C Callaghan, James F Burke, Kevin A Kerber, Lesli E Skolarus, John P Ney, Brandon Magliocco, Gregory J Esper
OBJECTIVE: To determine the association of a neurologist visit with headache health care utilization and costs. METHODS: Utilizing a large privately insured health care claims database, we identified patients with an incident headache diagnosis (ICD-9 codes 339.xx, 784.0x, 306.81) with at least 5 years follow-up. Patients with a subsequent neurologist visit were matched to controls without a neurologist visit using propensity score matching, accounting for 54 potential confounders and regional variation in neurologist density...
January 10, 2018: Neurology
https://www.readbyqxmd.com/read/29320915/healthcare-utilization-and-costs-associated-with-treatment-for-opioid-dependence
#7
Ankit Shah, Margaret Duncan, Nipun Atreja, Kei Sing Tai, Mugdha Gore
OBJECTIVE: Opioid use disorder (OUD) can be managed with medication assisted therapy (MAT) (methadone [MET], buprenorphine [BUP], or extended-release naltrexone [XR-NTX]) or counseling alone (non-pharmacological therapy [NPT]). The objective of this study was to evaluate healthcare resource utilization and costs associated with XR-NTX compared with alternative treatments for opioid dependence. METHODS: Adults with a diagnosis of opioid dependence who initiated treatment with XR-NTX, BUP, MET, or NPT between January 1, 2011 and December 31, 2014 were identified in the Truven Health MarketScan Commercial administrative claims database...
January 10, 2018: Journal of Medical Economics
https://www.readbyqxmd.com/read/29318085/exploring-older-adult-ed-fall-patients-understanding-of-their-fall-a-qualitative-study
#8
Kalpana N Shankar, Devon Taylor, Caroline T Rizzo, Shan W Liu
Objective: We sought to understand older patients' perspectives about their fall, fall risk factors, and attitude toward emergency department (ED) fall-prevention interventions. Methods: We conducted semistructured interviews between July 2015 and January 2016 of community-dwelling, nondemented patients in the ED, who presented with a fall to an urban, teaching hospital. Interviews were halted once we achieve thematic saturation with the data coded and categorized into themes...
December 2017: Geriatric Orthopaedic Surgery & Rehabilitation
https://www.readbyqxmd.com/read/29317399/effect-of-a-single-dose-of-i-v-ondansetron-on-qtc-interval-in-emergency-department-patients
#9
Kai Li, Kathy Vo, Byron K Lee, Newton Addo, Zlatan Coralic
PURPOSE: Results of a study to determine whether i.v. administration of a single dose of 4 mg of ondansetron was associated with QT interval prolongation in emergency department (ED) patients are reported. METHODS: In a prospective observational study conducted at an urban academic medical center ED, a convenience sample of adult ED patients treated with ondansetron 4 mg i.v. were enrolled. A 12-lead electrocardiogram (ECG) was obtained immediately before and 5 minutes after ondansetron administration...
January 9, 2018: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/29317154/mobile-integrated-health-to-reduce-post-discharge-acute-care-visits-a-pilot-study
#10
Jennica Siddle, Peter S Pang, Christopher Weaver, Elizabeth Weinstein, Daniel O'Donnell, Thomas P Arkins, Charles Miramonti
BACKGROUND: Mobile Integrated Health (MIH) leverages specially trained paramedics outside of emergency response to bridge gaps in local health care delivery. STUDY OBJECTIVE: To evaluate the efficacy of a MIH led transitional care strategy to reduce acute care utilization. METHODS: This was a retrospective cohort analysis of a quality improvement pilot of patient patients from an urban, single county EMS, MIH transitional care initiative. We utilized a paramedic/social worker (or social care coordinator) dyad to provide in home assessments, medication review, care coordination, and improve access to care...
December 29, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29316995/prehospital-modified-heart-score-predictive-of-30-day-adverse-cardiac-events
#11
Jason P Stopyra, William S Harper, Tyson J Higgins, Julia V Prokesova, James E Winslow, Robert D Nelson, Roy L Alson, Christopher A Davis, Gregory B Russell, Chadwick D Miller, Simon A Mahler
Introduction The History, Electrocardiogram (ECG), Age, Risk Factors, and Troponin (HEART) score is a decision aid designed to risk stratify emergency department (ED) patients with acute chest pain. It has been validated for ED use, but it has yet to be evaluated in a prehospital setting. Hypothesis A prehospital modified HEART score can predict major adverse cardiac events (MACE) among undifferentiated chest pain patients transported to the ED. METHODS: A retrospective cohort study of patients with chest pain transported by two county-based Emergency Medical Service (EMS) agencies to a tertiary care center was conducted...
January 10, 2018: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/29316937/estimate-of-incidence-and-cost-of-recreational-waterborne-illness-on-united-states-surface-waters
#12
Stephanie DeFlorio-Barker, Coady Wing, Rachael M Jones, Samuel Dorevitch
BACKGROUND: Activities such as swimming, paddling, motor-boating, and fishing are relatively common on US surface waters. Water recreators have a higher rate of acute gastrointestinal illness, along with other illnesses including respiratory, ear, eye, and skin symptoms, compared to non-water recreators. The quantity and costs of such illnesses are unknown on a national scale. METHODS: Recreational waterborne illness incidence and severity were estimated using data from prospective cohort studies of water recreation, reports of recreational waterborne disease outbreaks, and national water recreation statistics...
January 9, 2018: Environmental Health: a Global Access Science Source
https://www.readbyqxmd.com/read/29316329/rapid-and-safe-discharge-from-the-emergency-department-a-single-troponin-to-exclude-acute-myocardial-infarction
#13
Lisa Brichko, Hans G Schneider, William Chan, Jarrel Seah, De Villiers Smit, Anthony Dart, Jeremy P Stevens, Biswadev Mitra
OBJECTIVE: To determine variables that could facilitate safe discharge from the ED following a single high-sensitivity troponin I (HsTnI) result to exclude acute myocardial infarction (AMI). METHODS: A retrospective cohort study was performed at a tertiary hospital of all patients that had serial HsTnI performed within 12 h of arrival to the ED over a 3 year period. The primary exposure variable of interest was a very low troponin initial result (HsTnI <5 ng/L)...
January 8, 2018: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29311178/using-state-administrative-data-to-identify-social-complexity-risk-factors-for-children
#14
Kimberly C Arthur, Barbara A Lucenko, Irina V Sharkova, Jingping Xing, Rita Mangione-Smith
PURPOSE: Screening for social determinants of health is challenging but critically important for optimizing child health outcomes. We aimed to test the feasibility of using an integrated state agency administrative database to identify social complexity risk factors and examined their relationship to emergency department (ED) use. METHODS: We conducted a retrospective cohort study among children younger than 18 years with Washington State Medicaid insurance coverage (N = 505,367)...
January 2018: Annals of Family Medicine
https://www.readbyqxmd.com/read/29306214/the-essence-of-the-first-2-5%C3%A2-h-in-the-treatment-of-generalized-convulsive-status-epilepticus
#15
Leena Kämppi, Harri Mustonen, Kaisa Kotisaari, Seppo Soinila
PURPOSE: This study was designed to find realistic cut-offs of the delays predicting outcome after generalized convulsive status epilepticus (GCSE) and serving protocol streamlining of GCSE patients. METHOD: This retrospective study includes all consecutive adult (>16 years) patients (N = 70) diagnosed with GCSE in Helsinki University Central Hospital emergency department over 2 years. We defined ten specific delay parameters in the management of GCSE and determined functional outcome and mortality at hospital discharge...
December 28, 2017: Seizure: the Journal of the British Epilepsy Association
https://www.readbyqxmd.com/read/29305381/thirty-day-hospital-readmissions-among-mechanically-ventilated-emergency-department-patients
#16
David B Page, Anne M Drewry, Enyo Ablordeppey, Nicholas M Mohr, Marin H Kollef, Brian M Fuller
BACKGROUND: Unplanned 30-day readmissions have a negative impact on patients and healthcare systems. Mechanically ventilated ED patients are at high risk for complications, but factors associated with readmission are unknown. OBJECTIVE: (1) Determine the rate of 30-day hospital readmission for ED patients receiving mechanical ventilation. (2) Identify associations between ED-based risk factors and readmission. DESIGN: Retrospective cohort study...
January 5, 2018: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29305076/system-level-process-change-improves-communication-and-follow-up-for-emergency-department-patients-with-incidental-radiology-findings
#17
Steven J Baccei, Sneha A Chinai, Martin Reznek, Scott Henderson, Kevin Reynolds, D Eric Brush
The appropriate communication and management of incidental findings on emergency department (ED) radiology studies is an important component of patient safety. Guidelines have been issued by the ACR and other medical associations that best define incidental findings across various modalities and imaging studies. However, there are few examples of health care facilities designing ways to manage incidental findings. Our institution aimed to improve communication and follow-up of incidental radiology findings in ED patients through the collaborative development and implementation of system-level process changes including a standardized loop-closure method...
January 3, 2018: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/29305022/emergency-department-length-of-stay-for-ethanol-intoxication-encounters
#18
Lauren R Klein, Brian E Driver, James R Miner, Marc L Martel, Jon B Cole
BACKGROUND: Emergency Department (ED) encounters for ethanol intoxication are becoming increasingly common. The purpose of this study was to explore factors associated with ED length of stay (LOS) for ethanol intoxication encounters. METHODS: This was a multi-center, retrospective, observational study of patients presenting to the ED for ethanol intoxication. Data were abstracted from the electronic medical record. To explore factors associated with ED LOS, we created a mixed-effects generalized linear model...
December 8, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29304795/do-senior-medical-students-meet-recommended-emergency-medicine-curricula-requirements
#19
Sami Shaban, Arif Alper Cevik, Mustafa Emin Canakci, Caglar Kuas, Margret El Zubeir, Fikri Abu-Zidan
BACKGROUND: Emergency departments (EDs) offer a variety of learning opportunities for undergraduate medical students. It is however, difficult to evaluate whether they are receiving recommended training during their emergency medicine (EM) clerkship without identifying their clinical activities. We aimed to evaluate the clinical exposure of the final year medical students at our College during their EM clerkship. METHODS: This is a retrospective analysis of prospectively collected student logbooks...
January 5, 2018: BMC Medical Education
https://www.readbyqxmd.com/read/29301563/factors-related-to-negative-feelings-experienced-by-emergency-department-patients-and-accompanying-persons-an-israeli-study
#20
Simha F Landau, Judy Bendalak, Gila Amitay, Ohad Marcus
BACKGROUND: Studies on hospital violence have emphasized the importance of staff- service recipient interaction in leading to violent incidents. These incidents are the extreme result of service recipients' frustration and anger in their interaction with staff. The aim of this study was to analyze factors related to negative experiences of emergency department (ED) patients and accompanying persons in Israeli hospitals. METHODS: Structured interviews with 692 participants in seven major general Israeli hospitals: 322 patients and 370 accompanying persons...
January 4, 2018: Israel Journal of Health Policy Research
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