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Chronic illness, emergency medical

Takaki Emura, Kenji Hosoda, Shota Harai, Noboru Oyachi, Takeyuki Suzuki, Ken Takada, Koji Kobayashi, Hisatake Ikeda
BACKGROUND: Massive gastrointestinal bleeding in children, mostly caused by esophageal varices secondary to chronic liver disease, is uncommon. Dieulafoy lesion in the gastrointestinal tract is a rare but important cause of gastrointestinal bleeding; massive bleeding from this lesion can be fatal unless adequate treatment is promptly initiated. We report a case of gastric Dieulafoy lesion in a 2-year old successfully treated with endoscopic hemoclipping. CASE PRESENTATION: A 2-year-old Japanese boy was admitted to our department with sudden massive hematemesis...
October 19, 2016: Journal of Medical Case Reports
Judith L Griffin, Marie Yersin, Stéphanie Baggio, Katia Iglesias, Venetia-Sofia Velonaki, Karine Moschetti, Bernard Burnand, Jean-Blaise Wasserfallen, Francis Vu, Corine Ansermet, Olivier Hugli, Jean-Bernard Daeppen, Patrick Bodenmann
OBJECTIVES: Frequent Emergency Department (ED) users have an elevated mortality, yet little is known about risk factors. Our aim was to characterize deceased frequent ED users and determine predictors of mortality. METHODS: This is a post-hoc analysis of all-cause mortality among frequent ED users participating in a randomized clinical trial on case management at the Lausanne University Hospital (Switzerland). We enrolled 250 frequent ED users (5+ visits/past year) in a 12-month randomized clinical trial; those with an estimated survival of fewer than 18 months were excluded...
October 4, 2016: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
Alladi Mohan, G Sivaram Naik, J Harikrishna, D Prabath Kumar, M H Rao, Kvs Sarma, K K Guntupalli
BACKGROUND & OBJECTIVES: Ingestion of Cleistanthus collinus causes hypokalemia and cardiac arrhythmias leading to mortality in most cases. We undertook this retrospective study to evaluate the clinical presentation and predictors of outcome in critically ill patients admitted with C. collinus poisoning. METHODS: The case records of 56 patients admitted to the medical intensive care unit (MICU) of a tertiary care teaching hospital in south India (2000-2014) with C...
June 2016: Indian Journal of Medical Research
J Keszte, H Danker, A Dietz, E Meister, F Pabst, O Guntinas-Lichius, J Oeken, S Singer, A Meyer
In a German multi-center prospective cohort study, we wanted to assess the course of psychiatric comorbidity, utilization of mental health care and psychosocial care needs in laryngeal cancer patients during the first year after partial laryngectomy (PRL). Structured interviews with patients were conducted before surgery, 1 week (1 w), 3 months (3 m) and 1 year (12 m) after PRL. Psychiatric comorbidity was assessed using the Structured Clinical Interview for DSM-IV (SCID). Psychosocial care needs and utilization of mental health care were evaluated with standardized face-to-face interviews...
October 15, 2016: European Archives of Oto-rhino-laryngology
Margaret Fry, Lesley Fitzpatrick, Julie Considine, Ramon Z Shaban, Kate Curtis
INTRODUCTION: Older persons aged over 65years represent up to 41% of Australian Emergency Department (ED) presentations. Older persons present with acute and/or chronic conditions, have more Emergency Department visits, hospital admissions and readmissions than other age groups. However, little is known about the characteristics and trends of acute illness and chronic presentations and whether frailty changes these dimensions within this cohort. METHODS: A 12-month retrospective medical record audit of persons over 65years presenting to four EDs...
October 12, 2016: International Emergency Nursing
Emily Liffick, Nicole F Mehdiyoun, Jenifer L Vohs, Michael M Francis, Alan Breier
OBJECTIVE: Because of the chronicity, severity, and marked psychosocial impairment that may characterize the illness, schizophrenia is an incredibly costly disease. Recent data indicate that intervention earlier in the course of schizophrenia produces cost savings. This study compared health service utilization and associated costs for patients receiving treatment for first-episode psychosis (FEP) delivered within the early-intervention (EI) model at the Prevention and Recovery Center for Early Psychosis (PARC) and for a matched sample of FEP patients receiving treatment as usual at a geographically similar mental health clinic...
October 3, 2016: Psychiatric Services: a Journal of the American Psychiatric Association
Anne Maree Kelly, Anna Holdgate, Gerben Keijzers, Sharon Klim, Colin A Graham, Simon Craig, Win Sen Kuan, Peter Jones, Charles Lawoko, Said Laribi
BACKGROUND: This study aimed to determine epidemiology and outcome for patients presenting to emergency departments (ED) with shortness of breath who were transported by ambulance. METHODS: This was a planned sub-study of a prospective, interrupted time series cohort study conducted at three time points in 2014 and which included consecutive adult patients presenting to the ED with dyspnoea as a main symptom. For this sub-study, additional inclusion criteria were presentation to an ED in Australia or New Zealand and transport by ambulance...
September 22, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
D Leguay
This article attempts to identify and put into perspective the different approaches that could globally prevent the suffering induced by schizophrenia, from the detection of early psychosis to the impact on individual and family functioning and emotional health. Schizophrenia causes, at the community level, a number of difficult consequences and associated costs, which likely could be reduced if specific strategies, already known and documented internationally, were applied. Two areas not explored in this article: the role of medication and the issue of suicide prevention...
September 9, 2016: L'Encéphale
Neil R Orford, Sharyn L Milnes, Nigel Lambert, Laura Berkeley, Stephen E Lane, Nicholas Simpson, Tania Elderkin, Allison Bone, Peter Martin, Charlie Corke, Rinaldo Bellomo, Michael Bailey
OBJECTIVE: To describe the prevalence, characteristics, long-term outcomes and goals-of-care discussions of patients with objective indicators of life-limiting illnesses (LLIs) referred to the intensive care unit. DESIGN, SETTING AND PATIENTS: A prospective, observational, cohort study of all adult inpatients referred to the ICU by the medical emergency team or by direct referral, during the period 30 August 2012 to 1 February 2013, at a tertiary teaching hospital in Australia...
September 2016: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
Murray G Tucker, Sebastian Kekulawala, Michelle Kent, Sam Mostafa, Richard Harvey
BACKGROUND: The high prevalence of comorbid illicit drug use in persons with chronic psychotic illness represents a strong determinant of psychotic relapse and rehospitalization. Epidemiological studies indicate changing patterns of illicit drug use in Australia, which are concerning because of increased use of crystal methamphetamine, also known as "ice." An important complication of habitual use of crystal methamphetamine is the development of a dose-dependent acute psychotic reaction...
2016: Journal of Medical Case Reports
Karen A Abrashkin, Jonathan Washko, Jenny Zhang, Asantewaa Poku, Hyun Kim, Kristofer L Smith
Models addressing urgent clinical needs for older adults with multiple advanced chronic conditions are lacking. This observational study describes a Community Paramedicine (CP) model for treatment of acute medical conditions within an Advanced Illness Management (AIM) program, and compares its effect on emergency department (ED) use and subsequent hospitalization with that of traditional emergency medical services (EMS). Community paramedics were trained to evaluate and, with telemedicine-enhanced physician guidance, treat acute illnesses in individuals' homes...
August 30, 2016: Journal of the American Geriatrics Society
Richard Conway, Sean Cournane, Declan Byrne, Deirdre O'Riordan, Bernard Silke
BACKGROUND: The aim of this study was to detail the time profile and frequency distribution of mortality following an emergency admission and to compare these for weekday and weekend admissions. METHODS: We profiled in-hospital deaths following emergency medical admission between 2002 and 2014. We determined the frequency distribution, time pattern, causality and influence of day of admission on mortality out to 120days. We utilized a multivariable regression model (logistic for in-hospital mortality and truncated Poisson for count data) to adjust for major predictor variables...
August 18, 2016: European Journal of Internal Medicine
David Faraoni, Daniel Vo, Viviane G Nasr, James A DiNardo
BACKGROUND: Children with major and severe congenital heart disease (CHD) undergoing noncardiac surgery are at increased risk of mortality. The objective of this study was to identify the predictors for in-hospital mortality, and to develop a risk stratification score that could be used to help decision making and the development of perioperative management guidelines. METHODS: We included all children with major (eg, tetralogy of Fallot with wide open pulmonary insufficiency, hypoplastic left heart syndrome including stage 1 repair) or severe CHD (eg, children with uncorrected CHD, children with documented pulmonary hypertension, children with ventricular dysfunction requiring medications, or children listed for heart transplant) recorded in the 2012 and 2013 American College of Surgeons National Surgical Quality Improvement Program Pediatric databases in a derivation cohort, and those recorded in the 2014 database in a validation cohort...
October 2016: Anesthesia and Analgesia
Dimiter V Dimitrov
OBJECTIVES: A number of technologies can reduce overall costs for the prevention or management of chronic illnesses. These include devices that constantly monitor health indicators, devices that auto-administer therapies, or devices that track real-time health data when a patient self-administers a therapy. Because they have increased access to high-speed Internet and smartphones, many patients have started to use mobile applications (apps) to manage various health needs. These devices and mobile apps are now increasingly used and integrated with telemedicine and telehealth via the medical Internet of Things (mIoT)...
July 2016: Healthcare Informatics Research
Radica Z Alicic, Robert A Short, Cynthia L Corbett, Joshua J Neumiller, Brian J Gates, Kenn B Daratha, Celestina Barbosa-Leiker, Sterling McPherson, Naomi S Chaytor, Brad P Dieter, Stephen M Setter, Katherine R Tuttle
BACKGROUND: The hospital readmission rate in the population with chronic kidney disease (CKD) is high and strategies to reduce this risk are urgently needed. METHODS: The CKD-Medication Intervention Trial (CKD-MIT;; NCTO1459770) is a single-blind (investigators), randomized, clinical trial conducted at Providence Health Care in Spokane, Washington. Study participants are hospitalized patients with CKD stages 3-5 (not treated with kidney replacement therapy) and acute illness...
2016: American Journal of Nephrology
Alison Cuellar, Lorens A Helmchen, Gilbert Gimm, Jay Want, Sriteja Burla, Bradley J Kells, Iwona Kicinger, Len M Nichols
BACKGROUND: Enhanced primary care models have diffused slowly and shown uneven results. Because their structural features are costly and challenging for small practices to implement, they offer modest rewards for improved performance, and improvement takes time. OBJECTIVE: To test whether a patient-centered medical home (PCMH) model that significantly rewarded cost savings and accommodated small primary care practices was associated with lower spending, fewer hospital admissions, and fewer emergency room visits...
July 29, 2016: Journal of General Internal Medicine
Igor Belyaev, Amy Dean, Horst Eger, Gerhard Hubmann, Reinhold Jandrisovits, Markus Kern, Michael Kundi, Hanns Moshammer, Piero Lercher, Kurt Müller, Gerd Oberfeld, Peter Ohnsorge, Peter Pelzmann, Claus Scheingraber, Roby Thill
Chronic diseases and illnesses associated with non-specific symptoms are on the rise. In addition to chronic stress in social and work environments, physical and chemical exposures at home, at work, and during leisure activities are causal or contributing environmental stressors that deserve attention by the general practitioner as well as by all other members of the health care community. It seems necessary now to take "new exposures" like electromagnetic fields (EMF) into account. Physicians are increasingly confronted with health problems from unidentified causes...
September 1, 2016: Reviews on Environmental Health
Ruchi Bhandari, Suzanne M Marsh, Audrey A Reichard, Theresa R Tonozzi
BACKGROUND: Per a Congressional directive and funding, this study describes worker and workplace characteristics of emergency department (ED) patients who reported their injury/illness to their employer. The study also responds to Congress's request to enumerate injured/ill self-employed workers and workers with chronic conditions. METHODS: We conducted a follow-back study on injured/ill workers, including self-employed, identified from a national ED surveillance system from June 2012 through December 2013...
August 2016: American Journal of Industrial Medicine
Babar Bashir, Doron Schneider, Mary C Naglak, Thomas M Churilla, Marguerite Adelsberger
OBJECTIVES: Factors that influence the likelihood of readmission for chronic obstructive pulmonary disease (COPD) patients and the impact of posthospital care coordination remain uncertain. LACE index (L = length of stay, A = Acuity of admission; C = Charlson comorbidity index; E = No. of emergency department (ED) visits in last 6 months) is a validated tool for predicting 30-days readmissions for general medicine patients. We aimed to identify variables predictive of COPD readmissions including LACE index and determine the impact of a novel care management process on 30-day all-cause readmission rate...
August 2016: Hospital Practice (Minneapolis)
Caroline S Carlin, Thomas J Flottemesch, Leif I Solberg, Ann M Werner
BACKGROUND: Research connecting patient-centered medical homes (PCMHs) with improved quality and reduced utilization is inconsistent, possibly because individual domains of change, and the stage of change, are not incorporated in the research design. The objective of this study was to examine the association between stage and domain of change and patterns of health care utilization. METHODS: This was a cross-sectional observational study that including 87 Minnesota clinics certified as medical homes...
July 2016: Journal of the American Board of Family Medicine: JABFM
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