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https://www.readbyqxmd.com/read/28190410/the-effect-of-older-age-on-ems-use-for-transportation-to-an-emergency-department
#1
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
https://www.readbyqxmd.com/read/28187736/thrombocytopenia-on-the-first-day-of-emergency-department-visit-predicts-higher-risk-of-acute-kidney-injury-among-elderly-patients
#2
Chia-Ter Chao, Hung-Bin Tsai, Chih-Kang Chiang, Jenq-Wen Huang
BACKGROUND: Few studies have addressed risk factors for acute kidney injury (AKI) in geriatric patients. We investigated whether thrombocytopenia was a risk factor for AKI in geriatric patients with medical illnesses. METHODS: A prospective cohort study was conducted, by recruiting elderly (≥65 years) patients who visited the emergency department (ED) for medical illnesses during 2014. They all received hemogram for platelet count determination, and were stratified according to the presence of thrombocytopenia (platelets, <150 K/μL) during their initial ED evaluation...
February 10, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28169976/the-impact-of-alternative-payment-in-chronically-ill-and-older-patients-in-the-patient-centered-medical-home
#3
Claudia A Salzberg, Asaf Bitton, Stuart R Lipsitz, Cal Franz, Shimon Shaykevich, Lisa P Newmark, Japneet Kwatra, David W Bates
BACKGROUND: Patient-centered medical home (PCMH) has gained prominence as a promising model to encourage improved primary care delivery. There is a paucity of studies that evaluate the impact of payment models in the PCMH. OBJECTIVES: We sought to examine whether coupling coordinated, team-based care transformation plan with a novel reimbursement model affects outcomes related to expenditures and utilization. RESEARCH DESIGN: Interrupted time-series model with a difference-in-differences approach to assess differences between intervention and control groups, across time periods attributable to PCMH transformation and/or payment change...
February 6, 2017: Medical Care
https://www.readbyqxmd.com/read/28166464/implementation-of-a-pharmacy-consult-to-reduce-co-prescribing-of-opioids-and-benzodiazepines-in-a-veteran-population
#4
Deborah Pardo, Lacey Miller, Dana Chiulli
BACKGROUND: The dangers of co-administration of opioid pain relievers (OPRs) and benzodiazepines (BZDs) are well documented. The combination of OPRs and BZDs make up the majority of medications involved in prescription drug-related overdose and are often used concomitantly. This pattern is consistent among the Veteran population where mental health illness and substance abuse are prominent. The Veterans Health Administration implemented the Opioid Safety Initiative (OSI) aimed at improving patient safety surrounding OPRs...
February 6, 2017: Substance Abuse
https://www.readbyqxmd.com/read/28166331/the-illness-experience-of-undocumented-immigrants-with-end-stage-renal-disease
#5
Lilia Cervantes, Stacy Fischer, Nancy Berlinger, Maria Zabalaga, Claudia Camacho, Stuart Linas, Debora Ortega
Importance: The exclusion of undocumented immigrants from Medicare coverage for hemodialysis based on a diagnosis of end-stage renal disease (ESRD) requires physicians in some states to manage chronic illness in this population using emergent-only hemodialysis. Emergent-only dialysis is expensive and burdensome for patients. Objective: To understand the illness experience of undocumented immigrants with ESRD who lack access to scheduled hemodialysis. Design, Setting, and Participants: A qualitative, semistructured, interview study was conducted in a Colorado safety-net hospital from July 1 to December 31, 2015, with 20 undocumented immigrants (hereinafter referred to as undocumented patients) with ESRD and no access to scheduled hemodialysis...
February 6, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28162841/adherence-to-attention-deficit-hyperactivity-disorder-medication-during-the-transition-to-college
#6
Megan R Schaefer, Alana Resmini Rawlinson, Scott T Wagoner, Steven K Shapiro, Jan Kavookjian, Wendy N Gray
PURPOSE: The present study explores the medication self-management experiences of adolescents with attention-deficit/hyperactivity disorder (ADHD) during their transition to young adulthood in college. METHODS: Participants were college freshmen with ADHD prescribed daily medication for their condition. Ten individual interviews were conducted using a semistructured interview script. Measures related to ADHD medication management were also completed. Qualitative data were analyzed via directed content analysis and quantitative data via descriptive statistics...
February 2, 2017: Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine
https://www.readbyqxmd.com/read/28158200/impact-of-online-patient-reminders-to-improve-asthma-care-a-randomized-controlled-trial
#7
Andrew C Pool, Jennifer L Kraschnewski, Jennifer M Poger, Joshua Smyth, Heather L Stuckey, Timothy J Craig, Erik B Lehman, Chengwu Yang, Christopher N Sciamanna
IMPORTANCE: Asthma is one of the most burdensome chronic illnesses in the US. Despite widespread dissemination of evidence-based guidelines, more than half of the adults with asthma have uncontrolled symptoms. OBJECTIVE: To examine the efficacy of an online tool designed to improve asthma control. DESIGN: 12-month single blind randomized controlled trial of the online tool (Intervention condition, IC) versus an active control tool (CC). SETTING: Patients enrolled in an insurance plan...
2017: PloS One
https://www.readbyqxmd.com/read/28108265/palliative-care-and-parkinson-s-disease-meeting-summary-and-recommendations-for-clinical-research
#8
REVIEW
Benzi M Kluger, Siobhán Fox, Suzanne Timmons, Maya Katz, Nicholas B Galifianakis, Indu Subramanian, Julie H Carter, Miriam J Johnson, Edward W Richfield, David Bekelman, Jean S Kutner, Janis Miyasaki
INTRODUCTION: Palliative care is an approach to caring for patients and families affected by serious illnesses that focuses on the relief of suffering through the management of medical symptoms, psychosocial issues, advance care planning and spiritual wellbeing. Over the past decade there has been an emerging clinical and research interest in the application of palliative care approaches to Parkinson's disease (PD) and outpatient palliative care services are now offered by several movement disorders centers...
January 11, 2017: Parkinsonism & related Disorders
https://www.readbyqxmd.com/read/28097328/diabetes-outpatient-care-and-acute-complications-before-and-after-high-deductible-insurance-enrollment-a-natural-experiment-for-translation-in-diabetes-next-d-study
#9
J Frank Wharam, Fang Zhang, Emma M Eggleston, Christine Y Lu, Stephen Soumerai, Dennis Ross-Degnan
Importance: High-deductible health plans (HDHPs) have expanded under the Affordable Care Act and are expected to play a major role in the future of US health policy. The effects of modern HDHPs on chronically ill patients and adverse outcomes are unknown. Objective: To determine the association of HDHP with high-priority diabetes outpatient care and preventable acute complications. Design, Setting, and Participants: Controlled interrupted-time-series study using a large national health insurer database from January 1, 2003, to December 31, 2012...
January 9, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28040411/emergency-department-critical-care-unit-for-critically-ill-cardiovascular-patients-an-observation-study
#10
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/28034584/percutaneous-endovascular-aneurysm-repair-in-morbidly-obese-patients
#11
Jason A Chin, Laura Skrip, Bauer E Sumpio, Jonathan A Cardella, Jeffrey E Indes, Timur P Sarac, Alan Dardik, Cassius I Ochoa Chaar
OBJECTIVE: Endovascular aneurysm repair (EVAR) with percutaneous femoral access (PEVAR) has several potential advantages. Morbidly obese (MO) patients present unique anatomical challenges and have not been specifically studied. This study examines the trends in the use of PEVAR and its surgical outcomes compared with open femoral cutdown (CEVAR) in MO patients. METHODS: The American College of Surgeons National Surgical Quality Improvement Program files for the years 2005 to 2013 were reviewed...
December 26, 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28028673/outcomes-of-elderly-critically-ill-medical-and-surgical-patients-a-multicentre-cohort-study
#12
Ian M Ball, Sean M Bagshaw, Karen E A Burns, Deborah J Cook, Andrew G Day, Peter M Dodek, Demetrios J Kutsogiannis, Sangeeta Mehta, John G Muscedere, Alexis F Turgeon, Henry T Stelfox, George A Wells, Ian G Stiell
PURPOSE: Very elderly (over 80 yr of age) critically ill patients admitted to medical-surgical intensive care units (ICUs) have a high incidence of mortality, prolonged hospital length of stay, and dependent living conditions should they survive. The primary purpose of this study is to describe the outcomes and differences in outcomes between very elderly medical patients and their surgical counterparts admitted to Canadian ICUs, thereby informing decision-making for clinicians and substitute decision-makers...
March 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28006091/cardiometabolic-assessment-diagnosis-and-treatment-of-chronic-medical-illnesses-during-an-inpatient-psychiatric-hospitalization-colocated-medical-care-versus-treatment-as-usual
#13
Jason R Tatreau, Suzanne Harris, Brian Sheitman, Beat D Steiner
Background: Reverse colocation care models reduce lifestyle risk factors, emergency department visits, and readmissions. Persons with serious mental illness have higher than average rates of cardiovascular disease-related morbidity and mortality, with second-generation antipsychotics (SGAs) conferring added related risks. Little is written about reverse colocated medical care (RCL) in inpatient psychiatric settings. The objective of this study was to identify associations between screening, diagnosis, and treatment of chronic medical comorbidities and mode of medical care for patients discharged from 2 inpatient psychiatric units on SGAs...
December 22, 2016: Primary Care Companion to CNS Disorders
https://www.readbyqxmd.com/read/27999490/predictors-for-post-stroke-delirium-outcome
#14
Zikrija Dostovic, Ernestina Dostovic, Dzevdet Smajlovic, Omer C Ibrahimagic, Leila Avdic, Elvir Becirovic
BACKGROUND: There have been only a small number of studies that have evaluated the outcome of post-stroke delirium. OBJECTIVES: To evaluate the effects of gender, age, stroke localization, delirium severity, previous illnesses, associated medical complications on delirium outcome as well as, to determine effects of delirium on cognitive functioning one year after stroke. PATIENTS AND METHODS: Comprehensive neuropsychological assessments were performed within the first week of stroke onset, at hospital discharge, and followed-up for 3, 6 and 12 months after stroke...
October 2016: Materia Socio-medica
https://www.readbyqxmd.com/read/27965236/outcomes-of-emergency-medical-patients-admitted-to-an-intermediate-care-unit-with-detailed-admission-guidelines
#15
Catherine E Simpson, Sarina K Sahetya, Robert W Bradsher, Eric L Scholten, William Bain, Shazia M Siddique, David N Hager
BACKGROUND: An important, but not well characterized, population receiving intermediate care is that of medical patients admitted directly from the emergency department. OBJECTIVE: To characterize emergency medical patients and their outcomes when admitted to an intermediate care unit with clearly defined admission guidelines. METHODS: Demographic data, admitting diagnoses, illness severity, comorbid conditions, lengths of stay, and hospital mortality were characterized for all emergency medical patients admitted directly to an intermediate care unit from July through December 2012...
December 2016: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/27957661/-it-s-been-an-experience-a-life-learning-experience-a-qualitative-study-of-hospitalized-patients-with-substance-use-disorders
#16
Christine M Velez, Christina Nicolaidis, P Todd Korthuis, Honora Englander
BACKGROUND: Individuals with substance use disorders (SUD) have high rates of chronic illness and readmission, yet few are engaged in addiction treatment. Hospitalization may be a reachable moment for initiating and coordinating addiction care, but little is known about motivation for change in the inpatient setting. OBJECTIVE: To explore the experiences of hospitalized adults with SUD and to better understand patient and system level factors impacting readiness for change...
December 12, 2016: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/27917433/deaths-among-elderly-patients-in-the-emergency-department-a-needs-assessment-for-end-of-life-care
#17
Rakhee Yash Pal, Win Sen Kuan, Yiwen Koh, Kuhan Venugopal, Irwani Ibrahim
INTRODUCTION: Elderly patients with serious chronic diseases often present to the emergency department (ED) in the last moments of their life, many with identifiable trajectories of dying: organ failure; advanced cancer; and chronic frailty. These patients and their families may benefit more from good end-of-life (EOL) care provision than the standard resuscitative approach. This study aimed to determine the incidence and nature of death among patients aged 65 years and above in an ED, and characterise their trajectories of dying...
December 5, 2016: Singapore Medical Journal
https://www.readbyqxmd.com/read/27908330/sepsis-in-special-populations
#18
REVIEW
Matthew P Borloz, Khalief E Hamden
Sepsis is recognized by the presence of physiologic and laboratory changes that reflect the inflammatory response to infection on cellular and systemic levels. Comorbid conditions, such as cirrhosis, end-stage renal disease, and obesity, alter patients' susceptibility to infection and their response to it once present. Baseline changes in vital signs and chronic medications often mask clues to the severity of illness. The physiologic, hematologic, and biochemical adjustments that accompany pregnancy and the puerperium introduce similar challenges...
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27903142/systematic-literature-review-of-general-health-care-interventions-within-programs-of-assertive-community-treatment
#19
Erik R Vanderlip, Benjamin F Henwood, Debra R Hrouda, Piper S Meyer, Maria Monroe-DeVita, Lynette M Studer, April J Schweikhard, Lorna L Moser
OBJECTIVE: Assertive community treatment (ACT) is one of the few evidence-based practices for adults with severe mental illness. Interest has slowly waned for ACT implementation. Yet ACT remains an appealing services platform to achieve the triple aim of health care reform (improved health outcomes, reduced cost, and improved satisfaction) through integration of primary care and behavioral health services. This review highlights the evidence for ACT to improve general medical outcomes, reduce treatment costs, and increase access to treatment...
December 1, 2016: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/27884006/current-psychosomatic-practice
#20
Giovanni A Fava, Fiammetta Cosci, Nicoletta Sonino
Psychosomatic research has advanced over the past decades in dealing with complex biopsychosocial phenomena and may provide new effective modalities of patient care. Among psychosocial variables affecting individual vulnerability, course, and outcome of any medical disease, the role of chronic stress (allostatic load/overload) has emerged as a crucial factor. Assessment strategies include the Diagnostic Criteria for Psychosomatic Research. They are presented here in an updated version based on insights derived from studies carried out so far and encompass allostatic overload, type A behavior, alexithymia, the spectrum of maladaptive illness behavior, demoralization, irritable mood, and somatic symptoms secondary to a psychiatric disorder...
2017: Psychotherapy and Psychosomatics
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