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https://www.readbyqxmd.com/read/28544787/analysis-of-adults-with-congenital-heart-disease-presenting-to-pediatric-emergency-departments-with-arrhythmias
#1
Shaun Mohan, Brady S Moffett, Wilson Lam, Caridad de la Uz, Christina Miyake, Santiago O Valdes, Jeffrey J Kim
OBJECTIVE: As survivors of congenital heart disease (CHD) continue to age, healthcare utilization by this population has increased. It is unknown how often these patients utilize the emergency department (ED) at children's hospitals and how arrhythmias play a role in their utilization of care. DESIGN: Using a retrospective cohort design, the Pediatric Hospital Information System (PHIS) database was investigated and we studied adults (≥18 years) with CHD (ACHD) who presented to pediatric EDs from 2004 to 2014...
May 22, 2017: Congenital Heart Disease
https://www.readbyqxmd.com/read/28544642/evaluation-of-a-targeted-prescriber-education-intervention-on-emergency-department-discharge-oxycodone-prescribing
#2
Síne R Donaldson, Andrew M Harding, Simone E Taylor, Hassan Vally, Shaun L Greene
OBJECTIVES: The objective of this study was to evaluate the impact of an educational intervention on ED discharge opioid analgesic (OA) prescribing. METHODS: A brief, one-on-one, educational intervention was delivered to ED OA prescribers by an ED clinical champion. The percentage of patients receiving (i) written advice regarding appropriate oxycodone use, (ii) written or verbal advice regarding appropriate post-discharge follow up and (iii) written general practitioner notification that oxycodone had been prescribed were determined pre- and post-intervention, through review of electronic patient records and structured patient telephone interviews conducted 3-7 days after ED attendance...
May 24, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28544364/influenza-associated-delays-in-patient-throughput-and-premature-patient-departure-in-emergency-departments-in-new-south-wales-australia-a-time-series-analysis
#3
David J Muscatello, Kendall J Bein, Michael M Dinh
OBJECTIVES: Influenza outbreaks cause overcrowding in EDs. We aimed to quantify the impact of influenza on the National Emergency Access Targets and premature patient departure in New South Wales, Australia. METHODS: This was a retrospective observational study of 11 million presentations to 115 hospitals during 2010-2014, using routinely collected administrative records. A time series generalised additive regression model was used to assess the correlation between weekly influenza activity and the weekly proportion of patients leaving the ED in >4 h and the proportion that departed before commencing or completing treatment ('did not wait'), after controlling for background winter and holiday effects...
May 24, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28544288/impact-of-hospital-best-practice-mandates-on-prescription-opioid-dispensing-after-an-emergency-department-visit
#4
Benjamin C Sun, Nicoleta Lupulescu-Mann, Christina J Charlesworth, Hyunjee Kim, Daniel M Hartung, Richard A Deyo, K John McConnell
OBJECTIVE: Washington State mandated seven hospital "best practices" in July 2012, several of which may affect ED opioid prescribing and provide a policy template for addressing the opioid prescription epidemic. We tested the hypothesis that the mandates would reduce opioid dispensing after an ED visit. We further assessed for a selective effect in patients with prior risky or chronic opioid use. METHODS: We performed a retrospective, observational analysis of ED visits by Medicaid fee-for service beneficiaries in Washington State, between July 1, 2011 to June 30, 2013...
May 23, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28544279/controlled-clinical-trial-exploring-the-impact-of-a-brief-intervention-for-prevention-of-falls-in-an-emergency-department
#5
Kristie J Harper, Annette D Barton, Glenn Arendts, Deborah G Edwards, Antonio C Petta, Antonio Celenza
OBJECTIVE: To establish the effectiveness of a brief intervention to prevent falls in older patients presenting to the ED post-discharge. METHODS: The present study is a prospective single-centre, quasi-randomised controlled clinical trial of a brief targeted educational intervention to prevent falls. The intervention group received brief scripted education and were advised of their percentage probability of falling in the next 6 months. The key message was to reinforce the importance of falls prevention strategies and the seriousness of falls...
May 23, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28544100/undetectable-concentrations-of-an-fda-approved-high-sensitivity-cardiac-troponin-t-assay-to-rule-out-acute-myocardial-infarction-at-emergency-department-arrival
#6
Andrew D McRae, Grant Innes, Michelle Graham, Eddy Lang, James E Andruchow, Yunqi Ji, Shabnam Vatanpour, Tasnima Abedin, Hong Yang, Danielle A Southern, Dongmei Wang, Isolde Seiden-Long, Lawrence DeKoning, Peter Kavsak
BACKGROUND: The objective of this study was to quantify the sensitivity of very low concentrations of high-sensitivity cardiac troponin T (hsTnT) at ED arrival for acute myocardial infarction (AMI) in a large cohort of chest pain patients evaluated in real-world clinical practice. METHODS: This retrospective study included consecutive ED patients with suspected cardiac chest pain evaluated in four urban EDs were, excluding those with ST-elevation AMI, cardiac arrest or abnormal kidney function...
May 19, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28543608/evaluation-of-a-state-based-syndromic-surveillance-system-for-the-classification-and-capture-of-non-fatal-occupational-injuries-and-illnesses-in-new-jersey
#7
Marija Borjan, Margaret Lumia
BACKGROUND: This preliminary study evaluates a real-time syndromic surveillance system to track occupationally-related emergency room visits throughout New Jersey. METHODS: Emergency Department (ED) chief complaint fields were evaluated from 79 of 80 hospitals in NJ in 2014, using work-related keywords and ICD-9 E-codes, to determine its ability to capture non-fatal work-related injuries. Sensitivity analysis and descriptive statistics, were used to evaluate and summarize the occupational injuries identified...
May 23, 2017: American Journal of Industrial Medicine
https://www.readbyqxmd.com/read/28543184/a-systematic-review-of-patient-reported-measures-associated-with-vestibular-dysfunction
#8
REVIEW
Vicky M Stewart, M Dilani Mendis, Nancy Low Choy
OBJECTIVES/HYPOTHESIS: Use of clinical questionnaires to assist in the screening of vestibular disorders in the acute hospital setting is needed. The objective is to detail the clinimetric properties and clinical utility of patient-reported questionnaires for quantifying dizziness/vertigo symptoms associated with vestibular dysfunction, and to determine validity and utility for screening dizziness/vertigo in the emergency department. DATA SOURCES: We performed a systematic review of PubMed, CINAHL, Embase, and Web of Science in May 2015...
May 23, 2017: Laryngoscope
https://www.readbyqxmd.com/read/28542848/change-of-transfusion-and-treatment-paradigm-in-major-trauma-patients
#9
P Stein, A Kaserer, K Sprengel, G A Wanner, B Seifert, O M Theusinger, D R Spahn
Trauma promotes trauma-induced coagulopathy, which requires urgent treatment with fixed-ratio transfusions of red blood cells, fresh frozen plasma and platelet concentrates, or goal-directed administration of coagulation factors based on viscoelastic testing. This retrospective observational study compared two time periods before (2005-2007) and after (2012-2014) the implementation of changes in trauma management protocols which included: use of goal-directed coagulation management; admission of patients to designated trauma centres; whole-body computed tomography scanning on admission; damage control surgery; permissive hypotension; restrictive fluid resuscitation; and administration of tranexamic acid...
May 23, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28542661/-benign-acute-childhood-myositis-clinical-series-and-literature-review
#10
Felipe Cavagnaro S M, Alejandra Aird G, Ingrid Harwardt R, Carmen Gloria Marambio Q
Benign acute childhood myositis (BACM) is a rare clinical condition that mainly affects pre-school and school age-children. It is usually preceded by a viral illness, particularly influenza virus infection. OBJECTIVE: To describe a cluster of BACM cases that were seen in a paediatric unit. PATIENTS AND METHODS: A retrospective series of cases that presented with a clinical picture suggestive of BACM between August and November 2012 in the paediatric emergency department of a private clinic...
April 2017: Revista Chilena de Pediatría
https://www.readbyqxmd.com/read/28542412/low-rates-of-antibiotic-resistance-and-infectious-mortality-in-a-cohort-of-high-risk-hematology-patients-a-single-center-retrospective-analysis-of-blood-stream-infection
#11
Jason R Conn, Elizabeth M Catchpoole, Naomi Runnegar, Sally J Mapp, Kate A Markey
Febrile neutropenia (FN) is a medical emergency and can represent a life-threatening complication for hematology patients treated with intensive chemotherapy regimens. In clinical practice, the diagnostic yield of blood cultures and other investigations which aim to identify a causative organism or site of infection is low. We have retrospectively examined all blood cultures collected in a "real world" cohort of patients receiving chemotherapy for acute leukemia and patients with aggressive lymphoma treated with Hyper-CVAD/MTX-cytarabine, at a single tertiary center over a five-year period...
2017: PloS One
https://www.readbyqxmd.com/read/28542337/changes-in-hospitalizations-for-chronic-respiratory-diseases-after-two-successive-smoking-bans-in-spain
#12
Iñaki Galán, Lorena Simón, Elena Boldo, Cristina Ortiz, Rafael Fernández-Cuenca, Cristina Linares, María José Medrano, Roberto Pastor-Barriuso
BACKGROUND: Existing evidence on the effects of smoke-free policies on respiratory diseases is scarce and inconclusive. Spain enacted two consecutive smoke-free regulations: a partial ban in 2006 and a comprehensive ban in 2011. We estimated their impact on hospital admissions via emergency departments for chronic obstructive pulmonary disease (COPD) and asthma. METHODS: Data for COPD (ICD-9 490-492, 494-496) came from 2003-2012 hospital admission records from the fourteen largest provinces of Spain and from five provinces for asthma (ICD-9 493)...
2017: PloS One
https://www.readbyqxmd.com/read/28542336/does-ngal-reduce-costs-a-cost-analysis-of-urine-ngal-ungal-serum-creatinine-scr-for-acute-kidney-injury-aki-diagnosis
#13
Amay Parikh, John A Rizzo, Pietro Canetta, Catherine Forster, Meghan Sise, Omar Maarouf, Eugenia Singer, Antje Elger, Saban Elitok, Kai Schmidt-Ott, Jonathon Barasch, Thomas L Nickolas
INTRODUCTION: Urine neutrophil gelatinase-associated lipocalin (uNGAL) is a sensitive and specific diagnostic test for acute kidney injury (AKI) in the Emergency Department (ED), but its economic impact has not been investigated. We hypothesized that uNGAL used in combination with serum creatinine (sCr) would reduce costs in the management of AKI in patients presenting to the ED in comparison to using sCr alone. MATERIALS AND METHODS: A cost simulation model was developed for clinical algorithms to diagnose AKI based on sCr alone vs...
2017: PloS One
https://www.readbyqxmd.com/read/28542029/the-impact-of-the-sepsis-3-septic-shock-definition-on-previously-defined-septic-shock-patients
#14
Sarah A Sterling, Michael A Puskarich, Andrew F Glass, Faheem Guirgis, Alan E Jones
OBJECTIVE: The Third International Consensus Definitions Task Force (Sepsis-3) recently recommended changes to the definitions of sepsis. The impact of these changes remains unclear. Our objective was to determine the outcomes of patients meeting Sepsis-3 septic shock criteria versus patients meeting the "old" (1991) criteria of septic shock only. DESIGN: Secondary analysis of two clinical trials of early septic shock resuscitation. SETTING: Large academic emergency departments in the United States...
May 24, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28542027/retrospective-population-based-study-of-emergency-medical-services-attended-out-of-hospital-cardiac-arrests-in-children-in-belgium
#15
Sophie Vandeplassche, Patrick van de Voorde
OBJECTIVE: This study presents an analysis of clinical data of the circumstances and outcome of paediatric (0-16 years) out-of-hospital cardiac arrests (p-OHCA) in Belgium. METHODS: This was a retrospective study of a prospective population-based registration of physician-attended [mobile emergency group (MUG)] emergency medical services (EMS) interventions of p-OHCA in Belgium between 2010 and 2012. RESULTS: We identified 365 OHCA in 18 295 paediatric MUG interventions (2%)...
May 24, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/28541855/rate-and-reasons-for-repeat-ct-scanning-in-transferred-trauma-patients
#16
James F Holmes, Blake G Siglock, Michael T Corwin, Michael A Johnson, Edgardo S Salcedo, Gabriel S Espinoza, Ramit Lamba
To describe the reasons and additional radiation for CT scans repeated after transfer to a trauma center. Retrospective study of patients transferred to a trauma center. Patients had repeat CT if a CT of the same region was repeated at the trauma center's emergency department. Indications for repeat CT scanning were abstracted. Radiation dosage was calculated in millisieverts. A total of 370 had CT scans and were transferred. Mean age was 39.1 ± 28.0 years. Seventy-four [20.0%, 95% confidence interval (CI) 16...
May 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28541791/subsidies-for-oral-chemotherapy-and-use-of-immunomodulatory-drugs-among-medicare-beneficiaries-with-myeloma
#17
Adam J Olszewski, Stacie B Dusetzina, Charles B Eaton, Amy J Davidoff, Amal N Trivedi
Purpose The low-income subsidy (LIS) substantially lowers out-of-pocket costs for qualifying Medicare Part D beneficiaries who receive orally administered chemotherapy. We examined the association of LIS with the use of novel oral immunomodulatory drugs (IMiDs; lenalidomide and thalidomide) among beneficiaries with myeloma, who can receive either orally administered or parenteral (bortezomib-based) therapy. Methods Using SEER-Medicare data, we identified Part D beneficiaries diagnosed with myeloma in 2007 to 2011...
May 25, 2017: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28541758/suicide-risk-in-young-men-and-women-after-substance-intoxication
#18
Marlene Stenbacka, Mats Samuelsson, Peter Nordström, Jussi Jokinen
This study investigates suicide and overdoses in 1119 consecutive patients (64% women), 15 to 34 years of age, presenting at the emergency department after self-poisoning from1994 to 2000 and followed regarding death up to 2006. Regression and Kaplan-Meier survival analyses were performed for suicide and other causes of death. The patients had about a 60 times higher risk (SMR = 61.95) of death due to suicide and 26 times higher (SMR = 26.47) for all-cause mortality. Men had a nearly two times higher risk for suicide than women and half of the suicides occurred during the first two years after admission...
May 25, 2017: Archives of Suicide Research: Official Journal of the International Academy for Suicide Research
https://www.readbyqxmd.com/read/28541419/acute-toxicity-from-intravenous-use-of-the-tricyclic-antidepressant-tianeptine
#19
Sara K Dempsey, Justin L Poklis, Kacie Sweat, Kirk Cumpston, Carl E Wolf
Tianeptine (7-[([3-chloro-6,11]-dihydro-6-methyldibenzo[c,f][1,2]thiazepin-11-yl) amino] heptanoic acid S, S dioxide) is a tricyclic compound prescribed as an antidepressant in European countries, but is not currently approved for use in the United States. There are few published case reports of tianeptine intoxication. Presented is the first case of acute toxicity associated with the intravenous use of tianeptine. A 36-year-old male intentionally injected tianeptine powder intravenously to "help him see into the future"...
May 24, 2017: Journal of Analytical Toxicology
https://www.readbyqxmd.com/read/28541400/identifying-frailty-in-the-emergency-department-feasibility-study
#20
Amy Elliott, Kay Phelps, Emma Regen, Simon Paul Conroy
Introduction: identifying the most at risk older people in Emergency Departments (EDs) may help guide clinical practice, and service improvement in emergency care, but little is known about how to implement such tools in practice. Methods: consensus building was used to determine the desirable characteristics of a risk stratification process, including focus groups and literature reviewing. Candidate tools were tested using clinical vignettes in semi-structured interviews with a range of clinicians working in one large ED, assessing speed of use, ease of use and agreement with clinical judgement...
May 25, 2017: Age and Ageing
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