51
|
Chen JT, Yang K, Zhu Y, Wu XW. The impact of the scale and hierarchical structure of health human resources on the level of medical services-based on China's four major economic regions. Int J Equity Health 2024; 23:166. [PMID: 39169377 PMCID: PMC11337570 DOI: 10.1186/s12939-024-02239-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 07/27/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Ensuring that the scale and hierarchical structure of health human resources are rational, and that medical services are efficient and fair, is an important task of practical significance. On this basis, examining the impact of health human resources on the level of medical services presents a new and formidable challenge. This study aims to delve into how the scale and hierarchical structure of health human resources in China's four major economic regions affect the fairness and efficiency of medical services, and to identify optimization strategies. METHODS This study utilizes provincial panel data from China's four major economic regions spanning the years 2009 to 2021. Initially, it provides a statistical description of the current state of health human resources and the level of medical services. Subsequently, it employs a fixed-effects model to analyze the impact of the scale and hierarchical structure of health human resources, as well as their interactive effects, on the fairness and efficiency of medical services, and discusses the interactive mechanisms between medical service fairness and medical service efficiency. Furthermore, after conducting a comprehensive evaluation of the level of medical services using the entropy weight method, it explores the regional heterogeneity and temporal dynamics in the influence of the scale and hierarchical structure of health human resources on the level of medical services. Finally, the study examines the scientific validity and rationality of the research findings through various robustness checks, including the substitution of research variables and models. RESULTS The study found that the scale of health human resources has a promoting effect on the equity of medical services (β ≤ 0.643, p ≤ 0.01), but exhibits an inhibitory effect on the efficiency of medical services (β ≥ -0.079, p ≤ 0.1); the hierarchical structure of health human resources shows a positive impact on both the equity and efficiency of medical services (βequity ≤ 0.160, p ≤ 0.01; βefficiency ≤ 0.341, p ≤ 0.05); at the same time, the results indicate that the interactive effect of the scale and hierarchical structure of health human resources promotes equity in medical services (β = 0.067, p ≤ 0.01), but restricts the efficiency of medical services (β ≥ -0.039, p ≤ 0.01); the mechanism by which health human resources affect the level of medical services in China's western and northeastern regions is more pronounced than in the central and eastern regions; after the implementation of the "Healthy China 2030" Planning Outline, the role of health human resources in the level of medical services has been strengthened; in the robustness tests, the model remains robust after replacing the core explanatory variables, with R2 maintained between 0.869 and 0.972, and the dynamic GMM model test shows a significant second-order lag in the level of medical services (βequity ≤ 0.149, p ≤ 0.01; βefficiency ≤ 0.461, p ≤ 0.01); the channel test results prove that managerial personnel and other technical personnel are key pathways in regulating the impact of medical staff on the level of medical services. CONCLUSION This study provides an in-depth analysis of the impact of health human resources on the level of medical services, revealing that both the scale and hierarchical structure of health human resources significantly affect the equity and efficiency of medical services. Furthermore, the influence of health human resources on the level of medical services exhibits regional heterogeneity and temporal characteristics. Robustness tests ensure the scientific validity and robustness of the research conclusions. This provides effective references for optimizing the allocation of health human resources and improving the level of medical services.
Collapse
Affiliation(s)
- Jie-Ting Chen
- The School of Medicine, Shihezi University, Shihezi, Xinjiang, China
- The Academy of Education, Xinjiang Normal University, Urumqi, Xinjiang, China
| | - Kai Yang
- The School of Medicine, Shihezi University, Shihezi, Xinjiang, China
| | - Yan Zhu
- The School of Medicine, Shihezi University, Shihezi, Xinjiang, China
| | - Xiang-Wei Wu
- The School of Medicine, Shihezi University, Shihezi, Xinjiang, China.
| |
Collapse
|
52
|
Bacik A, Lopreiato JO, Burke HB. Survey of Current Simulation Based Training in the US Military Health System. Mil Med 2024; 189:423-430. [PMID: 39160867 DOI: 10.1093/milmed/usae147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 02/23/2024] [Accepted: 03/19/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION Simulation-based medical training has been shown to be effective and is widely used in civilian hospitals; however, it is unclear how widely and how effectively simulation is utilized in the U.S. Military Health System (MHS). The current operational state of medical simulation in the MHS is unknown, and there remains a need for a system-wide assessment of whether and how the advances in simulation-based medical training are employed to meet the evolving needs of the present-day warfighter. Understanding the types of skills and methods used within simulation programs across the enterprise is important data for leaders as they plan for the future in terms of curriculum development and the investment of resources. The aim of the present study is to survey MHS simulation programs in order to determine the prevalence of skills taught, the types of learners served, and the most common methodologies employed in this worldwide health care system. MATERIALS AND METHODS A cross-sectional survey of simulation activities was distributed to the medical directors of all 93 simulation programs in the MHS. The survey was developed by the authors based on lists of critical wartime skills published by the medical departments of the US Army, Navy, and Air Force. Respondents were asked to indicate the types of learners trained at their program, which of the 82 unique skills included in the survey are trained at their site, and for each skill the modalities of simulation used, i.e., mannequin, standardized patients, part task trainers, augmented/virtual reality tools, or cadaver/live tissue. RESULTS Complete survey responses were obtained from 75 of the 93 (80%) MHS medical simulation training programs. Across all skills included in the survey, those most commonly taught belonged predominantly to the categories of medic skills and nursing skills. Across all sites, the most common category of learner was the medic/corpsman (95% of sites), followed by nurses (87%), physicians (83%), non-medical combat lifesavers (59%), and others (28%) that included on-base first responders, law enforcement, fire fighters, and civilians. The skills training offered by programs included most commonly the tasks associated with medics/corpsmen (97%) followed by nursing (81%), advanced provider (77%), and General Medical Officer (GMO) skills (47%). CONCLUSION The survey demonstrated that the most common skills taught were all related to point of injury combat casualty care and addressed the most common causes of death on the battlefield. The availability of training in medic skills, nursing skills, and advanced provider skills were similar in small, medium, and large programs. However, medium and small programs were less likely to deliver training for advanced providers and GMOs compared to larger programs. Overall, this study found that simulation-based medical training in the MHS is focused on medic and nursing skills, and that large programs are more likely to offer training for advanced providers and GMOs. Potential gaps in the availability of existing training are identified as over 50% of skills included in the nursing, advanced provider, and GMO skill categories are not covered by at least 80% of sites serving those learners.
Collapse
Affiliation(s)
- Adam Bacik
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Silver Spring, MD 20910, USA
| | - Joseph O Lopreiato
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Harry B Burke
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| |
Collapse
|
53
|
Assunta F, Matteo A, Séverine V, Guy S, Aurélien K, Oriana KP, Dominique J, Josette S, Olivier H, Jérome P, Philippe D. Feasibility and acceptability of a serious game to study the effects of environmental distractors on emergency room nurse triage accuracy: A pilot study. Int Emerg Nurs 2024; 76:101504. [PMID: 39159597 DOI: 10.1016/j.ienj.2024.101504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/12/2024] [Accepted: 08/08/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND Emergency triage, which involves complex decision-making under stress and time constraints, may suffer from inaccuracies due to workplace distractions. A serious game was developed to simulate the triage process and environment. A pilot study was undertaken to collect preliminary data on the effects of distractors on emergency nurse triage accuracy. METHOD A 2 × 2 factorial randomized controlled trial (RCT) was designed for the study. A sample of 70 emergency room nurses was randomly assigned to three experimental groups exposed to different distractors (noise, task interruptions, and both) and one control group. Nurses had two hours to complete a series of 20 clinical vignettes, in which they had to establish a chief complaint and assign an emergency level. RESULTS Fifty-five nurses completed approximately 15 vignettes each during the allotted time. No intergroup differences emerged in terms of triage performance. Nurses had a very favorable appreciation of the serious game focusing on triage. CONCLUSION The results show that both the structure of our study and the serious game can be used to carry out a future RCT on a larger scale. The lack of a distractor effect raises questions about the frequency and intensity required to find a significant impact on triage performance.
Collapse
Affiliation(s)
- Fiorentino Assunta
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland Lausanne, Switzerland.
| | - Antonini Matteo
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland Lausanne, Switzerland; HE Arc - HES-SO University of Applied Sciences and Arts Western Switzerland, Neuchâtel, Switzerland
| | - Vuilleumier Séverine
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland Lausanne, Switzerland
| | - Stotzer Guy
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland Lausanne, Switzerland
| | - Kollbrunner Aurélien
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland Lausanne, Switzerland
| | - Keserue Pittet Oriana
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland Lausanne, Switzerland
| | - Jaccard Dominique
- School of Management and Engineering Vaud, HES-SO University of Applied Sciences and Arts Western Switzerland Yverdon-les-Bains, Switzerland
| | - Simon Josette
- Emergency Department, Geneva University Hospital, Geneva, Switzerland
| | - Hugli Olivier
- Emergency Department, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Pasquier Jérome
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Delmas Philippe
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland Lausanne, Switzerland
| |
Collapse
|
54
|
Levinthal DJ, Killian B, Issenman RM. Acute care of cyclic vomiting syndrome and cannabinoid hyperemesis syndrome in the home and emergency department for: Special supplement/proceedings of 3rd international symposium. Neurogastroenterol Motil 2024:e14901. [PMID: 39155452 DOI: 10.1111/nmo.14901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 08/05/2024] [Accepted: 08/07/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Cyclic vomiting syndrome (CVS) and cannabinoid hyperemesis syndrome (CHS) are both characterized by episodic, acute transitions from asymptomatic states to highly symptomatic states of nausea, repetitive vomiting, and often severe abdominal pain. Patients with CVS and CHS face significant challenges to abort or mitigate episodes at home and often require emergency department (ED)-based care. PURPOSE This paper reviews the current treatment approach to abort acute CVS and CHS episodes at home and in ED settings. Multiple pharmacologic and nonpharmacologic interventions have been demonstrated to potentially abort CVS or CHS episodes. Systemic pharmacologic agents often used as abortive therapy include triptans, antiemetics, anxiolytics, NK-1 receptor antagonists, antipsychotics, sedatives in general, and various analgesic / anti-inflammatory medications. Nonsystemic, nonpharmacologic approaches include reducing external stimuli (quiet room, dim lights, etc.), and hot water bathing or the application of topical capsaicin cream. More research is needed to develop evidence-based, individualized abortive treatment plans, as well as to determine whether the abortive treatment for CVS requires a fundamentally different approach than for CHS. When home-based approaches fail, all patients with CVS or CHS should receive nonjudgmental, informed, and compassionate care in the ED to abort their episode. Patients with more severe forms of CVS/CHS who require more frequent ED utilization should develop care plans with their ED to assure predictable and effective treatment.
Collapse
Affiliation(s)
| | - Blynda Killian
- Cyclic Vomiting Syndrome Association, Milwaukee, Wisconsin, USA
| | | |
Collapse
|
55
|
Viana J, Souza J, Rocha R, Santos A, Freitas A. Identification of avoidable patients at triage in a Paediatric Emergency Department: a decision support system using predictive analytics. BMC Emerg Med 2024; 24:149. [PMID: 39155373 PMCID: PMC11331632 DOI: 10.1186/s12873-024-01029-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 06/20/2024] [Indexed: 08/20/2024] Open
Abstract
BACKGROUND Crowding has been a longstanding issue in emergency departments. To address this, a fast-track system for avoidable patients is being implemented in the Paediatric Emergency Department where our study is conducted. Our goal is to develop an optimized Decision Support System that helps in directing patients to this fast track. We evaluated various Machine Learning models, focusing on a balance between complexity, predictive performance, and interpretability. METHODS This is a retrospective study considering all visits to a university-affiliated metropolitan hospital's PED between 2014 and 2019. Using information available at the time of triage, we trained several models to predict whether a visit is avoidable and should be directed to a fast-track area. RESULTS A total of 507,708 visits to the PED were used in the training and testing of the models. Regarding the outcome, 41.6% of the visits were considered avoidable. Except for the classification made by triage rules, i.e. considering levels 1,2, and 3 as non-avoidable and 4 and 5 as avoidable, all models had similar results in model's evaluation metrics, e.g. Area Under the Curve ranging from 74% to 80%. CONCLUSIONS Regarding predictive performance, the pruned decision tree had evaluation metrics results that were comparable to the other ML models. Furthermore, it offers a low complexity and easy to implement solution. When considering interpretability, a paramount requisite in healthcare since it relates to the trustworthiness and transparency of the system, the pruned decision tree excels. Overall, this paper contributes to the growing body of research on the use of machine learning in healthcare. It highlights practical benefits for patients and healthcare systems of the use ML-based DSS in emergency medicine. Moreover, the obtained results can potentially help to design patients' flow management strategies in PED settings, which has been sought as a solution for addressing the long-standing problem of overcrowding.
Collapse
Affiliation(s)
- João Viana
- CINTESIS - Centre for Health Technology and Services Research, University of Porto, Porto, Portugal.
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine of the University of Porto Al. Prof. Hernâni Monteiro, Porto, 4200 - 319, Portugal.
| | - Júlio Souza
- CINTESIS - Centre for Health Technology and Services Research, University of Porto, Porto, Portugal
- Institute of Engineering - Polytechnic of Porto, Porto, Portugal
| | - Ruben Rocha
- Serviço de Pediatria / Urgência Pediátrica, UAG da Mulher E da Criança, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Almeida Santos
- Serviço de Pediatria / Urgência Pediátrica, UAG da Mulher E da Criança, Centro Hospitalar Universitário de São João, Porto, Portugal
- Departamento de Ginecologia-Obstetrícia e Pediatria, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Alberto Freitas
- CINTESIS - Centre for Health Technology and Services Research, University of Porto, Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine of the University of Porto Al. Prof. Hernâni Monteiro, Porto, 4200 - 319, Portugal
| |
Collapse
|
56
|
Papan C, Sidorov S, Greiter B, Bühler N, Berger C, Becker SL, Meyer Sauteur PM. Combinatorial Host-Response Biomarker Signature (BV Score) and Its Subanalytes TRAIL, IP-10, and C-Reactive Protein in Children With Mycoplasma pneumoniae Community-Acquired Pneumonia. J Infect Dis 2024; 230:e247-e253. [PMID: 38092364 PMCID: PMC11326813 DOI: 10.1093/infdis/jiad573] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/04/2023] [Accepted: 12/14/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Host-response biomarkers to differentiate bacterial from viral etiology in children with respiratory infections have shown high accuracies, but are understudied in Mycoplasma pneumoniae (Mp) infections. METHODS We compared BV scores (0-34 indicating viral etiology, and 66-100 indicating bacterial etiology), tumor necrosis factor-related apoptosis-inducing ligand (TRAIL; pg/mL), interferon-γ inducible protein 10 (IP-10; pg/mL), and C-reactive protein (CRP; mg/L) serum levels between Mp-positive (Mp+) and Mp-negative (Mp-) community-acquired pneumonia (CAP) patients. We performed receiver operating characteristic (ROC) curve analyses for clinical features and biomarkers. RESULTS Of 80 CAP patients (median age, 6.3 years; 57.5% male), 26 had Mp+CAP. In Mp+CAP patients, compared to Mp-CAP patients, BV scores were lower (14.0 [3.0-27.8] vs 54.0 [12.0-84.8]; P = .0008), TRAIL levels were higher (86.5 [67.4-123.0] vs 65.5 [42.5-103.9]; P = .025), CRP levels were lower (12.9 [4.0-22.3] vs 36.7 [13.0-132.8]; P = .0019), and IP-10 levels were comparable (366.0 [150.2-603.8] vs 331.0 [154.3-878.8]; P = .73) (all median [interquartile range]). ROC analyses yielded a comparable discriminatory accuracy for the combination of age, fever duration, and duration of respiratory symptoms, with either procalcitonin or BV score (area under the ROC curve, 0.87 vs 0.86; P = .94). CONCLUSIONS Children with Mp+CAP have atypically low, viral levels of the BV score, underscoring the complementary role of microbiological testing.
Collapse
Affiliation(s)
- Cihan Papan
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Homburg, Saarland University, Germany
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Semjon Sidorov
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Beat Greiter
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Nina Bühler
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Homburg, Saarland University, Germany
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Sören L Becker
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Homburg, Saarland University, Germany
| | - Patrick M Meyer Sauteur
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
57
|
Büyük ET, Uzsen H, Koyun M, Ateş Y, Can S, Bakan F. Atraumatic care practice from the child and parent perspective: The case of a pediatric phlebotomy unit. J Pediatr Nurs 2024:S0882-5963(24)00314-2. [PMID: 39153917 DOI: 10.1016/j.pedn.2024.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 08/12/2024] [Accepted: 08/12/2024] [Indexed: 08/19/2024]
Abstract
PURPOSE This study aimed to determine the effect of the child's self-selected distraction methods used during the phlebotomy procedure on the feeling of fear and pain in children and parental satisfaction. METHODS The study, planned as a randomized controlled trial, was conducted with 219 children aged 5-10 years and their parents in the pediatric phlebotomy unit between March and June 2023. Different distraction methods (foam balloon, stress ball, musical book) were applied to the children in the intervention group during the phlebotomy procedure. The data were analyzed with the SPSS 22.0 package program. RESULTS There was a statistically significant difference between the scores of the children in the intervention and control groups on the Children's Fear Scale before the phlebotomy, and on the Wong-Baker Faces Pain Rating Scale after phlebotomy according to self- and parental assessment (p < 0.05). A statistically significant difference was found between the satisfaction levels of the parents after the procedure in the intervention and control groups with the health care service provided during the phlebotomy process (p < 0.05). CONCLUSION Distraction methods, one of the atraumatic nursing interventions used before the phlebotomy procedure, were determined to be effective in reducing the child's fear and the pain experienced due to the procedure. The study also showed that the satisfaction of parents was positively affected by the atraumatic care provided to their children. PRACTICE IMPLICATIONS The atraumatic care approach should be used to prevent anxiety and fear experienced by parents and children and to reduce the child's pain.
Collapse
Affiliation(s)
- Esra Tural Büyük
- Department of Pediatric Nursing, Faculty of Health Sciences, Ondokuz Mayis University, Samsun, Turkey.
| | - Hatice Uzsen
- Department of Pediatric Nursing, Faculty of Health Sciences, Ondokuz Mayis University, Samsun, Turkey
| | - Merve Koyun
- Department of Pediatric Nursing, Faculty of Health Sciences, Ondokuz Mayis University, Samsun, Turkey
| | - Yeşim Ateş
- Health Practice and Research Hospital, Ondokuz Mayis University, Samsun, Turkey
| | - Selma Can
- Health Practice and Research Hospital, Ondokuz Mayis University, Samsun, Turkey
| | - Figen Bakan
- Health Practice and Research Hospital, Ondokuz Mayis University, Samsun, Turkey
| |
Collapse
|
58
|
Tanguay K, Nadeau A, Brousseau AA, Archambault PM, Carmichael PH, Emond M, Deshaies JF, Sirois MJ, Mowbray FI, Blanchard PG, Mercier E. Nonmedical problems among older adults visiting the emergency department for low acuity conditions: A prospective multicentre cohort study. Heliyon 2024; 10:e35352. [PMID: 39170452 PMCID: PMC11336578 DOI: 10.1016/j.heliyon.2024.e35352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 07/17/2024] [Accepted: 07/26/2024] [Indexed: 08/23/2024] Open
Abstract
Background Data on the predictors of nonmedical problems (NMP) in older adults attending the emergency department (ED) for low acuity conditions is lacking and could help rapid identification of patients with NMP and integration of these needs into care planning. Objectives To determine the prevalence and predictors of NMP among older adults attending EDs for low acuity conditions. Methods Prospective cohort study in eight EDs (May-August 2021). We included cognitively intact ≥65 years old adults assigned a low triage acuity (3-5) using the CTAS. A questionnaire focusing on 11 NMP was administered. We used multiple logistic regression to identify predictors of NMP. Results Among the 1,061 participants included, the mean age was 77.1 ± 7.6, majority were female, and 41.6 % lived alone. At least one NMP was reported by 704 persons. Prevalence of each NMP: outdoor (41.1 %) and indoor (30.2 %) mobility issues, difficult access to dental care (35.1 %), transportation (4.1 %) and medication (5.4 %), loneliness (29.5 %), food insecurity (10.3 %), financial difficulties (9.5 %), unsafe living situation (4.1 %), physical/psychological violence (3.4 %), and abuse/neglect (3.3 %). Predictors of NMP were: age (OR 1.04 for each additional year), living alone (OR 2.20), pre-existing mental health conditions (OR 3.12), heart failure (OR 1.42), recent surgery/admission (OR 1.75), memory decline (OR 2.76), no family physician (OR 1.74) and consulting for a fall/functional decline (OR 2.48). Conclusions Nonmedical problems are frequent among older adults. We need to implement holistic ED processes that integrate these problems into care planning.
Collapse
Affiliation(s)
- Katherine Tanguay
- Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, QC, Canada
- Centre de recherche du CHU de Québec - Université Laval, Axe santé des populations et pratiques optimales en santé, Québec, Canada
| | - Alexandra Nadeau
- Centre de recherche du CHU de Québec - Université Laval, Axe santé des populations et pratiques optimales en santé, Québec, Canada
- VITAM – Centre de recherche en santé durable, Québec, QC, Canada
| | - Audrey-Anne Brousseau
- Département de médecine de famille et de médecine d'urgence, Faculté de médecine et sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Patrick M. Archambault
- Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, QC, Canada
- VITAM – Centre de recherche en santé durable, Québec, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Pierre-Hugues Carmichael
- Centre de recherche du CHU de Québec - Université Laval, Axe de recherche en vieillissement, Québec, QC, Canada
| | - Marcel Emond
- Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, QC, Canada
- Centre de recherche du CHU de Québec - Université Laval, Axe santé des populations et pratiques optimales en santé, Québec, Canada
- VITAM – Centre de recherche en santé durable, Québec, QC, Canada
| | - Jean-Francois Deshaies
- Département de médecine de famille et de médecine d'urgence, Faculté de médecine et sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Marie-Josée Sirois
- Centre de recherche du CHU de Québec - Université Laval, Axe santé des populations et pratiques optimales en santé, Québec, Canada
| | | | - Pierre-Gilles Blanchard
- Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, QC, Canada
- Centre de recherche du CHU de Québec - Université Laval, Axe santé des populations et pratiques optimales en santé, Québec, Canada
- VITAM – Centre de recherche en santé durable, Québec, QC, Canada
| | - Eric Mercier
- Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, QC, Canada
- Centre de recherche du CHU de Québec - Université Laval, Axe santé des populations et pratiques optimales en santé, Québec, Canada
- VITAM – Centre de recherche en santé durable, Québec, QC, Canada
| |
Collapse
|
59
|
Beyer A, Moon K, Hirsch T, Lode HN, Hoffmann W, van den Berg N. Implementation of a telemedical urgency assessment procedure in the pediatric emergency room: evaluation results. DAS GESUNDHEITSWESEN 2024. [PMID: 38740378 DOI: 10.1055/a-2325-0194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND In rural areas in Germany, the number of emergency departments with pediatric expertise decreases. Telemedicine solutions are used sporadically, but they lack certain parameters for assessing a child's health status, such as touch and smell. We tested and evaluated the implementation of a telemedical, cross-hospital urgency assessment in pediatric emergency rooms. The telemedical urgency assessments were carried out via video conferences and were compared to the usual on-site procedure. Primary results of the concordance analysis have been published elsewhere. This work describes the results of the evaluation of the implementation. METHODS The telemedical urgency assessment was carried out in 5 pediatric emergency departments during the years 2015-2019. Various methods were used to evaluate the implementation. The following reports are based on (a) a parent questionnaire with two statements to be evaluated (entire project duration), (b) a survey of the physicians using telemedicine after each case (entire project duration) and (c) detailed process documentation (July 2017 until end of the project). RESULTS A total of 266 patients under 18 years old, recruited from four hospitals, were included in the study. (a) 210 parents completed the questionnaire. 78% of the parents felt adequately cared for and 70% could imagine telemedicine becoming established as a future supplementary care procedure. (b) The physicians' questionnaires for the telemedicine site were completed in 232 cases (87%). The average satisfaction rating was 1.8 on a 6-point-likert-scale (95% confidence interval: 1.64; 1.95). (c) The most frequent implementation problem concerned the technical implementation of the video conference. The evaluation of the accompanying documentation revealed in particular implementation barriers in the technical area (e. g. limited video and/or audio quality) and in the provision of human resources. CONCLUSION Despite implementation barriers, the project showed that telemedical urgency assessment in acute pediatric care is a promising option for supporting care. Most of the participating clinicians needed a high level of support, which in some cases indicated a rather low level of digital competence. Increasing acceptance of telemedicine functionalities requires changes in society as a whole with improved framework conditions.
Collapse
Affiliation(s)
- Angelika Beyer
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Kilson Moon
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Thomas Hirsch
- Klinik für Kinder- und Jugendmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Holger N Lode
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Neeltje van den Berg
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
| |
Collapse
|
60
|
Guven R, Avci A, Korkut S, Altug E, Cakir A, Sogut O, Dogan S, Avsar M, Alay GH, Yilmaz G. Base excess is superior to creatinine in predicting haemodialysis: A multicenter study conducted Kahramanmaraş earthquake victims. Am J Emerg Med 2024; 85:29-34. [PMID: 39178629 DOI: 10.1016/j.ajem.2024.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 08/04/2024] [Accepted: 08/14/2024] [Indexed: 08/26/2024] Open
Abstract
PURPOSE This study had two main goals: to determine which rhabdomyolysis patients need haemodialysis; and to highlight the significance of blood gas parameters, particularly base excess, as predictors of the need for haemodialysis. METHOD A total of 270 patients were included in this multicentre, retrospective study. Among the patients who were transferred in from the earthquake region and developed rhabdomyolysis, those with creatine kinase (CK) values >1000 U/L were included in our study. The need for renal replacement in these patients was determined via laboratory tests, urine output monitoring and clinical follow-up. FINDINGS A total of 270 patients were included in our study. Univariate and multivariate regression analyses of laboratory parameters were performed to identify predictors of HD treatment. According to the univariate regression analysis, BE, HCO3, creatinine, CK, lactate, alanine transaminase (ALT) and aspartate transaminase (AST) levels were found to be significantly associated with receiving HD treatment. According to multivariate regression analysis, only BE (p = 0.003) was found to be a significant predictor of HD treatment. ROC analysis revealed that the optimal cutoff value for BE was -2.6; at this value, the sensitivity and specificity of BE for predicting HD treatment were 89% and 77.1%, respectively (AUC: 0.912; 95% CI: 0.872-0.943; p < 0.001). CONCLUSION Base excess is an effective predictor of the need for haemodialysis in patients with crush-related injuries that cause rhabdomyolysis and in patients who develop acute renal failure due to elevated CK.
Collapse
Affiliation(s)
- Ramazan Guven
- Health Science University, Istanbul Cam and Sakura City Research and Training Hospital, Department of Emergency Medicine, Istanbul, Turkey.
| | - Akkan Avci
- Health Science University, Adana City Research and Training Hospital, Department of Emergency Medicine, Adana, Turkey
| | - Semih Korkut
- Health Science University, Istanbul Cam and Sakura City Research and Training Hospital, Department of Emergency Medicine, Istanbul, Turkey
| | - Ertugrul Altug
- Health Science University, Istanbul Cam and Sakura City Research and Training Hospital, Department of Emergency Medicine, Istanbul, Turkey
| | - Adem Cakir
- Canakkale Mehmet Akif Ersoy State Hospital, Canakkale, Turkey
| | - Ozgur Sogut
- Health Science University, Istanbul Haseki Research and Training Hospital, Department of Emergency Medicine, Istanbul, Turkey.
| | - Serkan Dogan
- Health Science University, Istanbul Kanuni Sultan Suleyman Research and Training Hospital, Department of Emergency Medicine, Istanbul, Turkey
| | - Mustafa Avsar
- Yuregir State Hospital, Emergency Medicine Clinic, Adana, Turkey
| | - Gulcin Hilal Alay
- Health Science University, Istanbul Cam and Sakura City Research and Training Hospital, Department of Nephrology, Istanbul, Turkey
| | - Gulay Yilmaz
- Health Science University, Istanbul Cam and Sakura City Research and Training Hospital, Department of Nephrology, Istanbul, Turkey
| |
Collapse
|
61
|
Larsen JJ, Lauridsen H, Gundersen LW, Riecke BF, Schmidt TA. Abated crowding by fast-tracking the Throughput component of the ED for patients in no need of hospitalization with competency managed personnel. BMC Emerg Med 2024; 24:147. [PMID: 39148043 PMCID: PMC11328428 DOI: 10.1186/s12873-024-01069-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 08/09/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND Emergency department (ED) crowding is a major patient safety concern and has a negative impact on healthcare systems and healthcare providers. We hypothesized that it would be feasible to control crowding by employing a multifaceted approach consisting of systematically fast-tracking patients who are mostly not in need of a hospital stay as assessed by an initial nurse and treated by decision competent physicians. METHODS Data from 120,901 patients registered in a secondary care ED from the 4tth quarter of 2021 to the 1st quarter of 2024 was drawn from the electronic health record's data warehouse using the SAP Web Intelligence tool and processed in the Python programming language. Crowding was compared before and after ED transformation from a uniform department into a high flow (α) and a low flow (β) section with patient placement in gurneys/chairs or beds, respectively. Patients putatively not in need of hospitalization were identified by nurse, placed in in the α setting and assessed and treated by decision competent physicians. Incidence of crowding, number of patients admitted per day and readmittances within 72 h following ED admission before and after changes were determined. Values are number of patients, mean ± SEM and mean differences with 95% CIs. Statistical significance was ascertained using Student's two tailed t-test for unpaired values. RESULTS Before and after ED changes crowding of 130% amounted to 123.8 h and 19.3 h in the latter. This is a difference of -104.6 ± 23.9 h with a 95% CI of -159.9 to -49.3, Δ% -84 (p = 0.002). There was the same amount of patients / day amounting to 135.8 and 133.5 patients / day Δ% = -1.7 patients 95% CI -6.3 to 1.6 (p = 0.21). There was no change in readmittances within 72 h before and after changes amounting to 9.0% versus 9.5%, Δ% = 0.5, 95%, CI -0.007 to 1.0 (p > 0.052). CONCLUSION It appears feasible to abate crowding with unchanged patient admission and without an increase in readmittances by fast-track assessment and treatment of patients who are not in need of hospitalization.
Collapse
Affiliation(s)
- Jesper Juul Larsen
- Department of Emergency Medicine, North Zealand Hospital, Hillerød, Denmark
| | - Halfdan Lauridsen
- Department of Emergency Medicine, North Zealand Hospital, Hillerød, Denmark
| | | | - Birgit Falk Riecke
- Department of Emergency Medicine, North Zealand Hospital, Hillerød, Denmark
| | - Thomas A Schmidt
- Department of Emergency Medicine, North Zealand Hospital, Hillerød, Denmark.
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
62
|
Wiese JL, Watson TM, Bozinoff N, Rush B, Stergiopoulos V, Le Foll B, Rueda S. "Like the Wild West": Health care provider perspectives on impacts of recreational cannabis legalization on patients and providers at a tertiary psychiatric hospital in Ontario, Canada. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024:209487. [PMID: 39153735 DOI: 10.1016/j.josat.2024.209487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 07/18/2024] [Accepted: 08/13/2024] [Indexed: 08/19/2024]
Abstract
INTRODUCTION Legalization has increased cannabis availability in Canada. Research shows complex relationships between cannabis use and mental health, and a need for health care providers to engage with patients about cannabis use. Providers have noted gaps in knowledge and research on the medical effects of cannabis as barriers to service delivery. It is unclear how providers and patients in mental health care settings have been impacted by legalization. METHODS From June 1 to July 2, 2021, we conducted a qualitative study involving semi-structured interviews with 20 health care providers in a range of roles (e.g., physicians, pharmacists, nurses) within a psychiatric hospital setting. Participants responded to open-ended questions with follow-up probes on various topics related to cannabis legalization. Topics included impacts on patient mental and physical health, clinical impacts, education and training, legal cannabis retail system and the medical cannabis access system. RESULTS Thematic analysis identified several themes in the data. Participants reported that legalization has had some positive impacts relating to clinical care and cannabis safety. They also expressed concerns with increased rates of cannabis use, risks to mental health and ongoing challenges engaging with patients about cannabis. Participants made recommendations for medical educators and regulators (e.g., updated curriculums, clinical guidelines), the mental health care sector (e.g., implementation of standardized screening), government (e.g., public health campaigns, safe use guidelines), the medical cannabis access system (e.g., increased regulation, research), and the legal cannabis system (e.g., zoning changes, point-of-sale information). CONCLUSIONS This study begins to address the paucity of data on impacts of legalization from mental health service delivery settings. Findings show that although legalization has had some positive impacts, there are ongoing patient concerns and unmet provider needs. More research is needed to understand the experiences of providers delivering care to populations experiencing mental health and/or substance use concerns who use cannabis in the post-legalization era.
Collapse
Affiliation(s)
- Jessica L Wiese
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada.
| | - Tara Marie Watson
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada.
| | - Nikki Bozinoff
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada; Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada; Addictions Division, Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON M6J 1H4, Canada.
| | - Brian Rush
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada; Homewood Research Institute, 150 Delhi Street, Guelph, ON N1E 6K9, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada.
| | - Viky Stergiopoulos
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada; Centre for Addiction and Mental Health, 1000 Queen Street West, Toronto, ON M6J 1H4, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada; Acute Care Program, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON M6J 1H1, Canada.
| | - Bernard Le Foll
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada; Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada; Acute Care Program, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON M6J 1H1, Canada; Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada; Institute of Medical Sciences, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada.
| | - Sergio Rueda
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada; Institute of Medical Sciences, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON M5T 3M6, Canada.
| |
Collapse
|
63
|
Hachimi-Idrissi S. Epi overload: When too much juice sours the brain. Am J Emerg Med 2024:S0735-6757(24)00410-8. [PMID: 39174357 DOI: 10.1016/j.ajem.2024.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 08/14/2024] [Indexed: 08/24/2024] Open
Affiliation(s)
- Said Hachimi-Idrissi
- Emergency Department, Ghent University Hospital, Belgium; Faculty of Medicine and Health Sciences, Ghent University, Belgium; Faculty of Medicine and Pharmacy, Free University Brussels, Belgium.
| |
Collapse
|
64
|
Hofmann B, Andersen ER, Brandsæter IØ, Clement F, Elshaug AG, Bryan S, Aslaksen A, Hjørleifsson S, Lauritzen PM, Johansen BK, von Schweder GJ, Nomme F, Kjelle E. Success factors for interventions to reduce low-value imaging. Six crucial lessons learned from a practical case study in Norway. Curr Probl Diagn Radiol 2024:S0363-0188(24)00150-6. [PMID: 39164183 DOI: 10.1067/j.cpradiol.2024.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 07/28/2024] [Accepted: 08/08/2024] [Indexed: 08/22/2024]
Abstract
BACKGROUND Substantial overuse of health care services is identified and intensified efforts are incited to reduce low-value services in general and in imaging in particular. OBJECTIVE To report crucial success factors for developing and implementing interventions to reduce specific low-value imaging examinations based on a case study in Norway. MATERIALS AND METHODS Mixed methods design including one systematic review, one scoping review, implementation science, qualitative interviews, content analysis of stakeholders' input, and stakeholder deliberations. RESULTS The description and analysis of an intervention to reduce low-value imaging in Norway identifies six general success factors: 1) Acknowledging complexity: advanced knowledge synthesis, competence of the context, and broad and strong stakeholder involvement is crucial to manage de-implementation complexity. 2) Clear consensus-based criteria for selecting low-value imaging procedures are key. 3) Having a clear target group is critical. 4) Stakeholder engagement is essential to ascertain intervention relevance and compliance. 5) Active and well-motivated intervention collaborators is imperative. 6) Paying close attention to the mechanisms of low-value imaging and the barriers to reduce it is decisive. CONCLUSION Reducing low-value imaging is crucial to increase the quality, safety, efficiency, and sustainability of the health services. Reducing low-value imaging is a complex task and paying attention to specific practical success factors is key.
Collapse
Affiliation(s)
- Bjørn Hofmann
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, Norway; Centre for Medical Ethics, University of Oslo, Norway.
| | - Eivind Richter Andersen
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, Norway
| | - Ingrid Øfsti Brandsæter
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, Norway
| | - Fiona Clement
- Department of Community Health Sciences, Cumming School of Medicine. University of Calgary, Canada
| | - Adam G Elshaug
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - Stirling Bryan
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
| | - Aslak Aslaksen
- Department of Radiology, Haukeland University Hospital, Bergen, Norway; Department of Global Health and Primary Care, University of Bergen, Bergen, Norway
| | - Stefán Hjørleifsson
- Department of Global Health and Primary Care, University of Bergen, Bergen, Norway
| | - Peter Mæhre Lauritzen
- Division of radiology and nuclear medicine, Oslo University Hospital, Oslo Norway; Department of Life Sciences and Health, Faculty of Health Sciences, Oslo Metropolitan University, Norway
| | | | | | | | - Elin Kjelle
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, Norway
| |
Collapse
|
65
|
Palmer K, Atkinson J, Woodland J, McDougall P, Chandra K, Atkinson P. Social determinants of health in the emergency department. CAN J EMERG MED 2024:10.1007/s43678-024-00758-5. [PMID: 39141318 DOI: 10.1007/s43678-024-00758-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 07/26/2024] [Indexed: 08/15/2024]
Affiliation(s)
- Kate Palmer
- Department of Emergency Medicine, Saint John Regional Hospital, Saint John, NB, Canada
- University of New Brunswick, Fredericton, NB, Canada
| | | | - Jen Woodland
- Department of Psychology, University of New Brunswick, Saint John, NB, Canada
| | - Pam McDougall
- Department of Emergency Medicine, Horizon Health Network, Saint John, NB, Canada
| | - Kavish Chandra
- Department of Emergency Medicine, Horizon Health Network, Dalhousie Medicine New Brunswick, Saint John Regional Hospital, Saint John, NB, Canada
| | - Paul Atkinson
- Department of Emergency Medicine, Horizon Health Network, Dalhousie Medicine New Brunswick, Saint John Regional Hospital, Saint John, NB, Canada.
| |
Collapse
|
66
|
Rowe BH, Yang E, Corrick S, Hussain MW. Reducing computed tomography (CT) imaging for adults with minor traumatic brain injuries in the emergency department. BMJ 2024; 386:e074867. [PMID: 39137946 DOI: 10.1136/bmj-2023-074867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Affiliation(s)
- Brian H Rowe
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- School of Public Health, College of Health Science, University of Alberta
| | - Esther Yang
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- SPOR SUPPORT Unit, Alberta Health Services (AHS), Edmonton
| | - Shaina Corrick
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - M Wasif Hussain
- Department of Medicine, Division of Neurology, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta
| |
Collapse
|
67
|
Hasanzade A, Nejatollahi SMR, Mokhber Dezfouli M, Hazrati M, Sheikholeslami S, Imani M, Mohseni B, Ghorbani F. The Impact of Early Brain-Dead Donor Detection in the Emergency Department on the Organ Donation Process in Iran. Transpl Int 2024; 37:11903. [PMID: 39193259 PMCID: PMC11347348 DOI: 10.3389/ti.2024.11903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 07/31/2024] [Indexed: 08/29/2024]
Abstract
We aimed to assess the impact of hospital characteristics on the outcomes of detected possible brain-dead donors, in our organ procurement network in Iran. Data was collected through twice-daily calls with 57 hospitals' intensive care units and emergency departments over 1 year. The donation team got involved when there was suspicion of brain death before the hospital officially declared it. The data was categorized by hospital size, presence of neurosurgery/trauma departments, ownership, and referral site. Out of 813 possible donors, 315 were declared brain dead, and 203 were eligible for donation. After conducting family interviews (consent rate: 62.2%), 102 eligible donors became actual donors (conversion rate: 50.2%). While hospital ownership and the presence of trauma/neurosurgery care did not affect donation, early referral from the emergency department had a positive effect. Therefore, we strongly recommend prioritizing possible donor identification in emergency rooms and involving the organ donation team as early as possible. The use of twice-daily calls for donor identification likely contributed to the consistency in donation rates across hospitals, as this approach involves the donation team earlier and mitigates the impact of hospital characteristics. Early detection of possible donors from the emergency department is crucial in improving donation rates.
Collapse
Affiliation(s)
- Arman Hasanzade
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Reza Nejatollahi
- Hepato-Pancreato-Biliary and Transplant Surgery, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Mokhber Dezfouli
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdieh Hazrati
- Organ Transplantation and Donation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheil Sheikholeslami
- Organ Transplantation and Donation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Imani
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Bardia Mohseni
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Alborz, Iran
| | - Fariba Ghorbani
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Alborz, Iran
| |
Collapse
|
68
|
Rosic T, Cloutier P, Myran D, Imsirovic H, Kurdyak P, Gardner W. Physician Follow-Up of Pediatric and Young Adult Emergency Department Visits for Substance Use in Ontario, Canada. J Adolesc Health 2024:S1054-139X(24)00303-3. [PMID: 39140931 DOI: 10.1016/j.jadohealth.2024.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 04/08/2024] [Accepted: 06/24/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE To study the proportion and predictors of outpatient physician follow-up within 60 days of substance-related emergency department (ED) visits for Ontario youth. METHODS We examined administrative data on substance-related ED visits before and during the COVID-19 pandemic among youths aged 10-24 years in Ontario, Canada. Substance-related visits were identified using International Classification of Diseases-10-CA codes. We described demographic characteristics, receipt of mental health services in the year before the ED visit, disposition from the ED, and follow-up services within 60 days of the ED visit. RESULTS Between April 1, 2017, and May 31, 2021, 64,236 youth had at least one ED visit for substance use. Visits for alcohol were the most common (49%), followed by cannabis (32.3%). ED visits for all substances were more prevalent during the pandemic than prepandemic, except visits for alcohol. The receipt of follow-up physician care for substance use was low (33.2% prepandemic) but increased during the pandemic (41.7%; adjusted odds ratio 1.34, 95% CI 1.28, 1.39) and varied between substances. Mental health service history in the year before the substance-related ED visit had the strongest association with receipt of follow-up physician care within 60 days (adjusted odds ratio 6.86, 95% CI 6.57, 7.17). DISCUSSION Youth frequently do not receive physician follow-ups within two months of the substance-related ED visit, although higher follow-up proportions were seen during the pandemic after the implementation of virtual care. Further research is required to understand why follow-up is low and to examine interventions that can increase connection to care.
Collapse
Affiliation(s)
- Tea Rosic
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
| | - Paula Cloutier
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Daniel Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Paul Kurdyak
- The Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - William Gardner
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
69
|
Eid R, Zamparini E, Ouchrif Y, Snanoudj R, Ottolenghi C, Zaidan M. A case report of Paracetamol related pyroglutamic acidosis: mind the gap in a malnourished patient. BMC Nephrol 2024; 25:260. [PMID: 39138387 PMCID: PMC11323620 DOI: 10.1186/s12882-024-03678-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 07/18/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Pyroglutamic acidosis is a rare cause of high anion gap metabolic acidosis. Most cases of paracetamol related pyroglutamic acidosis are described in malnourished women and patients with kidney/liver failure, alcohol use or severe sepsis. In this report, we describe how pyroglutamic acidosis could be related to the use of chronic therapeutic paracetamol with only malnutrition as an associated risk factor. CASE PRESENTATION We report a case of a 67-year-old male patient developing a pyroglutamic acidosis. The patient was initially admitted to hospital for infectious osteoarthritis and developed a metabolic acidosis during his hospital stay. Analgesics included daily therapeutic doses of paracetamol. What makes our case unusual is that our malnourished male patient did not have renal or hepatic failure. The diagnosis of paracetamol related pyroglutamic acidosis was made after ruling out the main causes of metabolic acidosis. It was further confirmed by urine organic acids measurement showing a markedly elevated level of pyroglutamic aciduria. Paracetamol was discontinued allowing a prompt correction of the anion gap. CONCLUSION This case is a representative of pyroglutamic acidosis related to chronic therapeutic paracetamol with only malnutrition as an associated risk factor. Physicians should be aware of such unusual cause of metabolic acidosis, which may be more common than expected in hospitalized patients. A high clinical suspicion is needed when urine organic acids analysis is not available.
Collapse
Affiliation(s)
- Rita Eid
- Department of Nephrology, Dialysis, and Transplantation, Bicêtre University Hospital, APHP, Paris Saclay University, 78 rue du Général Leclerc, Le Kremlin-Bicêtre, 94270, France
| | - Emmanuel Zamparini
- Department of Infectious Diseases, Bicêtre University Hospital, APHP, Le Kremlin-Bicêtre, France
| | - Younes Ouchrif
- Department of Orthopedic Surgery, Bicêtre University Hospital, APHP, Le Kremlin-Bicêtre, France
| | - Renaud Snanoudj
- Department of Nephrology, Dialysis, and Transplantation, Bicêtre University Hospital, APHP, Paris Saclay University, 78 rue du Général Leclerc, Le Kremlin-Bicêtre, 94270, France
- Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Chris Ottolenghi
- Department of Metabolic Biochemistry, Necker University Hospital for Sick Children, APHP, Paris, France
| | - Mohamad Zaidan
- Department of Nephrology, Dialysis, and Transplantation, Bicêtre University Hospital, APHP, Paris Saclay University, 78 rue du Général Leclerc, Le Kremlin-Bicêtre, 94270, France.
- Paris-Saclay University, Le Kremlin-Bicêtre, France.
| |
Collapse
|
70
|
Butun A. Healthcare staff experiences on the impact of COVID-19 on emergency departments: a qualitative study. BMC Health Serv Res 2024; 24:921. [PMID: 39135193 PMCID: PMC11320844 DOI: 10.1186/s12913-024-11362-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 07/25/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a major impact on the access and delivery of healthcare services, posing unprecedented challenges to healthcare staff worldwide. Frontline healthcare staff faced unique stressors and challenges that impact their well-being and patient care. This qualitative study aimed to explore the experiences and perspectives of frontline ED healthcare staff on emergency care services during the COVID-19 pandemic, providing valuable insights into the challenges, adaptations, and lessons learned in delivering emergency care. METHODS This study utilized a qualitative approach. In-depth semi-structured interviews were conducted with 30 ED healthcare staff from three different hospitals located in Turkey between 15/03/2022 and 30/04/2022. Convenience sampling was used to recruit participants. The duration of the interviews ranged from 28 to 37 min. Data saturation was reached as no new information was gathered. The data were analyzed using the thematic analysis method. NVivo software was used to manage the data analysis process. Member check was carried out to ensure that the generated themes conformed to the participants' views. RESULTS 15 sub-themes under three themes emerged: (1) the impact of COVID-19 on emergency care services, including sub-themes of "introducing a COVID-19 unit in the ED", "changes in the routine functioning of EDs", "changes in the number of ED visits", "quality of care", "resources", and "increased workload"; (2) the psychological effects of COVID-19 on ED healthcare staff, including sub-themes of "staying away from family", "fear", "society's perspective on healthcare professionals", "morale-staff burnout", "psychological and emotional effects", and "unable to receive sufficient support"; and (3) the difficulties faced by ED healthcare staff, including sub-themes of "difficult working conditions", "community-based effects difficulties", and "COVID-19 is an unknown situation". CONCLUSION Staff burnout threatens the quality of patient care and staff retention, and therefore this should be addressed by ED directors and leaders. This study could inform appropriate stakeholders regarding lessons learned from COVID-19 to better manage future pandemics. Learning from such lived experiences and developing appropriate interventions to minimize the difficulties faced during COVID-19 would allow better management of future pandemics. This study calls for a reform to address the challenges faced by healthcare staff, improve the overall response to public health crises, and enhance the resilience of healthcare systems for future crises.
Collapse
Affiliation(s)
- Ahmet Butun
- Faculty of Health Sciences, Mardin Artuklu University, Kampus yerleskesi, Artuklu/Mardin, Mardin, 47000, Turkey.
| |
Collapse
|
71
|
Gottlieb M, Moyer E, Bernard K. Epidemiology of headache presentations to United States emergency departments from 2016 to 2023. Am J Emerg Med 2024; 85:1-6. [PMID: 39141930 DOI: 10.1016/j.ajem.2024.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/24/2024] [Accepted: 08/09/2024] [Indexed: 08/16/2024] Open
Abstract
INTRODUCTION Headaches are a common condition seen in the Emergency Department (ED), with numerous trials focused on improving care for these patients. However, there is limited recent large-scale, robust data available on the incidence, admission rates, evaluation, and treatment in the ED setting. METHODS This was a cross-sectional study of ED presentations for headache from 1/1/2016 to 12/31/2023 using the Epic Cosmos national database. All ED visits with headache-relevant ICD-10 coding were included. Outcomes included percentage of total ED visits, admission rates, computed tomography (CT) brain imaging, lumbar puncture (LP) performance, and medication administration. Medications were analyzed by class (NSAIDs, acetaminophen, dopamine antagonists, diphenhydramine, opioids, intravenous fluids, caffeine, and magnesium sulfate). Subgroup analyses were performed by specific types of dopamine antagonists. RESULTS Of 188,482,644 ED encounters, 6,007,090 (3.2%) were due to headache. Of these, 246,082 (4.1%) were admitted. Nearly half (46.6%) of patients received at least one CT. Rates of CT head without contrast increased from 38.2% to 47.9% over time, while rates of CT angiography rose from 2.8% to 10.2%. 1.4% of all patients received an LP, with rates decreasing from 1.8% to 1.1% over time. The most common medication was NSAIDs (45.3%), followed by dopamine antagonists (44.8%), diphenhydramine (38.1%), acetaminophen (24.8%), opioids (16.3%), magnesium sulfate (0.2%), and caffeine (0.1%). 50.8% of patients received intravenous fluids. Rates of opioids declined over time, while dopamine antagonists, acetaminophen, and intravenous fluid administration increased. CONCLUSION Headaches represent a common reason for ED presentation, with approximately 4% of patients being admitted. Imaging is frequently performed, with rises in CT without contrast and CT angiography rates over time, while LP rates have been declining. NSAIDs remain the most common medication given, with opioids declining over time while non-opioid agents such as dopamine antagonists have increased. These findings can help inform health policy initiatives, such as those focused on radiologic imaging and evidence-based medication administration.
Collapse
Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.
| | - Eric Moyer
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Kyle Bernard
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America
| |
Collapse
|
72
|
Usman S, Daloya J, Khan MJ, Haseeb S, Patel H, Mustafa S, Pantic D. Intermittent hemodialysis as a rewarming strategy for severe hypothermia in patients without renal failure: a case report. BMC Anesthesiol 2024; 24:284. [PMID: 39127621 DOI: 10.1186/s12871-024-02664-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
This case report highlights the effective use of intermittent hemodialysis (IHD) in warming a 71-year-old female patient with severe hypothermia who presented with a rectal temperature of 25 °C and signs of hemodynamic instability. The patient, found unconscious after prolonged exposure to cold exacerbated by alcohol consumption, initially showed some improvement in core temperature through active external rewarming methods. However, soon, her temperature plateaued at 27 °C. Patient was deemed unsuitable for extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass (CPB) due to her age, and urgent IHD was initiated. This approach resulted in a stable increase in core temperature at approximately 2.0 °C/hr, along with normalization of lactic acidosis, creatinine phosphokinase, and correction of electrolyte imbalances, culminating in her full recovery and discharge after seven days in the hospital.After reviewing this case alongside similar ones from before, this case report highlights the efficacy and safety of IHD as an efficient, readily available, and less invasive method for rewarming moderate to severe hypothermic patients who are hemodynamically unstable patients but do not have cardiac arrest or renal dysfunction. IHD is especially useful when less invasive cooling devices (Artic Sun/ CoolGard) are not available or more invasive extracorporeal life support options (ECMO/ CPB) are either not indicated or unavailable. IHD can also help improve concurrent electrolyte imbalances and/or toxin buildup. The report further emphasizes the necessity of monitoring for potential complications, such as post-dialysis hypophosphatemia and rebound hyperkalemia, following successful rewarming.
Collapse
Affiliation(s)
- Shaheryar Usman
- Mather Hospital, Northwell Health, 75 N Country Rd, Port Jefferson, NY, 11777, USA.
| | - Jordan Daloya
- Mather Hospital, Northwell Health, 75 N Country Rd, Port Jefferson, NY, 11777, USA
| | | | - Shahan Haseeb
- Mather Hospital, Northwell Health, 75 N Country Rd, Port Jefferson, NY, 11777, USA
| | - Himani Patel
- Mather Hospital, Northwell Health, 75 N Country Rd, Port Jefferson, NY, 11777, USA
| | - Saleem Mustafa
- Mather Hospital, Northwell Health, 75 N Country Rd, Port Jefferson, NY, 11777, USA
| | - Dorjan Pantic
- Division of Intensive Care Medicine, Mather Hospital, Northwell Health, Port Jefferson, NY, USA
- Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| |
Collapse
|
73
|
Richard L, Carter B, Wu L, Hwang SW. Disparities in all-cause mortality among people experiencing homelessness in Toronto, Canada during the COVID-19 pandemic: a cohort study. Front Public Health 2024; 12:1401662. [PMID: 39185124 PMCID: PMC11341496 DOI: 10.3389/fpubh.2024.1401662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 07/23/2024] [Indexed: 08/27/2024] Open
Abstract
People experiencing homelessness have historically had high mortality rates compared to housed individuals in Canada, a trend believed to have become exacerbated during the COVID-19 pandemic. In this matched cohort study conducted in Toronto, Canada, we investigated all-cause mortality over a one-year period by following a random sample of people experiencing homelessness (n = 640) alongside matched housed (n = 6,400) and low-income housed (n = 6,400) individuals. Matching criteria included age, sex-assigned-at-birth, and Charlson comorbidity index. Data were sourced from the Ku-gaa-gii pimitizi-win cohort study and administrative databases from ICES. People experiencing homelessness had 2.7 deaths/100 person-years, compared to 0.7/100 person-years in both matched unexposed groups, representing an all-cause mortality unadjusted hazard ratio (uHR) of 3.7 (95% CI, 2.1-6.5). Younger homeless individuals had much higher uHRs than older groups (ages 25-44 years uHR 16.8 [95% CI 4.0-70.2]; ages 45-64 uHR 6.8 [95% CI 3.0-15.1]; ages 65+ uHR 0.35 [95% CI 0.1-2.6]). Homeless participants who died were, on average, 17 years younger than unexposed individuals. After adjusting for number of comorbidities and presence of mental health or substance use disorder, people experiencing homelessness still had more than twice the hazard of death (aHR 2.2 [95% CI 1.2-4.0]). Homelessness is an important risk factor for mortality; interventions to address this health disparity, such as increased focus on homelessness prevention, are urgently needed.
Collapse
Affiliation(s)
- Lucie Richard
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
| | - Brooke Carter
- ICES Western, London Health Sciences Research Institute, London, ON, Canada
| | - Linda Wu
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Stephen W. Hwang
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of General Internal Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
74
|
Rodriguez R, Greenberg S. Is older age an appropriate criterion alone for ordering cervical spine CT after trauma. Acad Emerg Med 2024. [PMID: 39119986 DOI: 10.1111/acem.15001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 07/23/2024] [Indexed: 08/10/2024]
Affiliation(s)
- Rachel Rodriguez
- Department of Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Shannon Greenberg
- Department of Surgery, Indiana University, Indianapolis, Indiana, USA
| |
Collapse
|
75
|
Piland R, Jenkins RJ, Darwish D, Kram B, Karamchandani K. Substance-Use Disorders in Critically Ill Patients: A Narrative Review. Anesth Analg 2024:00000539-990000000-00898. [PMID: 39116017 DOI: 10.1213/ane.0000000000007078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Substance-use disorders (SUDs) represent a major public health concern. The increased prevalence of SUDs within the general population has led to more patients with SUD being admitted to intensive care units (ICUs) for an SUD-related condition or with SUD as a relevant comorbidity. Multiprofessional providers of critical care should be familiar with these disorders and their impact on critical illness. Management of critically ill patients with SUDs is complicated by both acute exposures leading to intoxication, the associated withdrawal syndrome(s), and the physiologic changes associated with chronic use that can cause, predispose patients to, and worsen the severity of other medical conditions. This article reviews the epidemiology of substance use in critically ill patients, discusses the identification and treatment of common intoxication and withdrawal syndromes, and provides evidence-based recommendations for the management of patients exposed to chronic use.
Collapse
Affiliation(s)
- Rebecca Piland
- From the Division of Critical Care, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Russell Jack Jenkins
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Dana Darwish
- From the Division of Critical Care, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Bridgette Kram
- Department of Pharmacy, Duke University Hospital, Durham, North Carolina
| | - Kunal Karamchandani
- From the Division of Critical Care, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
76
|
Panossian VS, Lagazzi E, Rafaqat W, Abiad M, Nzenwa IC, Arnold S, Hoekman AH, Ghaddar KA, DeWane MP, Velmahos GC, Kaafarani HMA, Hwabejire JO. Outcomes of severe isolated blunt chest trauma in young and geriatric patients. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02611-x. [PMID: 39112762 DOI: 10.1007/s00068-024-02611-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 07/14/2024] [Indexed: 08/29/2024]
Abstract
PURPOSE Our understanding of the growing geriatric population's risk factors for outcomes after traumatic injury remains incomplete. This study aims to compare outcomes of severe isolated blunt chest trauma between young and geriatric patients and assess predictors of mortality. METHODS The ACS-TQIP 2017-2020 database was used to identify patients with severe isolated blunt chest trauma. Patients having extra-thoracic injuries, no signs of life upon presentation to the emergency department (ED), prehospital cardiac arrest, or who were transferred to or from other hospitals were excluded. The primary outcome was in-hospital mortality. Univariate and multivariable regression analyses were performed to assess independent predictors of mortality. RESULTS A total of 189,660 patients were included in the study, with a median age of 58 years; 37.5% were aged 65 or older, and 1.9% died by discharge. Patients aged 65 and older had significantly higher mortality (3.4% vs. 1.0%, p < 0.001) and overall complications (7.0% vs. 4.7%, p < 0.001) compared to younger patients. Age ≥ 65 was independently associated with mortality (OR: 5.45, 95%CI: 4.96-5.98, p < 0.001), prolonged hospitalization, and complications. In the geriatric group, age > 75 was an independent predictor of mortality compared to ages 65-75 (OR: 2.62, 95%CI: 2.37-2.89, p < 0.001). Geriatric patients with an MVC, presenting with a GCS ≤ 8, and having an SBP < 90 had the highest mortality of 56.9%. CONCLUSION The geriatric trauma patient with isolated severe blunt chest injury has significantly higher mortality and morbidity compared to younger patients and warrants special consideration of multiple factors that affect outcomes. Individual predictors of mortality carry a greater impact on mortality in geriatric patients.
Collapse
Affiliation(s)
- Vahe S Panossian
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Emanuele Lagazzi
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Surgery, Humanitas Research Hospital, Rozzano, Italy
| | - Wardah Rafaqat
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - May Abiad
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ikemsinachi C Nzenwa
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Suzanne Arnold
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Anne H Hoekman
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Karen A Ghaddar
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Michael P DeWane
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - George C Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - John O Hwabejire
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
77
|
Cooper JA, Murphy S, Kirk R, O'Reilly D, Donnelly M. Data linkage studies of primary care utilisation after release from prison: a scoping review. BMC PRIMARY CARE 2024; 25:287. [PMID: 39112954 PMCID: PMC11308621 DOI: 10.1186/s12875-024-02527-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 07/17/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Primary care plays a central role in most, if not all, health care systems including the care of vulnerable populations such as people who have been incarcerated. Studies linking incarceration records to health care data can improve understanding about health care access following release from prison. This review maps evidence from data-linkage studies about primary care use after prison release. METHODS The framework by Arksey and O'Malley and guidance by the Joanna Briggs Institute (JBI) were used in this review. This scoping review followed methods published in a study protocol. Searches were performed (January 2012-March 2023) in MEDLINE, EMBASE and Web of Science Core Collection using key-terms relating to two areas: (i) people who have been incarcerated and (ii) primary care. Using eligibility criteria, two authors independently screened publication titles and abstracts (step 1), and subsequently, screened full text publications (step 2). Discrepancies were resolved with a third author. Two authors independently charted data from included publications. Findings were mapped by methodology, key findings and gaps in research. RESULTS The database searches generated 1,050 publications which were screened by title and abstract. Following this, publications were fully screened (n = 63 reviewer 1 and n = 87 reviewer 2), leading to the inclusion of 17 publications. Among the included studies, primary care use after prison release was variable. Early contact with primary care services after prison release (e.g. first month) was positively associated with an increased health service use, but an investigation found that a large proportion of individuals did not access primary care during the first month. The quality of care was found to be largely inadequate (measured continuity of care) for moderate multimorbidity. There were lower levels of colorectal and breast cancer screening among people released from custody. The review identified studies of enhanced primary care programmes for individuals following release from prison, with studies reporting a reduction in reincarceration and criminal justice system costs. CONCLUSIONS This review has suggested mixed evidence regarding primary care use after prison release and has highlighted challenges and areas of suboptimal care. Further research has been discussed in relation to the scoping review findings.
Collapse
Affiliation(s)
- Janine A Cooper
- Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK.
- Administrative Data Research Centre Northern Ireland (ADRC NI), Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK.
| | - Siobhán Murphy
- Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
- Administrative Data Research Centre Northern Ireland (ADRC NI), Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
| | - Richard Kirk
- South Eastern Health and Social Care Trust, Ulster Hospital, Dundonald, UK
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
- Administrative Data Research Centre Northern Ireland (ADRC NI), Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
| | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
- Administrative Data Research Centre Northern Ireland (ADRC NI), Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
| |
Collapse
|
78
|
Joseph S, Tomaschek R, Hug BL, Beeler PE. Enhancing communication and care coordination: A scoping review of encounter notification systems between emergency departments and primary care providers. Int J Med Inform 2024; 191:105579. [PMID: 39127014 DOI: 10.1016/j.ijmedinf.2024.105579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 07/20/2024] [Accepted: 07/27/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE This scoping review aims to explore the current state of encounter notification systems (ENS) between emergency departments (EDs) and primary care providers (PCPs), focusing on their mechanisms, effectiveness, impacts, and challenges in healthcare settings. METHODS A systematic search was conducted using PubMed/MEDLINE and Google Scholar to identify relevant literature on ENS between EDs and PCPs. Eligible studies were selected based on predefined criteria, and data were synthesized narratively. RESULTS The initial search yielded 1,396 articles, with 29 included in the review. Studies highlighted the significance of encounter notifications in improving communication and care coordination between EDs and PCPs, leading to enhanced patient outcomes. However, challenges such as technological barriers, privacy concerns, and variations in healthcare settings were identified. CONCLUSION ENS play a crucial role in enhancing communication and care coordination between EDs and PCPs. Despite challenges, these systems offer substantial benefits and opportunities for improving patient care in the ED-primary care continuum. Future research should focus on addressing implementation barriers and evaluating long-term impacts to optimize the effectiveness of ENS in this context.
Collapse
Affiliation(s)
- Staria Joseph
- Faculty of Health Sciences and Medicine, University of Lucerne, Switzerland
| | - Rebecca Tomaschek
- Center for Primary and Community Care, Faculty of Health Sciences and Medicine, University of Lucerne, Switzerland
| | - Balthasar L Hug
- Center for Primary and Community Care, Faculty of Health Sciences and Medicine, University of Lucerne, Switzerland; Department of General Internal Medicine, Cantonal Hospital Lucerne, Switzerland
| | - Patrick E Beeler
- Center for Primary and Community Care, Faculty of Health Sciences and Medicine, University of Lucerne, Switzerland.
| |
Collapse
|
79
|
Yadav K, Ohle R, Yan JW, Eagles D, Perry JJ, Zvonar R, Keller M, Nott C, Corrales-Medina V, Shoots L, Tran E, Suh KN, Lam PW, Fagan L, Song N, Dobson E, Hawken D, Taljaard M, Sikora L, Brehaut J, Stiell IG, Graham ID. Canadian Emergency Department Best Practices Checklist for Skin and Soft Tissue Infections Part 1: Cellulitis. CAN J EMERG MED 2024:10.1007/s43678-024-00754-9. [PMID: 39102151 DOI: 10.1007/s43678-024-00754-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 07/02/2024] [Indexed: 08/06/2024]
Affiliation(s)
- Krishan Yadav
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- School of Epidemiology and Public Health (SEPH), University of Ottawa, Ottawa, ON, Canada.
| | - Robert Ohle
- Department of Emergency Medicine, Health Sciences North, Sudbury, ON, Canada
- Health Sciences North Research Institute, Sudbury, ON, Canada
- Clinical Sciences Division, Northern Ontario Medical School University, Sudbury, ON, Canada
| | - Justin W Yan
- Division of Emergency Medicine, Department of Medicine, Western University, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
| | - Debra Eagles
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health (SEPH), University of Ottawa, Ottawa, ON, Canada
| | - Jeffrey J Perry
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health (SEPH), University of Ottawa, Ottawa, ON, Canada
| | - Rosemary Zvonar
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Pharmacy Department, The Ottawa Hospital, Ottawa, ON, Canada
| | - Maria Keller
- Emergency Department, Queensway Carleton Hospital, Ottawa, ON, Canada
| | - Caroline Nott
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of Infectious Disease, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Vicente Corrales-Medina
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of Infectious Disease, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Laura Shoots
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
- Emergency Department, Brant Community Healthcare System, Brantford, ON, Canada
| | - Evelyn Tran
- Department of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - Kathryn N Suh
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of Infectious Disease, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Philip W Lam
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Laura Fagan
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Nuri Song
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Monica Taljaard
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health (SEPH), University of Ottawa, Ottawa, ON, Canada
| | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, ON, Canada
| | - Jamie Brehaut
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health (SEPH), University of Ottawa, Ottawa, ON, Canada
| | - Ian G Stiell
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health (SEPH), University of Ottawa, Ottawa, ON, Canada
| | - Ian D Graham
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health (SEPH), University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
80
|
Zambri SNA, Poh K, Noor Azhar AM, Mohd Kamil MK, Md Yusuf MH, Selamat MA, Muhammad Yusuf S, Hairudin NA, Mohamed Shafri NI, Sa'ari NA, Syukri Azhar M, Azizah Ariffin MA. A time-motion study on impact of spatial separation for empiric airborne precautions in emergency department length of stay. J Clin Nurs 2024. [PMID: 39101391 DOI: 10.1111/jocn.17398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/19/2024] [Accepted: 07/22/2024] [Indexed: 08/06/2024]
Abstract
AIMS To evaluate the impact of spatial separation on patient flow in the emergency department. DESIGN This was a retrospective, time-and-motion analysis conducted from 15 to 22 August, 2022 at the emergency department of a tertiary hospital in Kuala Lumpur, Malaysia. During this duration, spatial separation was implemented in critical and semi-critical zones to separate patients with symptoms of respiratory infections into respiratory area, and patients without into non-respiratory area. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. METHODS Patients triaged to critical and semi-critical zones were included in this study. Timestamps of patient processes in emergency department until patient departure were documented. RESULTS The emergency department length-of-stay was longer in respiratory area compared to non-respiratory area; 527 min (381-698) versus 390 min (285-595) in critical zone and 477 min (312-739) versus 393 min (264-595) in semi-critical zone. In critical zone, time intervals of critical flow processes and compliance to hospital benchmarks were similar in both areas. More patients in respiratory area were managed within the arrival-to-contact ≤30 min benchmark and more patients in non-respiratory area had emergency department length-of-stay ≤8 h. CONCLUSIONS The implementation of spatial separation in infection control should address decision-to-departure delays to minimise emergency department length of stay. IMPACT The study evaluated the impact of spatial separation on patient flow in the emergency department. Emergency department length-of-stay was significantly prolonged in the respiratory area. Hospital administrators and policymakers can optimise infection control protocols measures in emergency departments, balancing infection control measures with efficient patient care delivery. REPORTING METHOD STROBE guidelines. NO PATIENT OR PUBLIC CONTRIBUTION None. TRIAL AND PROTOCOL REGISTRATION The study obtained ethics approval from the institution's Medical Ethics Committee (MREC ID NO: 20221113-11727). STATISTICAL ANALYSIS The author has checked and make sure our submission has conformed to the Journal's statistical guideline. There is a statistician on the author team (Noor Azhar).
Collapse
Affiliation(s)
- Siti Nur Aliyah Zambri
- Department of Emergency Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Khadijah Poh
- Department of Emergency Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | | | - Mohd Hafyzuddin Md Yusuf
- Department of Emergency Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Muhamad Akmal Selamat
- Department of Emergency Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | | | | | | | | | | |
Collapse
|
81
|
McGuire SS, Klassen A, Luke A, Rentz L, Liedl CP, Mullan AF, Sztajnkrycer MD. Providing Performance Feedback and Patient Outcome Follow-Up to Emergency Medical Services (EMS) is Associated with Subsequent Improved Clinical Performance. PREHOSP EMERG CARE 2024:1-7. [PMID: 39047172 DOI: 10.1080/10903127.2024.2383323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/17/2024] [Accepted: 07/14/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE Emergency Medical Services (EMS) clinicians desire performance feedback (PF) and patient outcome follow-up (POF). Within our agency, both a peer-review and feedback/outcome (PF/POF) process exist. Our objective was to determine whether receiving feedback and outcome data improved future clinical care amongst EMS, based upon peer-review scores. METHODS This retrospective cohort study took place between 1/1/2020 and 6/7/2023 within an EMS agency site with 22,000 average annual 9-1-1 calls. Requests for PF/POF were submitted on an individual basis beginning June 2020 and completed by a dedicated EMS nurse, EMS physician, or emergency medicine (EM) resident. Peer-review of select high-acuity cases were scored by two Quality Assurance (QA) specialists within the categories of assessment, treatment, disposition/outcome and process/administrative guidelines. Association between overall peer-review score and number of PF/POF requests at time of assessment was evaluated by linear regression. RESULTS A total of 378 PF/POF requests were received, with the most common patient complaints being cardiac (n = 105; 27.8%, including 49 (13.0%) out of hospital cardiac arrests), altered mental status/neurologic (n = 103; 27.2%), trauma (n = 61; 16.1%, including 2 (0.5%) traumatic arrests); and respiratory distress (n = 47; 12.4%). A total of 378 runs meeting QA criteria were peer-reviewed post-PF/POF process implementation, including 337 (89.2%) cardiac/respiratory arrests, 27 (7.1%) with difficult airway management, and 14 (3.7%) major trauma/traumatic arrests. The number of prior PF/POF requests made by the team leader was associated with higher overall peer-review scores. Team leaders with >5 prior PF/POF requests had a peer-review score 0.39 points greater (95% CI: 0.16 - 0.62, p = 0.001) than those with <5 prior requests. The number of prior PF/POF requests amongst the entire crew was also associated with higher peer-review scores. Crews that collectively had >5 prior PF/POF requests had an increase in peer-review score 0.32 points greater (95% CI: 0.14 - 0.50, p < 0.001) than those with <5 prior requests. CONCLUSION Providing performance feedback and patient outcome follow-up to EMS is associated with improved peer-review scores of clinical performance. Future studies should assess if those that are submitting cases for feedback/outcome are higher performers at baseline or if the process of receiving feedback/outcome improves their performance.
Collapse
Affiliation(s)
- Sarayna S McGuire
- Division of Prehospital Medicine, Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic Ambulance Service, Mayo Clinic, Rochester, Minnesota
| | - Aaron Klassen
- Division of Prehospital Medicine, Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic Ambulance Service, Mayo Clinic, Rochester, Minnesota
| | - Anuradha Luke
- Division of Prehospital Medicine, Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic Ambulance Service, Mayo Clinic, Rochester, Minnesota
| | - Lisa Rentz
- Division of Prehospital Medicine, Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
| | - Chad P Liedl
- Mayo Clinic Ambulance Service, Mayo Clinic, Rochester, Minnesota
| | - Aidan F Mullan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Matthew D Sztajnkrycer
- Division of Prehospital Medicine, Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
82
|
Cevik AA, Cakal ED, Kwan J, Chu S, Mtombeni S, Anantharaman V, Jouriles N, Peng DTK, Singer A, Cameron P, Ducharme J, Wai A, Manthey DE, Hobgood C, Mulligan T, Menendez E, Jakubaszko J. IFEM model curriculum: emergency medicine learning outcomes for undergraduate medical education. Int J Emerg Med 2024; 17:98. [PMID: 39103797 DOI: 10.1186/s12245-024-00671-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 07/04/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND The International Federation for Emergency Medicine (IFEM) published its model curriculum for medical student education in emergency medicine in 2009. Because of the evolving principles of emergency medicine and medical education, driven by societal, professional, and educational developments, there was a need for an update on IFEM recommendations. The main objective of the update process was creating Intended Learning Outcomes (ILOs) and providing tier-based recommendations. METHOD A consensus methodology combining nominal group and modified Delphi methods was used. The nominal group had 15 members representing eight countries in six regions. The process began with a review of the 2009 curriculum by IFEM Core Curriculum and Education Committee (CCEC) members, followed by a three-phase update process involving survey creation [The final survey document included 55 items in 4 sections, namely, participant & context information (16 items), intended learning outcomes (6 items), principles unique to emergency medicine (20 items), and content unique to emergency medicine (13 items)], participant selection from IFEM member countries and survey implementation, and data analysis to create the recommendations. RESULTS Out of 112 invitees (CCEC members and IFEM member country nominees), 57 (50.9%) participants from 27 countries participated. Eighteen (31.6%) participants were from LMICs, while 39 (68.4%) were from HICs. Forty-four (77.2%) participants have been involved with medical students' emergency medicine training for more than five years in their careers, and 56 (98.2%) have been involved with medical students' training in the last five years. Thirty-five (61.4%) participants have completed a form of training in medical education. The exercise resulted in the formulation of tiered ILO recommendations. Tier 1 ILOs are recommended for all medical schools, Tier 2 ILOs are recommended for medical schools based on perceived local healthcare system needs and/or adequate resources, and Tier 3 ILOs should be considered for medical schools based on perceived local healthcare system needs and/or adequate resources. CONCLUSION The updated IFEM ILO recommendations are designed to be applicable across diverse educational and healthcare settings. These recommendations aim to provide a clear framework for medical schools to prepare graduates with essential emergency care capabilities immediately after completing medical school. The successful distribution and implementation of these recommendations hinge on support from faculty and administrators, ensuring that future healthcare professionals are well-prepared for emergency medical care.
Collapse
Affiliation(s)
- Arif Alper Cevik
- Emergency Medicine Section, Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
- Department of Emergency Medicine, Tawam Hospital, Al Ain, UAE.
| | - Elif Dilek Cakal
- Emergency Department, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - James Kwan
- Department of Emergency Medicine, Tan Tock Seng Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Simon Chu
- University of Adelaide, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
| | - Sithembile Mtombeni
- Department of Emergency Medicine, University of Namibia, Northern Campus, Oshakati, Namibia
| | | | - Nicholas Jouriles
- Department of Emergency Medicine, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | | | - Andrew Singer
- Australian Government Department of Health and Aged Care, Canberra, ACT, Australia
- Australian National University Medical School, Acton, ACT, Australia
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
- The Alfred Hospital, Emergency and Trauma Centre, Melbourne, Australia
| | | | - Abraham Wai
- Department of Emergency Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - David Edwin Manthey
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Cherri Hobgood
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Terrence Mulligan
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Edgardo Menendez
- Department of Emergency Medicine, Churruca Hospital UBA, Buenos Aires, Argentina
| | - Juliusz Jakubaszko
- Department of Emergency Medicine, Wroclaw University of Medicine, Wroclaw, Poland
| |
Collapse
|
83
|
Almendros A, Steagall PV, Lun SC, Speelman J, Giuliano A. Challenges of the Calgary-Cambridge Consultation Guide in Veterinary Multicultural and Multilingual Scenarios and the Role of Veterinary Translators. Animals (Basel) 2024; 14:2270. [PMID: 39123795 PMCID: PMC11310950 DOI: 10.3390/ani14152270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/22/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
The Calgary-Cambridge Guide is a widely recognised framework for teaching communication skills to healthcare professionals that has become a cornerstone of communication training programs in medicine and other healthcare fields. In the context of veterinary medicine, its integration into communication training programs has become an asset improving communication, education, interaction, and quality of service, enhancing the veterinary-client-patient relationship (VCPR). In veterinary medicine, however, a more challenging consultation dynamic involves the veterinarian, the owner, and the animal. The addition of a veterinary assistant that acts as an interpreter or translator is common in Hong Kong where the native language (Cantonese) coexists with English when consultations are led by non-native language speakers. This addition converts this commonly dyadic model into a triadic communication model. The addition of an assistant interpreter influences the way consultations are conducted, how information is conveyed, and how interpersonal cues and empathy are delivered. In this report we depict challenges applying the Calgary-Cambridge Guide in multicultural and multilingual veterinary medical centres in Hong Kong and highlight the role of veterinary supporting staff in these scenarios, specifically veterinary assistant interpreters.
Collapse
Affiliation(s)
- Angel Almendros
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong SAR, China
- Veterinary Medical Centre, City University of Hong Kong, Hong Kong SAR, China
| | - Paulo V. Steagall
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong SAR, China
- Centre of Animal Health and Welfare, City University of Hong Kong, Hong Kong SAR, China
| | - Suen Caesar Lun
- Department of Linguistics and Translation, College of Liberal Arts and Social Sciences, City University of Hong Kong, Hong Kong SAR, China
| | | | - Antonio Giuliano
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong SAR, China
- Veterinary Medical Centre, City University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
84
|
Pellino G, Espín-Basany E. Why are we so sceptical about the omission of antibiotics in patients with acute uncomplicated diverticulitis? Cir Esp 2024:S2173-5077(24)00184-4. [PMID: 39102982 DOI: 10.1016/j.cireng.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 08/07/2024]
Affiliation(s)
- Gianluca Pellino
- Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
| | - Eloy Espín-Basany
- Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain.
| |
Collapse
|
85
|
Melnikow J, Xing G, Miller ME, Loureiro S, Padovani AJ, Whitney R, Kravitz RL. Workplace support for physicians during the COVID-19 Pandemic: Did it affect burnout? BMC Health Serv Res 2024; 24:888. [PMID: 39097691 PMCID: PMC11298071 DOI: 10.1186/s12913-024-11366-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 07/26/2024] [Indexed: 08/05/2024] Open
Abstract
BACKGROUND A concern before 2020, physician burnout worsened during the COVID-19 pandemic. Little empirical data are available on pandemic workplace support interventions or their influence on burnout. We surveyed a national sample of frontline physicians on burnout and workplace support during the pandemic. METHODS We surveyed a stratified random sample of 12,833 US physicians most likely to care for adult COVID-19 patients from the comprehensive AMA Physician Professional Data ™ file. The sample included 6722 primary care physicians (3331 family physicians, 3391 internists), 880 hospitalists, 1783 critical care physicians (894 critical care physicians, 889 pulmonary intensivists), 2548 emergency medicine physicians, and 900 infectious disease physicians. The emailed survey elicited physicians' perceptions of organizational interventions to provide workplace support and/or to address burnout. Burnout was assessed with the Professional Fulfillment Index Burnout Composite scale (PFI-BC). Proportional specialty representation and response bias were addressed by survey weighting. Logistic regression assessed the association of physician characteristics and workplace interventions with burnout. RESULTS After weighting, respondents were representative of the total sample. Overall physician burnout was 45.4%, significantly higher than in our previous survey. Open-ended responses mentioned that staffing shortages (physician, nursing, and other staff) combined with the increased volume, complexity, and acuity of patients during the pandemic increased job demands. The most frequent workplace support interventions were direct pandemic control measures (increased access to personal protective equipment, 70.0%); improved telehealth functionality (43.4%); and individual resiliency tools (yoga, meditation, 30.7%). Respondents placed highest priority on workplace interventions to increase financial support and increase nursing and clinician staffing. Factors significantly associated with lower odds of burnout were practicing critical care (compared with emergency medicine) OR 0.33 (95% CI 0.12 - 0.93), improved telehealth functionality OR 0.47 (95% CI 0.23 - 0.97) and being in practice for 11 years or longer OR 0.44 (95% CI 0.19-0.99). CONCLUSIONS Burnout across frontline specialties increased during the pandemic. Physician respondents focused on inadequate staffing in the context of caring for more and sicker patients, combined with the lack of administrative efforts to mitigate problems. Burnout mitigation requires system-level interventions beyond individual-focused stress reduction programs to improve staffing, increase compensation, and build effective teams.
Collapse
Affiliation(s)
- Joy Melnikow
- Department of Family and Community Medicine, Center for Healthcare Policy and Research, University of California, 4860 Y St. Suite 2300, DavisSacramento, CA, 95817, USA.
| | - Guibo Xing
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA, USA
| | - Marykate E Miller
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA, USA
| | - Sabrina Loureiro
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
| | | | - Robin Whitney
- The Valley Foundation School of Nursing, San Jose State University, San Jose, CA, USA
| | - Richard L Kravitz
- Division of General Internal Medicine, University of California, Davis, Sacramento, CA, USA
| |
Collapse
|
86
|
Santhakumaran S, Baiad A, Ranjbari D, Correa JA, Chaudhry Z, Toffoli D. Impact of 5 waves of COVID-19 on pediatric ophthalmology. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00187-X. [PMID: 39106963 DOI: 10.1016/j.jcjo.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/05/2024] [Accepted: 06/16/2024] [Indexed: 08/09/2024]
Abstract
OBJECTIVE To characterize the impact of multiple waves of COVID-19 on pediatric ophthalmology at a tertiary care hospital. METHODS Medical records were reviewed from pediatric patients seen for ophthalmic emergencies at the Montreal Children's Hospital (Montreal, Canada) from 5 COVID-19 periods: March 13 to May 31, 2020; September 20, 2020, to February 21, 2021; March 21 to May 31, 2021; August 17 to November 5, 2021; and December 19, 2021, to January 25, 2022, as well as 2 pre-COVID time periods: March 13 to May 31, in 2018 and 2019). RESULTS There was a significant reduction in ophthalmic consultations when comparing pre-COVID to all 5 COVID waves (p < 0.0001). There was an increase in the average number of daily urgent (p = 0.01) ophthalmic consultations from waves 1 to 4. Mean household income of patients was not significantly different pre-COVID compared to during the 5 COVID waves (p = 0.96). The most common referral reason was ocular trauma (38.0% of cases). There was a non-significant trend demonstrating more infectious disease presentations during waves 3 to 5 (p = 0.07). There was no difference in symptom duration prior to presentation (p = 0.54); however, there was a difference in the time between emergency room and ophthalmology assessment in waves 3 and 4 compared with wave 5 (p = 0.003). CONCLUSION The number of pediatric ophthalmology consultations was less during the 5 COVID waves than pre-COVID. An increase in urgent pediatric ophthalmology consultations occurred as COVID-19 infection rates in Quebec decreased. Access to health care and time to care were preserved across waves compared with pre-pandemic.
Collapse
Affiliation(s)
| | - Abed Baiad
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Dorsai Ranjbari
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - José A Correa
- Department of Mathematics and Statistics, McGill University, Montreal, QC, Canada
| | - Zoya Chaudhry
- Department of Ophthalmology & Visual Sciences, McGill University, Montreal, QC, Canada
| | - Daniela Toffoli
- Department of Ophthalmology & Visual Sciences, McGill University, Montreal, QC, Canada
| |
Collapse
|
87
|
Huang T, Safranek C, Socrates V, Chartash D, Wright D, Dilip M, Sangal RB, Taylor RA. Patient-Representing Population's Perceptions of GPT-Generated Versus Standard Emergency Department Discharge Instructions: Randomized Blind Survey Assessment. J Med Internet Res 2024; 26:e60336. [PMID: 39094112 PMCID: PMC11329854 DOI: 10.2196/60336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/07/2024] [Accepted: 06/22/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Discharge instructions are a key form of documentation and patient communication in the time of transition from the emergency department (ED) to home. Discharge instructions are time-consuming and often underprioritized, especially in the ED, leading to discharge delays and possibly impersonal patient instructions. Generative artificial intelligence and large language models (LLMs) offer promising methods of creating high-quality and personalized discharge instructions; however, there exists a gap in understanding patient perspectives of LLM-generated discharge instructions. OBJECTIVE We aimed to assess the use of LLMs such as ChatGPT in synthesizing accurate and patient-accessible discharge instructions in the ED. METHODS We synthesized 5 unique, fictional ED encounters to emulate real ED encounters that included a diverse set of clinician history, physical notes, and nursing notes. These were passed to GPT-4 in Azure OpenAI Service (Microsoft) to generate LLM-generated discharge instructions. Standard discharge instructions were also generated for each of the 5 unique ED encounters. All GPT-generated and standard discharge instructions were then formatted into standardized after-visit summary documents. These after-visit summaries containing either GPT-generated or standard discharge instructions were randomly and blindly administered to Amazon MTurk respondents representing patient populations through Amazon MTurk Survey Distribution. Discharge instructions were assessed based on metrics of interpretability of significance, understandability, and satisfaction. RESULTS Our findings revealed that survey respondents' perspectives regarding GPT-generated and standard discharge instructions were significantly (P=.01) more favorable toward GPT-generated return precautions, and all other sections were considered noninferior to standard discharge instructions. Of the 156 survey respondents, GPT-generated discharge instructions were assigned favorable ratings, "agree" and "strongly agree," more frequently along the metric of interpretability of significance in discharge instruction subsections regarding diagnosis, procedures, treatment, post-ED medications or any changes to medications, and return precautions. Survey respondents found GPT-generated instructions to be more understandable when rating procedures, treatment, post-ED medications or medication changes, post-ED follow-up, and return precautions. Satisfaction with GPT-generated discharge instruction subsections was the most favorable in procedures, treatment, post-ED medications or medication changes, and return precautions. Wilcoxon rank-sum test of Likert responses revealed significant differences (P=.01) in the interpretability of significant return precautions in GPT-generated discharge instructions compared to standard discharge instructions but not for other evaluation metrics and discharge instruction subsections. CONCLUSIONS This study demonstrates the potential for LLMs such as ChatGPT to act as a method of augmenting current documentation workflows in the ED to reduce the documentation burden of physicians. The ability of LLMs to provide tailored instructions for patients by improving readability and making instructions more applicable to patients could improve upon the methods of communication that currently exist.
Collapse
Affiliation(s)
- Thomas Huang
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
- Department for Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, United States
| | - Conrad Safranek
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
- Department for Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, United States
| | - Vimig Socrates
- Department for Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, United States
- Program of Computational Biology and Bioinformatics, Yale University, New Haven, CT, United States
| | - David Chartash
- Department for Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, United States
- School of Medicine, University College Dublin, National University of Ireland, Dublin, Ireland
| | - Donald Wright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
- Department for Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, United States
| | - Monisha Dilip
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Rohit B Sangal
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Richard Andrew Taylor
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
- Department for Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, United States
| |
Collapse
|
88
|
de Malleray H, de Lesquen H, Boddaert G, Raux M, Lefrançois V, Delhaye N, Ponsin P, Cordorniu A, Floch T, Bounes F, Gaertner E, Hardy A, Bordes J, Meaudre É, Cardinale M. French practice of emergency resuscitative thoracotomy. A study based on the Traumabase Registry. J Visc Surg 2024:S1878-7886(24)00095-X. [PMID: 39097430 DOI: 10.1016/j.jviscsurg.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2024]
Abstract
AIM OF THE STUDY Emergency resuscitative thoracotomy (ERT) has been described as a potentially life-saving procedure for trauma patients who have been admitted in refractory shock or with recent loss of sign of life (SOL). This nationwide registry analysis aimed to describe the French practice of ERT. PATIENTS AND METHODS From 2015 to 2021, all severe trauma patients who underwent ERT were extracted from the TraumaBase→ registry. Demographic data, prehospital management and in-hospital outcomes were recorded to evaluate predictors of success-to rescue after ERT at 24-hour and 28-day. RESULTS Only 10/26 Trauma centers have an effective practice of ERT, three of them perform more than 1 ERT/year. Sixty-six patients (74% male, 49/66) with a median age of 37 y/o [26-51], mostly with blunt trauma (52%, 35/66) were managed with ERT. The median pre-hospital time was 64mins [45-89]. At admission, the median injury severity score was 35 [25-48], and 51% (16/30) of patients have lost SOL. ERT was associated with a massive transfusion protocol including 8 RBCs [6-13], 6 FFPs [4-10], and 0 PCs [0-1] in the first 6h. The overall success-to-rescue after ERT at 24-h and 28-d were 27% and 15%, respectively. In case of refractory shock after penetrating trauma, survival was 64% at 24-hours and 47% at 28-days. CONCLUSIONS ERT integrated into the trauma protocol remains a life-saving procedure that appears to be underutilized in France, despite significant success-to-rescue observed by trained teams for selected patients.
Collapse
Affiliation(s)
- Hilaire de Malleray
- Department of Anesthesiology and Critical Care Medicine, Sainte Anne Military Teaching Hospital, Toulon, France.
| | - Henri de Lesquen
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France.
| | - Guillaume Boddaert
- Department of Thoracic and Vascular Surgery, Percy Military Teaching Hospital, Clamart, France.
| | - Mathieu Raux
- Department of Anesthesiology and Critical Care Medicine, AP-HP-Sorbonne University, Pitié-Salpêtrière University Hospital, Paris, France.
| | - Valentin Lefrançois
- Department of Anesthesiology and Critical Care Medicine, Caen University Hospital, Caen, France.
| | - Nathalie Delhaye
- Department of Anesthesiology and Critical Care Medicine, European Hospital Georges Pompidou, AP-HP, Paris, France.
| | - Pauline Ponsin
- Department of Anesthesiology and Intensive Care, Percy Military Teaching Hospital, Clamart, France.
| | - Anaïs Cordorniu
- Department of Anesthesiology and Critical Care, Beaujon Hospital, Beaujon, France.
| | - Thierry Floch
- Department of Anesthesiology and Critical Care Medicine, Reims University Hospital, Reims, France.
| | - Fanny Bounes
- Department of Anesthesiology and Critical Care Toulouse University Hospital, Toulouse, France.
| | - Elisabeth Gaertner
- Department of Anesthesiology and Critical Care, Louis Pasteur Hospital, Colmar, France.
| | - Alexia Hardy
- Department of Anesthesiology and Critical Care, Valenciennes Hospital, Beaujon, France.
| | - Julien Bordes
- Department of Anesthesiology and Critical Care Medicine, Sainte Anne Military Teaching Hospital, Toulon, France.
| | - Éric Meaudre
- Department of Anesthesiology and Critical Care Medicine, Sainte Anne Military Teaching Hospital, Toulon, France.
| | - Michael Cardinale
- Department of Anesthesiology and Critical Care Medicine, Sainte Anne Military Teaching Hospital, Toulon, France.
| |
Collapse
|
89
|
Matias-Soto J, Pineda-Galan C, Martin-Sanchez AI, Gonzalez-Mesa JM, Aguayo-Alves A, Luque-Suarez A. Unveiling relevant emotions, cognitions, and behaviours from the viewpoint of people with chronic low back pain: A qualitative study with patient involvement. Musculoskelet Sci Pract 2024; 72:103123. [PMID: 38905971 DOI: 10.1016/j.msksp.2024.103123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/30/2024] [Accepted: 06/12/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVE To gain insight into the emotions, cognitions, and behaviours experienced by people with chronic low back pain (CLBP) undergoing invasive treatment in a pain unit. DESIGN A cross-sectional qualitative study based on individual interviews. This study included patient involvement in its design and development. METHODS An interpretative phenomenological approach was adopted to understand the multidimensional experience of patients. The interview script was a translated, adapted, and expanded version of the one proposed by Cognitive and Functional Therapy. A mixed coding method was applied to structure the interviews. Three themes were created, with the three most frequently reported emotions, cognitions, and behaviours as subthemes. A patient with CLBP approved the initial protocol and the aim of the study. Subsequently, the patient contributed questions to the interview script, checked the coding process, and approved the final version of the manuscript. RESULTS Twenty-two patients undergoing epidural infiltrations in a pain unit were interviewed. (i)"Fears", (ii)"Frustration", and (iii)"Worry" were the three most commonly expressed emotions. Cognitions related to (i)"Pain predictability", (ii)"Pain description and perception", and (iii)"Pain interference/disability" were also widely reported. The theme "Behaviours" was composed of the following subthemes: (i)"Strategies for managing symptoms", (ii)"Social behaviours", and (iii)"Strategies for coping with daily tasks". Noteworthily, cognitions related to the (i)"Diagnosis", (ii)"Health system attention", and (iii)"Medical prescriptions" arose from questions provided by patient involvement. CONCLUSION Patients with CLBP expressed a wide variety of emotions, cognitions, and behaviours that must be considered by health professionals with the goal of providing the best patient-centred care.
Collapse
Affiliation(s)
- Javier Matias-Soto
- Universidad de Málaga, Andalucía Tech, Facultad de Ciencias de la Salud, Departamento de Fisioterapia, Campus de Teatinos, Arquitecto Francisco Peñalosa, 3, 29071, Malaga, Spain; Chair of Health and Pain, University of Malaga, Malaga, Spain.
| | - Consolacion Pineda-Galan
- Universidad de Málaga, Andalucía Tech, Facultad de Ciencias de la Salud, Departamento de Fisioterapia, Campus de Teatinos, Arquitecto Francisco Peñalosa, 3, 29071, Malaga, Spain; Chair of Health and Pain, University of Malaga, Malaga, Spain
| | | | | | - Adriane Aguayo-Alves
- Universidad de Málaga, Andalucía Tech, Facultad de Ciencias de la Salud, Departamento de Fisioterapia, Campus de Teatinos, Arquitecto Francisco Peñalosa, 3, 29071, Malaga, Spain; Chair of Health and Pain, University of Malaga, Malaga, Spain
| | - Alejandro Luque-Suarez
- Universidad de Málaga, Andalucía Tech, Facultad de Ciencias de la Salud, Departamento de Fisioterapia, Campus de Teatinos, Arquitecto Francisco Peñalosa, 3, 29071, Malaga, Spain; Chair of Health and Pain, University of Malaga, Malaga, Spain
| |
Collapse
|
90
|
Mullan PC, Levasseur KA, Bajaj L, Nypaver M, Chamberlain JM, Thull-Freedman J, Ostrow O, Jain S. Recommendations for Choosing Wisely in Pediatric Emergency Medicine: Five Opportunities to Improve Value. Ann Emerg Med 2024; 84:167-175. [PMID: 38349290 DOI: 10.1016/j.annemergmed.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/15/2023] [Accepted: 01/04/2024] [Indexed: 07/22/2024]
Abstract
Unnecessary diagnostic tests and treatments in children cared for in emergency departments (EDs) do not benefit patients, increase costs, and may result in harm. To address this low-value care, a taskforce of pediatric emergency medicine (PEM) physicians was formed to create the first PEM Choosing Wisely recommendations. Using a systematic, iterative process, the taskforce collected suggested items from an interprofessional group of 33 ED clinicians from 6 academic pediatric EDs. An initial review of 219 suggested items yielded 72 unique items. Taskforce members independently scored each item for its extent of overuse, strength of evidence, and potential for harm. The 25 highest-rated items were sent in an electronic survey to all 89 members of the American Academy of Pediatrics PEM Committee on Quality Transformation (AAP COQT) to select their top ten recommendations. The AAP COQT survey had a 63% response rate. The five most selected items were circulated to over 100 stakeholder and specialty groups (within the AAP, CW Canada, and CW USA organizations) for review, iterative feedback, and approval. The final 5 items were simultaneously published by Choosing Wisely United States and Choosing Wisely Canada on December 1, 2022. All recommendations focused on decreasing diagnostic testing related to respiratory conditions, medical clearance for psychiatric conditions, seizures, constipation, and viral respiratory tract infections. A multinational PEM taskforce developed the first Choosing Wisely recommendation list for pediatric patients in the ED setting. Future activities will include dissemination efforts and interventions to improve the quality and value of care specific to recommendations.
Collapse
Affiliation(s)
- Paul C Mullan
- Division of Emergency Medicine, Department of Pediatrics, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, VA.
| | - Kelly A Levasseur
- Division of Pediatrics, Central Michigan University, Children's Hospital of Michigan, Detroit, MI
| | - Lalit Bajaj
- Department of Pediatrics and Emergency Medicine, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO
| | - Michele Nypaver
- Departments of Emergency Medicine and Pediatrics, University of Michigan Medical School, and Michigan Emergency Department Improvement Collaborative (funded by BCBSM), Ann Arbor, MI
| | - James M Chamberlain
- Division of Emergency Medicine, Pediatrics and Emergency Medicine, George Washington University, Children's National Hospital, Washington, DC
| | - Jennifer Thull-Freedman
- Departments of Pediatrics and Emergency Medicine, University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada
| | - Olivia Ostrow
- Division of Emergency Medicine, University of Toronto, the Hospital for Sick Children, Toronto, ON, Canada
| | - Shabnam Jain
- Pediatrics and Emergency Medicine, Emory University, Children's Healthcare of Atlanta, Atlanta, GA
| |
Collapse
|
91
|
Abouchaleh N, Bayart C. Strategies to minimize procedure-related pain and anxiety: lessons from pediatric dermatology. Curr Opin Pediatr 2024; 36:406-410. [PMID: 38957126 DOI: 10.1097/mop.0000000000001371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
PURPOSE OF REVIEW Recent studies have suggested that prolonged or repeated episodes of general anesthesia early in childhood may adversely affect neurodevelopment. This, combined with rising healthcare costs and decreasing access, has sparked interest in performing pediatric procedures in the office setting when possible. It is essential to address the physical and psychological discomfort that often accompany this experience, particularly in children. RECENT FINDINGS Healthcare providers performing procedures on children can draw from a spectrum of established techniques, new technology, and novel use of medications to decrease peri-procedural pain and anxiety. These techniques include distraction, optimization of local anesthesia, and mild to moderate sedation. SUMMARY We recommend using a combination of techniques to minimize pain and anxiety to improve safety, decrease healthcare costs, improve patient experience, and prevent childhood trauma and persistent negative perception of the healthcare system.
Collapse
Affiliation(s)
| | - Cheryl Bayart
- Cincinnati Children's Hospital Medical Center, University of Cincinnati-Affiliate, Cincinnati, Ohio, USA
| |
Collapse
|
92
|
Olender RT, Roy S, Jamieson HA, Hilmer SN, Nishtala PS. Drug Burden Index Is a Modifiable Predictor of 30-Day Hospitalization in Community-Dwelling Older Adults With Complex Care Needs: Machine Learning Analysis of InterRAI Data. J Gerontol A Biol Sci Med Sci 2024; 79:glae130. [PMID: 38733108 PMCID: PMC11215698 DOI: 10.1093/gerona/glae130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Older adults (≥65 years) account for a disproportionately high proportion of hospitalization and in-hospital mortality, some of which may be avoidable. Although machine learning (ML) models have already been built and validated for predicting hospitalization and mortality, there remains a significant need to optimize ML models further. Accurately predicting hospitalization may tremendously affect the clinical care of older adults as preventative measures can be implemented to improve clinical outcomes for the patient. METHODS In this retrospective cohort study, a data set of 14 198 community-dwelling older adults (≥65 years) with complex care needs from the International Resident Assessment Instrument-Home Care database was used to develop and optimize 3 ML models to predict 30-day hospitalization. The models developed and optimized were Random Forest (RF), XGBoost (XGB), and Logistic Regression (LR). Variable importance plots were generated for all 3 models to identify key predictors of 30-day hospitalization. RESULTS The area under the receiver-operating characteristics curve for the RF, XGB, and LR models were 0.97, 0.90, and 0.72, respectively. Variable importance plots identified the Drug Burden Index and alcohol consumption as important, immediately potentially modifiable variables in predicting 30-day hospitalization. CONCLUSIONS Identifying immediately potentially modifiable risk factors such as the Drug Burden Index and alcohol consumption is of high clinical relevance. If clinicians can influence these variables, they could proactively lower the risk of 30-day hospitalization. ML holds promise to improve the clinical care of older adults. It is crucial that these models undergo extensive validation through large-scale clinical studies before being utilized in the clinical setting.
Collapse
Affiliation(s)
| | - Sandipan Roy
- Department of Mathematical Sciences, University of Bath, Bath, UK
| | - Hamish A Jamieson
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Sarah N Hilmer
- Faculty of Medicine and Health, Kolling Institute, Northern Clinical School, The University of Sydney and Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Prasad S Nishtala
- Department of Life Sciences & Centre for Therapeutic Innovation, University of Bath, Bath, UK
| |
Collapse
|
93
|
Ndungu A, Nellums L, Bramley L. Exploring Health Information Seeking Among Participants from a Black Ethnic Group in the UK: a Qualitative Study. J Racial Ethn Health Disparities 2024; 11:2475-2487. [PMID: 37450252 DOI: 10.1007/s40615-023-01713-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/15/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
Empirical evidence has shown that individuals from minority ethnic communities have been at an increased risk of COVID-19 infections and adverse clinical outcomes including hospitalization, intensive care unit admission, and mortality. The COVID-19 vaccine has been heralded as key in ending the global pandemic. However, evidence suggests that although minority ethnic communities have been disproportionately affected by COVID-19, vaccine delivery to these communities has been poor. A barrier to the vaccine uptake has been health information. Health information is an important variable in the health decision-making process. Lack of or wrong health information has serious implications. Health information leads to better understanding of personal health and appropriate utilization of health services and consequently improves an individual's health outcomes. This study sought to explore the health information seeking practices among participants from a Black ethnic minority community in the UK. This study interviewed six Black Africans from the UK. The study explored and highlighted the thoughts, perceptions, and experiences of the participants while health information seeking. This study found challenges in health information access, assumptions about health information and feelings of being dismissed, and an information void. Participants acknowledge that there is a lot that could be done to improve their health information experiences. Targeted health information and measures such as cultural sensitivity and competency could be important in improving health information seeking, not just for Black Africans but all ethnic minorities in the UK.
Collapse
Affiliation(s)
- Antony Ndungu
- Department of Research and Education for Emergency Department, Acute Medicine and Major Trauma, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - Laura Nellums
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Louise Bramley
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| |
Collapse
|
94
|
Waltzman M, Ozonoff A, Fournier KA, Welcher J, Milliren C, Landschaft A, Bulis J, Kimia AA. Surveillance of Health Care-Associated Violence Using Natural Language Processing. Pediatrics 2024; 154:e2023063059. [PMID: 38973359 PMCID: PMC11291961 DOI: 10.1542/peds.2023-063059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 03/14/2024] [Accepted: 03/18/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Patient and family violent outbursts toward staff, caregivers, or through self-harm, have increased during the ongoing behavioral health crisis. These health care-associated violence (HAV) episodes are likely under-reported. We sought to assess the feasibility of using nursing notes to identify under-reported HAV episodes. METHODS We extracted nursing notes across inpatient units at 2 hospitals for 2019: a pediatric tertiary care center and a community-based hospital. We used a workflow for narrative data processing using a natural language processing (NLP) assisted manual review process performed by domain experts (a nurse and a physician). We trained the NLP models on the tertiary care center data and validated it on the community hospital data. Finally, we applied these surveillance methods to real-time data for 2022 to assess reporting completeness of new cases. RESULTS We used 70 981 notes from the tertiary care center for model building and internal validation and 19 332 notes from the community hospital for external validation. The final community hospital model sensitivity was 96.8% (95% CI 90.6% to 100%) and a specificity of 47.1% (39.6% to 54.6%) compared with manual review. We identified 31 HAV episodes in July to December 2022, of which 26 were reportable in accordance with the hospital internal criteria. Only 7 of 26 cases were reported by employees using the self-reporting system, all of which were identified by our surveillance process. CONCLUSIONS NLP-assisted review is a feasible method for surveillance of under-reported HAV episodes, with implementation and usability that can be achieved even at a low information technology-resourced hospital setting.
Collapse
Affiliation(s)
- Mark Waltzman
- Boston Children’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Al Ozonoff
- Boston Children’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | - Amir A Kimia
- Boston Children’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Connecticut Children’s Hospital, Hartford, Connecticut
| |
Collapse
|
95
|
Bjurström MF, Borgquist O, Kander T, Lundén R, Fagerlund MJ, Lipcsey M, Sturesson LW. Audio podcast and procedural video use in anaesthesiology and intensive care: A nationwide survey of Swedish anaesthetists. Acta Anaesthesiol Scand 2024; 68:923-931. [PMID: 38686931 DOI: 10.1111/aas.14433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Digital modalities which enable asynchronous learning, such as audio podcasts and videos demonstrating procedures, may benefit acquisition and retention of knowledge and clinical skills. The main objective of this nationwide cross-sectional survey study was to evaluate key aspects and factors related to usage of audio podcasts and procedural videos in anaesthesiology and intensive care. METHODS A 20-item multiple-choice-question online survey was created through a consensus process including pilot testing among residents and consultants. Data were collected over a 3-month period, September-November 2023. RESULTS The survey was completed by 466 anaesthetists. More than a third reported using procedural videos ≥1 time per week, whereas fewer than one in four participants used audio podcasts at least once per week. Multivariable logistic regression analysis showed that working at a university hospital, male sex, and younger age were independently associated with podcast use ≥1 time per week, with the highest odds ratio (OR) for younger age (<40 years vs. ≥40 years old; OR 5.86 (95% confidence interval 3.55-9.67), p < .001). Younger age was also significantly associated with higher frequency of video use (OR 1.71 (1.13-2.58), p = .011), while working predominantly in intensive care was associated with a lower frequency of video use. Podcasts were often used during commuting (42.3%), household work (30.7%), and exercise (24.9%), indicating a role in multi-tasking. Approximately half of respondents expressed that audio podcast-based learning has a moderate to very large positive impact on acquisition of theoretical knowledge, as well as practical skills. A vast majority, 85.2%, reported that procedural videos have a moderate to very large impact on development of clinical skills. CONCLUSION Audio podcasts and procedural videos are appreciated tools with potential to supplement more traditional didactic techniques in anaesthesiology and intensive care. Procedural video use is common, with perceived large effects on development of clinical skills. Further data are needed to fully understand learning outcomes, quality of peer-review processes, and potential sex-differences.
Collapse
Affiliation(s)
| | - Ola Borgquist
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Thomas Kander
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Robin Lundén
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Malin J Fagerlund
- Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institute, Stockholm, Sweden
| | - Miklós Lipcsey
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | | |
Collapse
|
96
|
Schoppel K, Keilman A, Fayyaz J, Padlipsky P, Diaz MCG, Wing R, Hughes M, Franco M, Swinger N, Whitfill T, Walsh B. Comparing Leadership Skills of Senior Emergency Medicine Residents in 3-Year Versus 4-Year Programs During Simulated Pediatric Resuscitation: A Pilot Study. Pediatr Emerg Care 2024; 40:591-597. [PMID: 38809592 DOI: 10.1097/pec.0000000000003216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
OBJECTIVES The majority of pediatric patients in the United States (US) are evaluated and treated at general emergency departments. It is possible that discrepancies in length of emergency medicine (EM) residency training may allow for variable exposure to pediatric patients, critical resuscitations, and didactic events. The goal of this pilot study was to compare leadership skills of graduating EM residents from 3- to 4-year programs during simulated pediatric resuscitations using a previously validated leadership assessment tool, the Concise Assessment of Leader Management (CALM). METHODS This was a prospective, multicenter, simulation-based cohort pilot study that included graduating 3 rd - and 4 th -year EM resident physicians from 6 EM residency programs. We measured leadership performance across 3 simulated pediatric resuscitations (sepsis, seizure, cardiac arrest) using the CALM tool and compared leadership scores between the 3 rd - and 4 th -year resident cohorts. We also correlated leadership to self-efficacy scores. RESULTS Data was analyzed for 47 participating residents (24 3 rd -year residents and 23 4 th -year residents). Out of a total possible CALM score of 66, residents from 3-year programs scored 45.2 [SD ± 5.2], 46.8 [SD ± 5.0], and 46.6 [SD ± 4.7], whereas residents from 4-year programs scored 45.5 [SD ± 5.2], 46.4 [SD ± 5.0], and 48.2 [SD ± 4.3] during the sepsis, seizure, and cardiac arrest cases, respectively. The mean leadership score across all 3 cases for the 3-year cohort was 46.2 [SD ± 4.8] versus 46.7 [SD ± 4.5] ( P = 0.715) for the 4-year cohort. CONCLUSIONS These data show feasibility for a larger cohort project and, while not statistically significant, suggest no difference in leadership skills between 3 rd - and 4 th -year EM residents in our study cohort. This pilot study provides the basis of future work that will assess a larger multicenter cohort with the hope to obtain a more generalizable dataset.
Collapse
Affiliation(s)
- Kyle Schoppel
- From the Indiana University School of Medicine/Riley Hospital for Children
| | | | - Jabeen Fayyaz
- The Hospital for Sick Children/University of Toronto
| | | | | | | | | | | | - Nathan Swinger
- From the Indiana University School of Medicine/Riley Hospital for Children
| | | | | |
Collapse
|
97
|
Sarvas E, Webb J, Landrigan-Ossar M, Yin L. Oral Health Care for Children and Youth With Developmental Disabilities: Clinical Report. Pediatrics 2024; 154:e2024067603. [PMID: 39034828 DOI: 10.1542/peds.2024-067603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 07/23/2024] Open
Abstract
Oral health is an essential component of overall health for all individuals. The oral health of children and youth with developmental disabilities (CYDD) involves unique characteristics and needs of which pediatricians and pediatric clinicians can be aware. Risk for oral disease in CYDD is multifactorial and includes underlying medical conditions, medications, and ability to participate in preventive oral health care and treatment, and lack of access to providers is common for this population despite being eligible for Medicaid. Pediatric clinicians are uniquely positioned to support the oral health needs of CYDD and their families through the medical home. This clinical report aims to inform pediatric clinicians about the unique oral health needs of CYDD. It provides guidance on assessing caries risk and periodontal status using structured screening instruments; understanding dental trauma, the role of diet and caries risk, trauma prevention, and malocclusion; and providing anticipatory guidance on oral hygiene that includes tooth brushing, use of fluoridated toothpaste, assessing community water fluoridation, advocating for a dental home by 1 year of age, and transition to adult dental care as part of adolescent health care. It also highlights special considerations for dental treatment rendered under sedation or general anesthesia that CYDD may need. Pediatric clinicians can help reduce risk of CYDD developing dental disease by understanding the unique needs of their patients and their barriers to accessing oral health care in their community, communicating with the child's dental home, and advocating for safe and accessible dental procedures.
Collapse
Affiliation(s)
| | | | | | - Larry Yin
- Associate Professor of Clinical Pediatrics, Keck School of Medicine of USC and Children's Hospital Los Angeles, Los Angeles, California
| |
Collapse
|
98
|
Seeburruth D, Tong XC, Kirwan C, Ramsden S, Kibria A, Carter J, Huang J, McArthur R, Clayton N, de Wit K. Eligibility for anticoagulation initiation in atrial fibrillation: Agreement between emergency physician and medical record review. Acad Emerg Med 2024; 31:824-827. [PMID: 38456355 DOI: 10.1111/acem.14889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/04/2024] [Accepted: 02/12/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Darshana Seeburruth
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - X Catherine Tong
- Department of Family Medicine, McMaster University, Kitchener-Waterloo, Ontario, Canada
| | - Christopher Kirwan
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Sophie Ramsden
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Aqsa Kibria
- Royal College of Surgeons in Ireland (RCSI), Bahrain
| | - Jaimie Carter
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Johnny Huang
- Department of Family Medicine, McMaster University, Kitchener-Waterloo, Ontario, Canada
| | - Robyn McArthur
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Natasha Clayton
- Emergency Department, Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Kerstin de Wit
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
99
|
Mofina A, France C, Brown G, Sinha SK, Heurter D, Viveky N, MacLeod S, Jantzi M, Foster N, Hirdes J. Predictors of Pain and Mood Disturbances Among Older People in Custody Using an interRAI Assessment. JOURNAL OF CORRECTIONAL HEALTH CARE 2024; 30:285-294. [PMID: 38946596 DOI: 10.1089/jchc.23.06.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
The population of people in federal custody in Canada is aging. Those in custody report experiencing poorer health and high rates of chronic health conditions. Two health concerns that are disproportionately higher among those in custody are mood disorders and pain. This cross-sectional study examined health indicators associated with pain and depressive symptoms among older people (50 years and above) from multiple facilities and security levels in federal custody in Canada. Participants were assessed using the interRAI Emergency Department Contact Assessment, which captures key health indicators. Chi square and logistic regression analyses were conducted to describe the population and identify health indicators associated with mood- and pain-related outcomes, respectively. Of the 1,422 participants in this study, the majority (55%) experienced pain and at least 1 out of 5 experienced depressive symptoms. Health indicators associated with depressive symptoms and/or pain were functional measures, including mobility, managing medication(s), and dyspnea. Depressive symptoms and pain are highly prevalent among older adults in federal custody. The relationship between functional health, depressive symptoms, and pain highlights the importance of interprofessional health care and biopsychosocial intervention(s).
Collapse
Affiliation(s)
- Amanda Mofina
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Charlene France
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | | | - Samir K Sinha
- Sinai Health System, Toronto, Canada
- University Health Network, Toronto, Canada
| | | | | | | | - Micaela Jantzi
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | | | - John Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| |
Collapse
|
100
|
Rudolf F, Oyama LC, El‐Kareh R. Impact of an automated patient outcome feedback system on emergency medicine resident patient follow-up: An interrupted time series analysis. AEM EDUCATION AND TRAINING 2024; 8:e11011. [PMID: 38974783 PMCID: PMC11222962 DOI: 10.1002/aet2.11011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/13/2024] [Accepted: 06/18/2024] [Indexed: 07/09/2024]
Abstract
Objectives Emergency medicine (EM) residents desire, but often lack, reliable feedback of patient outcomes following handoffs to other providers. This gap is a substantial barrier to calibrating their diagnostic decision making and learning. To address this educational priority, we developed and evaluated the Post-Handoff Reports of Outcomes (PHAROS) system-an automated system within our electronic health record (EHR) to deliver provider-specific patient outcome feedback. Methods PHAROS includes: (1) individualized lists of patients seen and brief summaries of each case, (2) flags for important posthandoff events, and (3) links to charts to facilitate review. Starting June 2020, we coupled PHAROS with a resident educational session and individualized emails every 2 weeks outlining patients seen, number of posthandoff events, and instructions on how to access the PHAROS system. Results From July 2017 through April 2022, we measured the proportion of handoffs followed by reaccessing patients' charts between 2 and 14 days posthandoff-a proxy for following up on the patient's outcomes. We performed an interrupted time series analysis on this outcome to determine if PHAROS was associated with a significant change in the trend of our outcome over time. Our secondary outcome was the number of times PHAROS was viewed each month. Our primary outcome had a significant increase in the slope over time (+0.13%/month, p = 0.03) after the introduction of the personalized reports and a nonsignificant change (-1.6%, p = 0.07) at the time of the intervention. The median (IQR) number of views of PHAROS per month was 33.2 (23.75-38.75). Conclusions The PHAROS system was associated with a significant increase in the rate of posthandoff chart reaccess among EM residents over time. The PHAROS project demonstrated the feasibility of harnessing the capabilities of the EHR to create an automated system to support EM trainee feedback of patient outcomes-a key component of diagnostic calibration and learning.
Collapse
Affiliation(s)
- Frances Rudolf
- Department of Emergency MedicineUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Leslie C. Oyama
- Department of Emergency MedicineUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Robert El‐Kareh
- Department of MedicineUniversity of California San DiegoSan DiegoCaliforniaUSA
- Department of QualityUniversity of California San DiegoSan DiegoCaliforniaUSA
| |
Collapse
|