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Búřilová P, Melišková M, Búřil J, Haršány M, Pokorná A. The Use of Screening Tests in Differential Diagnosis in Nursing Care. Crit Care Nurs Q 2024; 47:83-89. [PMID: 38031311 DOI: 10.1097/cnq.0000000000000493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Geriatric syndromes involving instability are associated with a higher risk of further complications in patients with trauma requiring subsequent surgery. Acute stroke symptoms require prompt recognition and initiation of reperfusion treatment. This case study describes the patient's stroke symptoms in a timeline and explores the benefit of objective assessment using screening tests and their importance in the differential diagnosis in nursing. Dysphagia is one of the stroke symptoms that can lead to aspiration pneumonia and increase the risk of mortality. This article aims to inform general nurses about the importance of early recognition of dysphagia and other stroke symptoms using adequate screening tests to ensure quality care. Geriatric syndromes encompass instability, resulting in a higher risk of complications, especially in trauma patients. This case study describes a patient with acute ischemic stroke with vague and unrecognized symptoms of dysphagia and explores the rationale for objective screening tests in nursing care.
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Affiliation(s)
- Petra Búřilová
- Departments of Health Sciences (Mss Búřilová and Melišková and Dr Pokorná) and Public Health (Ms Búřilová), Faculty of Medicine (Drs Búřil and Haršány), Masaryk University, Brno, Czech Republic; Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic (Ms Búřilová and Drs Búřil and Pokorná); and Department of Neurology, St. Anne's University Hospital, Brno, Czech Republic (Drs Búřil and Haršány)
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Wardrop R, Ranse J, Chaboyer W, Crilly J. Profile and outcomes of emergency department presentations based on mode of arrival: A state-wide retrospective cohort study. Emerg Med Australas 2021; 34:519-527. [PMID: 34908237 DOI: 10.1111/1742-6723.13914] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/02/2021] [Accepted: 12/05/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Understanding how people arrive to the ED assists in planning health services' response to fluctuating ED demand. The present study aimed to describe and compare demographics, clinical characteristics and health service outcomes of adult ED patient presentations based on mode of arrival: brought in by police (BIBP)/brought in by ambulance (BIBA)/privately arranged transport (PAT). METHODS A retrospective cohort study of ED patient presentations made between 1 January 2018 and 31 December 2020 from all public hospital EDs across Queensland, Australia. Descriptive and inferential analyses were performed to ascertain presentation characteristics and predictors of health service outcomes. RESULTS From 4 707 959 ED presentations, 0.9% were BIBP, 34.8% were BIBA and 64.0% were PAT. Presentations BIBP were younger and comprised a higher proportion of mental health problems and Emergency Examination Authority orders compared to presentations BIBA or PAT. Compared to presentations BIBP or PAT, presentations BIBA were more likely to be assigned more urgent triage scores, be admitted to hospital, and have a longer ED length of stay (LOS). Compared to other modes of arrival, presentations arriving by PAT were more likely to be discharged and have a shorter ED LOS. CONCLUSION Presentations BIBA and BIBP encountered a longer ED LOS and higher admission rates than PAT, suggesting more complex care needs than those from PAT. Clinical care pathways for specific modes of arrival that support pre-hospital providers and patients and are considerate of the throughput and output stages of ED care may be needed.
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Affiliation(s)
- Rachel Wardrop
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Jamie Ranse
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Julia Crilly
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
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Eliakundu AL, Cadilhac DA, Kim J, Andrew NE, Bladin CF, Grimley R, Dewey HM, Donnan GA, Hill K, Levi CR, Middleton S, Anderson CS, Lannin NA, Kilkenny MF. Factors associated with arrival by ambulance for patients with stroke: a multicentre, national data linkage study. Australas Emerg Care 2021; 24:167-173. [PMID: 33642255 DOI: 10.1016/j.auec.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hospital arrival via ambulance influences treatment of acute stroke. We aimed to determine the factors associated with use of ambulance and access to evidence-based care among patients with stroke. METHODS Patients with first-ever strokes from the Australian Stroke Clinical Registry (2010-2013) were linked with administrative data (emergency, hospital admissions). Multilevel, multivariable regression models were used to determine patient, clinical and system factors associated with arrival by ambulance. RESULTS Among the 6,262 patients with first-ever stroke, 4,737 (76%) arrived by ambulance (52% male; 80% ischaemic). Patients who were older, frailer, with comorbidities or were unable to walk on admission (stroke severity) were more likely to arrive by ambulance to hospital. Compared to those using other means of transport, those who used ambulances arrived to hospital sooner after stroke onset (minutes, 124 vs 397) and were more likely to receive reperfusion therapy (adjusted odds ratio, 1.57, 95% CI: 1.09, 2.27). CONCLUSION Patients with stroke who use ambulances arrived faster and were more likely to receive reperfusion therapy compared to those using personal transport. Further public education about using ambulance services at all times, instead of personal transport when stroke is suspected is needed to optimise access to time critical care.
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Affiliation(s)
- Amminadab L Eliakundu
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Joosup Kim
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
| | - Christopher F Bladin
- Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Ambulance Victoria, Doncaster, Victoria, Australia
| | - Rohan Grimley
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Sunshine Coast Clinical School, Griffith University, Birtinya, Queensland, Australia
| | - Helen M Dewey
- Eastern Health Clinical School, Box Hill, Victoria, Australia
| | - Geoffrey A Donnan
- Melbourne Brain Centre, University of Melbourne, Parkville, Victoria, Australia
| | - Kelvin Hill
- Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Stroke Foundation, Victoria, Australia
| | - Christopher R Levi
- Acute Stroke Services, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne &Australian Catholic University
| | - Craig S Anderson
- The George Institute for Global Health and Faculty of Medicine, University of New South Wales, New South Wales, Australia
| | - Natasha A Lannin
- Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Monique F Kilkenny
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia.
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Hoyer C, Weber L, Sandikci V, Ebert A, Platten M, Szabo K. Decreased admissions and change in arrival mode in patients with cerebrovascular events during the first surge of the COVID-19 pandemic. Neurol Res Pract 2020; 2:47. [PMID: 33225224 PMCID: PMC7668014 DOI: 10.1186/s42466-020-00094-w] [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: 10/21/2020] [Accepted: 11/02/2020] [Indexed: 11/24/2022] Open
Abstract
Background and purpose Investigating clinical characteristics of patients presenting with cerebrovascular events during the pandemic may provide valuable insight into further understanding the phenomenon of decreased stroke admissions during the COVID-19 pandemic. Method Data of patients presenting with a cerebrovascular event to the emergency department during weeks 12–17/2020 were compared to data from the respective weeks in 2019. Results A significant reduction in the number of admissions by 35.9% (p = 0.005) was observed during the COVID-19 epoch. In addition, significantly more patients arrived by ambulance during the COVID-19 epoch (2019: 75.7%, 2020: 94.2%; p = 0.001). Conclusion Our data may have implications as to how campaigns raising awareness for serious medical conditions in the context of the pandemic should be framed.
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Demont A, Quentin J, Bourmaud A. [Impact of models of care integrating direct access to physiotherapy in primary care and emergency care contexts in patients with musculoskeletal disorders: A narrative review]. Rev Epidemiol Sante Publique 2020; 68:306-313. [PMID: 32893028 DOI: 10.1016/j.respe.2020.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/08/2020] [Accepted: 08/01/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Musculoskeletal disorders are increasing in prevalence, principally due to sedentary behaviors. Strong evidence supports an early need for first-line treatment including physiotherapy. New and innovative models in primary and emergency care have been drawn up and put the physiotherapist's skills to work in early and first-line management of patients with musculoskeletal disorders. The objectives of this review were to identify and describe studies assessing models of care integrating direct access to physiotherapy in primary care and in emergency care for patients with musculoskeletal disorders and to provide perspectives on the application of these two models in France. METHODS A literature review was carried out including studies extracted from four scientific databases: PubMed, CINAHL, Embase, and PEDro. The selected articles had to address the clinical effectiveness or efficiency of these models for the provision of care in primary or in emergency care. A narrative literature review method was used. The synthesis deals with the qualitative analysis of the included studies. RESULTS Thirty-nine studies were included in this review: 19 on assessment of the direct access to physiotherapy model in primary care and 20 on the direct access to physiotherapy model in emergency departments as concerns patients with musculoskeletal disorders. The studies showed that the different models incorporating direct access to physiotherapy in primary or in emergency care provided better outcomes in terms of quality and access to care while maintaning a similar degree of safety. However, the methodology of the studies included was estimated as being of heterogeneous quality. CONCLUSION The studies dealing with the new models for provision of care integrating direct access to physiotherapy in primary care or emergency care impart two lessons: (1) they are not designed to replace the physician; (2) collaboration between different health professionals aimed at improving patients' access to efficient care is to be encouraged. It would be worthwhile to focus upon dissemination factors that would enhance the efficiency of these innovative models in other countries, as in France.
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Affiliation(s)
- A Demont
- Inserm 1123 ECEVE, faculté de médecine, université Paris-Diderot, Paris, France; École universitaire de kinésithérapie, université d'Orléans, Orléans, France.
| | - J Quentin
- Pôle Saint-Hélier, centre de médecine physique et réadaptation, Rennes, France
| | - A Bourmaud
- Inserm 1123 ECEVE, faculté de médecine, université Paris-Diderot, Paris, France
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