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Chawla S, Papp A. Adult kitchen-related burn injuries: The impact of COVID-19. Burns 2023; 49:1328-1334. [PMID: 36566093 PMCID: PMC9722612 DOI: 10.1016/j.burns.2022.11.009] [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: 07/27/2022] [Revised: 10/19/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Kitchen-related burn injuries are common and preventable. To limit the spread of COVID-19, public health orders encouraged the public to stay at home which may have led to an increase in kitchen-related burn injuries. OBJECTIVE To assess adult kitchen-related burns treated in an outpatient setting in general, and especially looking at the impact of the COVID-19 pandemic on the incidence and epidemiology of these burns. METHODS For this retrospective, population-based study, data were obtained for adult patients who suffered burn injuries resulting in a visit to a Canadian tertiary Burn Clinic between April 2016 and March 2021 specifically looking at demographics, burn etiology, severity and anatomical location and the need for surgery. Separately, we compared the patients before and after the beginning of the COVID-19 pandemic (April 1, 2020). RESULTS A total of 1380 burn patients were identified. Of these, 38 % (N = 521) sustained a kitchen-related burn. The median patient age was 40 years (range 18-95) and 282 (54.1 %) were female. The most common etiology and location were scald (76.8 %) and anterior arm (28.5 %), respectively. Thirty-two (6.1 %) patients required admission to the Burn Unit and 26 of these had surgeries. Additionally, 72 (13.8 %) patients had surgery as an outpatient. During the COVID-19 pandemic, East Asian patients saw a significant increase in kitchen burns (p < 0.01). CONCLUSION Over 1/3 of burns at the outpatient burn clinic were kitchen-related. About 94 % of these were treated as outpatient only. The incidence of kitchen-related burns did not change during the COVID-19 pandemic, but we found significant differences in ethnic distribution. These results provide a unique opportunity to focus on communication and education and set up preventative measures.
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Affiliation(s)
- Sahil Chawla
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Anthony Papp
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
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Castner J, Stanislo K, Castner M, Monsen KA. Public health nursing workforce and learning needs: A national sample survey analysis. Public Health Nurs 2023; 40:339-352. [PMID: 36683284 PMCID: PMC10328423 DOI: 10.1111/phn.13171] [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: 08/03/2022] [Revised: 12/12/2022] [Accepted: 12/26/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Generate national estimates of the public health nursing workforce's (1) demographic and work characteristics and (2) continuing education learning needs in the United States. DESIGN Secondary data analysis of the 2018 National Sample Survey of Registered Nurses. SAMPLE Total 7352 of the 50,273 survey respondents were categorized as public health nurses (PHNs), representing an estimated 467,271 national workforce. MEASUREMENTS Survey items for demographics, practice setting, training topics, and language(s) spoken fluently were analyzed. RESULTS Workforce demographic characteristics are included. Mental health training was the most frequently endorsed topic by PHNs, followed by patient-centered care and evidence-based care. Training topic needs vary by practice setting. CONCLUSIONS Results here can be used as a needs assessment for national public health nursing professional development and education initiatives. Further research is needed to refine and survey a nationally representative sample in a manner meaningful to public health nursing practice.
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Affiliation(s)
- Jessica Castner
- Administration, Castner Incorporated, Grand Island, New York
| | | | - Martin Castner
- Administration, Castner Incorporated, Grand Island, New York
- David B. Falk College of Sport and Human Dynamics, College of Arts and Sciences, Castner Incorporated, Syracuse University, Syracuse, New York
| | - Karen A Monsen
- University of Minnesota School of Nursing, Minneapolis, Minnesota
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Chau PH, Lau KKL, Qian XX, Luo H, Woo J. Visits to the accident and emergency department in hot season of a city with subtropical climate: association with heat stress and related meteorological variables. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2022; 66:1955-1971. [PMID: 35900375 PMCID: PMC9330976 DOI: 10.1007/s00484-022-02332-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 07/08/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND Literature reporting the association between heat stress defined by universal thermal climate index (UTCI) and emergency department visits is mainly conducted in Europe. This study aimed to investigate the association between heat stress, as defined by the UTCI, and visits to the accident and emergency department (AED) in Hong Kong, which represents a subtropical climate region. METHODS A retrospective study involving 13,438,846 AED visits in the public sector from May 2000 to September 2016, excluding 2003 and 2009, was conducted in Hong Kong. Age-sex-specific ANCOVA models of daily AED rates on heat stress and prolonged heat stress, adjusting for air quality, prolonged poor air quality, typhoon, rainstorm, year, day of the week, public holiday, summer vacation, and fee charging, were used. RESULTS On a day with strong heat stress (32.1 °C ≤ UTCI ≤ 38.0 °C), the AED visit rate (per 100,000) increased by 0.9 (95% CI: 0.5, 1.3) and 1.7 (95% CI: 1.3, 2.1) for females and males aged 19-64 and 4.1 (95% CI: 2.7, 5.4) and 4.1 (95% CI: 2.6, 5.6) for females and males aged ≥ 65, while keeping other variables constant. On a day with very strong heat stress (38.1 °C ≤ UTCI ≤ 46.0 °C), the corresponding rates increased by 0.6 (95% CI: 0.1, 1.2), 2.2 (95% CI: 1.7, 2.7), 4.9 (95% CI: 3.1, 6.7), and 4.7 (95% CI: 2.7, 6.6), respectively. The effect size of heat stress associated with AED visit rates was negligible among those aged ≤ 18. Heat stress showed the greatest effect size for males aged 19-64 among all subgroups. CONCLUSION Biothermal condition from heat stress was associated with the health of the citizens in a city with a subtropical climate and reflected in the increase of daily AED visit. Public health recommendations have been made accordingly for the prevention of heat-related AED visits.
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Affiliation(s)
- Pui Hing Chau
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
| | - Kevin Ka-Lun Lau
- Department of Civil, Environmental and Natural Resources Engineering, Luleå University of Technology, Luleå, Sweden
| | - Xing Xing Qian
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Hao Luo
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Jean Woo
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Mullan PC, Vazifedan T. Changing temporal trends in patient volumes in a pediatric emergency department during a COVID-19 pandemic lockdown: A retrospective cohort study. PLoS One 2022; 17:e0271708. [PMID: 36094943 PMCID: PMC9467366 DOI: 10.1371/journal.pone.0271708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/29/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Emergency department (ED) teams have had to adjust limited staffing resources to meet the fluctuating levels of patient volume and acuity during the COVID-19 pandemic. Historically, Mondays have had the highest reported ED volumes. We are unaware of any studies reporting on the change of this Monday effect during the COVID-19 pandemic. Methods This retrospective, observational study of a single pediatric ED compared a pandemic lockdown period (3/23/2020-11/1/2020) with a seasonally comparative period (3/25/2019-11/3/2019). We compared the mean number of patients who arrived on Monday versus any other specific weekday (Tuesday, Wednesday, Thursday, or Friday) and the aggregate of other weekdays (Tuesday to Friday) for both study periods. Secondary analyses investigated overall mean volumes, admission rates, and differences in triage acuity levels. Results There were 31,377 and 18,098 patients in the comparative and pandemic periods. The mean number of ED visits on Mondays in the comparative period was significantly more than any other weekday and the aggregate of weekdays (latter p<0.001). In contrast, there were no significant differences in the mean number of ED visits on Mondays in the pandemic period relative to any other weekday and the aggregate of weekdays (all p>0.05). The pandemic period had significantly lower mean volumes, higher admission rates, and more patients with higher acuity levels. Conclusion The previously experienced Monday effect of increased relative ED patient volumes was not seen during the pandemic period. This change has operational implications for scheduling ED staffing resources. Larger database studies are needed to determine the generalizability of these findings.
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Affiliation(s)
- Paul C. Mullan
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children’s Hospital of the King’s Daughters, Norfolk, Virginia, United States of America
- Eastern Virginia Medical School, Norfolk, Virginia, United States of America
- * E-mail:
| | - Turaj Vazifedan
- Department of Pediatrics, Children’s Hospital of the King’s Daughters, Norfolk, Virginia, United States of America
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Kruchevsky D, Levanon S, Givon A, Bodas M, Ramon Y, Ullmann Y, Zeltzer AA. Burns During Coronavirus Disease 19 Lockdown: a Multi-Center Retrospective Study in Israel. J Burn Care Res 2022; 44:75-80. [PMID: 35666996 PMCID: PMC9214151 DOI: 10.1093/jbcr/irac078] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Indexed: 01/11/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic forced many countries into lockdowns to limit the spread of infection. Israel's containment measures included school closures, mobility restrictions, and workforce reductions. Our study evaluated the effect of COVID-19 on the occurrence and patterns of burn injuries. The study data was obtained via retrospective chart review of burn patients treated between March 15, 2020 and April 30, 2020, namely the period of strict national lockdown. This data was compared against data from paralleling periods between 2017 and 2019. A total of 686 patients were treated for burn injuries in the two study periods. Age group analysis revealed an increased ratio of pediatric patients aged 0-3 years during the lockdown (55.91% vs 40.79%, P = .002). In contrast, there were fewer patients presenting with burn injuries in the 7-16 and 17-29 age groups (9.66% vs 3.15%, P = .017; 16.46% vs 7.09%, P = .007, respectively). During both study periods, scald injuries were the most common burn etiology and burn injuries occurred most often at home. This predominance was further pronounced during the lockdown (71.65% vs 58.68%, P = .007; 90.55% vs 74.60%, P = .0001, respectively). The lockdown period underlined the danger faced by pediatric patients in their household environment. This danger was possibly compounded by an improper level of adult supervision as parents transitioned to remote work. These findings can educate us about factors that render burn injuries more likely not only during lockdowns, but also during regular times, thus shaping the development of burn prevention practices.
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Affiliation(s)
- Dani Kruchevsky
- Address correspondence to Dani Kruchevsky, MD, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa 31096, Israel.
| | - Shir Levanon
- Rappaport Faculty of Medicine, Technion Institute, Haifa, Israel
| | - Adi Givon
- Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
| | - Moran Bodas
- Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel,School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Yitzchak Ramon
- Plastic & Reconstructive Surgery Department, Rambam Health Care Campus, Haifa, Israel
| | - Yehuda Ullmann
- Plastic & Reconstructive Surgery Department, Rambam Health Care Campus, Haifa, Israel
| | - Assaf A Zeltzer
- Plastic & Reconstructive Surgery Department, Rambam Health Care Campus, Haifa, Israel,Rappaport Faculty of Medicine, Technion Institute, Haifa, Israel
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Mahony T, Harder VS, Ang N, McCulloch CE, Shaw JS, Thombley R, Cabana MD, Kleinman LC, Bardach NS. Weekend Versus Weekday Asthma-Related Emergency Department Utilization. Acad Pediatr 2022; 22:640-646. [PMID: 34543671 DOI: 10.1016/j.acap.2021.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/09/2021] [Accepted: 09/08/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess variation in asthma-related emergency department (ED) use between weekends and weekdays. METHODS Cross-sectional administrative claims-based analysis using California 2016 Medicaid data and Vermont 2016 and Massachusetts 2015 all-payer claims databases. We defined ED use as the rate of asthma-related ED visits per 100 child-years. A weekend visit was a visit on Saturday or Sunday, based on date of ED visit claim. We used negative binomial regression and robust standard errors to assess variation between weekend and weekday rates, overall and by age group. RESULTS We evaluated data from 398,537 patients with asthma. The asthma-related ED visit rate was slightly lower on weekends (weekend: 18.7 [95% confidence interval (CI): 18.3-19.0], weekday: 19.6 [95% CI, 19.3-19.8], P < .001). When stratifying by age group, 3- to 5-year-olds had higher rates of asthma-related ED visits on weekends than weekdays (weekend: 33.7 [95% CI, 32.6-34.7], weekday: 29.8 [95% CI, 29.1-30.5], P < .001) and 12- to 17-year-olds had lower rates of ED visits on weekends than weekdays (weekend: 13.0 [95% CI: 12.5-13.4], weekday: 16.3 [95% CI: 15.9-16.7], P < .001). In the other age groups (6-11, 18-21 years) there were not statistically significant differences between weekend and weekday rates (P > .05). CONCLUSIONS In this multistate analysis of children with asthma, we found limited overall variation in pediatric asthma-related ED utilization on weekends versus weekdays. These findings suggest that increasing access options during the weekend may not necessarily decrease asthma-related ED use.
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Affiliation(s)
- Talia Mahony
- Department of Pediatrics, University of California, San Francisco (T Mahony and NS Bardach)
| | - Valerie S Harder
- Department of Pediatrics, Larner College of Medicine, University of Vermont (VS Harder and JS Shaw), Burlington, Vt
| | - Nikkolson Ang
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco (N Ang, R Thombley, and NS Bardach)
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco (CE McCulloch)
| | - Judith S Shaw
- Department of Pediatrics, Larner College of Medicine, University of Vermont (VS Harder and JS Shaw), Burlington, Vt
| | - Robert Thombley
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco (N Ang, R Thombley, and NS Bardach)
| | - Michael D Cabana
- Department of Pediatrics, Albert Einstein College of Medicine (MD Cabana), Bronx, NY; Children's Hospital at Montefiore (MD Cabana), Bronx, NY
| | - Lawrence C Kleinman
- Rutgers Robert Wood Johnson School of Medicine (LC Kleinman), New Brunswick, NJ
| | - Naomi S Bardach
- Department of Pediatrics, University of California, San Francisco (T Mahony and NS Bardach); Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco (N Ang, R Thombley, and NS Bardach).
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7
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Castner J. A Case for Case Reviews. J Emerg Nurs 2021; 47:514-517. [PMID: 34275521 DOI: 10.1016/j.jen.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/12/2021] [Indexed: 12/01/2022]
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Vu M, Erdelyi S, Mangat B, Chan H, Brubacher JR, Staples JA. Emergency department visits on Lunar New Year's Eve in Vancouver, Canada. Am J Emerg Med 2021; 55:196-198. [PMID: 34175194 DOI: 10.1016/j.ajem.2021.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/06/2021] [Accepted: 06/12/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
- Mitchell Vu
- Department of Medicine, University of British Columbia, Vancouver, Canada.
| | - Shannon Erdelyi
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada.
| | - Birinder Mangat
- Department of Medicine, University of British Columbia, Vancouver, Canada.
| | - Herbert Chan
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada.
| | - Jeffrey R Brubacher
- Centre for Clinical Epidemiology & Evaluation (C2E2), Vancouver, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, Canada.
| | - John A Staples
- Department of Medicine, University of British Columbia, Vancouver, Canada; Centre for Clinical Epidemiology & Evaluation (C2E2), Vancouver, Canada.
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Lowe J, Brown I, Duriseti R, Gallegos M, Ribeira R, Pirrotta E, Wang NE. Emergency Department Access During COVID-19: Disparities in Utilization by Race/Ethnicity, Insurance, and Income. West J Emerg Med 2021; 22:552-560. [PMID: 34125026 PMCID: PMC8203020 DOI: 10.5811/westjem.2021.1.49279] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION In March 2020, shelter-in-place orders were enacted to attenuate the spread of coronavirus 2019 (COVID-19). Emergency departments (EDs) experienced unexpected and dramatic decreases in patient volume, raising concerns about exacerbating health disparities. METHODS We queried our electronic health record to describe the overall change in visits to a two-ED healthcare system in Northern California from March-June 2020 compared to 2019. We compared weekly absolute numbers and proportional change in visits focusing on race/ethnicity, insurance, household income, and acuity. We calculated the z-score to identify whether there was a statistically significant difference in proportions between 2020 and 2019. RESULTS Overall ED volume declined 28% during the study period. The nadir of volume was 52% of 2019 levels and occurred five weeks after a shelter-in-place order was enacted. Patient demographics also shifted. By week 4 (April 5), the proportion of Hispanic patients decreased by 3.3 percentage points (pp) (P = 0.0053) compared to a 6.2 pp increase in White patients (P = 0.000005). The proportion of patients with commercial insurance increased by 11.6 pp, while Medicaid visits decreased by 9.5 pp (P < 0.00001) at the initiation of shelter-in-place orders. For patients from neighborhoods <300% federal poverty levels (FPL), visits were -3.8 pp (P = 0.000046) of baseline compared to +2.9 pp (P = 0.0044) for patients from ZIP codes at >400% FPL the week of the shelter-in-place order. Overall, 2020 evidenced a consistently elevated proportion of high-acuity Emergency Severity Index (ESI) level 1 patients compared to 2019. Increased acuity was also demonstrated by an increase in the admission rate, with a 10.8 pp increase from 2019. Although there was an increased proportion of high-acuity patients, the overall census was decreased. CONCLUSION Our results demonstrate changing ED utilization patterns circa the shelter-in-place orders. Those from historically vulnerable populations such as Hispanics, those from lower socioeconomic areas, and Medicaid users presented at disproportionately lower rates and numbers than other groups. As the pandemic continues, hospitals should use operations data to monitor utilization patterns by demographic, in addition to clinical indicators. Messaging about availability of emergency care and other services should include vulnerable populations to avoid exacerbating healthcare disparities.
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Affiliation(s)
- Jason Lowe
- Stanford University School of Medicine, Department of Emergency Medicine, Palo Alto, California
| | - Ian Brown
- Stanford University School of Medicine, Department of Emergency Medicine, Palo Alto, California
| | - Ram Duriseti
- Stanford University School of Medicine, Department of Emergency Medicine, Palo Alto, California
| | - Moises Gallegos
- Stanford University School of Medicine, Department of Emergency Medicine, Palo Alto, California
| | - Ryan Ribeira
- Stanford University School of Medicine, Department of Emergency Medicine, Palo Alto, California
| | - Elizabeth Pirrotta
- Stanford University School of Medicine, Department of Emergency Medicine, Palo Alto, California
| | - N Ewen Wang
- Stanford University School of Medicine, Department of Emergency Medicine, Palo Alto, California
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Kruchevsky D, Arraf M, Levanon S, Capucha T, Ramon Y, Ullmann Y. Trends in Burn Injuries in Northern Israel During the COVID-19 Lockdown. J Burn Care Res 2021; 42:135-140. [PMID: 32914186 PMCID: PMC7499677 DOI: 10.1093/jbcr/iraa154] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Coronavirus disease 2019 obliged many countries to apply lockdown policies to contain the spread of infection. The restrictions in Israel included limitations on movement, reduction of working capacity, and closure of the educational system. The present study focused on patients treated at a referral center for burns in northern Israel. Their goal was to investigate temporal variations in burn injuries during this period. Data were retrospectively extracted from the medical records of burn patients treated at our hospital between March 14, 2020 and April 20, 2020 (ie, the period of aggravated lockdown). Data from this period were compared with that from paralleling periods between 2017 and 2019. During the lockdown and paralleling periods, 178 patients were treated for burn injuries, of whom 44% were under 18. Although no restrictions were enforced during the virus outbreak period with regard to seeking medical care, we noticed a decrease in the number of patients admitted to the emergency room for all reasons. Of particular interest was a 66% decrease in the number of adult burn patients (P < .0001). Meanwhile, among the pediatric population, no significant decrease was observed. Nonetheless, subgroups with higher susceptibility to burn injuries included children aged 2 to 5 years (56.3% vs 23.8%, P = .016) and female patients from all pediatric age groups (57.1% vs 25%, P = .027). These findings may be explained by the presumably busier kitchen and dining areas during the lockdown. Overall, the study results can assist with building a stronger understanding of varying burn injuries and with developing educational and preventive strategies.
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Affiliation(s)
- Dani Kruchevsky
- Plastic and Reconstructive Surgery Department, Rambam Health Care Campus, Haifa, Israel
| | - Maher Arraf
- Plastic and Reconstructive Surgery Department, Rambam Health Care Campus, Haifa, Israel
| | - Shir Levanon
- Rappaport Faculty of Medicine, Technion Institute, Haifa, Israel
| | - Tal Capucha
- Rappaport Faculty of Medicine, Technion Institute, Haifa, Israel
| | - Yitzchak Ramon
- Plastic and Reconstructive Surgery Department, Rambam Health Care Campus, Haifa, Israel
| | - Yehuda Ullmann
- Plastic and Reconstructive Surgery Department, Rambam Health Care Campus, Haifa, Israel
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11
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Ghada W, Estrella N, Pfoerringer D, Kanz KG, Bogner-Flatz V, Ankerst DP, Menzel A. Effects of weather, air pollution and Oktoberfest on ambulance-transported emergency department admissions in Munich, Germany. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 755:143772. [PMID: 33229084 DOI: 10.1016/j.scitotenv.2020.143772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/16/2020] [Accepted: 11/03/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Climate change and increasing risks of extreme weather events affect human health and lead to changes in the emergency department (ED) admissions and the emergency medical services (EMS) operations. For a better allocation of resources in the healthcare system, it is essential to predict ED numbers based on environmental variables. This publication aims to quantify weather, air pollution and calendar-related effects on daily ED admissions. METHODS Analyses were based on 575,725 admissions from the web-based IVENA system recording all patients in the greater Munich area with pre-hospital emergency care in ambulance operations during 2014-2018. Linear models were used to identify statistically significant associations between daily ED admissions and calendar, meteorological and pollution factors, allowing for lag effects of one to three days. Separate analyses were performed for seasons, with additional subset analyses by sex, age and surgical versus internal department. RESULTS ED admissions were exceptionally high during the three-week Oktoberfest, particularly for males and on the weekends, as well as during the New Year holiday. Admissions significantly increased during the years of study, decreased in spring and summer holidays, and were lower on Sundays while higher on Mondays. In the warmer seasons, admissions were significantly associated with higher temperature, adjusting for the effects of sunshine and humidity in all age groups except for the elderly. Adverse weather conditions in non-summer seasons were either linked to increasing ED admissions (from storms, gust) or decreasing them from rain. Mostly, but not exclusively, in winter, increasing ED admissions were associated with colder minimum temperatures as well as with higher NO and PM10 concentrations. CONCLUSIONS In addition to standard calendar-related factors, incorporating seasonal weather, air pollutant and interactions with patient demographics into resource planning models can improve the daily allocation of resources and staff of EMS operations at hospital and city levels.
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Affiliation(s)
- Wael Ghada
- TUM School of Life Sciences, Technical University of Munich, Freising, Germany.
| | - Nicole Estrella
- TUM School of Life Sciences, Technical University of Munich, Freising, Germany
| | - Dominik Pfoerringer
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Karl-Georg Kanz
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Emergency Medical Services Authority, Munich, Germany
| | - Viktoria Bogner-Flatz
- Emergency Medical Services Authority, Munich, Germany; Department of General, Trauma and Reconstructive Surgery, Ludwig Maximilians University Hospital Munich, Munich, Germany
| | - Donna P Ankerst
- TUM School of Life Sciences, Technical University of Munich, Freising, Germany; Department of Mathematics, Technical University of Munich, Garching, Germany
| | - Annette Menzel
- TUM School of Life Sciences, Technical University of Munich, Freising, Germany; Institute for Advanced Study, Technical University of Munich, Garching, Germany
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12
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Jabour AM. The Impact of Longer Consultation Time: A Simulation-Based Approach. Appl Clin Inform 2020; 11:857-864. [PMID: 33368059 DOI: 10.1055/s-0040-1721320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Maintaining a sufficient consultation length in primary health care (PHC) is a fundamental part of providing quality care that results in patient safety and satisfaction. Many facilities have limited capacity and increasing consultation time could result in a longer waiting time for patients and longer working hours for physicians. The use of simulation can be practical for quantifying the impact of workflow scenarios and guide the decision-making. OBJECTIVE To examine the impact of increasing consultation time on patient waiting time and physician working hours. METHODS Using discrete events simulation, we modeled the existing workflow and tested five different scenarios with a longer consultation time. In each scenario, we examined the impact of consultation time on patient waiting time, physician hours, and rate of staff utilization. RESULTS At baseline scenarios (5-minute consultation time), the average waiting time was 9.87 minutes and gradually increased to 89.93 minutes in scenario five (10 minutes consultation time). However, the impact of increasing consultation time on patients waiting time did not impact all patients evenly where patients who arrive later tend to wait longer. Scenarios with a longer consultation time were more sensitive to the patients' order of arrival than those with a shorter consultation time. CONCLUSION By using simulation, we assessed the impact of increasing the consultation time in a risk-free environment. The increase in patients waiting time was somewhat gradual, and patients who arrive later in the day are more likely to wait longer than those who arrive earlier in the day. Increasing consultation time was more sensitive to the patients' order of arrival than those with a shorter consultation time.
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Affiliation(s)
- Abdulrahman M Jabour
- Department of Health Informatics, Faculty of Public Health and Tropical Medicine at Jazan University, Jazan, Saudi Arabia
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Smith JY, Sow MM. Access To E-Prescriptions And Related Technologies Before And After Hurricanes Harvey, Irma, And Maria. Health Aff (Millwood) 2020; 38:205-211. [PMID: 30715984 DOI: 10.1377/hlthaff.2018.05247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hurricanes Harvey, Irma, and Maria devastated parts of the US mainland and Puerto Rico during the 2017 hurricane season, causing loss of life and substantial damage and interrupting access to health care for many people in the hurricane impact zones. Using data on e-prescriptions and medication history transactions from a large health information network for the period August 2017-May 2018, we examined providers' access to these technologies across affected areas. Although e-prescribing and medication history transactions decreased considerably during each hurricane, transaction volumes returned to normal levels in the days immediately following Hurricanes Harvey and Irma in Texas and Florida. E-prescribing activity in Puerto Rico did not return to baseline levels at all during the study period, and medication history transactions returned to normal only after an extended period following Hurricane Maria.
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Affiliation(s)
- Jaime Y Smith
- Jaime Y. Smith ( ) is the principal researcher and statistician for the Division of Business Intelligence at Surescripts in Arlington, Virginia
| | - Max M Sow
- Max M. Sow is vice president of the Division of Business Intelligence at Surescripts
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El-Masri M, Bornais J, Omar A, Crawley J. Predictors of Nonurgent Emergency Visits at a Midsize Community-Based Hospital System: Secondary Analysis of Administrative Health Care Data. J Emerg Nurs 2020; 46:478-487. [DOI: 10.1016/j.jen.2020.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/31/2020] [Accepted: 02/01/2020] [Indexed: 12/01/2022]
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Castner J, Jungquist CR, Mammen MJ, Pender JJ, Licata O, Sethi S. Prediction model development of women's daily asthma control using fitness tracker sleep disruption. Heart Lung 2020; 49:548-555. [PMID: 32089295 DOI: 10.1016/j.hrtlng.2020.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 01/12/2020] [Accepted: 01/22/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Night-time wakening with asthma symptoms is an important indicator of disease control and severity, with no gold-standard objective measurement. OBJECTIVE The study objective was to use fitness tracker sleep data to develop predictive models of daily disease control-related asthma-specific wakening and FEV1 in working-aged women with poorly controlled asthma. METHODS A repeated measures panel design included data from 43 women with poorly controlled asthma. Two components of asthma control were the primary outcomes, measured daily as (1) self-reported asthma-specific wakening and (2) self-administered spirometry to measure FEV1. Data were analyzed using generalized linear mixed models. RESULTS Our models demonstrated predictive value (AUC=0.77) for asthma-specific night-time wakening and good predictive value (AUC=0.83) for daily FEV1. CONCLUSIONS: Fitness tracker sleep efficiency and wake counts demonstrate clinical utility as predictive of asthma-specific night-time wakening and daily FEV1. Fitness tracker sleep data demonstrated predictive capability for daily asthma outcomes.
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Affiliation(s)
- Jessica Castner
- The Rockefeller Heilbrunn Family Center for Research Nursing Nurse Scholar, New York, NY, USA; University at Buffalo, Buffalo, NY, USA; Castner Incorporated, Grand Island, NY 14072, USA.
| | | | - Manoj J Mammen
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - John J Pender
- University at Buffalo School of Nursing Graduate, Buffalo, NY, USA
| | - Olivia Licata
- Department of Biomedical Engineering & Department of Materials Design and Innovation, University at Buffalo School of Engineering and Applied Sciences, Buffalo, NY, USA
| | - Sanjay Sethi
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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Duwalage KI, Burkett E, White G, Wong A, Thompson MH. Forecasting daily counts of patient presentations in Australian emergency departments using statistical models with time‐varying predictors. Emerg Med Australas 2020; 32:618-625. [DOI: 10.1111/1742-6723.13481] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Kalpani I Duwalage
- School of Mathematical Sciences, Queensland University of Technology Brisbane Queensland Australia
| | - Ellen Burkett
- Emergency DepartmentPrincess Alexandra Hospital Brisbane Queensland Australia
- Healthcare Improvement UnitClinical Excellence Queensland Brisbane Queensland Australia
| | - Gentry White
- School of Mathematical Sciences, Queensland University of Technology Brisbane Queensland Australia
| | - Andy Wong
- Emergency DepartmentPrincess Alexandra Hospital Brisbane Queensland Australia
| | - Mery H Thompson
- School of Mathematical Sciences, Queensland University of Technology Brisbane Queensland Australia
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Socioeconomic determinants of pediatric asthma emergency department visits under regional economic development in western New York. Soc Sci Med 2019; 222:133-144. [PMID: 30640031 DOI: 10.1016/j.socscimed.2019.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 09/19/2018] [Accepted: 01/02/2019] [Indexed: 12/26/2022]
Abstract
Although the links between asthma in children and physical environmental factors have been well established, the role of community-level socioeconomic status remains inconclusive. Consequently, little attention has been paid to the dynamic changes in the associations between socioeconomic status and asthma outcomes due to structural changes in the community, such as an influx of financial resources. This study examined the relationship between community-level socioeconomic status indicators and asthma-related emergency department utilization for school-aged children in 2011 and 2015, assessing the early impact of a large-scale regional economic development project in western New York, United States. Our analyses controlled for other community-level health risk factors, such as environmental exposure, and spatial correlation of the emergency department usage data. Results indicated that both median household income and health insurance coverage were key socioeconomic predictors of the children's asthma-related emergency department utilization over the study period. We also found that the risk of emergency department utilization for asthma decreased significantly in the area in which regional economic development projects were completed during the initial stage of the project. Through a comparison study we demonstrated that the spatial correlation present in asthma-related ED utilization improved model fit and corrected biases in the estimates. Although our findings suggest that improving the socioeconomic status of communities contributes to a reduction in emergency department utilization for pediatric asthma, more empirical studies are warranted for evaluating the comprehensive effects of regional economic development on public health.
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Yoo EH, Brown P, Eum Y. Ambient air quality and spatio-temporal patterns of cardiovascular emergency department visits. Int J Health Geogr 2018; 17:18. [PMID: 29884205 PMCID: PMC5994043 DOI: 10.1186/s12942-018-0138-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 06/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Air pollutants have been associated with various adverse health effects, including increased rates of hospital admissions and emergency room visits. Although numerous time-series studies and case-crossover studies have estimated associations between day-to-day variation in pollutant levels and mortality/morbidity records, studies on geographic variations in emergency department use and the spatial effects in their associations with air pollution exposure are rare. METHODS We focused on the elderly who visited emergency room for cardiovascular related disease (CVD) in 2011. Using spatially and temporally resolved multi-pollutant exposures, we investigated the effect of short-term exposures to ambient air pollution on emergency department utilization. We developed two statistical models with and without spatial random effects within a hierarchical Bayesian framework to capture the spatial heterogeneity and spatial autocorrelation remaining in emergency department utilization. RESULTS Although the cardiovascular effect of spatially homogeneous pollutants, such as PM2.5 and ozone, was unchanged, we found the cardiovascular effect of NO[Formula: see text] was pronounced after accounting for the spatially correlated structure in emergency department utilization. We also identified areas with high ED utilization for CVD among the elderly and assessed the uncertainty associated with risk estimates. CONCLUSIONS We assessed the short-term effect of multi-pollutants on cardiovascular risk of the elderly and demonstrated the use of community multiscale air quality model-derived spatially and temporally resolved multi-pollutant exposures to an epidemiological study. Our results indicate that NO[Formula: see text] was significantly associated with the elevated ED utilization for CVD among the elderly.
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Affiliation(s)
- Eun-Hye Yoo
- Department of Geography, University at Buffalo, Buffalo, NY, USA.
| | - Patrick Brown
- Department of Statistical Sciences, University of Toronto, Toronto, Canada
| | - Youngseob Eum
- Department of Geography, University at Buffalo, Buffalo, NY, USA
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Emergency Department Crowding and Time at the Bedside: A Wearable Technology Feasibility Study. J Emerg Nurs 2018; 44:624-631.e2. [PMID: 29704980 DOI: 10.1016/j.jen.2018.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/05/2018] [Accepted: 03/06/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION ED crowding is a public health crisis, limiting quality and access to lifesaving care. The purpose of this study was to (1) evaluate the feasibility of radio-frequency identification tags to measure clinician-patient contact and (2) to test the relationship between ED occupancy and clinician-patient contact time. METHODS In this 4-week observational study, radio-frequency identification tags were worn by emergency clinicians in a 21-bay urban teaching hospital emergency department. The time-motion data were merged with electronic medical repository patient information (N = 3,237) to adjust for occupancy, age, gender, and acuity. Qualitative themes were generated from focus group (N = 39) debriefings of the quantitative results. RESULTS Data were collected on 56,342 total clinician events. Adjusting for patient age, increasing ED occupancy increased the number of times the attending physician entered and left the patient room (b = 0 .008, 95% confidence interval [CI] = [0.001-0.016], P = 0.03). There was no relationship for patient gender, triage acuity, shift at arrival, disposition to home, or discharge diagnosis category with either total minutes or number of encounters per patient visit. No time-motion and occupancy associations were observed for nurses, residents, or nurse practitioners/physician assistants. Debriefings indicated occupancy influenced the quality of care, despite maintaining the same quantity of contact time. DISCUSSION The physical environment and clinician privacy concerns limit the feasibility of wearable tracking technology in the emergency setting. Attending physician care becomes more fragmented with increasing ED occupancy. Other clinicians report changes in the quality of care, whereas the quantity of time and encounters were unchanged with occupancy rates.
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Emergency Department Weekend Presentation and Mortality in Patients With Acute Myocardial Infarction. Nurs Res 2017; 66:20-27. [DOI: 10.1097/nnr.0000000000000196] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gautreaux K. Calendar Trends for ED Patients. J Emerg Nurs 2016; 42:471-472. [PMID: 27912805 DOI: 10.1016/j.jen.2016.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 08/05/2016] [Indexed: 10/20/2022]
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Castner J. Response to Gautreaux. J Emerg Nurs 2016; 42:472-473. [PMID: 27912806 DOI: 10.1016/j.jen.2016.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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