RESUMO
Accurate prediction of the likelihood of same-day discharge could make it possible to direct one-third of the medical in-take to an ambulatory care unit, thereby facilitating bed management. In Phase 1 of this study, we identified seven independent factors that contribute to an ambulatory care score (Amb score) that can potentially be used as a tool to select ambulatory emergency care (AEC) patients from the medical emergency in-take. A high score was associated with discharge within 12 hours of assessment and treatment in hospital. In Phase 2, we verified and internally validated the performance of the Amb score in a different cohort of patients, finding that it functioned well in identifying early discharges (ie AEC patients), with an area under the receiver operator curve (AUROC) of 0.91 (95% CI 0.88-0.94). An Amb score of > or = 5 has a sensitivity of 96% (95% CI 90-98) and a specificity of 62% (95% CI 55-68) in identifying potential AEC patients.
Assuntos
Assistência Ambulatorial , Serviço Hospitalar de Emergência , Seleção de Pacientes , Triagem/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/economia , Área Sob a Curva , Atenção à Saúde/métodos , Serviço Hospitalar de Emergência/economia , Feminino , Indicadores Básicos de Saúde , Humanos , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Admissão do Paciente , Alta do Paciente , Estudos Prospectivos , Curva ROC , Medição de Risco/métodosRESUMO
OBJECTIVE: To report improvement of azoospermia and hypogonadism after high-dose corticosteroid therapy in a patient with testicular sarcoidosis. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 27-year-old man with testicular sarcoidosis and azoospermia. INTERVENTION(S): High-dose corticosteroid therapy was commenced in an attempt to improve sperm count and restore gonadal function. MAIN OUTCOME MEASURE(S): Analysis of sperm count, T, and gonadotropin response to steroid therapy. RESULT(S): FSH and LH concentrations decreased and T levels increased in parallel with control of disease activity with steroid therapy. Repeat semen analysis demonstrated a significant increase in sperm count, allowing sperm banking to take place. CONCLUSION(S): High-dose corticosteroid therapy may be indicated in testicular sarcoidosis, not only for control of systemic disease activity but also for recovery of gonadal function and spermatogenesis.
Assuntos
Corticosteroides/uso terapêutico , Oligospermia/etiologia , Sarcoidose/complicações , Sarcoidose/tratamento farmacológico , Doenças Testiculares/complicações , Doenças Testiculares/tratamento farmacológico , Corticosteroides/administração & dosagem , Adulto , Relação Dose-Resposta a Droga , Hormônio Foliculoestimulante/sangue , Humanos , Hormônio Luteinizante/sangue , Masculino , Sarcoidose/sangue , Sarcoidose/fisiopatologia , Contagem de Espermatozoides , Espermatogênese/efeitos dos fármacos , Doenças Testiculares/sangue , Doenças Testiculares/fisiopatologiaRESUMO
The ECG is a test that is used frequently in the acute setting. It has a significant impact on decisions regarding patient discharge and further investigations. On a single day in the ambulatory emergency care setting two patients presented with chest pain. The ECG findings were abnormal, but also out of context with the clinical findings. On close inspection of the ECG machine it was identified that although all leads attached to the patient were in the correct position, the two cables connecting the leads to the machine had been reversed. Had the error not been discovered promptly there was the potential that further, more harmful investigations would have been performed. These cases highlight that although the ECG is a simple and non-invasive investigation it should be an adjunct to clinical working diagnosis.