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1.
Ann Emerg Med ; 82(3): e97-e105, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37596031

RESUMO

Mental and behavioral health (MBH) emergencies in children and youth continue to increasingly affect not only the emergency department (ED), but the entire spectrum of emergency medical services for children, from prehospital services to the community. Inadequate community and institutional infrastructure to care for children and youth with MBH conditions makes the ED an essential part of the health care safety net for these patients. As a result, an increasing number of children and youth are referred to the ED for evaluation of a broad spectrum of MBH emergencies, from depression and suicidality to disruptive and aggressive behavior. However, challenges in providing optimal care to these patients include lack of personnel, capacity, and infrastructure, challenges with timely access to a mental health professional, the nature of a busy ED environment, and paucity of outpatient post-ED discharge resources. These factors contribute to prolonged ED stays and boarding, which negatively affects patient care and ED operations. Strategies to improve care for MBH emergencies, including systems level coordination of care, is therefore essential. The goal of this policy statement and its companion technical report is to highlight strategies, resources, and recommendations for improving emergency care delivery for pediatric MBH.


Assuntos
Transtornos do Comportamento Infantil , Emergências , Transtornos Mentais , Humanos , Masculino , Feminino , Criança , Adolescente , Transtornos Mentais/terapia , Serviços Médicos de Emergência , Transtornos do Comportamento Infantil/terapia , Pessoal de Saúde , Serviços de Saúde Mental
2.
Dermatol Online J ; 22(7)2016 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-27617732

RESUMO

The current outbreak of Zika virus is a growing public health concern, especially for pregnant women. Zika virus infection may manifest as a maculopapular skin eruption that progresses rostrocaudally, with or without hemorrhagic manifestations such as petechiae and gingival bleeding. Recognizing the cutaneous findings associated with Zika virus may aid in early diagnosis, particularly in individuals at increased risk for the disease.


Assuntos
Toxidermias/etiologia , Prurido/etiologia , Púrpura/etiologia , Infecção por Zika virus/complicações , Surtos de Doenças , Diagnóstico Precoce , Humanos , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/epidemiologia
3.
J Am Coll Emerg Physicians Open ; 3(2): e12664, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35310402

RESUMO

Pediatric pain is challenging to assess and manage. Frequently underestimated in children, untreated pain may have consequences including increased fear, anxiety, and psychological issues. With the current opioid crisis, emergency physicians must be knowledgeable in both pharmacologic and non-pharmacologic approaches to address pain and anxiety in children that lead to enhanced patient cooperation and family satisfaction. This document focuses pain management and distress mitigation strategies for the brief diagnostic and therapeutic procedures commonly performed.

4.
J Am Coll Emerg Physicians Open ; 2(4): e12512, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34322681

RESUMO

The opioid crisis has greatly affected not only adults but also children as well. As clinicians develop effective approaches to minimize pain and distress in children, the risks and benefits of opioids must be carefully considered. Children of parents with opioid use disorder are also at risk of living in unstable environments, performing poorly academically, engaging in future drug use, and having increased stress, which affects their development before entering adulthood. This statement focuses on the effects of the opioid crisis on children and adolescents and is intended to inform institutional policies, improve education, advocate for evidence-informed guidelines, and improve the care of children affected by the opioid epidemic who are seen in the emergency department.

5.
Cutis ; 99(2): E25-E29, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28319637

RESUMO

Mohs micrographic surgery (MMS) is the gold standard for treating high-risk skin cancers and skin cancers in areas where skin sparing is essential. However, relatively little is known about patient-reported satisfaction with this procedure. In this study, we used qualitative research methods to determine themes of patient-reported satisfaction and dissatisfaction with MMS on one popular online resource (RealSelf). Real-world patient feedback provides an opportunity for physicians to explore the patient mind-set and to target areas of potential improvement in MMS patient satisfaction.


Assuntos
Cirurgia de Mohs/métodos , Satisfação do Paciente , Neoplasias Cutâneas/cirurgia , Feminino , Humanos , Internet , Masculino
6.
Psoriasis (Auckl) ; 6: 93-104, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28856115

RESUMO

Erythrodermic psoriasis (EP) is a rare and severe variant of psoriasis vulgaris, with an estimated prevalence of 1%-2.25% among psoriatic patients. The condition presents with distinct histopathologic and clinical findings, which include a generalized inflammatory erythema involving at least 75% of the body surface area. The pathogenesis of EP is not well understood; however, several studies suggest that the disease is associated with a predominantly T helper 2 (Th2) phenotype. Given the morbidity and potential mortality associated with the condition, there is a need for a better understanding of its pathophysiology. The management of EP begins with a comprehensive assessment of the patient's presentation and often requires multidisciplinary supportive measures. In 2010, the medical board of the US National Psoriasis Foundation published consensus guidelines advocating the use of cyclosporine or infliximab as first-line therapy in unstable cases, with acitretin and methotrexate reserved for more stable cases. Since the time of that publication, additional information regarding the efficacy of newer agents has emerged. We review the latest data with regard to the treatment of EP, which includes biologic therapies such as ustekinumab and ixekizumab.

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