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1.
PLoS One ; 19(6): e0304865, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38848410

RESUMEN

People experiencing homelessness are more likely to utilize emergency departments than their non-homeless counterparts. However, obtaining a bed in a homeless shelter for patients can be complex. To better understand the challenges of finding a safe discharge plan for homeless patients in the emergency department, our team conducted interviews with emergency department social workers and homeless shelter case managers in the Boston area. We identified and mapped the stages in the processes performed by both parties, identifying challenges with successful placement into a shelter. Furthermore, we assembled a data dictionary of key factors considered when assessing a patient's fit for a homeless shelter. By identifying bottlenecks and areas of opportunity, this study serves as a first step in enabling homeless individuals to receive the post-discharge assistance they require.


Asunto(s)
Servicio de Urgencia en Hospital , Personas con Mala Vivienda , Alta del Paciente , Investigación Cualitativa , Humanos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Boston , Masculino , Femenino , Trabajadores Sociales/psicología , Adulto
2.
West J Emerg Med ; 24(5): 888-893, 2023 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-37788029

RESUMEN

Introduction: Black and Hispanic patients are frequently assigned lower acuity triage scores than White patients. This can lead to longer wait times, less aggressive care, and worse outcomes. In this study we aimed to determine whether these effects are more pronounced for patients with subjective complaints. Methods: We performed a retrospective analysis for all adult visits between 2016-2019 at an urban academic emergency department (ED) with acuity-based pods. We determined rates of initial high-acuity triage both across all patients and among the subset located in the high-acuity pod at time of disposition (either through initial assignment or subsequent up-triage). Analysis was performed for common chief complaints categorized as subjective (chest pain, dyspnea, any pain); observed (altered mental status); numeric (fever, hypotension); or protocolized (stroke, ST-elevation myocardial infarction). We constructed logistic regression models to control for age, race, gender, method of arrival, and final disposition. Results: We analyzed 297,355 adult ED visits. Black and Hispanic patients were less likely to be triaged to high-acuity beds (adjusted odds ratio [aOR] 0.76, 95% confidence interval [CI] 0.73-0.79 for Black, and aOR 0.87, 95% CI 0.84-0.90 for Hispanic patients). This effect was more pronounced for those with subjective chief complaints, including chest pain (aOR 0.76, 95% CI 0.73-0.79 for Black and 0.88, 95% CI 0.78-0.99 for Hispanic patients), dyspnea (aOR 0.79, 95% CI 0.68-0.92 and 0.8, 95% CI 0.72-0.99), and any pain (aOR 0.83, 95% CI 0.75-0.92 and 0.89, 95% CI 0.82-0.97, respectively). Among patients in the high-acuity pod at time of disposition, Black and Hispanic patients were disproportionately triaged to lower acuity pods on arrival (aOR 1.47, 95% CI 1.33-1.63 for Black and aOR 1.27, 95% CI 1.15-1.40 for Hispanic adults), with significant differences observed only for subjective chief complaints. No differences were observed for observed, objective, or protocolized complaints in either analysis. Conclusion: Black and Hispanic adults, including those who ultimately required high-acuity resources, were disproportionately triaged to lower acuity pods. This effect was more pronounced for patients with subjective chief complaints. Additional work is needed to identify and overcome potential bias in the assessment of patients with subjective chief complaints in ED triage.


Asunto(s)
Dolor en el Pecho , Triaje , Adulto , Humanos , Estudios Retrospectivos , Factores Raciales , Dolor en el Pecho/diagnóstico , Servicio de Urgencia en Hospital , Disnea/diagnóstico
4.
Acad Emerg Med ; 28(9): 957-965, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34533261

RESUMEN

BACKGROUND: Research regarding disparities in physical restraint use in the emergency department (ED) is limited. We evaluated the role of race, ethnicity, and preferred language on the application of physical restraint among ED patients held under a Massachusetts section 12(a) order for mandatory psychiatric evaluation. METHODS: We identified all ED patient encounters with a section 12(a) order across a large integrated 11-hospital health system from January 2018 through December 2019. Information on age, race, ethnicity, preferred language, insurance, mental illness, substance use, history of homelessness, and in-network primary care provider was obtained from the electronic health record. We evaluated for differences in physical restraint use between subgroups via a mixed-effect logistic regression with random-intercept model. RESULTS: We identified 32,054 encounters involving a section 12(a) order. Physical restraints were used in 2,458 (7.7%) encounters. Factors associated with physical restraint included male sex (adjusted odds ratio [aOR] = 1.44, 95% confidence interval [CI] = 1.28 to 1.63), Black/African American race (aOR = 1.22, 95% CI = 1.01 to 1.48), Hispanic ethnicity (aOR = 1.45, 95% CI = 1.22 to 1.73), Medicaid insurance (aOR = 1.21, 95% CI = 1.05 to 1.39), and a diagnosis of bipolar disorder or psychotic disorder (aOR = 1.51, 95% CI = 1.31 to 1.74). Across all age groups, patients who were 25 to 34 years of age were at highest risk of restraint (aOR = 2.01, 95% CI = 1.69 to 2.39). Patients with a primary care provider within our network (aOR = 0.81, 95% CI = 0.72 to 0.92) were at lower risk of restraint. No associations were found between restraint use and language, history of alcohol or substance use, or homelessness. CONCLUSION: Black/African American and Hispanic patients under an involuntary mandatory emergency psychiatric evaluation hold order experience higher rates of physical restraint in the ED. Factors contributing to racial disparities in the use of physical restraint, including the potential role of structural racism and other forms of bias, merits further investigation.


Asunto(s)
Etnicidad , Restricción Física , Adulto , Servicio de Urgencia en Hospital , Femenino , Disparidades en Atención de Salud , Hispánicos o Latinos , Humanos , Masculino , Estados Unidos
5.
Plast Reconstr Surg ; 140(5): 920-929, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-29068926

RESUMEN

Despite the growth of technically more sophisticated skin resurfacing modalities, such as those based on light, radiofrequency, and ultrasound, chemical peel procedures have risen 5 to 25 percent over the past year alone. Chemexfoliation carries historical significance and has markedly evolved since its inception in ancient times. As a result of plastic surgery and dermatologic advancements, modern-day chemexfoliation offers plastic surgeons additional safe and effective options for patients with rhytides, dyschromias, and other signs of light- and environment-induced skin damage. This review discusses the historical evolution of chemexfoliation procedures, highlights modern-day practice habits, and touches on the clinically relevant applications of chemical peels.


Asunto(s)
Quimioexfoliación/historia , Quimioexfoliación/efectos adversos , Quimioexfoliación/métodos , Quimioexfoliación/tendencias , Europa (Continente) , Historia del Siglo XVI , Historia del Siglo XIX , Historia del Siglo XX , Historia del Siglo XXI , Historia Antigua , Humanos , Rejuvenecimiento , Estados Unidos
6.
Yale J Biol Med ; 88(4): 383-8, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-26604862

RESUMEN

Castleman disease (CD) is a rare and heterogeneous disorder characterized by lymphadenopathy that may occur in a single lymph node (unicentric) or multiple lymph nodes (multicentric), the latter typically occurring secondary to excessive proinflammatory hypercytokinemia. While a cohort of multicentric Castleman disease (MCD) cases are caused by Human Herpes Virus-8 (HHV-8), the etiology of HHV-8 negative, idiopathic MCD (iMCD), remains unknown. Breakthroughs in "omics" technologies that have facilitated the development of precision medicine hold promise for elucidating disease pathogenesis and identifying novel therapies for iMCD. However, in order to leverage precision medicine approaches in rare diseases like CD, stakeholders need to overcome several challenges. To address these challenges, the Castleman Disease Collaborative Network (CDCN) was founded in 2012. In the past 3 years, the CDCN has worked to transform the understanding of the pathogenesis of CD, funded and initiated genomics and proteomics research, and united international experts in a collaborative effort to accelerate progress for CD patients. The CDCN's collaborative structure leverages the tools of precision medicine and serves as a model for both scientific discovery and advancing patient care.


Asunto(s)
Investigación Biomédica/métodos , Enfermedad de Castleman/diagnóstico , Medicina de Precisión/métodos , Enfermedad de Castleman/etiología , Enfermedad de Castleman/terapia , Conducta Cooperativa , Humanos , Enfermedades Raras/diagnóstico , Enfermedades Raras/etiología , Enfermedades Raras/terapia , Investigación
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