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1.
J Korean Med Sci ; 37(7): e54, 2022 Feb 21.
Artículo en Inglés | MEDLINE | ID: mdl-35191231

RESUMEN

BACKGROUND: The code stroke system is designed to identify stroke patients who may benefit from reperfusion therapy. It is essential for emergency physicians to rapidly distinguish true strokes from stroke mimics to activate code stroke. This study aimed to investigate the clinical and neurological characteristics that can be used to differentiate between stroke and stroke mimics in the emergency department (ED). METHODS: We conducted a retrospective observational study of code stroke patients in the ED from January to December 2019. The baseline characteristics and the clinical and neurological features of stroke mimics were compared with those of strokes. RESULTS: A total of 409 code stroke patients presented to the ED, and 125 (31%) were diagnosed with stroke mimics. The common stroke mimics were seizures (21.7%), drug toxicity (12.0%), metabolic disorders (11.2%), brain tumors (8.8%), and peripheral vertigo (7.2%). The independent predictors of stroke mimics were psychiatric disorders, dizziness, altered mental status, and seizure-like movements, while current smoking, elevated systolic blood pressure, atrial fibrillation on the initial electrocardiogram, hemiparesis as a symptom, and facial palsy as a sign suggested a stroke. In addition, the likelihood of a stroke in code stroke patients tended to increase as the number of accompanying deficits increased from the following set of seven focal neurological deficits: hemiparesis (or upper limb monoparesis), unilateral limb sensory change, facial palsy, dysarthria, aphasia (or neglect), visual field defect, and oculomotor disorder (P < 0.001). CONCLUSION: Some clinical and neurological characteristics have been identified to help differentiate stroke mimics from true stroke. In particular, the likelihood of stroke tended to increase as the number of accompanying focal neurological deficits increased.


Asunto(s)
Accidente Cerebrovascular , Terapia Trombolítica , Diagnóstico Diferencial , Mareo/complicaciones , Mareo/etiología , Servicio de Urgencia en Hospital , Humanos , Estudios Retrospectivos , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/tratamiento farmacológico
2.
BMC Emerg Med ; 22(1): 75, 2022 05 06.
Artículo en Inglés | MEDLINE | ID: mdl-35524171

RESUMEN

BACKGROUND: We conducted a systematic review of studies published in peer-reviewed journals on HIV screening programs conducted in pediatric emergency departments (PEDs) in the United States (US) with the objective of describing the methods, testing yields and challenges in these programs. METHODS: We searched for full-text, English-language, original research articles focused on the conduct, development, initiation or implementation of any HIV screening program in a US PED through eight online databases (Pubmed (MEDLINE), Scopus, Embase, Cochrane, Web of Science, CINAHL, PsycInfo and Google Scholar) from their inception through July 2020. We also searched for articles on the websites of thirteen emergency medicine journals, 24 pediatric and adolescent health journals, and ten HIV research journals, and using the references of articles found through these searches. Data on HIV testing program components and yield of testing was extracted by one investigator independently and verified by a second investigator. Each program was summarized and critiqued. RESULTS: Of the eight articles that met inclusion criteria, most involved descriptions of their HIV testing program, except for one that was focused on quality improvement of their program. Five described an opt-in and three an opt-out approach to HIV screening. Programs differed greatly by type of HIV test utilized and who initiated or performed testing. There were large variations in the percentage of patients offered (4.0% to 96.7%) and accepting (42.7% to 86.7%) HIV testing, and HIV seropositivity in the studies ranged from 0 to 0.6%. Five of the eight studies reported an HIV seropositivity greater than 0.1%, above Centers for Disease Control and Prevention recommended threshold for testing in a healthcare setting. CONCLUSIONS: The studies illustrate opportunities to further optimize the integration of HIV screening programs within US PEDs and reduce barriers to testing, improve efficiency of testing results and increase effectiveness of programs to identify cases. Future research should focus on advancing the methodology of screening programs beyond feasibility studies as well as conducting investigations on their implementation and longer-term sustainability.


Asunto(s)
Seropositividad para VIH , Adolescente , Niño , Servicio de Urgencia en Hospital , Prueba de VIH , Humanos , Tamizaje Masivo/métodos , Mejoramiento de la Calidad , Estados Unidos
3.
BMC Emerg Med ; 22(1): 79, 2022 05 06.
Artículo en Inglés | MEDLINE | ID: mdl-35524195

RESUMEN

BACKGROUND: The number of ambulance assignments and the influx of patients to the emergency departments (EDs) in Sweden have increased in recent years. This is one reason the protocol for prehospital emergency care was developed around referring patients for non-conveyance, either through the see-and-convey elsewhere approach or through the see-and-treat approach. However, this protocol has led to challenges in patient assessments. This study aimed to investigate the underlying causes of patient harm among those referred for the see-and-treat approach by the emergency medical services. METHODS: This three-phase study involved a mixed-methods design. Cases of injuries, internal investigations and incident analyses of referrals for the see-and-treat approach in two regions in south eastern Sweden from 2015 to 2020 were examined using qualitative content analysis. This qualitative analysis was the basis for the quantitative analysis of the ambulance records. After the qualitative analysis was completed, a review protocol was developed; 34 variables were used to review 240 randomly selected ambulance records logged in 2020, wherein patients were referred for the see-and-treat approach. Finally, the review results were synthesised. RESULTS: The qualitative analysis revealed three common themes: 'assessment of patients', 'guidelines' and 'environment and organisation'. These results were confirmed by a medical journal review. Shortcomings were found in the anamnesis and in the number of targeted examinations performed. The checklist for referring patients for the see-and-treat approach and the information sheet to be provided to the patients were not used. In 34% of the ambulance records examined, the EMS clinicians deviated from the current guidelines for a see-and-treat referral. CONCLUSIONS: The results indicated that the low adherence to guidelines and the patient assessment deviating from the protocol put patients at risk of being harmed during a see-and-treat referral. Measures are needed to guarantee a safe assessment of an increasing number of patients who are referred for the see-and-treat approach, especially the multi-sick elderly patients.


Asunto(s)
Ambulancias , Servicios Médicos de Urgencia , Anciano , Servicio de Urgencia en Hospital , Humanos , Derivación y Consulta , Suecia
4.
BMC Health Serv Res ; 22(1): 626, 2022 May 10.
Artículo en Inglés | MEDLINE | ID: mdl-35538575

RESUMEN

BACKGROUND: Nursing home residents are at increased risk for hospital transfers resulting in emergency department visits, observation stays, and hospital admissions; transfers that can also result in adverse resident outcomes. Many nursing home to hospital transfers are potentially avoidable. Residents who experience repeat transfers are particularly vulnerable to adverse outcomes, yet characteristics of nursing home residents who experience repeat transfers are poorly understood. Understanding these characteristics more fully will help identify appropriate intervention efforts needed to reduce repeat transfers. METHODS: This is a mixed-methods study using hospital transfer data, collected between 2017 and 2019, from long-stay nursing home residents residing in 16 Midwestern nursing homes who transferred four or more times within a 12-month timeframe. Data were obtained from an acute care transfer tool used in the Missouri Quality Initiative containing closed- and open-ended questions regarding hospital transfers. The Missouri Quality Initiative was a Centers for Medicare and Medicaid demonstration project focused on reducing avoidable hospital transfers for long stay nursing home residents. The purpose of the analysis presented here is to describe characteristics of residents from that project who experienced repeat transfers including resident age, race, and code status. Clinical, resident/family, and organizational factors that influenced transfers were also described. RESULTS: Findings indicate that younger residents (less than 65 years of age), those who were full-code status, and those who were Black were statistically more likely to experience repeat transfers. Clinical complexity, resident/family requests to transfer, and lack of nursing home resources to manage complex clinical conditions underlie repeat transfers, many of which were considered potentially avoidable. CONCLUSIONS: Improved nursing home resources are needed to manage complex conditions in the NH and to help residents and families set realistic goals of care and plan for end of life thus reducing potentially avoidable transfers.


Asunto(s)
Medicare , Casas de Salud , Anciano , Servicio de Urgencia en Hospital , Hospitalización , Hospitales , Humanos , Transferencia de Pacientes , Estados Unidos
5.
BMJ Open ; 12(5): e056510, 2022 May 02.
Artículo en Inglés | MEDLINE | ID: mdl-35501078

RESUMEN

INTRODUCTION: Urolithiasis affects many people throughout their lives. Among the maternal population, although the morbidity of acute urolithiasis in pregnant women is unremarkable, it is the leading cause of hospitalisation during pregnancy. There is no effective clinical diagnostic tool to help doctors diagnose diseases. Our primary aim was to develop and validate a clinical prediction model based on statistical methods to predict the probability of having disease in pregnant women who visited the emergency department because of urolithiasis-induced colic. METHODS AND ANALYSIS: We will use multivariate logistic regression analysis to build a multivariate regression linear model. A receiver operating characteristic curve plot and calibration plot will be used to measure the discrimination value and calibration value of the model, respectively. We will also use least absolute shrinkage and selection operator regression analysis combined with logistic regression analysis to select predictors and construct the multivariate regression model. The model will be simplified to an application that has been reported before, and users will only need to enter their clinical parameters so that risk probability is automatically derived. ETHICS AND DISSEMINATION: The review and approval documents of the clinical research ethics committee have been received from the ethics committee of our hospital (The Third Affiliated Hospital of Wenzhou Medical University). We will disseminate research findings through presentations at scientific conferences and publication in peer-reviewed journals.


Asunto(s)
Cólico Renal , Urolitiasis , China/epidemiología , Servicio de Urgencia en Hospital , Femenino , Humanos , Masculino , Modelos Estadísticos , Embarazo , Mujeres Embarazadas , Pronóstico , Cólico Renal/diagnóstico , Cólico Renal/etiología , Estudios Retrospectivos , Urolitiasis/complicaciones , Urolitiasis/diagnóstico , Urolitiasis/epidemiología
7.
PLoS One ; 17(5): e0268123, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35536825

RESUMEN

Low back pain is a common presentation to emergency departments, but the reasons why people choose to attend the emergency department have not been explored. We aimed to fill this gap with this study to understand why persons with low back pain choose to attend the emergency department. Between July 4, 2017 and October 1, 2018, consecutive patients with a complaint of low back pain presenting to the University of Alberta Hospital emergency department were screened. Those enrolled completed a 13-item questionnaire to assess reasons and expectations related to their presentation. Demographics, acuity and disposition were obtained electronically. Factors associated with admission were examined in a logistic regression model. After screening 812 patients, 209 participants met the study criteria. The most common Canadian Triage and Acuity Scale score was 3 (73.2%). Overall, 37 (17.7%) received at least one consultation, 89.0% of participants were discharged home, 9.6% were admitted and 1.4% were transferred. Participants had a median pain intensity of 8/10 and a median daily functioning of 3/10. When asked, 64.6% attended for pain control while 44.5% stated ease of access. Most participants expected to obtain pain medication (67%) and advice (56%). Few attended because of cost savings (3.8%). After adjustment, only advanced age and ambulance arrival were significantly associated with admission. In conclusion, most low back pain patients came to the emergency department for pain control yet few were admitted and the majority did not receive a consultation. Timely alternatives for management of low back pain in the emergency department appear needed, yet are lacking.


Asunto(s)
Dolor de la Región Lumbar , Triaje , Canadá/epidemiología , Servicio de Urgencia en Hospital , Humanos , Dolor de la Región Lumbar/diagnóstico , Dolor de la Región Lumbar/epidemiología , Dolor de la Región Lumbar/terapia , Estudios Prospectivos
8.
PLoS One ; 17(5): e0266377, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35536834

RESUMEN

OBJECTIVE: To identify hospital and primary care health service use among people with mental health conditions or addictions in an integrated primary-secondary care database in Toronto, Ontario. METHOD: This was a retrospective cohort study of adults with mental health diagnoses using data from the Health Databank Collaborative (HDC), a primary care-hospital linked database in Toronto. Data were included up to March 31st 2019. Negative binomial and logistic regression were used to evaluate associations between health care utilization and various patient characteristics and mental health diagnoses. RESULTS: 28,482 patients age 18 or older were included. The adjusted odds of at least one mental health diagnosis were higher among younger patients (18-30 years vs. 81+years aOR = 1.87; 95% CI:1.68-2.08) and among female patients (aOR = 1.35; 95% CI: 1.27-1.42). Patients with one or more mental health diagnoses had higher adjusted rates of hospital visits compared to those without any mental health diagnosis including addiction (aRR = 1.74, 95% CI: 1.58-1.91) and anxiety (aRR = 1.28, 95% CI: 1.23-1.32). 14.5% of patients with a psychiatric diagnosis were referred to the hospital for specialized psychiatric services, and 38% of patients referred were eventually seen in consultation. The median wait time from the date of referral to the date of consultation was 133 days. CONCLUSIONS: In this community, individuals with mental health diagnoses accessed primary and hospital-based health care at greater rates than those without mental health diagnoses. Wait times for specialized psychiatric care were long and most patients who were referred did not have a consultation. Information about services for patients with mental health conditions can be used to plan and monitor more integrated care across sectors, and ultimately improve outcomes.


Asunto(s)
Trastornos Mentales , Salud Mental , Adolescente , Adulto , Servicio de Urgencia en Hospital , Femenino , Humanos , Masculino , Trastornos Mentales/epidemiología , Ontario/epidemiología , Estudios Retrospectivos
9.
S Afr Med J ; 112(5): 347-351, 2022 04 29.
Artículo en Inglés | MEDLINE | ID: mdl-35587248

RESUMEN

BACKGROUND: With 23.5 suicide-related deaths per 100 000 population, South Africa (SA) has the eighth-highest age-standardised suicide rate in the world. Intentional self-poisoning is associated with significant morbidity, mortality and cost. In SA, self-poisoning is the leading method of suicide in females and the second leading method in males. OBJECTIVES: To determine the profile of patients presenting with intentional self-poisoning to the Charlotte Maxeke Johannesburg Academic Hospital emergency department. METHODS: The study was a cross-sectional, retrospective audit of the medical records of patients who presented over a 12-month period with intentional self-poisoning. RESULTS: Of the 288 patients included, 62.8% were female, 62.1% were aged 18 - 30 years, 22.2% were foreign nationals, 88.9% were single, 62.8% were unemployed, 82.3% reported that the episode was precipitated by an acute stressful event, 5.6% required intensive care unit (ICU) admission, and 4.5% died prior to hospital discharge. Organophosphate/carbamate pesticide ingestion was the most common method of self-poisoning (25.3%) and was responsible for the majority of ICU admissions (81.3%), cases requiring hospitalisation for >6 days (56.5%) and deaths (69.2%). CONCLUSION: A large proportion of patients were female, 18 - 30 years of age, single, unemployed, and reported an acute stressful event as a precipitant. Organophosphate/carbamate pesticide ingestion was the most common method of self-poisoning and accounted for the majority of deaths and ICU admissions. Nationwide efforts should be aimed at enhancing awareness and implementing strategies to identify those at increased risk of suicidal behaviour.


Asunto(s)
Insecticidas , Plaguicidas , Envenenamiento , Carbamatos , Estudios Transversales , Servicio de Urgencia en Hospital , Femenino , Hospitales , Humanos , Masculino , Organofosfatos , Envenenamiento/epidemiología , Estudios Retrospectivos , Sudáfrica/epidemiología
10.
Vet Rec ; 190(10): 400, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-35593557
11.
Niger J Clin Pract ; 25(5): 636-640, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-35593606

RESUMEN

Background and Aim: Primary dysmenorrhea (PD) is a common presentation for emergency departments. This study investigates the diagnostic value of oxidative stress and ischemia markers in patients with PD. Materials and Methods: The participants were classified into the PD group (patients with PD) and the control group (healthy volunteers). Thiol/Disulfide Homeostasis (TDH) parameters (Ds, Disulfide; NT, Native Thiol; TT, Total Thiol) and serum ischemia modified albumin (IMA) levels of the groups were measured. The Numeric Rating Scale (NRS) was used for pain assessment. Bivariate correlation analysis was performed to test the relationship between NRS and oxidative stress parameters. A P < 0.05 was considered significant. Results: A total of 135 patients (PD group, n = 83; Control group, n = 52) were included in the study. PD group had statistically higher oxidant biomarkers (Ds level, Ds/NT ratio and Ds/TT ratio) and lower antioxidant biomarkers (NT/TT ratio) compared to the control group (p = 0.001; 0.003; 0.002, and 0.002, respectively). Serum IMA level in the PD group was higher than in the control group (P = 0.000). There was a positive correlation between IMA and NRS score (r = 0.342, P < 0.01), but no correlation was found between the other oxidative stress parameters and NRS. Conclusions: PD is characterized by increased oxidative stress and ischemia in the endometrium, which can be detected by TDH parameters and serum IMA. NRS score in PD patients is positively correlated with serum IMA level, which suggests IMA level can be valuable to determine the severity of endometrial ischemia and pain in patients with PD.


Asunto(s)
Dismenorrea , Albúmina Sérica , Biomarcadores , Disulfuros , Servicio de Urgencia en Hospital , Femenino , Humanos , Estrés Oxidativo , Compuestos de Sulfhidrilo
12.
Health Informatics J ; 28(2): 14604582221101538, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35593747

RESUMEN

Although many emergency hospital admissions may be unavoidable, a proportion of these admissions represent a failure of the care system. The adverse consequences of avoidable emergency hospital admissions affect patients, carers, care systems and substantially increase care costs. The aim of this study was to develop and validate a risk prediction model to estimate the individual probability of emergency admission in the next 12 months within a regional population. We deterministically linked routinely collected data from secondary care with population level data, resulting in a comprehensive research dataset of 190,466 individuals. The resulting risk prediction tool is based on a logistic regression model with five independent variables. The model indicated a discrimination of area under the receiver operating characteristic curve of 0.9384 (95% CI 0.9325-0.9443). We also experimented with different probability cut-off points for identifying high risk patients and found the model's overall prediction accuracy to be over 95% throughout. In summary, the internally validated model we developed can predict with high accuracy the individual risk of emergency admission to hospital within the next year. Its relative simplicity makes it easily implementable within a decision support tool to assist with the management of individual patients in the community.


Asunto(s)
Servicio de Urgencia en Hospital , Hospitalización , Hospitales , Humanos , Modelos Logísticos , Curva ROC , Estudios Retrospectivos
13.
Stud Health Technol Inform ; 291: 118-130, 2022 May 20.
Artículo en Inglés | MEDLINE | ID: mdl-35593761

RESUMEN

The prediction of the demography of Spain shows that Spain will experience an aging population soon. Aging is a condition of chronic disease resulting in overcrowding Emergency Department. Despite chronic diseases, Covid-19 became a serious issue for emergency Department staff and health care providers. All of these matters emphasized the importance of the Virtual Emergency Department which can provide faster and more affordable medical services while everyone can keep the social distance as much as possible. In this chapter, we investigated the role of IT in the healthcare system and the possible suggested solutions. We have studied the existing telemedicine, e-health, machine learning algorithms and in the end, their combination to built an integrated virtual emergency department to cover all the aspects. We have proposed a model for this integrated model and studied the possibility of success in each step including admission, triage, diagnoses, and clinical advice based on literature.


Asunto(s)
COVID-19 , Telemedicina , Anciano , Servicio de Urgencia en Hospital , Hospitalización , Humanos , Triaje
14.
JAMA Netw Open ; 5(5): e2213154, 2022 May 02.
Artículo en Inglés | MEDLINE | ID: mdl-35594046

RESUMEN

Importance: The emergency department (ED) discharge process often involves haste and poor communication. Objectives: To assess the association of an automated telephone call 2 days after ED discharge with the likelihood of an unplanned ED revisit at both 72 hours and 7 days after the index visit and with perceived care metrics measured at 14 days. Design, Setting, and Participants: This prospective nonrandomized clinical trial was conducted at a single academically affiliated county emergency department among 8110 patients presenting to and discharged from the ED during a 10-week period from June 25 to August 30, 2018. Initial statistical analysis was performed from February 1 to November 30, 2020, with additional analyses performed from March 1 to 16, 2022. Interventions: Participants were allocated in a nonrandom fashion to 1 of 2 groups: patients who received an automated telephone call 2 days after discharge were compared with patients who received no call 2 days after discharge. All patients received a telephone questionnaire at 14 days to assess secondary outcome measures. Main Outcomes and Measures: The primary outcome was a return visit to the ED at 7 days. Secondary outcomes included a return visit to the ED within 72 hours, a return visit to the ED within 7 days resulting in hospital admission, and patient-reported perceptions of their care measured by 4 questions related to quality metrics assessed at 14 days. A secondary analysis compared patients who actually responded to the initial call at 2 days with all nonresponders, regardless of whether they received a call. Analyses were made on an intention-to-treat basis. Results: More than 15 000 patients were seen in the ED during the 10-week study period, and 10 948 were discharged. A total of 8110 patient encounters (4460 male patients [55.0%]; 3313 Hispanic patients [40.9%]; mean [SD] age, 40.5 [19.4] years) were enrolled. A total of 2958 patients (36.5%) received an automated telephone call at 2 days after discharge, while 5152 (63.5%) received no call. Rates of ED return within 7 days of the initial index visit were significantly lower among those who received a call at 2 days than those who did not receive a call (224 of 2958 [7.6%] vs 533 of 5152 [10.3%]; P < .001). Patients who received a 2-day call were more likely than those who did not receive a call to have followed up with a health care clinician (67.9% [374 of 551] vs 66.3% [604 of 911]), understood their health issues (77.5% [490 of 632] vs 74.9% [780 of 1042]), and have received their discharge medications (87.0% [507 of 583] vs 83.6% [793 of 949]), although none of these differences between the 2 groups were statistically significant. Conclusions and Relevance: A telephone call to patients 2 days after discharge from the ED was associated with decreased ED use at 7 days after the index visit and may have been associated with marginal improvements in measured quality of care metrics.


Asunto(s)
Servicio de Urgencia en Hospital , Alta del Paciente , Adulto , Hospitalización , Humanos , Masculino , Estudios Prospectivos , Teléfono
18.
BMC Emerg Med ; 22(1): 88, 2022 May 20.
Artículo en Inglés | MEDLINE | ID: mdl-35596154

RESUMEN

BACKGROUND: Overcrowding in emergency departments (ED) is a critical problem worldwide, and streaming can alleviate crowding to improve patient flows. Among triage scales, patients labeled as "triage level 3" or "urgent" generally comprise the majority, but there is no uniform criterion for classifying low-severity patients in this diverse population. Our aim is to establish a machine learning model for prediction of low-severity patients with short discharge length of stay (DLOS) in ED. METHODS: This was a retrospective study in the ED of China Medical University Hospital (CMUH) and Asia University Hospital (AUH) in Taiwan. Adult patients (aged over 20 years) with Taiwan Triage Acuity Scale level 3 were enrolled between 2018 and 2019. We used available information during triage to establish a machine learning model that can predict low-severity patients with short DLOS. To achieve this goal, we trained five models-CatBoost, XGBoost, decision tree, random forest, and logistic regression-by using large ED visit data and examined their performance in internal and external validation. RESULTS: For internal validation in CMUH, 33,986 patients (75.9%) had a short DLOS (shorter than 4 h), and for external validation in AUH, there were 13,269 (82.7%) patients with short DLOS. The best prediction model was CatBoost in internal validation, and area under the receiver operating cha racteristic curve (AUC) was 0.755 (95% confidence interval (CI): 0.743-0.767). Under the same threshold, XGBoost yielded the best performance, with an AUC value of 0.761 (95% CI: 0.742- 0.765) in external validation. CONCLUSIONS: This is the first study to establish a machine learning model by applying triage information alone for prediction of short DLOS in ED with both internal and external validation. In future work, the models could be developed as an assisting tool in real-time triage to identify low-severity patients as fast track candidates.


Asunto(s)
Alta del Paciente , Triaje , Adulto , Anciano , Servicio de Urgencia en Hospital , Humanos , Tiempo de Internación , Aprendizaje Automático , Estudios Retrospectivos
19.
Br J Hosp Med (Lond) ; 83(4): 1-8, 2022 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-35506721

RESUMEN

Following dislocation of the glenohumeral joint with an isolated greater tuberosity fracture, closed reduction in the emergency department can lead to fracture propagation or iatrogenic fractures. This article assesses the evidence regarding when anterior dislocations of the shoulder with an isolated fracture of the greater tuberosity can be safely reduced in the emergency department, as there is currently no clear guidance on this. A total of eight articles described 172 cases which underwent closed reduction, which resulted in 22 cases of iatrogenic fractures. Female sex, increased patient age and fragments of the greater tuberosity were associated with an increased risk of iatrogenic fractures. Closed reduction in the emergency department appears to be a safe option in younger patients and those with greater tuberosity fractures less than 40% of the width of the humeral head.


Asunto(s)
Luxaciones Articulares , Luxación del Hombro , Fracturas del Hombro , Servicio de Urgencia en Hospital , Femenino , Humanos , Enfermedad Iatrogénica , Hombro , Luxación del Hombro/terapia , Fracturas del Hombro/terapia
20.
BMJ Open ; 12(5): e056466, 2022 May 04.
Artículo en Inglés | MEDLINE | ID: mdl-35508339

RESUMEN

OBJECTIVE: To study the impact of financial barriers to healthcare on health status, healthcare utilisation and costs among patients with cognitive impairment. DESIGN: Cross-sectional. SETTING: National Health Interview Survey (NHIS), 2011-2017. PARTICIPANTS: Patients with cognitive impairment aged 18 years or older. INTERVENTIONS: Financial barriers to healthcare were identified using a series of NHIS prompts asking about the affordability of healthcare services. PRIMARY OUTCOME MEASURES: Health status was based on a survey prompt about respondents' general health. Healthcare utilisation included office visits, home healthcare visits, hospital stays and emergency department (ED) visits. Economic burden was based on the family spending on medical care. Logistic regression models were used to examine the impact of financial barriers to healthcare access on health status, home healthcare visits, office visits, hospital stays and ED visits, respectively. RESULTS: Compared with cognitively impaired respondents without financial barriers to healthcare access, those with financial barriers were more likely to be unhealthy (OR 0.64, 95% CI 0.57 to 0.72). Cognitively impaired respondents with financial barriers were less likely to have home healthcare (OR 0.69, 95% CI 0.48 to 0.99) and more likely to have hospital stays (OR 1.33, 95% CI 1.19 to 1.48) and ED visits (OR 1.50, 95% CI 1.35 to 1.67). In addition, compared with cognitively impaired respondents without financial barriers to healthcare access, those with the barriers were more likely to have an increased economic burden (OR=1.85, 95% CI 1.65 to 2.07). CONCLUSION: Financial barriers to healthcare worsened health status and increased use of ED, hospitalisation and economic burden. Policy decision-makers, providers and individuals with cognitive impairment should be aware of the impact of financial barriers and take corresponding actions to reduce the impact.


Asunto(s)
Disfunción Cognitiva , Estrés Financiero , Disfunción Cognitiva/terapia , Estudios Transversales , Servicio de Urgencia en Hospital , Accesibilidad a los Servicios de Salud , Estado de Salud , Humanos , Aceptación de la Atención de Salud
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