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2.
Epidemiol Health ; 42: e2020006, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32023775

RESUMEN

OBJECTIVES: The 2019 novel coronavirus (2019-nCoV) from Wuhan, China is currently recognized as a public health emergency of global concern. METHODS: We reviewed the currently available literature to provide up-to-date guidance on control measures to be implemented by public health authorities. RESULTS: Some of the epidemiological characteristics of 2019-nCoV have been identified. However, there remain considerable uncertainties, which should be considered when providing guidance to public health authorities on control measures. CONCLUSIONS: Additional studies incorporating more detailed information from confirmed cases would be valuable.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , China/epidemiología , Infecciones por Coronavirus/prevención & control , Urgencias Médicas , Salud Global , Humanos , Salud Pública
3.
Rev Med Liege ; 75(2): 83-88, 2020 Feb.
Artículo en Francés | MEDLINE | ID: mdl-32030931

RESUMEN

Facing the aging of primary care practitioners and their still increasing duties, we implemented a new and original solution to maintain the continuity of primary care in the area surrounding of our university hospital. Thereby, we created a new model of nurse telephone triage for the regulation of out-of-hours primary care calls, the SALOMON algorithm ("Système Algorithmique Liégeois d'Orientation pour la Médecine Omnipraticienne Nocturne"). Following the nurse telephone triage and the assessment of the illness severity, the patient is referred to four potential orientations : Emergency Medical Services (EMS), Emergency Department Referred Consultation (EDRC), Primary Care Physician Home visit (PCPH) and Primary Care Physician Delayed visit (PCPD). In this article, we aim to describe the SALOMON model and present a 12-month feasibility study in order to determine the safety of the tool. We can also notice nurse and general practitioner satisfaction about this approach with a positive impact on the global primary care out-of-hour organization. Currently, SALOMON seems to be full of promise. Further investigations on a larger cohort are needed to determine more precisely the reliability of the algorithm.


Asunto(s)
Servicio de Urgencia en Hospital , Atención Secundaria de Salud , Triaje , Urgencias Médicas , Humanos , Reproducibilidad de los Resultados , Teléfono
4.
5.
Am J Dent ; 33(1): 48-52, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32056416

RESUMEN

PURPOSE: Non-traumatic dental condition visits (NTDCs) represent about 1.4% to 2% of all Emergency Department (ED) visits and are limited to palliative care only, while associated with high cost of care. Feasibility of establishing a tele-dental approach to manage NTDCs in ED and Urgent care (UC) settings was undertaken to explore the possibility of utilizing remote tele-dental consults. METHODS: Participants with NTDCs in ED/UCs were examined extra and intra-orally: (1) directly by ED provider, (2) remotely by tele-dental examiner (trained dentist) using intra-oral camera and high-definition pan-tilt-zoom (PTZ) camera, (3) directly by treating dentist post ED/UC visit (if applicable) and, (4) secondary assessment by tele-dental reviewer. Comparisons were drawn between differential diagnoses and recommended managements provided by ED/UC providers, tele-dental examiner, treating dentist, and tele-dental reviewer. RESULTS: 13 patients participated in the study. The overall inter-rater agreement between the tele-dental examiner and tele-dental reviewer was high while it was low between tele-dentists and the ED providers. The preliminary testing of tele-dental intervention in the ED/UC setting demonstrated potential feasibility in addressing the NTDC landing in ED/UC. Larger interventional studies in multi-site setting are needed to validate this approach and especially evaluate impact on cost, ED/UC workflow and patient outcomes. CLINICAL SIGNIFICANCE: Using tele-dentistry to triage non-traumatic dental visits to the emergency room may be a promising approach. Once this approach is validated through a larger study, tele-dental outreach could help in directing non-traumatic dental emergency patients to the appropriate dental setting to provide treatment for the patients.


Asunto(s)
Enfermedades Estomatognáticas , Odontopatías , Atención Odontológica , Urgencias Médicas , Estudios de Factibilidad , Humanos
7.
Praxis (Bern 1994) ; 109(1): 35-41, 2020 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-31910762

RESUMEN

CME: Hypercalcemia Abstract. Hypercalcemia is defined as albumin-corrected calcium >2.6 mmol/l. Symptoms of hypercalcemia are mainly neurological-psychiatrical and cardiovascular. Severe symptomatic hypercalcemia is an emergency and requires an immediate therapy. At the same time, the underlying cause of hypercalcemia has to be identified and treated. Based on pathophysiology, hypercalcemia can be divided into four groups: parathyroid hormone dysfunction, disturbances of vitamin D metabolism, of bone metabolism or of renal calcium excretion. Medical history and specific laboratory diagnostics help to identify one of these groups and to make the correct final diagnosis.


Asunto(s)
Hipercalcemia , Calcio/metabolismo , Calcio en la Dieta , Urgencias Médicas , Humanos , Hipercalcemia/diagnóstico , Hipercalcemia/etiología , Hormona Paratiroidea
11.
Anaesthesia ; 75 Suppl 1: e83-e89, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31903571

RESUMEN

Standardised peri-operative care pathways for patients undergoing emergency laparotomy or laparoscopy for non-traumatic pathologies have been shown to be inadequate and associated with high morbidity and mortality. Recent research has highlighted this problem and showed that simple pathways with 'rescue' interventions have been associated with reduced mortality when implemented successfully. These rescue pathways have focused on early diagnosis and surgery, specialist surgeon and anaesthetist involvement, goal-directed therapy and intensive or intermediary postoperative care for high-risk patients. In elective surgery, enhanced recovery has resulted in reduced length of stay and morbidity by the application of procedure-specific, evidence-based interventions inside rigorously implemented patient pathways based on multidisciplinary co-operation. The focus has been on attenuation of peri-operative stress and pain management to facilitate early recovery. Patients undergoing emergency laparotomy are a heterogeneous group consisting mostly of patients with intestinal perforations and/or obstruction with varying levels of comorbidity and frailty. However, present knowledge of the different pathophysiology and peri-operative trajectory of complications in these patient groups is limited. In order to move beyond rescue pathways and to establish enhanced recovery for emergency laparotomy, it is essential that research on both the peri-operative pathophysiology of the different main patient groups - intestinal obstruction and perforation - and the potentially differentiated impact of interventions is carried out. Procedure- and pathology-specific knowledge is lacking on key elements of peri-operative care, such as: multimodal analgesia; haemodynamic optimisation and fluid management; attenuation of surgical stress; nutritional optimisation; facilitation of mobilisation; and the optimal use and organisation of specialised wards and improved interdisciplinary collaboration. As such, the future challenges in improving peri-operative patient care in emergency laparotomy are moving from simple rescue pathways to establish research that can form a basis for morbidity- and procedure-specific enhanced recovery protocols as seen in elective surgery.


Asunto(s)
Abdomen/cirugía , Laparoscopía/métodos , Complicaciones Posoperatorias/prevención & control , Recuperación de la Función , Urgencias Médicas , Fluidoterapia , Humanos , Modalidades de Fisioterapia
12.
Anaesthesia ; 75 Suppl 1: e75-e82, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31903572

RESUMEN

Patients undergoing emergency laparotomy are a heterogeneous group with regard to comorbidity, pre-operative physiological state and surgical pathology. There are many factors to consider in the peri-operative period for these patients. Surgical duration should be as short as possible for adequate completion of the procedure. This is of particular importance in the elderly and comorbid population. To date, there are limited data addressing the role of damage control surgery in emergency general surgery. Dual consultant-led care in all stages of emergency laparotomy care is increasing, with increased presence out of hours and also for high-risk patients. The role of the stoma care team should be actively encouraged in all patients who may require a stoma. Due to the emergent and unpredictable nature of surgical emergencies, healthcare teams may need to employ novel strategies to ensure early input from the stoma care team. It is important for all members of the medical teams to ensure that patients have given consent for both anaesthesia and surgery before emergency laparotomy. Small studies suggest that patients and their families are not aware of the high risk of morbidity and mortality following emergency laparotomy before operative intervention. Elderly patients should have early involvement from geriatric specialists and careful attention paid to assessment of frailty due to its association with mortality and morbidity. Additionally, the use of enhanced recovery programmes in emergency general surgery has been shown to have some impact in reducing length of stay in emergency surgical patients. However, the emergent nature of this surgery has been shown to be a detrimental factor in full implementation of enhanced recovery programmes. The use of a national database to collect data on patients undergoing emergency laparotomy and their processes of care has led to reduced mortality and length of stay in the UK. However, internationally, fewer data are available to draw conclusions.


Asunto(s)
Abdomen/cirugía , Laparoscopía/métodos , Atención Perioperativa/métodos , Complicaciones Posoperatorias/prevención & control , Urgencias Médicas , Humanos
14.
Eur J Dent Educ ; 24(1): 53-62, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31518475

RESUMEN

INTRODUCTION: In the United Kingdom, the General Dental Council requires newly graduated dentists to be competent in managing orthodontic emergencies. Undergraduate students typically receive limited exposure to orthodontics, with teaching primarily delivered via conventional lectures. Flipped teaching involves knowledge being acquired in students' own time, with class time focussing on construction of meaning. METHODS: A total of 61 undergraduate dental students were randomised into either a flipped or a conventional group. The conventional group (n = 30) attended a lecture describing the management of six common emergencies. The flipped group (n = 31) were given access to six videos via a virtual learning environment and later completed practical tasks related to the material. Both groups completed a single best answer assessment. Perceptions of flipped classroom teaching were explored via focus groups. RESULTS: For questions on orthodontic emergencies, the conventional group had a mean examination result of 70.5% (SD 8.0%) compared with the flipped group of 72.8% (SD 12.9%). There was no significant difference between the groups (P = .532). For regular orthodontic questions, the conventional group had a mean examination result of 64.8% (SD: 19.9%) compared with 78.3% (SD: 21.7%). There was no significant difference between the groups (P = .083). Thematic analysis identified the following themes: ways in which videos encourages more effective learning, improved engagement, awareness of learning needs and proposed teaching/curriculum changes. The overarching theoretical perspective was facilitating an experiential learning cycle using flipped classroom teaching. CONCLUSIONS: In the context of this investigation, the flipped classroom method of teaching resulted in comparable examination performance and improved levels of satisfaction.


Asunto(s)
Educación en Odontología , Urgencias Médicas , Aprendizaje Basado en Problemas , Curriculum , Educación en Odontología/métodos , Humanos , Aprendizaje , Enseñanza , Reino Unido
18.
Emerg Med Clin North Am ; 38(1): 103-124, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31757245

RESUMEN

Shoulder pain is a common presentation in the emergency department. The list of differential diagnoses is broad. This article summarizes common diagnoses of shoulder pain, including bony, infectious, and connective tissue pathologies and their proper treatment. It also reviews which shoulder pain conditions are emergency diagnoses and need immediate treatment and which diagnoses need conservative management and outpatient follow-up.


Asunto(s)
Articulación Acromioclavicular/lesiones , Clavícula/lesiones , Urgencias Médicas , Húmero/lesiones , Procedimientos Ortopédicos/métodos , Radiografía/métodos , Heridas y Traumatismos/diagnóstico , Articulación Acromioclavicular/diagnóstico por imagen , Clavícula/diagnóstico por imagen , Manejo de la Enfermedad , Humanos , Húmero/diagnóstico por imagen , Heridas y Traumatismos/terapia
19.
Emerg Med Clin North Am ; 38(1): 125-142, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31757246

RESUMEN

Traumatic injuries of the hip and pelvis are commonly encountered in the emergency department. This article equips all emergency medicine practitioners with the knowledge to expertly diagnose, treat, and disposition these patients. Pelvic fractures occurring in young patients tend to be associated with high-energy mechanisms and polytrauma. Pelvic and hip fractures in the elderly are often a result of benign trauma but are associated with significant morbidity and mortality.


Asunto(s)
Manejo de la Enfermedad , Urgencias Médicas , Fracturas Óseas/diagnóstico , Traumatismo Múltiple , Procedimientos Ortopédicos/métodos , Huesos Pélvicos/lesiones , Radiografía/métodos , Fracturas Óseas/terapia , Humanos , Huesos Pélvicos/diagnóstico por imagen
20.
Emerg Med Clin North Am ; 38(1): 143-165, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31757247

RESUMEN

Knee and leg injuries are extremely common presentations to the emergency department. Understanding the anatomy of the knee, particularly the vasculature and ligamentous structures, can help emergency physicians (EPs) diagnose and manage these injuries. Use of musculoskeletal ultrasonography can further aid EPs through the diagnostic process. Proper use of knee immobilizers can also improve long-term patient outcomes.


Asunto(s)
Manejo de la Enfermedad , Urgencias Médicas , Traumatismos de la Rodilla/diagnóstico , Articulación de la Rodilla/diagnóstico por imagen , Procedimientos Ortopédicos/métodos , Humanos , Traumatismos de la Rodilla/terapia , Traumatismos de la Pierna/diagnóstico , Traumatismos de la Pierna/terapia
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