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1.
BMC Gastroenterol ; 21(1): 250, 2021 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-34092231

RESUMO

BACKGROUND: Few studies have reported whether a biopsy in emergency gastroscopy (EG) increased the risk of rebleeding in patients with Forrest I acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) combined with suspected malignant gastric ulcer (SMGU). This study aims to conduct a multicenter retrospective cohort study using propensity score matching to verify whether a biopsy in EG increases the risk of rebleeding in patients diagnosed with Forrest I ANVUGIB combined with SMGU. METHODS: Using the data for propensity-matched patients, logistic regression models were fitted using rebleeding as the dependent variable. Survival time was defined as the length of time the patient experienced from visiting the emergency department to rebleeding. We used the Kaplan-Meier (KM) method to analyze the 30-day survival of the patients with and without a biopsy after matching, and the log-rank test was performed to examine the differences in survival. RESULTS: With the use of propensity score matching, 308 patients who underwent a biopsy in EG were matched with 308 patients who did not. In the five logistic regression models, there were no significant group differences in the risk of rebleeding in patients with Forrest I ANVUGIB combined with SMGU between the biopsy and no-biopsy groups. The probability of survival was not significantly different between the no-biopsy and biopsy groups. CONCLUSIONS: In this multicenter, retrospective propensity score matching cohort study, compared with patients without a biopsy, patients with a biopsy during EG had no increased risk of rebleeding, and there was no significant difference in the rate of rebleeding.


Assuntos
Úlcera Gástrica , Biópsia , Estudos de Coortes , Serviço Hospitalar de Emergência , Hemorragia Gastrointestinal/etiologia , Gastroscopia , Humanos , Recidiva , Estudos Retrospectivos , Úlcera Gástrica/complicações
2.
Wiad Lek ; 74(5): 1222-1228, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34090295

RESUMO

OBJECTIVE: The aim: Conducting a comprehensive analysis on ensuring the mechanism of state regulation of the development of medical emergency response as an element of the civil protection system of Ukraine in the context of dynamic changes of external and internal factors of its functioning. PATIENTS AND METHODS: Materials and methods: The data of the state statistical reporting for the period 2010-2019 and the legislative acts of Ukraine on medical emergency response were used as the materials of study. Bibiliosemantic and statistical method and the method of structural-and-logical analysis were applied in the course of study. CONCLUSION: Conclusions: The sustainable socio-economic development of Ukraine should be accompanied by the formation of a safe environment for the society and each individual, guaranteeing an acceptable level of risk and a modern security system based on the principles of international law. The high degree of the Ukrainian industry concentration is currently in a conflict with the low technological discipline of production, which creates objective preconditions for the growth of man-made and technologically-environmental disasters, catastrophes, and other emergencies. Outbreaks of particularly dangerous and infectious diseases, which are of concern not only because of their prevalence but also because of the potential danger to the health of the nation, its economy and international reputation of the state can pose a significant threat to the socio-political and socioeconomic stability of the state. Ukraine is a potentially vulnerable area for epidemics due to a number of natural, geographical and geopolitical factors. Therefore, the health consequences (real and potential) of any emergency are certainly a threat to the national security of Ukraine both directly and due to the extremely negative impact on the socio-economic, socio-political and psychological conditions of the population. Increasing the level of public administration for medical emergency response will increase the effectiveness of emergency response measures.


Assuntos
Desastres , Emergências , Serviço Hospitalar de Emergência , Humanos , Direito Internacional , Ucrânia
3.
Viruses ; 13(6)2021 05 26.
Artigo em Inglês | MEDLINE | ID: mdl-34073414

RESUMO

Over two years (2012-2014), 719 nasopharyngeal samples were collected from 6-week- to 12-month-old infants presenting at the emergency department with moderate to severe acute bronchiolitis. Viral testing was performed, and we found that 98% of samples were positive, including 90% for respiratory syncytial virus, 34% for human rhino virus, and 55% for viral co-detections, with a predominance of RSV/HRV co-infections (30%). Interestingly, we found that the risk of being infected by HRV is higher in the absence of RSV, suggesting interferences or exclusion mechanisms between these two viruses. Conversely, coronavirus infection had no impact on the likelihood of co-infection involving HRV and RSV. Bronchiolitis is the leading cause of hospitalizations in infants before 12 months of age, and many questions about its role in later chronic respiratory diseases (asthma and chronic obstructive pulmonary disease) exist. The role of virus detection and the burden of viral codetections need to be further explored, in order to understand the physiopathology of chronic respiratory diseases, a major public health issue.


Assuntos
Bronquiolite Viral/virologia , Coinfecção/virologia , Bronquiolite Viral/epidemiologia , Coinfecção/epidemiologia , Serviço Hospitalar de Emergência , França/epidemiologia , Humanos , Lactente , Reação em Cadeia da Polimerase Multiplex , Nasofaringe/virologia , Vírus Sincicial Respiratório Humano/classificação , Vírus Sincicial Respiratório Humano/genética , Vírus Sincicial Respiratório Humano/isolamento & purificação , Vírus/classificação , Vírus/genética , Vírus/isolamento & purificação
4.
Am J Case Rep ; 22: e931532, 2021 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-34103465

RESUMO

BACKGROUND The World Health Organization has set clear guidelines for the management of snakebite envenomation. However, challenges have been reported in the clinical application of guidelines, such as identification of the biting snake, hypersensitivity reactions to the antivenom, and influence of repeated antivenom administration during hospital stay. This report aims to discuss how these challenges can affect patient management and to highlight improvement opportunities. CASE REPORT An 18-year-old man presented to the Emergency Department without remarkable signs of envenomation following a snakebite. An initial dose of antivenom was given despite the misidentification of snake species. An allergic reaction developed and was successfully managed. Following admission, the coagulation profile and local tissue reaction worsened. Upon consulting the Drug and Poison Information Center, it was discovered that a subtherapeutic dose of antivenom was administered. The patient was rechallenged after the administration of premedication. Coagulation profile could not be maintained; therefore, 2 extra doses of antivenom were administered, resulting in sustained improvement in local tissue reaction and coagulation profile. CONCLUSIONS First, victims presenting without signs and symptoms of envenomation may benefit from close monitoring for late presentation of envenomation signs. Second, dosing guidelines are suggested to consider Institute of Safe Medication Practices recommendations for order sets to reduce the possibility of medication errors. Third, premedication may be an effective alternative in patients who develop allergic reaction to the locally produced equine antivenom in the setting of absent goat-derived antivenom. Lastly, antivenom administration should be titrated to patient response even if it occurs over several days.


Assuntos
Mordeduras de Serpentes , Adulto , Animais , Antivenenos/uso terapêutico , Serviço Hospitalar de Emergência , Cavalos , Humanos , Tempo de Internação , Mordeduras de Serpentes/complicações , Mordeduras de Serpentes/terapia , Centros de Atenção Terciária
5.
BMJ Open ; 11(6): e041024, 2021 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-34135028

RESUMO

OBJECTIVE: To compare the daily practice of two emergency departments (ED) in the Netherlands, where systemic inflammatory response syndrome (SIRS) criteria and quick Sequential Organ Failure Assessment (qSOFA) score are used differently as screening tools for culture-positive sepsis. DESIGN: A prospective cross-sectional multicentre study. SETTING: Two EDs at two European clinical teaching hospitals in the Netherlands. PARTICIPANTS: 760 patients with suspected infection who met SIRS criteria or had a qualifying qSOFA score who were treated at two EDs in the Netherlands from 1 January to 1 March 2018 were included. METHODS: SIRS criteria and qSOFA score were calculated for each patient. The first hospital treated the patients who met SIRS criteria following the worldwide Surviving Sepsis Campaign protocol. At the second hospital, only patients who met the qualifying qSOFA score received this treatment. Therefore, patients could be divided into five groups: (1) SIRS+, qSOFA-, not treated according to protocol (reference group); (2) SIRS+, qSOFA-, treated according to protocol; (3) SIRS+, qSOFA+, treated according to protocol; (4) SIRS-, qSOFA+, not treated according to protocol; (5) SIRS-, qSOFA+, treated according to protocol. PRIMARY AND SECONDARY OUTCOME MEASURES: To prove culture-positive sepsis was present, cultures were used as the primary outcome. Secondary outcomes were in-hospital mortality and intensive care unit (ICU) admission. RESULTS: 98.9% met SIRS criteria and 11.7% met qSOFA score. Positive predictive values of SIRS criteria and qSOFA score were 41.2% (95% CI 37.4% to 45.2%) and 48.1% (95% CI 37.4% to 58.9%), respectively. HRs were 0.79 (95% CI 0.40 to 1.56, p=0.500), 3.42 (95% CI 1.82 to 6.44, p<0.001), 18.94 (95% CI 2.48 to 144.89, p=0.005) and 4.97 (95% CI 1.44 to 17.16, p=0.011) for groups 2-5, respectively. CONCLUSION: qSOFA score performed as well as SIRS criteria for identifying culture-positive sepsis and performed significantly better for predicting in-hospital mortality and ICU admission. This study shows that SIRS criteria are no longer necessary and recommends qSOFA score as the standard for identifying culture-positive sepsis in the ED. TRIAL REGISTRATION NUMBER: NL8315.


Assuntos
Escores de Disfunção Orgânica , Sepse , Estudos Transversais , Serviço Hospitalar de Emergência , Mortalidade Hospitalar , Humanos , Países Baixos/epidemiologia , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Sepse/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico
6.
Medicine (Baltimore) ; 100(22): e26155, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087872

RESUMO

BACKGROUND: It is still controversial in the current literature whether omalizumab is beneficial for children with asthma. Given that there is no high-quality meta-analysis to incorporate existing evidence, the purpose of this protocol is to design a systematic review and meta-analysis of the level I evidence to ascertain whether omalizumab is beneficial and safe for children with asthma. METHODS: The systematic literature review is structured to adhere to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The following search terms will be used in PUBMED, Scopus, EMBASE, and Cochrane Library databases on June, 2021, as the search algorithm: (omalizumab) AND (asthma) AND (children). The primary outcome is the long-term safety and tolerability of omalizumab. The other outcomes include asthma control, quality of life, use of asthma controller medications, and spirometry measurements and emergency room visits due to asthma, and serum trough concentrations of omalizumab, free and total immunoglobulin E measured. Review Manager software (v 5.3; Cochrane Collaboration) will be used for the meta-analysis. RESULTS: The review will add to the existing literature by showing compelling evidence and improved guidance in clinic settings. REGISTRATION NUMBER: 10.17605/OSF.IO/G6N3P.


Assuntos
Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Omalizumab/uso terapêutico , Antiasmáticos/administração & dosagem , Antiasmáticos/efeitos adversos , Criança , Serviço Hospitalar de Emergência/estatística & dados numéricos , Humanos , Imunoglobulina E/sangue , Omalizumab/administração & dosagem , Omalizumab/efeitos adversos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Testes de Função Respiratória
8.
Medicina (Kaunas) ; 57(6)2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34064050

RESUMO

Syncope accounts for up to 2% of emergency department visits and results in the hospitalization of 12-86% of patients. There is often a low diagnostic yield, with up to 50% of hospitalized patients being discharged with no clear diagnosis. We will outline a structured approach to the syncope patient in the emergency department, highlighting the evidence supporting the role of clinical judgement and the initial electrocardiogram (ECG) in making the preliminary diagnosis and in safely identifying the patients at low risk of short- and long-term adverse events or admitting the patient if likely to benefit from urgent intervention. Clinical decision tools and additional testing may aid in further stratifying patients and may guide disposition. While hospital admission does not seem to offer additional mortality benefit, the efficient utilization of outpatient testing may provide similar diagnostic yield, preventing unnecessary hospitalizations.


Assuntos
Serviço Hospitalar de Emergência , Síncope , Hospitalização , Humanos , Alta do Paciente , Risco , Síncope/diagnóstico
9.
BMJ Case Rep ; 14(5)2021 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-34059545

RESUMO

Neonatal suppurative submandibular sialadenitis and abscess formation is an exceedingly rare entity. This report describes a complex case of a male neonate with a methicillin-resistant Staphylococcus aureus (MRSA) submandibular abscess, requiring emergency intubation due to acute airway compromise. The patient was admitted to the paediatric intensive care unit, received appropriate antibiotic treatment and underwent urgent surgical drainage of the abscess. He made a full recovery and remains well 18 months later. No comorbidities or common risk factors for the disease were identified. Although extremely uncommon, neonatal submandibular abscesses can lead to significant morbidity. Neonates tend to present insidiously, and sudden clinical deterioration with airway compromise is possible. MRSA has been increasingly implicated in these infections, even in the absence of relevant risk factors. As such, continued clinical vigilance is essential for prompt diagnosis and prevention of life-threatening complications. Multidisciplinary input is paramount for appropriate management of these complex infections.


Assuntos
Staphylococcus aureus Resistente à Meticilina , Sialadenite , Abscesso/diagnóstico , Abscesso/tratamento farmacológico , Abscesso/cirurgia , Antibacterianos/uso terapêutico , Criança , Serviço Hospitalar de Emergência , Humanos , Recém-Nascido , Masculino , Sialadenite/tratamento farmacológico
10.
Rev Esp Salud Publica ; 952021 Jun 07.
Artigo em Espanhol | MEDLINE | ID: mdl-34092784

RESUMO

OBJECTIVE: Hospital emergency services have specific care characteristics that make them more vulnerable to the risk of legal claims. The fact of suffering a legal claim for professional practice is a very traumatic event. The objective of this study was to find out the opinion of the professionals of the hospital emergency services in Spain on the importance of practices associated with defensive medicine. METHODS: Survey of 1,449 professionals from public and private hospital emergency services throughout the national territory was made, in the period between March 13th and April 3rd, 2017. A univariate analysis was performed to identify variables in relation to the practice of defensive medicine, and the determination of the groups of greater association (chi2 test) to evaluate these variables. RESULTS: 96.1% expressed the need to strengthen their medical-legal training. 91.3% of the cases felt more legal pressure and 88.7% declared that they act conditioned by the threat of judicial claim. Regarding patient treatments, 89.8% stated that they perform diagnostic tests that may not be necessary and 63% of professionals stated that they extend the stay of patients in the emergency department. As for the healthcare organization, 88% declared that they do not feel protected by the structure and 79.1% do not felt support from the center's management. CONCLUSIONS: Practices associated with defensive medicine are frequent in our country, with a high proportion of criminal proceedings, and the two main causes are dispensable diagnostic tests and unnecessary prolongation of length of stay.


Assuntos
Atitude do Pessoal de Saúde , Medicina Defensiva/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Recursos Humanos em Hospital/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recursos Humanos em Hospital/estatística & dados numéricos , Espanha , Inquéritos e Questionários
11.
PLoS One ; 16(6): e0252441, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34061888

RESUMO

BACKGROUND: As a result of the novel coronavirus disease 2019 (COVID-19), there have been widespread changes in healthcare access. We conducted a retrospective population-based study in Alberta, Canada (population 4.4 million), where there have been approximately 1550 hospital admissions for COVID-19, to determine the impact of COVID-19 on hospital admissions and emergency department (ED visits), following initiation of a public health emergency act on March 15, 2020. METHODS: We used multivariable negative binomial regression models to compare daily numbers of medical/surgical hospital admissions via the ED between March 16-September 23, 2019 (pre COVID-19) and March 16-September 23, 2020 (post COVID-19 public health measures). We compared the most frequent diagnoses for hospital admissions pre/post COVID-19 public health measures. A similar analysis was completed for numbers of daily ED visits for any reason with a particular focus on ambulatory care sensitive conditions (ACSC). FINDINGS: There was a significant reduction in both daily medical (incident rate ratio (IRR) 0.86, p<0.001) and surgical (IRR 0.82, p<0.001) admissions through the ED in Alberta post COVID-19 public health measures. There was a significant decline in daily ED visits (IRR 0.65, p<0.001) including ACSC (IRR 0.75, p<0.001). The most common medical/surgical diagnoses for hospital admissions did not vary substantially pre and post COVID-19 public health measures, though there was a significant reduction in admissions for chronic obstructive pulmonary disease and a significant increase in admissions for mental and behavioral disorders due to use of alcohol. CONCLUSIONS: Despite a relatively low volume of COVID-19 hospital admissions in Alberta, there was an extensive impact on our healthcare system with fewer admissions to hospital and ED visits. This work generates hypotheses around causes for reduced hospital admissions and ED visits which warrant further investigation. As most publicly funded health systems struggle with health-system capacity routinely, understanding how these reductions can be safely sustained will be critical.


Assuntos
COVID-19/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pandemias , Admissão do Paciente/estatística & dados numéricos , SARS-CoV-2/patogenicidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Alcoolismo/epidemiologia , COVID-19/transmissão , Canadá/epidemiologia , Feminino , Regulamentação Governamental , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Distanciamento Físico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Estudos Retrospectivos
12.
Medicine (Baltimore) ; 100(22): e26252, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087914

RESUMO

ABSTRACT: Suicide is an increasingly serious public health care concern worldwide. The impact of decreased in-house psychiatric resources on emergency care for suicidal patients has not been thoroughly examined. We evaluated the effects of closing an in-hospital psychiatric ward on the prehospital and emergency ward length of stay (LOS) and disposition location in patients who attempted suicide.This was a retrospective before-and-after study at a community emergency department (ED) in Japan. On March 31, 2014, the hospital closed its 50 psychiatric ward beds and outpatient consultation days were decreased from 5 to 2 days per week. Electronic health record data of suicidal patients who were brought to the ED were collected for 5 years before the decrease in in-hospital psychiatric services (April 1, 2009-March 31, 2014) and 5 years after the decrease (April 1, 2014-March 31, 2019). One-to-one propensity score matching was performed to compare prehospital and emergency ward LOS, and discharge location between the 2 groups.Of the 1083 eligible patients, 449 (41.5%) were brought to the ED after the closure of the psychiatric ward. Patients with older age, burns, and higher comorbidity index values, and those requiring endotracheal intubation, surgery, and emergency ward admission, were more likely to receive ED care after the psychiatric ward closure. In the propensity matched analysis with 418 pairs, the after-closure group showed a significant increase in median prehospital LOS (44.0 minutes vs 51.0 minutes, P < .001) and emergency ward LOS (3.0 days vs 4.0 days, P = .014) compared with the before-closure group. The rate of direct home return was significantly lower in the after-closure group compared with the before-closure group (87.1% vs 81.6%, odds ratio: 0.66; 95% confidence interval: 0.45-0.96).The prehospital and emergency ward LOS for patients who attempted suicide in the study site increased significantly after a decrease in hospital-based mental health services. Conversely, there was significant reduction in direct home discharge after the decrease in in-house psychiatric care. These results have important implications for future policy to address the increasing care needs of patients who attempt suicide.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Fechamento de Instituições de Saúde/estatística & dados numéricos , Hospitais Comunitários/estatística & dados numéricos , Tentativa de Suicídio/psicologia , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Desinstitucionalização/estatística & dados numéricos , Serviços Médicos de Emergência/normas , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Fechamento de Instituições de Saúde/legislação & jurisprudência , Hospitalização/estatística & dados numéricos , Humanos , Japão/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/legislação & jurisprudência , Serviços de Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Unidade Hospitalar de Psiquiatria/economia , Unidade Hospitalar de Psiquiatria/organização & administração , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Tentativa de Suicídio/estatística & dados numéricos
13.
Health Aff (Millwood) ; 40(6): 896-903, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34097513

RESUMO

Prior studies suggest that the COVID-19 pandemic was associated with decreases in emergency department (ED) volumes, but it is not known whether these decreases varied by visit acuity or by demographic and socioeconomic risk factors. In this study of more than one million non-COVID-19 visits to thirteen EDs in a large St. Louis, Missouri, health system, we observed an overall 35 percent decline in ED visits. The decrease in medical and surgical visits ranged from 40 percent to 52 percent across acuity levels, with no statistically significant differences between higher- and lower-acuity visits after correction for multiple comparisons. Mental health visits saw a smaller decrease (-32 percent), and there was no decrease for visits due to substance use. Medicare patients had the smallest decrease in visits (-31 percent) of the insurance groups; privately insured (-46 percent) and Medicaid (-44 percent) patients saw larger drops. There were no observable differences in ED visit decreases by race. These findings can help inform interventions to ensure that people requiring timely ED care continue to seek it and to improve access to lower-risk alternative settings of care where appropriate.


Assuntos
COVID-19 , Pandemias , Idoso , Serviço Hospitalar de Emergência , Humanos , Cobertura do Seguro , Medicare , Missouri/epidemiologia , SARS-CoV-2 , Estados Unidos
14.
BMC Pediatr ; 21(1): 252, 2021 05 31.
Artigo em Inglês | MEDLINE | ID: mdl-34059005

RESUMO

BACKGROUND: Racial/ethnic disparities in the use of opioids to treat pain disorders have been previously reported in the emergency department (ED). Further research is needed to better evaluate the impact race/ethnicity may have on the use of opioids in adolescents for the management of pain disorders in the ED. METHODS: This was a cross-sectional study using data from the National Hospital Ambulatory Medical Care Survey from 2006 to 2016. Multivariate models were used to evaluate the role of race/ethnicity in the receipt of opioid agonists while in the ED. All ED visits with patients aged 11-21 years old were analyzed. Races/ethnicities were stratified as non-Hispanic Whites, non-Hispanic Blacks, and Hispanics. In addition to race, statistical analysis included the following covariates: pain score, pain diagnosis, age, region, sex, and payment method. RESULTS: There was a weighted total of 189,256,419 ED visits. Those visits involved 109,826,315 (58%) non-Hispanic Whites, 46,314,977 (24%) non-Hispanic Blacks, and 33,115,127 (18%) Hispanics, with 21.6% (95% CI, 21.1%-22.1), 15.2% (95% CI, 14.6-15.9%), and 17.4% (95% CI, 16.5-18.2%) of those visits reporting use of opioids, respectively. Regardless of age, sex, and region, non-Hispanic Whites received opioids at a higher rate than non-Hispanic Blacks and Hispanics. Based on diagnosis, non-Hispanic Whites received opioids at a higher rate in multiple pain diagnoses. Additionally, non-Hispanic Blacks and Hispanics were less likely to receive an opioid when reporting moderate pain (aOR = 0.738, 95% CI 0.601-0.906, aOR = 0.739, 95% CI 0.578-0.945, respectively) and severe pain (aOR = 0.580, 95% CI 0.500-0.672, aOR = 0.807, 95% CI 0.685-0.951, respectively) compared to non-Hispanic Whites. CONCLUSIONS: Differences in the receipt of opioid agonists in EDs among the races/ethnicities exist, with more non-Hispanic Whites receiving opioids than their minority counterparts. Non-Hispanic Black women may be an especially marginalized population. Further investigation into sex-based and regional differences are needed.


Assuntos
Analgésicos Opioides , Grupos Étnicos , Adolescente , Adulto , Analgésicos Opioides/uso terapêutico , Criança , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Humanos , Dor/tratamento farmacológico , Adulto Jovem
15.
Ann Palliat Med ; 10(5): 5706-5713, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34107714

RESUMO

BACKGROUND: At present, the treatment of acute ischaemic stroke (AIS) by aticepase (rt-PA) in emergency veins has become the main treatment mode in hospital, but the research on early hemorrhage complications in patients with emergency thrombolysis is rarely reported. This research aims to study the earlier warning index of early hemorrhage complications in patients with emergency thrombolysis. METHODS: A retrospective analysis was performed on the clinical data of rt-PA intravenous thrombolysis-treated AIS patients in the advanced stroke center of the emergency department of a tertiary grade hospital from January 2018 to May 2020. Patients were divided into a hemorrhage group and non-hemorrhage group according to the hemorrhage situation within 24 hours after thrombolytic therapy. The differences between the 2 groups in terms of pre-thrombolysis risk factors were analyzed. Logistic regression analysis was used to analyze the independent risk factors associated with post-thrombolysis hemorrhage. RESULTS: After intravenous thrombolysis, the hemorrhage group had 91 cases and the non-hemorrhage group had 146 cases. Logistic regression analysis showed that atrial fibrillation, systolic blood pressure before thrombolysis, platelet count, and antiplatelet drugs were independent risk factors for hemorrhage after intravenous thrombolysis (P<0.05). CONCLUSIONS: Patients with AIS have a higher incidence of hemorrhage after intravenous thrombolysis. Atrial fibrillation, systolic blood pressure before thrombolysis, platelet count, and antiplatelet drugs were independent risk factors for hemorrhage after intravenous thrombolysis. These independent risk factors can provide a basis for clinical nurses to evaluate hemorrhage risk in AIS patients after intravenous thrombolysis.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Isquemia Encefálica/tratamento farmacológico , Serviço Hospitalar de Emergência , Fibrinolíticos/efeitos adversos , Hemorragia , Humanos , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/efeitos adversos , Resultado do Tratamento
16.
Shanghai Kou Qiang Yi Xue ; 30(2): 151-155, 2021 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-34109353

RESUMO

PURPOSE: To analyze the clinical data of oral emergency cases and the characteristics of oral emergency diseases, and provide clinical basis for improving the quality of oral emergency treatment and making reasonable arrangement. METHODS: A total of 137 740 patients in oral emergency department from January 1st, 2017 to December 31st, 2018 were collected and analyzed retrospectively according to gender, age, time of visit and diagnosis. The results were analyzed with Chi-square test by Excel 7.0 and SPSS 19.0 software package. RESULTS: The ratio of men and women was 1.13:1, with an average age of 35.71 years. The highest incidence was seen in October 2018, and the lowest was in February 2017. The peak time of oral emergency was 20:00 to 21:00. The top three disease entity were maxillofacial injury (29.17%), facial infection (26.95%) and pulpitis (10.08%). CONCLUSIONS: There is a wide range of diseases and a large number of patients in oral emergency and the visiting time is relatively concentrated. Dentists for emergency need to master the professional knowledge of oral surgery and endodontics. In order to make precise strategies to formulate the scale of oral emergency, considerations should be taken with the changing features of the period and month of oral emergency treatment.


Assuntos
Emergências , Traumatismos Maxilofaciais , Adulto , Serviço Hospitalar de Emergência , Feminino , Humanos , Incidência , Masculino , Estudos Retrospectivos
17.
MMWR Morb Mortal Wkly Rep ; 70(23): 858-864, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34111059

RESUMO

Throughout the COVID-19 pandemic, older U.S. adults have been at increased risk for severe COVID-19-associated illness and death (1). On December 14, 2020, the United States began a nationwide vaccination campaign after the Food and Drug Administration's Emergency Use Authorization of Pfizer-BioNTech COVID-19 vaccine. The Advisory Committee on Immunization Practices (ACIP) recommended prioritizing health care personnel and residents of long-term care facilities, followed by essential workers and persons at risk for severe illness, including adults aged ≥65 years, in the early phases of the vaccination program (2). By May 1, 2021, 82%, 63%, and 42% of persons aged ≥65, 50-64, and 18-49 years, respectively, had received ≥1 COVID-19 vaccine dose. CDC calculated the rates of COVID-19 cases, emergency department (ED) visits, hospital admissions, and deaths by age group during November 29-December 12, 2020 (prevaccine) and April 18-May 1, 2021. The rate ratios comparing the oldest age groups (≥70 years for hospital admissions; ≥65 years for other measures) with adults aged 18-49 years were 40%, 59%, 65%, and 66% lower, respectively, in the latter period. These differential declines are likely due, in part, to higher COVID-19 vaccination coverage among older adults, highlighting the potential benefits of rapidly increasing vaccination coverage.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/epidemiologia , COVID-19/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , COVID-19/mortalidade , Humanos , Incidência , Pessoa de Meia-Idade , Mortalidade/tendências , Estados Unidos/epidemiologia , Adulto Jovem
18.
BMJ Open ; 11(6): e044496, 2021 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-34117044

RESUMO

OBJECTIVE: During the influenza epidemic season, the fragile elderlies are not only susceptible to influenza infections, but are also more likely to develop severe symptoms and syndromes. Such circumstances may pose a significant burden to the medical resources especially in the emergency department (ED). Disposition of the elderly patients with influenza infections to either the ward or intensive care unit (ICU) accurately is therefore a crucial issue. STUDY DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Elderly patients (≥65 years) with influenza visiting the ED of a medical centre between 1 January 2010 and 31 December 2015. PRIMARY OUTCOME MEASURES: Demographic data, vital signs, medical history, subtype of influenza, national early warning score (NEWS) and outcomes (mortality) were analysed. We investigated the ability of NEWS to predict ICU admission via logistic regression and the receiver operating characteristic (ROC) analysis. RESULTS: We included 409 geriatric patients in the ED with a mean age of 79.5 years and approximately equal sex ratio. The mean NEWS ±SD was 3.4±2.9, and NEWS ≥8 was reported in 11.0% of the total patients. Logistic regression revealed that NEWS ≥8 predicted ICU admission with an OR of 5.37 (95% CI 2.61 to 11.04). The Hosmer-Lemeshow goodness-of-fit test was calculated as 0.95, and the adjusted area under the ROC was 0.72. An NEWS ≥8 is associated with ICU-admission and may help to triage elderly patients with influenza infections during the influenza epidemic season. CONCLUSION: The high specificity of NEWS ≥8 to predict ICU admission in elderly patients with influenza infection during the epidemic season may avoid unnecessary ICU admissions and ensure proper medical resource allocation.


Assuntos
Escore de Alerta Precoce , Influenza Humana , Idoso , Serviço Hospitalar de Emergência , Mortalidade Hospitalar , Humanos , Influenza Humana/diagnóstico , Influenza Humana/epidemiologia , Unidades de Terapia Intensiva , Curva ROC , Estudos Retrospectivos , Estações do Ano
19.
BMJ Open ; 11(6): e044213, 2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-34130958

RESUMO

OBJECTIVES: The primary objective of this study was to evaluate the effectiveness of a half-day training on de-escalation of violence against healthcare personnel regarding prevention and management of violence incidents versus a similar tertiary-level hospital with no such training. Secondary objectives were to compare the overall satisfaction, burnout, fear of violence and confidence in coping with patients' aggression of the healthcare personnel in the two hospitals. DESIGN: Mixed method design, with a comparative cross-sectional (quantitative) and focus group discussions (qualitative) components. SETTING: Emergency departments of the two tertiary care hospitals in district Peshawar over 6 months starting from May 2018. PARTICIPANTS: Healthcare personnel in the emergency departments of the two hospitals (trained vs untrained). OUTCOME MEASURES: Violence exposure (experienced/witnessed) assessed through a previously validated tool in the past 5 months. Burnout, confidence in coping with patient aggression and overall job satisfaction were also assessed through validated tools. The qualitative component explored the perceptions of healthcare personnel regarding the management of violence and the importance of training on de-escalation of violence through focus group discussions in the two hospitals. RESULTS: The demographic characteristics of the healthcare personnel within the two hospitals were quite similar. The de-escalation training did not lead to a reduction in the incidences of violence; however, confidence in coping with patient aggression and the overall satisfaction were significantly improved in the intervention hospital. The de-escalation training was lauded by the respondents as led to an improvement in communication skills, and the healthcare personnel suggested for scale-up to all the cadres and hospitals. CONCLUSION: The study found significant improvements in the confidence of healthcare personnel in coping with patient aggression, along with better job satisfaction and less burnout in the intervention hospital following the de-escalation training.


Assuntos
Violência , Violência no Trabalho , Agressão , Atitude do Pessoal de Saúde , Estudos Transversais , Serviço Hospitalar de Emergência , Humanos , Paquistão , Violência/prevenção & controle , Violência no Trabalho/prevenção & controle
20.
Rev Med Suisse ; 17(743): 1183-1185, 2021 Jun 16.
Artigo em Francês | MEDLINE | ID: mdl-34133097

RESUMO

Point-of-care ultrasound is a diagnostic tool that is gaining increasingly more ground in general and emergency practice; it allows the clinician to answer certain precise questions, including the presence of a small bowel occlusion. For this indication, ultrasound is useful in rapidly establishing a diagnosis and planning further work up.


Assuntos
Serviço Hospitalar de Emergência , Sistemas Automatizados de Assistência Junto ao Leito , Emergências , Humanos , Atenção Primária à Saúde , Ultrassonografia
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