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Admission avoidance

Jeffrey M Caterino, David Adler, Danielle D Durham, Sai-Ching Jim Yeung, Matthew F Hudson, Aveh Bastani, Steven L Bernstein, Christopher W Baugh, Christopher J Coyne, Corita R Grudzen, Daniel J Henning, Adam Klotz, Troy E Madsen, Daniel J Pallin, Cielito C Reyes-Gibby, Juan Felipe Rico, Richard J Ryan, Nathan I Shapiro, Robert Swor, Arvind Venkat, Jason Wilson, Charles R Thomas, Jason J Bischof, Gary H Lyman
Importance: Better understanding of the emergency care needs of patients with cancer will inform outpatient and emergency department (ED) management. Objective: To provide a benchmark description of patients who present to the ED with active cancer. Design, Setting, and Participants: This multicenter prospective cohort study included 18 EDs affiliated with the Comprehensive Oncologic Emergencies Research Network (CONCERN). Of 1564 eligible patients, 1075 adults with active cancer were included from February 1, 2016, through January 30, 2017...
March 1, 2019: JAMA Network Open
T Allaeys, V Dhooghe, S Nicolay, G Hubens
BACKGROUND: Roux-en-Y gastric bypass is a frequently carried out bariatric procedure, proven to be effective in the management of obesity and its accompanying health issues. Following its popularity, admission to the emergency department for abdominal pain is often seen with known early and late onset causes. We present a case of a young woman with vague abdominal pain years after her gastric bypass, who eventually underwent a resection of a 'candy cane' like biliopancreatic blind loop...
March 22, 2019: Acta Chirurgica Belgica
Jocelyn R Grunwell, Courtney E McCracken, Curtis D Travers, Robert J Geller, Pradip P Kamat
AIM: To prospectively validate a pediatric clinical prediction model to identify children at low risk of clinically significant ingestions to prevent unnecessary pediatric intensive care unit (PICU) admissions. METHODS: Calls received by the Georgia Poison Center about children for acute ingestions between May 25, 2017 and May 17, 2018 were scored in real time using the full, age-stratified, and simplified clinical scoring tool to reduce childhood admissions to PICUs for poisoning (RECAP2 )...
March 22, 2019: Clinical Toxicology
Linda Sealy, Christina Saunders, Jeffrey Blume, Roger Chalkley
The association between GRE scores and academic success in graduate programs is currently of national interest. GRE scores are often assumed to be predictive of student success in graduate school. However, we found no such association in admission data from Vanderbilt's Initiative for Maximizing Student Diversity (IMSD), which recruited historically underrepresented students for graduate study in the biomedical sciences at Vanderbilt University spanning a wide range of GRE scores. This study avoids the typical biases of most GRE investigations of performance where primarily high-achievers on the GRE were admitted...
2019: PloS One
Pei-Ling Tang, Hung-Chih Chen, Wei-Chun Huang, Shuo-Fang Li, Hsiao-Ching Kuo
Background/purpose: Avoiding mortality has been the ultimate goal in the management of head and neck cancer (HNC) patients with emergency department (ED) visits, however, risk factors and causes of mortality are not well studied. The objective of the present study is to verify the factors associated with long-term mortality of patients with HNC who visited ED. Materials and methods: We retrospectively collected data of 1660 HNC patients who made ED visits from the Longitudinal Health Insurance Database 2000 during 2000-2012 in Taiwan...
September 2018: Journal of Dental Sciences
Jennifer L Rosenthal, Monica K Lieng, James P Marcin, Patrick S Romano
OBJECTIVES: While hospital-hospital transfers of pediatric patients are often necessary, some pediatric transfers are potentially avoidable. Pediatric potentially avoidable transfers (PATs) represent a process with high costs and safety risks but few, if any, benefits. To better understand this issue, we described pediatric interfacility transfers with early discharges. METHODS: We conducted a descriptive study using electronic medical record data at a single-center over a 12-month period to examine characteristics of pediatric patients with a transfer admission source and early discharge...
March 19, 2019: Pediatric Emergency Care
Marcela Forgerini, Stephania Mieli, Patrícia de Carvalho Mastroianni
BACKGROUND: Risks regarding hospital admission due to adverse drug reactions and drug interactions from use of omeprazole have been reported. The question guiding the present review was "Which adverse events occur in patients using omeprazole in a Food and Drug Administration-approved and/or off-label manner?" It was also proposed to evaluate the safety of use of omeprazole. DESIGN AND SETTING: Qualitative narrative review with critical evaluation, in a public university...
November 2018: São Paulo Medical Journal
A Septfons, T Goronflot, B Jaulhac, V Roussel, S De Martino, S Guerreiro, T Launay, L Fournier, H De Valk, J Figoni, T Blanchon, E Couturier
BACKGROUND: Lyme borreliosis (LB) is the most frequent vector-borne disease in France. Since 2009, surveillance of LB is conducted by a sentinel network of general practitioners (GPs). This system, in conjunction with the national hospitalisation database was used to estimate the incidence and describe the characteristics of LB in France. AIM: To describe the estimated incidence and trends in GP consultations and hospital admissions for LB in France and identify risk groups and high-incidence regions...
March 2019: Euro Surveillance: European Communicable Disease Bulletin
Luca Pasina, Barbara Brignolo Ottolini, Laura Cortesi, Mauro Tettamanti, Carlotta Franchi, Alessandra Marengoni, Pier Mannuccio Mannucci, Alessandro Nobili
OBJECTIVE: Older people approaching the end of life are at high risk for adverse drug reactions. Approaching end of life should change the therapeutic aims, triggering a reduction in the number of drugs. The main aim of this study was to describe the preventive and symptomatic drug treatments prescribed to patients discharged from internal medicine and geriatric wards, with limited life expectancy. The secondary aim was to describe the potentially severe DDIs. MATERIALS AND METHODS: We analyzed Registry of Polytherapies Societa Italiana di Medicina Interna (REPOSI), a network of internal medicine and geriatric wards, to describe the drug therapy of patients discharged with limited life expectancy...
March 20, 2019: Medical Principles and Practice: International Journal of the Kuwait University, Health Science Centre
Guangmei Wang, Jiali Wang, Shuo Wu, Wen Zheng, He Zhang, Jingjing Ma, Jiaqi Zheng, Feng Xu, Yuguo Chen
BACKGROUND: More sensitive troponin assays have the potential to better evaluate the patients with suspected acute coronary syndrome (ACS). Meanwhile, they may result in avoidable diagnostic testing. HYPOTHESIS: Our aim was to determine the clinical impact of implementing a more sensitive cardiac troponin I (cTnI) assay in patients with acute non-traumatic chest pain presenting to the emergency department (ED). METHODS: This is a pre-post cohort study...
March 19, 2019: Clinical Cardiology
Caroline Elbaum, Kristyn S Beam, Olaf Dammann, Christiane E L Dammann
OBJECTIVE: To evaluate the association between morbidities preceding and following neonatal intensive care unit (NICU) admission with hypothermia. STUDY DESIGN: NICU admission temperatures for 1271 infants admitted to the NICU at Tufts Medical Center (TMC) between 2012 and 2015 were compared to all Vermont Oxford Network (VON) centers in 2014. We analyzed demographic data, prevalence of hypothermia, and associations with prenatal and neonatal morbidities. RESULT: Prevalence of hypothermia at TMC was 19% compared to 25% in the VON...
March 18, 2019: Journal of Maternal-fetal & Neonatal Medicine
Matjaž Groznik, Matej Cimerman, Lara Lusa, Nina Ružić Gorenjec, Alojz Ihan
BACKGROUND: Early diagnosis of acute posttraumatic osteomyelitis (POM) is of vital importance for avoiding devastating complications. Diagnosing POM is difficult due to the lack of a highly specific and sensitive test, such as in myocardial infarct, stroke and intracranial bleeding. Serum inflammatory markers, C-reactive protein (CRP), procalcitonin (PCT), white blood cells (WBC) can support clinical findings but they are not able to differentiate between inflammatory response to infection and the host response to non-infection insult with high specificity and sensitivity...
March 5, 2019: Injury
L Testa, R Seah, K Ludlow, J Braithwaite, R J Mitchell
Care transitions for older people moving from residential aged care facilities (RACFs) to hospital services are associated with greater challenges and poorer outcomes. An integrative review was conducted to investigate models of care designed to avoid or improve transitions for older people residing in RACFs to hospital settings. Twenty-one studies were included in the final analysis. Models of care aimed to either improve or avoid transitions of residents through enhanced primary care in RACFs, promoting quality improvement in RACFs, instilling comprehensive hospital care, conducting outreach services, transferring information, or involved a combination of outreach services and comprehensive hospital care...
March 12, 2019: Geriatric Nursing
Sahil Koppikar, David Yu, Mark Ropeleski, David Robertson
Connective tissue diseases can be associated with rare gastrointestinal complications such as pneumatosis intestinalis and pneumoperitoneum. In this article, we report a unique case of recurrent pneumatosis intestinalis and spontaneous pneumoperitoneum without evidence of peritonitis in a patient with long-standing mixed connective tissue disease. Computed tomography scan of the abdomen and pelvis revealed pneumatosis of the jejunum and intra-abdominal free air, without evidence of perforation. The patient was managed non-operatively...
December 2018: Archives of Rheumatology
Kalay Moodley, Tabia Henry Akintobi, Therese Fish, Daniel S Blumenthal
BACKGROUND: The WHO Africa Region faces a shortage of health workers due to inadequate production of health workers and emigration of physicians and nurses to wealthier countries. South Africa and the United States share a history of discriminatory policies and practices resulting in groups that are under-represented amongst health professionals. One US response is the Area Health Education Centers Program (AHEC), a pipeline program to recruit members of under-represented groups into the health professions...
April 30, 2018: Annals of Global Health
Kuven K Moodley, Valerie Jones, Mahinda Yogarajah, Bhavini Patel, Umesh Vivekananda, Pablo Garcia-Reitboeck, Kiran Samra, Gillian Cluckie, Oliver Foster, Anthony C Pereira, Niranjanan Nirmalananthan
St George's Hospital hyperacute neurology service (HANS) is a comprehensive, consultant-delivered service set in a teaching hospital regional neuroscience centre. The service addresses deficiencies in acute neurological care previously highlighted by the Royal College of Physicians and the Association of British Neurologists. HANS adopts a disease-agnostic approach to acute neurology, prioritising the emergency department (ED) management of both stroke and stroke mimics alike alongside proactive daily support to the acute medical unit and acute medical take...
March 2019: Clinical Medicine: Journal of the Royal College of Physicians of London
Gillian Puckeridge, Morne Terblanche, Marianne Wallis, Yoke Lin Fung
BACKGROUND: Anaemia in hip fracture patients has been associated with increased risk of allogenic blood transfusion (ABT), poorer functional outcomes and increased mortality. Few studies have reported the prevalence of anaemia on admission or its progression prior to surgery in this cohort. We aimed to measure the prevalence of anaemia on admission in older persons who sustain a hip fracture, identify if anaemia develops or progresses prior to surgery, and to report associations with outcome...
March 12, 2019: BMC Geriatrics
F Graziano, R Maugeri, G R Giammalva, E Lo Bue, G Zabbia, D G Iacopino
BACKGROUND: CustomBone® prosthesis is a widely recognized effective and successful technique for the reconstruction of cranial bone defects. Prior the cranioplasty implant, meticulous dissection within thick scar tissue is required. During this delicate surgical manoeuvre is vital to avoid damage to the skin flap itself and to the underlying cerebrovascular structures. We report our experience and potential applications of a novel, pulsed monopolar radiofrequency energy device (PEAK PlasmaBlade™, Medtronic plc)...
March 11, 2019: British Journal of Neurosurgery
J Coral-Casas, A Ricaurte-Fajardo, S J McCormick, I Baracaldo, C A Jimenez, J A Mejia
INTRODUCTION: Reversible cerebral vasoconstriction syndrome (RCVS) is a low incidence disability with a multifactorial etiology and a wide array of symptoms. The main symptom is a thunderclap headache, accompanied sometimes with various neurological deficits that can lead to death. RCVS is usually diagnosed through radiological imaging technology. The treatment includes adopting general measures of monitoring, symptomatic management, identifying the etiology and acting on it to avoid recurrence...
March 16, 2019: Revista de Neurologia
Ginenus Fekadu, Hunduma Wakassa, Firew Tekle
Background: The fact that the majority of patients come late creates management difficulties as these first hours are important to avoid secondary insults to the brain and preserve the ischemic penumbra. Although thrombolytic treatments are currently not available in our hospital, significant delays during the prehospital or in-hospital phases of care create management difficulties and would make such advanced treatments impossible in the future in Ethiopia. Methods: Prospective observational study was carried at stroke unit of Jimma University Medical Center for 4 consecutive months from March 10 to July 10, 2017...
2019: Stroke Research and Treatment
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