The Impact of Clinical Seizure Characteristics on Recognition and Treatment of New‐onset Focal Epilepsy in Emergency Departments

2020 ◽  
Author(s):  
Jacob Pellinen ◽  
Erica Tafuro ◽  
Avi Baehr ◽  
Sarah Barnard ◽  
Manisha Holmes ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Focal Epilepsy ◽  
Clinical Seizure ◽  
The Impact ◽  
New Onset

Authors’ response to AAEM on the impact of advanced practice provider staffing in emergency departments

2021 ◽  
Author(s):  
Jesse M. Pines ◽  
Amer Z. Aldeen ◽  
John Bedolla ◽  
Maura Polansky ◽  
Tamara S. Ritsema ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Advanced Practice ◽  
The Impact

scholarly journals New onset of atrial fibrillation in cardiogenic shock

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
H Santos ◽  
T Vieira ◽  
J Fernandes ◽  
AR Ferreira ◽  
M Rios ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiogenic Shock ◽  
Linear Regression Analysis ◽  
Clinical Signs ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
The Impact ◽  
New Onset

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The development of cardiogenic shock (CS) is associated with worse prognosis, and can produce several hemodynamic manifestations. Then, is not surprised the manifestation of new-onset atrial fibrillation (AF) in these patients. Purpose Evaluate the impact of cardiovascular previous history, clinical signs and diagnosis procedures at admission as predictors of new-onset of AF in CS. Methods Single-centre retrospective study, engaging patients hospitalized for CS between 1/01/2014-30/10/2018. 222 patients with CS are included, 40 of them presented new onset of AF. Chi-square test, T-student test and Mann-Whitney U test were used to compare categorical and continuous variables. Multiple linear regression analysis was performed to evaluate predictors of new-onset AF in CS patients. Results CS patients without AF had a mean age of 61.08 ± 13.77 years old, on the other hand new-onset of AF patients in the setting of CS had a mean age of 67.02 ± 14.21 years old (p = 0.016). Nevertheless, no differences between the two groups was detected regarding the sex cardiovascular history (namely arterial hypertension, diabetes, dyslipidemia, obesity, smoker status, alcohol intake, previous acute coronary syndrome, history of angina, previous cardiomyopathy), neoplasia history, cardiac arrest during the CS, clinical signs at admission (like heart rate, blood pressure, respiratory rate), blood results (hemoglobin, leukocytes, troponin, creatinine, C-Reactive protein), left ventricular ejection fraction and the culprit lesion. New-onset of AF in CS patient had not impact in mortality rates. Multiple logistic regression reveals that only age was a predictor of new onset of AF in CS patients (odds ratio 1.032, confident interval 1.004-1.060, p = 0.024). Conclusions Age was the best predictor of new-onset AF in CS patients. The presence of this arrhythmia can have a hemodynamic impact, however, seems not influenced the final outcome.

117 The Impact of Hurricane Sandy on Mental Health-Related Emergency Departments Visits

2014 ◽  
Vol 64 (4) ◽  
pp. S42
Author(s):  
K.C. Frankel ◽  
C.M. Allegra ◽  
B. Eskin ◽  
J.R. Allegra
Keyword(s):  
Mental Health ◽  
Emergency Departments ◽  
Hurricane Sandy ◽  
Health Related ◽  
The Impact

scholarly journals The impact on patient flow after the integration of nurse practitioners and physician assistants in 6 Ontario emergency departments

CJEM ◽  
2009 ◽  
Vol 11 (05) ◽  
pp. 455-461 ◽  
Author(s):  
James Ducharme ◽  
Robert J. Alder ◽  
Cindy Pelletier ◽  
Don Murray ◽  
Joshua Tepper
Keyword(s):  
Health Care ◽  
Nurse Practitioners ◽  
Emergency Departments ◽  
Patient Flow ◽  
Physician Assistants ◽  
Wait Times ◽  
Care Providers ◽  
Lengths Of Stay ◽  
Left Without Being Seen ◽  
The Impact

ABSTRACT Objective: We sought to assess the impact of the integration of the new roles of primary health care nurse practitioners (NPs) and physician assistants (PAs) on patient flow, wait times and proportions of patients who left without being seen in 6 Ontario emergency departments (EDs). Methods: We performed a retrospective review of health records data on patient arrival time, time of initial assessment by a physician, time of discharge from the ED and discharge status. Results: Whether a PA or NP was directly involved in the care of patients or indirectly involved by being on duty, the wait times, lengths of stay and proportion of patients who left without being seen were significantly reduced. When a PA or NP were directly involved in patients' care, patients were 1.6 (95% confidence interval [CI] 1.3–2.1, p < 0.05) and 2.1 (95% CI 1.6–2.8, p < 0.05) times more likely to be seen within the wait time benchmarks, respectively. Lengths of stay were 30.3% (95% CI 21.6%–39.0%, p < 0.01) and 48.8% (95% CI 35.0%–62.7%, p < 0.01) lower when PAs and NPs, respectively, were involved. When PAs and NPs were not on duty, the proportion of patients who left without being seen were 44% (95% CI 31%–63%, p < 0.01) and 71% (95% CI 53%–96%, p < 0.05), respectively. Conclusion: The addition of PAs or NPs to the ED team can improve patient flow in medium-sized community hospital EDs. Given the ongoing shortage of physicians, use of alternative health care providers should be considered. These results require validation, as their generalizability to other locations or types of EDs is not known.

scholarly journals Evaluating alcohol intoxication management services: the EDARA mixed-methods study

2020 ◽  
Vol 8 (24) ◽  
pp. 1-214 ◽  
Author(s):  
Simon C Moore ◽  
Davina Allen ◽  
Yvette Amos ◽  
Joanne Blake ◽  
Alan Brennan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Alcohol Intoxication ◽  
Ethnographic Study ◽  
Acute Alcohol Intoxication ◽  
Front Line ◽  
Night Time ◽  
Number Of Patients ◽  
The Impact ◽  
Management Services

Background Front-line health-care services are under increased demand when acute alcohol intoxication is most common, which is in night-time environments. Cities have implemented alcohol intoxication management services to divert the intoxicated away from emergency care. Objectives To evaluate the effectiveness, cost-effectiveness and acceptability to patients and staff of alcohol intoxication management services and undertake an ethnographic study capturing front-line staff’s views on the impact of acute alcohol intoxication on their professional lives. Methods This was a controlled mixed-methods longitudinal observational study with an ethnographic evaluation in parallel. Six cities with alcohol intoxication management services were compared with six matched control cities to determine effects on key performance indicators (e.g. number of patients in the emergency department and ambulance response times). Surveys captured the impact of alcohol intoxication management services on the quality of care for patients in six alcohol intoxication management services, six emergency departments with local alcohol intoxication management services and six emergency departments without local alcohol intoxication management services. The ethnographic study considered front-line staff perceptions in two cities with alcohol intoxication management services and one city without alcohol intoxication management services. Results Alcohol intoxication management services typically operated in cities in which the incidence of acute alcohol intoxication was greatest. The per-session average number of attendances across all alcohol intoxication management services was low (mean 7.3, average minimum 2.8, average maximum 11.8) compared with the average number of emergency department attendances per alcohol intoxication management services session (mean 78.8), and the number of patients diverted away from emergency departments, per session, required for services to be considered cost-neutral was 8.7, falling to 3.5 when ambulance costs were included. Alcohol intoxication management services varied, from volunteer-led first aid to more clinically focused nurse practitioner services, with only the latter providing evidence for diversion from emergency departments. Qualitative and ethnographic data indicated that alcohol intoxication management services are acceptable to practitioners and patients and that they address unmet need. There was evidence that alcohol intoxication management services improve ambulance response times and reduce emergency department attendance. Effects are uncertain owing to the variation in service delivery. Limitations The evaluation focused on health service outcomes, yet evidence arose suggesting that alcohol intoxication management services provide broader societal benefits. There was no nationally agreed standard operating procedure for alcohol intoxication management services, undermining the evaluation. Routine health data outcomes exhibited considerable variance, undermining opportunities to provide an accurate appraisal of the heterogenous collection of alcohol intoxication management services. Conclusions Alcohol intoxication management services are varied, multipartner endeavours and would benefit from agreed national standards. Alcohol intoxication management services are popular with and benefit front-line staff and serve as a hub facilitating partnership working. They are popular with alcohol intoxication management services patients and capture previously unmet need in night-time environments. However, acute alcohol intoxication in emergency departments remains an issue and opportunities for diversion have not been entirely realised. The nurse-led model was the most expensive service evaluated but was also the most likely to divert patients away from emergency departments, suggesting that greater clinical involvement and alignment with emergency departments is necessary. Alcohol intoxication management services should be regarded as fledgling services that require further work to realise benefit. Future work Research could be undertaken to determine if a standardised model of alcohol intoxication management services, based on the nurse practitioner model, can be developed and implemented in different settings. Future evaluations should go beyond the health service and consider outcomes more generally, especially for the police. Future work on the management of acute alcohol intoxication in night-time environments could recognise the partnership between health-care, police and ambulance services and third-sector organisations in managing acute alcohol intoxication. Trial registration Current Controlled Trials ISRCTN63096364. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 24. See the NIHR Journals Library website for further project information.

scholarly journals Peritraumatic Stress From a Disaster Increases Risk for Onset of Chronic Diseases Among Older Adults

2022 ◽  
Vol 6 (1) ◽  
Author(s):  
Laura P Sands ◽  
Quyen Do ◽  
Pang Du ◽  
Rachel Pruchno
Keyword(s):  
Older Adults ◽  
Physical Health ◽  
Lung Disease ◽  
Chronic Diseases ◽  
Hospital Admissions ◽  
Panel Study ◽  
Hurricane Sandy ◽  
The Impact ◽  
Disaster Exposure ◽  
New Onset

Abstract Background and Objectives Our understanding of the impact of disaster exposure on the physical health of older adults is largely based on hospital admissions for acute illnesses in the weeks following a disaster. Studies of longer-term outcomes have centered primarily on mental health. Missing have been studies examining whether exposure to disaster increases the risk for the onset of chronic diseases. We examined the extent to which 2 indicators of disaster exposure (geographic exposure and peritraumatic stress) were associated with new onset of cardiovascular disease, diabetes, arthritis, and lung disease to improve our understanding of the long-term physical health consequences of disaster exposure. Research Design and Methods We linked self-reported data collected prior to and following Hurricane Sandy from a longitudinal panel study with Medicare data to assess time to new onset of chronic diseases in the 4 years after the hurricane. Results We found that older adults who reported high levels of peritraumatic stress from Hurricane Sandy had more than twice the risk of experiencing a new diagnosis of lung disease, diabetes, and arthritis in the 4 years after the hurricane compared to older adults who did not experience high levels of peritraumatic stress. Geographic proximity to the hurricane was not associated with these outcomes. Analyses controlled for known risk factors for the onset of chronic diseases, including demographic, psychosocial, and health risks. Discussion and Implications Findings reveal that physical health effects of disaster-related peritraumatic stress extend beyond the weeks and months after a disaster and include new onset of chronic diseases that are associated with loss of functioning and early mortality.

Measuring impact of telephone triage in Acute Medicine

2017 ◽  
Vol 16 (3) ◽  
pp. 104-106
Author(s):  
Huma Asmat ◽  
◽  
Shah Khalid Shinwari ◽  
Timothy Cooksley ◽  
Roger Duckitt ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Emergency Departments ◽  
Local Context ◽  
Telephone Triage ◽  
Time Data ◽  
Acute Medicine ◽  
The Impact ◽  
First Time

The Society for Acute Medicine’s Benchmarking Audit (SAMBA) was undertaken for the 5th time in June 2016. For the first time, data on telephone triage calls prior to admission to Acute Medical Units were collected: 1238 patients were referred from Emergency Departments, 925 from General Practitioners (GPs), 52 from clinics and 147 from other sources. Calls from Emergency Departments rarely resulted in admission avoidance. Calls from Primary Care resulted in avoidance of an admission in 115 (12%) patients; the percentage of avoided admissions was highest if the call was taken by a Consultant. Consultant triage might result in admission avoidance but the impact of local context on the effectiveness is not clear.

Abstract 15761: New Onset Atrial Fibrillation After Transcatheter Aortic Valve Implantation: A Pooled Meta-Analysis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Arun Kanmanthareddy ◽  
Madhu Reddy ◽  
Venkata S Koripalli ◽  
Avanija Buddam ◽  
Nivedita Adabala ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Meta Analysis ◽  
Mortality Data ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
The Impact ◽  
New Onset

Introduction: Atrial fibrillation (AF) after cardiac surgery is associated with increased morbidity and mortality. Data comparing the occurrence of AF after transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) is unknown. Methods: We identified all studies reporting outcomes after TAVI in all available electronic databases. Meta-analysis of all the studies was performed using random effects model to a) evaluate the incidence of AF and b) compare the incidence of AF between TAVI and SAVR. Results: The incidence of AF was reported in 7 studies, 5 prospective observational studies and 2 randomized controlled studies. The cumulative event rate for new onset AF at 30 days after TAVI was 0.1 (95% CI; 0.06 -0.17). Three studies reported incidence of AF after TAVI and SAVR. The odds ratio (OR) of developing new onset AF with TAVI compared to SAVR was 0.3 (95% CI; 0.10 - 0.88) at 30 days. One year outcome of new onset AF was reported in only two studies. Although, the incidence of AF was lower in the TAVI group, this did not reach statistical significance (OR 0.7, 95% CI; 0.46 -1.07). Conclusion: The incidence of new onset AF after TAVI is 10% within the first 30 days. This risk is 70% lower in patients undergoing TAVI compared to SAVR. The impact of AF after TAVI in terms of stroke, mortality and future recurrences of AF are unknown. Further studies are therefore necessary to study these outcomes.

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