scholarly journals Reported and unreported potentially important incidental findings in urgent nonenhanced abdominal CT for renal colic

2021 ◽  
Author(s):  
Elena Belloni ◽  
Stefania Tentoni ◽  
Ilaria Fiorina ◽  
Chandra Bortolotto ◽  
Olivia Bottinelli ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health Status ◽  
Pleural Effusion ◽  
Incidental Findings ◽  
Renal Colic ◽  
Legal Issues ◽  
Abdominal Ct ◽  
Significant Difference ◽  
Original Report ◽  
The Difference

PURPOSE: To retrospectively evaluate the prevalence of reported and unreported potentially important incidental findings in consecutive nonenhanced abdominal CTs performed specifically for renal colic in the urgent setting. METHOD: One radiologist, blinded to the finalized report, retrospectively re-evaluated nonenhanced abdominal CTs performed from January through December 2017 on adult patients from the Emergency Department with the specific request of urgent evaluation for renal colic, searching for potentially important incidental findings. RESULTS: The CTs of 312 patients were included in the study. Thirty-eight findings were reported in 38 different CTs, whereas the re-evaluation added 47 unreported findings in 47 different CTs, adding to total of 85 findings (27%). The difference in the proportion of reported and unreported potentially important incidental findings between the original report and re-evaluation was significant (P<.001). No significant difference was found between the age of patients with and without reported findings. The proportion of potentially important findings did not vary significantly among the three shifts neither in the original report nor in the re-evaluation. The most frequent findings, both reported and unreported, were pleural effusion, lymphadenopaties and liver nodules. CONCLUSIONS: Potentially important additional findings are frequently present in urgent nonenhanced abdominal CTs performed for renal colic, and many are not described in the finalized reports. Radiologists should take care not to under report potentially important incidental findings even in the urgent setting because of the possible consequences on the patient’s health status and in order to avoid legal issues, while satisfying the need for timely and efficient reporting.

Abstract 14721: Impact of Covid-19 on Cardiology Consultation in Tertiary Care Hospital of a Developing Country

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
ghufran adnan ◽  
Osman Faheem ◽  
Maria Khan ◽  
Pirbhat Shams ◽  
Jamshed Ali
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Reduction Rate ◽  
Care Hospital ◽  
Chi Square ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Drastic Increase ◽  
Chi Square Test ◽  
The Difference

Introduction: COVID-19 pandemic has overwhelmed the healthcare system of Pakistan. There has been observation regarding changes in pattern of patient presentation to emergency department (ED) for all diseases particularly cardiovascular. The aim of the study is to investigate these changes in cardiology consultations and compare pre-COVID-19 and COVID-19 era. Hypothesis: There is a significant difference in cardiology consultations during COVID era as compared to non-COVID era. Method: We collected data retrospectively of consecutive patients who visited emergency department (ED) during March-April 2019 (non-COVID era) and March-April 2020 (COVID era). Comparison has been made to quantify the differences in clinical characteristics, locality, admission, type, number, and reason of Cardiology consults generated. Results: We calculated the difference of 1351 patients between COVID and non-COVID era in terms of cardiology consults generated from Emergency department, using Chi-square test. Out of which 880 (59%) are male with mean age of 61(SD=15). Analysis shows pronounced augmentation in number of comorbidities [Hypertension(6%), Chronic kidney disease (6%), Diabetes (5%)] but there was 36% drop in total cardiology consultations and 43% reduction rate in patient’s ED visit from other cities during COVID era. There was 60% decrease in acute coronary syndrome presentation in COVID era, but fortuitously drastic increase (30%) in type II myocardial injury has been noted. Conclusion: There is a remarkable decline observed in patients presenting with cardiac manifestations during COVID era. Lack in timely care could have a pernicious impact on outcomes, global health care organizations should issue directions to adopt telemedicine services in underprivileged areas to provide timely care to cardiac patients.

scholarly journals Significance of serum-pleural effusion albumin gradient in differentiating transudative and exudative pleural effusions in comparison to light’s criteria

2017 ◽  
Vol 4 (2) ◽  
pp. 457
Author(s):  
Sujatha G. ◽  
Vindhya P. ◽  
Kalyan Kumar K.
Keyword(s):  
Pleural Effusion ◽  
Clinical Outcome ◽  
Pleural Fluid ◽  
Venous Blood ◽  
P Value ◽  
Protein Ratio ◽  
Clinical Disorder ◽  
Significant Difference ◽  
The Difference ◽  
Sensitivity Specificity

Background: Approximately one million patients develop pleural effusion every year. It is a common clinical disorder and is either a manifestation or a complication of one or other respiratory or non-respiratory disorders. It leads to serious prognosis, if not diagnosed and treated properly. To calculate SEAG and Light’s criteria and to compare SEAG with Light’s criteria in analyzing pleural effusions.Methods: A total of hundred patients were selected for the study. Pleural fluid of patients who met the inclusion and exclusion criteria were collected, when pleural fluid is being tapped for diagnostic thoracocentesis. Venous blood sample was collected along with diagnostic thoracocentesis or within 24 hours of thoracocentesis.  Written informed consent was obtained from them for thoracocentesis.Results: In our study we compared the clinical outcome with outcome as per Pleural fluid/Serum protein ratio (p value of <0.0001), pleural fluid/serum LDH (p value of <0.0001) and pleural fluid LDH (p value of <0.0001) separately and the p values were statistically significant. The sensitivity, specificity, PPV and NPV of Light’s criteria were 77.2%, 100%, 100%, 93.9% respectively. We compared Light’s criteria outcome with clinical outcome and the difference was statistically significant (p value of <0.0001). SEAG showed 100% sensitivity, 97.43% specificity, 91.6% PPV and is 91.66% and NPV is 100%. We compared the clinical outcome with SEAG and there was statistically significant difference (p value of <0.0001). We compared SEAG with Light’s criteria and the difference was statistically significant (p <0.0001). We compared Light’s plus pleural fluid protein gradient with SEAG and the difference is statistically significant (p value of <0.0001).Conclusions: SEAG is more sensitive for classifying transudates and more specific for exudates than Light’s criteria.

scholarly journals Intravenous Paracetamol vs Intranasal Desmopressin for Renal Colic in the Emergency Department: A Randomized Clinical Trial

Pain Medicine ◽  
2020 ◽  
Vol 21 (12) ◽  
pp. 3437-3442
Author(s):  
Hamed Basir Ghafouri ◽  
Niloofar Abazarian ◽  
Mohammadreza Yasinzadeh ◽  
Ehsan Modirian
Keyword(s):  
Clinical Trial ◽  
Emergency Department ◽  
Pain Score ◽  
Randomized Clinical Trial ◽  
Renal Colic ◽  
Rating Scale ◽  
Pain Scores ◽  
Intravenous Paracetamol ◽  
Significant Difference ◽  
Intranasal Desmopressin

Abstract Objective To evaluate the analgesic efficacy of intranasal desmopressin alone vs intravenous paracetamol in patients referred to the emergency department with renal colic. Design Randomized clinical trial. Setting This study was conducted in the emergency unit of a university hospital. Subjects Patients referred to the emergency room with renal colic. Primary Outcome Effect of intranasal desmopressin in pain relief in comparison with intravenous paracetamol. Methods In this trial, 240 patients diagnosed with renal colic were randomly divided into two groups to compare the analgesic effect of intravenous paracetamol (15 mg/kg) and intranasal desmopressin spray (40 μg). Pain scores were measured by a numeric rating scale at baseline and after 15, 30, and 60 minutes. Adverse effects and need for rescue analgesic (0.05 mg/kg max 3 mg morphine sulphate) were also recorded at the end of the study. Results Three hundred patients were eligible for the study; however, 240 were included in the final analysis. The patients in the two groups were similar in their baseline characteristics and baseline pain scores. The mean pain score after 15 minutes was more reduced and was clinically significant (&gt;3) in the desmopressin group (P &lt; 0.0001). There was no significant difference between mean pain scores in the two groups after 30 minutes (P = 0.350) or 60 minutes (P = 0.269), but the efficacy of the two drugs was significant in terms of pain reduction (&gt;6). Conclusions Our study showed that intranasal desmopressin is as effective as intravenous paracetamol for renal colic pain management; however, significant clinical reduction in pain score occurred faster with intranasal desmopressin.

scholarly journals The Effect of Bedside Presentations in the Emergency Department on Patient Satisfaction

2011 ◽  
Vol 3 (4) ◽  
pp. 481-486 ◽  
Author(s):  
Craig I. Schranz ◽  
Robert J. Sobehart ◽  
Kiva Fallgatter ◽  
Robert H. Riffenburgh ◽  
Michael J. Matteucci
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Resident Education ◽  
Statistical Significance ◽  
Future Research ◽  
First Year ◽  
Convenience Sample ◽  
Visual Analog Scales ◽  
Significant Difference ◽  
The Difference

Abstract Background Due to increasing time constraints, the use of bedside presentations in resident education has declined. We examined whether patient satisfaction in the emergency department is affected when first-year residents present at the bedside with attendings. Methods We performed an observational, prospective, nonblinded study in the emergency department of a military teaching hospital. We alternately assigned first-year residents to present a convenience sample of 248 patients to the attending physician at the patient's bedside or away from the patient. We measured patient satisfaction by using the Patient Satisfaction Questionaire-18 (PSQ-18), a validated survey instrument that utilizes a Likert scale, and additional nonvalidated survey questions involving Likert and visual analog scales. Results While the median PSQ-18 score of 74 (95% confidence interval [CI], 72–76) was higher for patient satisfaction when residents made bedside presentations than that for standard presentations, 72 (95% CI, 70–74), the difference did not reach statistical significance (P  =  .33). Conclusion There was no significant difference in overall patient satisfaction between residents' bedside presentations and presentations to attendings away from the patient. Although not significant, the differences noted in PSQ-18 subscales of communication, general satisfaction, and interpersonal manner warrant further investigation. Patients did not appear to be uncomfortable with having their care discussed and with having subsequent resident education at the bedside. Future research on patient satisfaction after implementation of standardized bedside teaching techniques may help further elucidate this relationship.

scholarly journals P109: Does an elevated troponin ultimately matter? An assessment of outcomes in patients presenting to the emergency department with non-cardiac complaints

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S104-S104
Author(s):  
K. Endres ◽  
B. Chow ◽  
H. Garuba
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Preliminary Data ◽  
Diagnostic Testing ◽  
Retrospective Chart Review ◽  
Cardiac Events ◽  
Significant Difference ◽  
Chi Squared ◽  
Invaluable Tool ◽  
The Difference

Introduction: Acute myocardial infarction (MI) is one of the most time-sensitive diagnoses made in the emergency department (ED). Troponin (TNI) measurement is an invaluable tool; however, its utility depends on the clinical context and is highest where there is a strong pre-test probability. Studies show that most TNI elevations are due to non-cardiovascular causes; however, elevated TNI has been associated with increased morbidity and mortality, often prompting additional investigations. The aim of our study was to compare 1-year cardiac outcomes of patients who presented to the ED with non-cardiac complaints and elevated TNI who had further cardiac testing versus those who did not. Methods: We conducted a retrospective chart review of patients ≥18 seen in the ED for non-cardiac complaints with a high TNI from January-June 2016. Patients were stratified into two groups: 1) those who received diagnostic testing for ischemia and/or a cardiac consultation and 2) those without cardiac consultation or testing. Data was also collected on major adverse cardiac events within 1-year of ED presentation. Chi-squared analysis assessed the difference in proportions of outcomes between groups. We present our preliminary data. Results: In total, 1500 patients met inclusion criteria and 861 have been analyzed thus far. Of these 861, 209 went on to have either diagnostic testing for ischemia and/or a cardiology consult while 652 had no further investigations. There was no statistically significant difference in the proportion of patients who developed unstable angina (p = 0.9824), ST-elevation myocardial infarction (STEMI) (p = 0.9956), non-STEMI (p = 0.9008), stroke/TIA (p = 0.9657), revascularization (p = 0.8873), cardiac hospitalization (p = 0.9446) or died (p = 0.8972), within 1-year of their ED presentation. Conclusion: In patients with isolated elevated TNI and non-cardiac complaints, preliminary data showed no difference in mortality or cardiac event rates between those who had further testing/consultations and those who did not. TNI ordering could be cautiously limited to only presenting complaints/preliminary diagnoses likely to have cardiac etiology or sequelae or those in whom further testing would impact management/outcomes. Quality of care may be improved by reducing length of stay in the ED and potential risks of unnecessary tests. Future studies include determining cost implications and classifying what level of TNI elevation in non-ACS patients may predict a future cardiac outcome.

Trial to End Ambulance Diversion in Boston: Report from the Conference of the Boston Teaching Hospitals Consortium

2011 ◽  
Vol 26 (2) ◽  
pp. 122-126 ◽  
Author(s):  
Franklin D. Friedman ◽  
Niels K. Rathlev ◽  
Laura White ◽  
Stephen K. Epstein ◽  
Assaad Sayah ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medical Services ◽  
Online Survey ◽  
Medical Services ◽  
Teaching Hospitals ◽  
Routine Practice ◽  
Ambulance Diversion ◽  
Emergency Medical ◽  
Significant Difference ◽  
The Difference

AbstractIntroduction: Annual ambulance diversion hours in Boston increased more than six-fold from 1997 to 2006. Although interventions and best practices were implemented, there was no reduction in the number of diversion hours.Objectives: A consortium of Boston teaching hospitals instituted a two-week moratorium on citywide diversion from 02 October 2006 to 15 October 2006. The hypothesis was that there would be no significant difference in measures of hospital and emergency medical services (EMS) efficiency compared with the two weeks immediately prior.Methods: A total of nine hospitals and the municipal emergency medical services in Boston submitted data for analysis. The following mean daily hospital measures were studied: (1) emergency department volume; (2) number of emergency department admissions; (3) length of stay (LOS) for all patients; and (4) number of elopements. Mean EMS at-hospital time by destination and the percent of all Boston EMS transports to each hospital destination were calculated. The median differences (MD) were calculated as “before” minus “during” the study period and were compared with paired, Wilcoxon, non-parametric tests. Additional mean EMS measures for all destinations included: (1) to hospital time; (2) number of responses with transport initiated per day; (3) incident entry to arrival; and (4) at-hospital time.Results: The LOS for admitted patients (MD = 0.30 hours; IQR 0.10,1.30; p = 0.03) and number of daily admissions (MD = -1.50 patients; IQR -1.50, -0.10; p = 0.04) were significantly different statistically. The results for LOS for all patients, LOS for discharged patients, ED volume, EMS time at hospital by destination, number of elopements, and percent of Boston EMS transports to each hospital revealed no statistically significant differences. The difference between the study and control periods for mean EMS to hospital time, at-hospital time, and incident entry to arrival was a maximum of 0.6 minutes. The vast majority of EMS respondents to an online survey believed that the “no diversion” policy should be made routine practice.Conclusions: The LOS for admitted patients decreased by 18 minutes, and the number of admissions increased by 1.5 patients per day during the study period. The “no diversion” policy resulted in minimal changes in EMS efficiency and operations. Diversion was temporarily eliminated in a major city without significant detrimental changes in ED, hospital, or EMS efficiency.

Abstract P491: Characterizing Agreement in Level of Inter-extremity Blood-Pressure Readings of Adults in the Emergency Department (CALIBRATE Study)

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Zain A Bhutta ◽  
Isma Qureshi ◽  
Mohammad Shujauddin ◽  
Sarah Thomas ◽  
Maarij Masood ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Recruitment Strategy ◽  
Asia Pacific ◽  
Continuous Variables ◽  
Arab Population ◽  
Significant Difference ◽  
The Absolute ◽  
The Difference ◽  
The Right

Introduction: Inter-arm blood-pressure difference (IBPD) has been studied previously in multiple settings, but few reports are available from the Emergency department (ED) setting, where BP varies significantly due to acute medical conditions or stress from various factors. CALIBRATE aims to study the inter-arm blood pressure differences in the patients presenting to the ED in Qatar and to assess the IBPD distribution in this population. Methods: In sitting position, two consecutive BP measurements were obtained from the right and left arm for each participant using calibrated automated machines and appropriate cuff sizes. Considering the demographic mix of the population presenting to the ED, a 1:1 of male to female and 2:1 for GCC (Gulf Cooperation Council) to non-GCC recruitment strategy was predefined. The data were recorded using predefined data fields including patient demographics, past medical, social and family history. The continuous variables were reported as mean (SD) or median (IQR) based on the distribution of data. The data was analyzed using Stata MP 14.0 (College Station, Texas). Results: A total of 1800 patients were prospectively recruited from the ED. The mean age was 34 (10) years. The absolute systolic blood pressure (ΔSBP) difference between the right and left arm was same for the first (ΔSBP1) and the second reading (ΔSBP2), as 6 mmHg (3-10). The absolute average of ΔSBP1 and ΔSBP2 was 7 mmHg (4-10). The difference in SBP of less than 20 mmHg for IBP was seen in 95 th percentile of the population with single reading, whereas, with the average of two individual readings it was observed in 97 th percentile. No meaningful association could be detected between the significant IBPD and the study variables such as age, demographics, regions of interest and risk factors. Although, patients with diagnosed hypertension met the pre-defined criterion for significance, this difference was not clinically significant. There was no significant difference between IBPD noted for the Asia-pacific or Arab population. Conclusion: In population presenting to the ED, the IBPD of at least 20 mmHg reached at 95 th percentile validating the known significant difference. The utility of SBP difference can be improved further by taking the average of two individual readings.

scholarly journals Effect of Continuous Nursing Intervention of Artificial Intelligence on Discharged Patients after Heart Valve Replacement and Application of Omaha System (Preprint)

2020 ◽  
Author(s):  
Jing Zhang ◽  
Qiong Zhou ◽  
George Nelson
Keyword(s):  
Quality Of Life ◽  
Health Status ◽  
Statistical Significance ◽  
Control Group ◽  
Observation Group ◽  
Health Status Questionnaire ◽  
Significant Difference ◽  
Omaha System ◽  
The Difference

UNSTRUCTURED The purpose of this study is to explore the effect of continuous nursing system of artificial intelligence (AI) on patients discharged from hospital after heart valve replacement (HVR) and the application value of Omaha system. The patients undergoing HVR were taken as the research objects and divided into control group (routine nursing) and observation group (continuous nursing). Through the continuous nursing system of AI, the patients discharged from the hospital were monitored remotely, and the vital signs of patients were analyzed by AI. Different nursing methods were used to intervene the patients. Nursing evaluation data were used for nursing evaluation of patients undergoing HVR. Activity of Daily Life Scale (ADL) was used to evaluate patients' daily living ability, health status questionnaire was used to evaluate patients' health status, and World Health Organization Quality of Life-Brief version (WHOQOL-BREF) was used to evaluate patients' quality of life. The results showed that, before intervention, there was no significant difference in the scores of ADL between the control group and the observation group, with no statistical significance (P > 0.05). After intervention, the scores of ADL in the observation group were higher than those in the control group (P < 0.05), and the differences were statistically significant (P < 0.05); before intervention, the scores of ADL in the control group were higher than those in the control group, with statistical significance (P < 0.05). Before intervention, there was no significant difference in the health status questionnaire score between the control group and the observation group, without statistical significance (P > 0.05). After intervention, the health status questionnaire score of the observation group was higher than that of the control group, and the difference was statistically significant (P < 0.05). Before intervention, there was no significant difference in WHO quality of life evaluation score between the control group and the observation group, without statistical significance (P > 0.05). After intervention, the WHO quality of life evaluation score of the observation group was higher than that of the control group, and the difference was statistically significant (P < 0.05). After intervention, the KBS evaluation of nursing problem outcomes in the observation group was higher than that before intervention, and the difference was statistically significant (P < 0.05). In conclusion, the continuous nursing system of AI based on Omaha system can effectively evaluate the nursing problems of patients after discharge and improve the quality of life of patients, which has important application value.

scholarly journals Mental Health Status & Stress: A Comparative Study among Yoga- doer and Yoga- non doer Older Adults

2015 ◽  
Vol 2 (2) ◽  
Author(s):  
Dr. Krishna J. Vaghela1
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Health Status ◽  
Comparative Study ◽  
Mental Health Status ◽  
Inventory Data ◽  
Male And Female ◽  
Significant Difference ◽  
Stress Inventory ◽  
The Difference

The present study has been designed to investigate the difference of mental health status and stress among yoga- doer and yoga – non doer older adults. The research was conducted over a sample of 120 older adults both yoga – doer and yoga – non doer as well as male and female.[30 yoga – doer and 30 yoga – non doer male older adults and 30 yoga – doer and 30 – yoga non doer female older adults.] All the participants were administered the mental health inventory and stress inventory. Data was analyzed using t test. The results reported that there exists a significant difference in mental health status among yoga- doer and yoga – non doer older adults both male and female. Yoga – doer older adults had better mental as compare to yoga – non doer older adults. Significant difference is also observed between yoga- doer and yoga – non doer older adults as regarding to their level of stress scores. Yoga also helpful in reduce stress level.

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