Determinants of variation in analgesic and opioid prescribing practice in an emergency department

2006 ◽  
Vol 2 (6) ◽  
pp. 335 ◽  
Author(s):  
Alan Heins, MD ◽  
Marianthe Grammas, BS ◽  
Janet Kaye Heins, RN, MSN, CRNP ◽  
Melissa W. Costello, MD ◽  
Kun Huang, MS ◽  
...  
Keyword(s):  
Emergency Department ◽  
Practice Variation ◽  
World Health ◽  
Emergency Physicians ◽  
Adequate Treatment ◽  
Treatment Disparities ◽  
Assessment And Treatment ◽  
Prescribing Practice ◽  
Health Organization ◽  
To Receive

Objective: Adequate treatment of patients’ pain is a top priority for the World Health Organization (WHO), American Medical Association (AMA), and American College of Emergency Physicians (ACEP), but “adequate” is not clearly defined. Most previous studies of emergency department (ED) pain treatments have centered on musculoskeletal pain in terms of rates of analgesia and disparities in treatment based on race and age. This study will examine complaints of pain other than musculoskeletal and will focus on treatment disparities that may result from differences in patient and physician characteristics.Methods: This retrospective study is of ED patients 18 years and older with nonmusculoskeletal pain who were seen by ED faculty over a period of eight weeks. Logistic regression and c2 tests were performed to quantify effects of doctor, patient, and clinical characteristics on rates of ED analgesia, ED opioids, and analgesic prescriptions at discharge.Results: A total of 1,360 patients were included. There was wide variation in the type and frequency of ED analgesia depending on the attending doctor. For example, patients seen by one specific ED doctor were less than half as likely to receive any analgesia and seven times less likely to receive an opioid than those seen by another doctor. Age, race, doctor’s training and experience, and whether the patient had chronic pain were important predictors of ED analgesia. There were similar findings for ED opioids and discharge analgesics.Conclusion: Pain practices in EDs are highly variable and seem inadequate when measured against the goals of WHO, AMA, and ACEP. Patient age, race, and type of pain and the physician’s identity, training, and experience all contribute to practice variation. Further research is needed to identify the causes of these variations, and there is a need to develop interventions to standardize and improve pain assessment and treatment.

scholarly journals Comparison of gelatin and HES 130/0.4 solution for fluid resuscitation in children with dengue shock syndrome

2013 ◽  
Vol 53 (6) ◽  
pp. 328
Author(s):  
Merry Mawardi ◽  
Tony Rampengan ◽  
Jeanette Manoppo ◽  
Novie Homenta Rampengan
Keyword(s):  
Body Temperature ◽  
Fluid Resuscitation ◽  
Pulse Pressure ◽  
Randomized Study ◽  
Dengue Shock Syndrome ◽  
World Health ◽  
Chi Square ◽  
Unusual Manifestation ◽  
Health Organization ◽  
To Receive

Background Dengue shock syndrome (DSS) is characterizedby severe vascular leakage and hemostasis disorder, which causesdeath in 1-5% of cases. World Health Organization managementguidelines for fluid resuscitation in DSS remain empirical, ratherthan evidence-based.Objective To as sess the efficacy of ge latin compared tohydroxyethyl starch (HES) 130/0.4 solution for fluid resuscitationin children with DSS.Methods We performed a multi-centered, randomized study tocompare gelatin and HES 130/0.4 solution for resuscitation ofchildren with DSS. We randomly assigned 25 children with DSSto receive gelatin fluid and 25 children to receive HES 130/0.4.Statistical analyses were performed using Chi-square and MannWhitneytests.Results More rapid increase in pulse pressure was noted insubjects treated with HES 130/0.4 compared to those treatedwith gelatin at 8 hours and 28 hours of therapy (P=0.037 andP=0.048). The decrease in hematocrit in subjects treated withHES 130/0.4 was faster than that of gelatin at 4 hours of therapy(P=0.001). One patient died due to an unusual manifestation ofDSS. Respiratory rate decreased faster in subjects treated withHES 130/0.4 than those treated with gelatin at 4 hours and 8hours of therapy (P< 0.05). Body temperature remained higherin subjects treated with gelatin than HES 130/0.4 at 36 hours and48 hours of therapy (P< 0.05). However, the decrease in plateletcounts in subjects treated with HES 130/0.4 was more than thatof gelatin (P=0.018).Conclusion HES 130/0.4 solution may be better for volume replacementcompared to gelatin and is safe for fluid resuscitationin children with DSS.

scholarly journals Microscopic Examination Of Postcapillary Cerebral Venues In Hemorrhagic Stroke

2021 ◽  
Vol 03 (08) ◽  
pp. 69-73
Author(s):  
Khaidarov Nodir Kadyrovich ◽  
◽  
Shomurodov Kahramon Erkinovich ◽  
Kamalova Malika Ilhomovna ◽  
◽  
...  
Keyword(s):  
Hemorrhagic Stroke ◽  
Surgical Intervention ◽  
Neurological Complications ◽  
World Health ◽  
Timely Manner ◽  
Global Response ◽  
Adequate Treatment ◽  
The World ◽  
Circulatory Disorders ◽  
Health Organization

Hemorrhagic stroke among acute cerebral circulatory disorders is characterized by severe neurological complications and the need to choose between surgical intervention or therapeutic therapy. According to the World Health Organization (WHO)". Globally, stroke deaths will reach 7.8 million by 2030 unless an aggressive global response to the epidemic is put in place" 1. Subarachnoid haemorrhage, which accounts for half of the non-traumatic intracerebral haemorrhage, affects the most active and able-bodied population. The most important medical and social objectives are to monitor the course of the disease from the first hours after the onset of stroke, to prescribe adequate treatment in a timely manner, and to reduce mortality and disability rates [5,9].

scholarly journals COVID-19 lock-down significantly reduced the number of surgical presentations in an emergency department

2020 ◽  
Author(s):  
René Fahrner ◽  
Stefan Bähler ◽  
Gregor Lindner
Keyword(s):  
Emergency Department ◽  
Time Course ◽  
Control Period ◽  
Final Analysis ◽  
Patient Characteristics ◽  
Medical Specialty ◽  
World Health ◽  
Number Of Patients ◽  
Health Organization ◽  
The Impact

Abstract IntroductionCoronavirus disease 2019 (COVID-19) is an acute virus infection that was declared by the World Health Organization (WHO) as a pandemic. As a consequence, the Swiss government decreed a public lock-down to reduce and restrict further infections. The aim of this investigation was to provide the impact of the COVID-19 lock-down on the presentations of patients in an interdisciplinary emergency department (ED).Patients, Materials and MethodsA retrospective study was performed at an interdisciplinary Swiss ED during the lock-down period. All patients who presented to the ED were enrolled in this investigation and compared to a control cohort during the same time period in 2019. Data regarding patient characteristics, medical specialty, time course of presentations during the observation period, and outpatient or hospital admission were analyzed.ResultsIn total, 7,072 patients were included in the final analysis. During the lock-down period, the number of ED presentations significantly decreased by 29% in comparison to the control period in the previous year (p<0.0001). The analysis of the time course revealed that in each week, the number of patients was lower, with a 13% to 43% reduction. Irrespective of the medical specialty, the number of presentations decreased during the COVID-19 situation, whereas this decrease was higher in surgical diseases (31%, p<0.0001) than in non-surgical presentations (3.6%, p=0.4).DiscussionThe socio-economic lock-down impacted the number of presentations in an ED. Mainly, surgical diseases and injuries were affected in terms of a reduction of presentations during the COVID-19 lock-down period.

scholarly journals Mercy Not Sacrifice: Lessons from Christianity for COVID-19 Pandemic

2021 ◽  
pp. 1-3
Keyword(s):  
World Health Organization ◽  
Traumatic Events ◽  
Point Of View ◽  
World Health ◽  
Spiritual Support ◽  
Religious Rituals ◽  
The World ◽  
Health Organization ◽  
To Receive

The World Health Organization announced that Coronavirus disease-2019 (COVID-19) officially a pandemic after its detection in Wuhan, China. From a religious point of view, most churches announced a suspension of all liturgical activities. Church practices have been altered in an effort to contain the virus. In this article we will enumerate the lessons applied from Christianity to behave in such pandemics. Introduction On March 11, 2020, the World Health Organization announced that the COVID-19 officially a pandemic after barreling through 114 countries in three months and infecting over three million people [1]. It's comprehensible that people tend to use religion to deal with a crisis or explain the tragedy by reference to an Act of God and seeking a church to receive spiritual support and healing during such traumatic events. Nonetheless, all over the world, liturgical services are being suspended [2]. Several million worshipers have been deprived of the existential comfort of attending religious rituals in a moment of critical vagueness and confusion.

scholarly journals SARS-CoV-2 Omicron variant: healthcare workers' perceptions and beliefs of vaccine effectiveness and advocacy: a national survey during the first week of the World Health Organization variant alert

2021 ◽  
Author(s):  
Mohamad-Hani Temsah ◽  
Fadi Aljamaan ◽  
Shuliweeh Alenezi ◽  
Khalid Alhasan ◽  
Abdulkarim Alrabiaah ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Healthcare Workers ◽  
Tertiary Care ◽  
Vaccine Effectiveness ◽  
World Health ◽  
Online Questionnaire ◽  
Variant Discovery ◽  
Health Organization ◽  
Mandatory Vaccination ◽  
To Receive

Background: As COVID-19 Omicron variant spread in several countries, healthcare workers' (HCWs) perceptions of vaccine effectiveness, booster and worries warrant reassessment. Methods: Online questionnaire among HCWs in Saudi Arabia (KSA) was collected between Dec 1-6, 2021, aiming to assess their Omicron variant's perceptions, worries, and booster-vaccine advocacy. Results: Among the 1285 HCWs participants in the study, two-thirds were females, 41% were nurses,46.4% were physicians, and 50% worked in tertiary care hospitals. Vaccination was perceived to be the most effective way to prevent the spread of Omicron variant and future variants by 66.9%. The respondents perceived social distancing (78%), universal masking (77.8%), and avoiding unnecessary travel (71.4%), slightly superior to vaccination to prevent COVID-19 variants spread. Of the respondents, 99.5% received two doses of COVID-19 vaccine. Regarding the booster dose, 96% either received it or planned to receive it once they are eligible. 57.7% of the respondents agreed that Omicron could cause a new COVID-19 wave worldwide, 45.9% agreed it may cause another COVID-19 wave in Saudi Arabia and 46.1% indicated the possibility of another lockdown. Overall, the HCWs worry level of the Omicron variant correlated significantly and strongly with their perception of the effectiveness of vaccination and preventive measures. Male HCWs had a significant agreement with mandatory vaccination of all eligible adult populations while HCWs who are unwilling to receive the vaccine had a strong disagreement with mandatory vaccination. Conclusions: The current study was conducted in the first week of Omicron variant discovery in KSA and only two-thirds of HCWs felt that vaccination is the best option to prevent the variant spread, indicating the need to further motivation campaigns for vaccination and booster doses education among HCWs. HCWs had a strong belief in non-pharmacologic interventions that should be encouraged and augmented. It is important to further study and enhance coping strategies for HCWs as we move through the third year of the pandemic with more potential variants, to protect HCWs from fatigue and burnout.

scholarly journals The COVID States Project #75: Attitudes toward COVID-19 boosters before and after Omicron

2021 ◽  
Author(s):  
Roy H. Perlis ◽  
Matthew Baum ◽  
Kristin Lunz Trujillo ◽  
David Lazer ◽  
Alauna Safarpour ◽  
...  
Keyword(s):  
District Of Columbia ◽  
The United States ◽  
World Health ◽  
Vaccine Hesitancy ◽  
Dominant Form ◽  
The Us ◽  
Before And After ◽  
Control And Prevention ◽  
Health Organization ◽  
To Receive

Recognizing that the protection conferred by COVID-19 vaccines may wane over time, the US Centers for Disease Control and Prevention (CDC) has encouraged adults in the United States to receive booster shots that can augment their immunity to the virus. While the Biden administration sought to encourage all adults to receive boosters, the CDC initially authorized the shots only for higher-risk individuals. Subsequently, authorization was broadened to all adults, although only higher-risk individuals were encouraged to pursue boosters. Most recently, after substantial criticism, the CDC changed its language to encourage all adults to receive boosters.But regardless of the language, are US adults sufficiently convinced to seek booster shots? Will the same factors that contributed to COVID-19 vaccine hesitancy and vaccine resistance impact booster shots? The answers may have profound public health implications as the US enters the season during which respiratory viruses typically have the greatest impact, and the highly-transmissible Omicron variant rapidly becomes the dominant form of COVID-19, after being labeled a variant of concern by the World Health Organization on November 26th.Between November 3rd and December 3rd, 2021, the COVID States Project asked 22,277 adults in all 50 US states and the District of Columbia about their attitudes and behaviors regarding COVID-19. In particular, we asked about whether people are vaccinated or intend to be vaccinated, and whether they had sought booster shots or intend to seek a booster shot. In this brief report, we examine attitudes toward COVID-19 booster shots, and whether they differ across particular groups of people. Since the survey was ongoing when news about Omicron emerged in the US, we also take an initial look at whether these attitudes have begun to shift along with perceptions of the threat posed by COVID-19 subsequent to the November 26th announcement.

scholarly journals COVID-19 in Children a Descriptive Study at the Security Forces Hospital (SFH)-AL Riyadh-Saudi Arabia

2021 ◽  
pp. 21-27
Author(s):  
Elsharif A. Bazie ◽  
Abdulkarim Alanazi ◽  
Wejdan Hamed Abdullah Alshammari ◽  
Fahad Mishal Alharbi ◽  
Faisal Ahmed Alghamdi
Keyword(s):  
Emergency Department ◽  
Severe Acute Respiratory Syndrome ◽  
Clinical Presentation ◽  
Descriptive Study ◽  
Respiratory Viruses ◽  
World Health ◽  
Security Forces ◽  
Wide Range ◽  
Pediatric Populations ◽  
Health Organization

Coronaviruses (CoV) are RNA respiratory viruses that present with a wide range of symptomatology which range from common cold to severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). In December 2019 a new strain was discovered in China named Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2), named “COVID-19” by World Health Organization (WHO). Objective: To study the prevalence and clinical presentation of COVID-19 among children attended pediatrics emergency department. Result: from 1st March to 30th of June 2020. During the study period, a total of 223 patients with age between 16 days and 12 years were diagnosed as positive COVID-19. Male were 52%. Fever was found in 39.9%, cough in 14.3%, and diarrhea in 3.6%. Conclusion: our study gives a clue to the clinical presentation of COVID-19 in pediatric populations.

scholarly journals Severe COVID-19 in cardiopath young pregnant without vertical transmission: a case report

2020 ◽  
Author(s):  
Ana Paula Figueiredo de Montalvão França ◽  
Danielly do Vale Pereira ◽  
Elaine Valéria Rodrigues ◽  
Flávia Nunes Vieira ◽  
Karine Santos Machado ◽  
...  
Keyword(s):  
Vertical Transmission ◽  
Viral Infections ◽  
Previous History ◽  
Risk Groups ◽  
World Health ◽  
Adequate Treatment ◽  
Emergency Cesarean ◽  
The World ◽  
History Of ◽  
Health Organization

Abstract Background: The new betacoronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of COVID-19, and has spread rapidly around the world, reaching more than 200 countries, around 7 million people and causing more than 400.000 deaths according to the World Health Organization. Case presentation: A 26-year-old female at 28 weeks of gestation with regular prenatal care, a heart disease condition and no previous history of recent national or international traveling presented to a cardiology hospital, in Northern Brazil, with dry cough, sustained/continuous high fever, which quickly evolved to respiratory failure. Once stabilized an emergency cesarean was performed to preserve the fetus life. After surgery both patient and newborn were in Intensive Care Unit, then both patient and newborn nasopharyngeal and oropharyngeal secretion were obtained to test for respiratory viral infections, such as SARS-CoV-2, also blood samples were collected for laboratory exams. The patient’s tested positive for SARS-CoV-2 however her newborn SARS-CoV-2. And during treatment due patient’s conditions and severity the case evolved to death.Conclusion: This report highlights the relevance of comorbidities for the unfavorable clinical course of COVID-19, despite the adequate treatment used for patients affected by COVID-19, especially among the risk groups, as well as demonstrating the absence of vertical transmission of SARS-CoV-2.

scholarly journals Smart helmet using internet of things

2021 ◽  
Vol 10 (2) ◽  
pp. 90
Author(s):  
Mohamed A. Torad
Keyword(s):  
Emergency Department ◽  
Internet Of Things ◽  
Detection System ◽  
Electrical Signal ◽  
Piezoelectric Sensors ◽  
World Health ◽  
The World ◽  
Health Organization ◽  
Tracking Device ◽  
Accident Detection

The rate of death relative to the size of the world's population has remained constant, according to the world health organization (WHO). WHO targets to minimize the ratio of road death to the half by 2022. This paper discusses a way for accident detection and notification which can decrease this ratio. Piezoelectric sensors used inside a helmet to detect degree of trauma which interpret into electrical signal that used to determine if trauma is serious or not based on predetermined threshold. This trauma can be a result of any type of accidents. So, a detection system established to request immediate help from relatives and emergency department by sending SMS to them contains the longitude and latitude. In normal mode helmet can work as tracking device for the relatives.

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