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1.
Timothy H. Self Justin B. Usery Amanda M. Howard-Thompson Chris Sands 《The Journal of asthma》2007,44(4):243-248
Management of asthma in emergency departments (ED) has been well documented to be deficient over many years, despite national and international guidelines. This review summarizes the effect of ED protocols aimed at improving the assessment and treatment of asthma in the ED. We performed a PubMed search of the English literature for ED asthma protocols published from 1986 to 2006 and identified 11 studies. Protocols were effective in improving at least some areas of management, including use of appropriate patient assessment, drug therapy per national guidelines, and patient education. A small number of protocols with the specific aims of reducing the length of stay in the ED as well as rates of hospital admission and return visits were effective. Persistent education of ED staff regarding protocols based on current management guidelines and adoption of easy-to-use forms can facilitate improved care of patients with asthma in the ED. 相似文献
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Timothy H. Self Cary R. Chrisman Darius L. Mason Mark J. Rumbak 《The Journal of asthma》2013,50(10):807-812
Minority populations in the United States continue to experience a disproportionate share of emergency department (ED) visits and hospitalizations due to asthma. This review examines programs that have attempted to reduce these acute care visits in African American and Hispanic patients. We performed a PubMed search of the English literature for studies published from March 1990 to March 2005, aimed at reducing ED visits and hospitalizations in patients with asthma. Decreased acute care visits in African American and Hispanic patients with asthma have been demonstrated in several studies over the past 15 years, including collaboration by physicians, nurses, and clinical pharmacists in achieving this goal. These studies have shown that reduced acute care visits are associated with optimal drug therapy per national guidelines, concurrent with patient education, environmental control, and objective monitoring of this inflammatory airway disease. Early intensive patient education was a key feature of these successful programs. Written action plans, including early use of oral corticosteroids at home, and rapport with patients are other key components of programs that have resulted in a decrease in ED visits and hospitalizations. 相似文献
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Timothy H. Self Cary R. Chrisman Darius L. Mason Mark J. Rumbak 《The Journal of asthma》2005,42(10):807-812
Minority populations in the United States continue to experience a disproportionate share of emergency department (ED) visits and hospitalizations due to asthma. This review examines programs that have attempted to reduce these acute care visits in African American and Hispanic patients. We performed a PubMed search of the English literature for studies published from March 1990 to March 2005, aimed at reducing ED visits and hospitalizations in patients with asthma. Decreased acute care visits in African American and Hispanic patients with asthma have been demonstrated in several studies over the past 15 years, including collaboration by physicians, nurses, and clinical pharmacists in achieving this goal. These studies have shown that reduced acute care visits are associated with optimal drug therapy per national guidelines, concurrent with patient education, environmental control, and objective monitoring of this inflammatory airway disease. Early intensive patient education was a key feature of these successful programs. Written action plans, including early use of oral corticosteroids at home, and rapport with patients are other key components of programs that have resulted in a decrease in ED visits and hospitalizations. 相似文献
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Matthew G Clark Abdallah Dalabih 《Journal of clinical research in pediatric endocrinology》2014,6(3):190-191
Management protocols have been shown to be effective in the pediatric emergency medicine (PEM) and pediatric critical care (PCC) settings. Treatment protocols define clear goals which are achieved with consistency in implementation. Over the last decade, many new recommendations have been proposed on managing diabetic ketoacidosis (DKA). Although no perfect set of guidelines exist, many institutions are developing DKA treatment protocols. We sought to determine the variability between institutions in implementation of these protocols. 相似文献
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Jaime M. Hughes Caroline E. Freiermuth Megan Shepherd‐Banigan Luna Ragsdale Stephanie A. Eucker Karen Goldstein S. Nicole Hastings Rachel L. Rodriguez Jessica Fulton Katherine Ramos Amir Alishahi Tabriz Adelaide M. Gordon Jennifer M. Gierisch Andrzej Kosinski John W. Williams 《Journal of the American Geriatrics Society》2019,67(7):1516-1525
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Ula Hwang MD MPH Scott M. Dresden MD MS Mark S. Rosenberg DO MBA Melissa M. Garrido PhD George Loo MPA MPH DrPh Jeremy Sze BS Stephanie Gravenor MBA D. Mark Courtney MD Raymond Kang MA Carolyn W. Zhu PhD Carmen Vargas‐Torres MA Corita R. Grudzen MD MSHS Lynne D. Richardson MD The GEDI WISE Investigators 《Journal of the American Geriatrics Society》2018,66(3):459-466
Objectives
To examine the effect of an emergency department (ED )‐based transitional care nurse (TCN ) on hospital use.Design
Prospective observational cohort.Setting
Three U.S. (NY , IL , NJ ) ED s from January 1, 2013, to June 30, 2015.Participants
Individuals aged 65 and older in the ED (N = 57,287).Intervention
The intervention was first TCN contact. Controls never saw a TCN during the study period.Measurements
We examined sociodemographic and clinical characteristics associated with TCN use and outcomes. The primary outcome was inpatient admission during the index ED visit (admission on Day 0). Secondary outcomes included cumulative 30‐day admission (any admission on Days 0–30) and 72‐hour ED revisits.Results
A TCN saw 5,930 (10%) individuals, 42% of whom were admitted. After accounting for observed selection bias using entropy balance, results showed that when compared to controls, TCN contact was associated with lower risk of admission (site 1: ?9.9% risk of inpatient admission, 95% confidence interval (CI ) = ?12.3% to ?7.5%; site 2: ?16.5%, 95% CI = ?18.7% to ?14.2%; site 3: ?4.7%, 95% CI = ?7.5% to ?2.0%). Participants with TCN contact had greater risk of a 72‐hour ED revisit at two sites (site 1: 1.5%, 95% CI = 0.7–2.3%; site 2: 1.4%, 95% CI = 0.7–2.1%). Risk of any admission within 30 days of the index ED visit also remained lower for TCN patients at both these sites (site 1: ?7.8%, 95% CI = ?10.3% to ?5.3%; site 2: ?13.8%, 95% CI = ?16.1% to ?11.6%).Conclusion
Targeted evaluation by geriatric ED transitions of care staff may be an effective delivery innovation to reduce risk of inpatient admission.11.
Old and New Geriatric Screening Tools in a Belgian Emergency Department: A Diagnostic Accuracy Study
Pieter Heeren RN MSc Els Devriendt RN PhD Nathalie I.H. Wellens SLT PhD Mieke Deschodt RN PhD Johan Flamaing MD PhD Marc Sabbe MD PhD Koen Milisen RN PhD 《Journal of the American Geriatrics Society》2020,68(7):1454-1461
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Arvind Venkat Kohei Hasegawa Jeanne M. Basior Cameron Crandall Megan Healy P. Charles Inboriboon Ashley F. Sullivan Carlos A. Camargo Jr 《Respirology (Carlton, Vic.)》2015,20(6):994-997
We investigated whether racial/ethnic disparities exist in asthma management among 1785 adults requiring emergency department (ED) treatment. In this multicentre study, non‐Hispanic blacks with increased chronic asthma severity were only as likely (P > 0.05) as non‐Hispanic whites or Hispanics to utilize controller medications or see asthma specialists before ED presentation and to be prescribed recommended inhaled corticosteroids at ED discharge. Improved ED education on evidence‐based chronic disease management is needed to address continuing race/ethnicity‐based asthma disparities. 相似文献
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Colleen Marie McGovern Margaret Redmond Kimberly Arcoleo David R. Stukus 《The Journal of asthma》2017,54(9):977-982
Objective: Since the Affordable Care Act's implementation, emergency department (ED) visits have increased. Poor asthma control increases the risk of acute exacerbations and preventable ED visits. The Centers for Medicare and Medicaid Services support the reduction of preventable ED visits to reduce healthcare spending. Implementation of interventions to avoid preventable ED visits has become a priority for many healthcare systems yet little data exist examining children's missed asthma management primary care (PC) appointments and subsequent ED visits. Methods: Longitudinal, retrospective review at a children's hospital was conducted for children with diagnosed asthma (ICD-9 493.xx), ages 2–18 years, scheduled for a PC visit between January 1, 2010, and June 30, 2012 (N = 3895). Records were cross-referenced with all asthma-related ED visits from January 1, 2010 to December 31, 2012. Logistic regression with maximum likelihood estimation was conducted. Results: None of the children who completed a PC appointment experienced an ED visit in the subsequent 6 months whereas 2.7% of those with missed PC appointments had an ED visit (χ2 = 64.28, p <.0001). Males were significantly more likely to have an ED visit following a missed PC appointment than females (χ2 = 34.37, p <.0001). There was a statistically significant interaction of sex × age. Younger children (<12 years) made more visits than older children. Conclusions: The importance of adherence to PC appointments for children with asthma as one mechanism for preventing ED visits was demonstrated. Interventions targeting missed visits could decrease asthma-related morbidity, preventable ED visits, and healthcare costs. 相似文献
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《The Journal of asthma》2013,50(5):442-448
Background. Asthma exacerbation patterns are cyclic in nature and often correlate with air particle concentrations. Objective. To examine the relationship between asthma-related emergency department (ED) visits and outdoor air quality for pediatric and adult patients in a high asthma prevalence area, the New York City borough of the Bronx. Methods. Numbers of daily asthma-related adult and pediatric ED visits during one complete year (1999) were obtained from the seven major Bronx hospitals. Daily values of nitrogen oxides (NOx), ozone (O3), sulfur dioxide (SO2), and pollen counts were acquired. Results. Asthma-related ED visit numbers were highest in December–January and lowest in July. There were three distinct peaks of increased asthma ED visits: winter (December–January), spring (late April–May), and fall (October). The spring peak was the most striking and coincided with high tree pollen counts (tree pollen: r = 0.90, p = .03). We observed a positive correlation between asthma ED visits in the winter and SO2 and NOx levels. Winter peaks of SO2 and NOx in early December appeared to precede the winter asthma peak. Conclusions. The spring asthma peak is closely associated with increased tree pollen counts, and the asthma increase at this time is likely due to allergic reactions to pollen. No significant associations could be established with the fall peak. The winter peak correlates with elevated SO2 and NOx levels. 相似文献
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S. Lovinsky 《The Journal of asthma》2013,50(9):1011-1014
Introduction. As asthma presentation is episodic, patients with acute exacerbations often present in the emergency department (ED) where preventative regimen may not always be addressed. Addressing initiation and modification of controller medications in the setting of an acute exacerbation may facilitate improved asthma control and decrease the frequency of ED visits, particularly so for families who receive most of their asthma management in the ED. However, this aspect has not yet been explored. Methods. We reviewed a random sample of 363 charts, 10% of the total number of asthmatic children, aged 2–18, seen from January to December 2007 in the pediatric ED of an urban teaching hospital located in Bronx, NY, USA. We quantified the frequency of modification of the preventative regimen and the influence of seasons on this practice. Results. Of these 363 children, 42.4% of patients were not previously on a controller medication. Of these, 9.7% were started on a new controller medication, with a significantly higher percent occurring in the summer months. Of those that were previously on a controller medication, 2.87% were started on a new controller medication and 0.95% had their controller medication dose increased. However, the regimen was not adjusted in 14.3% that had been seen four or more times in the preceding 2 years. Of the total 363 children, 78.5% were discharged from the ED on a short course of oral steroids, and this was not part of their preventative regimen. Only four charts had physician-documented asthma severity classification. Conclusions. We found that the preventative regimen was modified in only 0.9–2% of all asthmatic children seen in an urban ED whereas 78.5% were started on systemic steroids. Asthma severity was evaluated in a very small number of patients. Because modification of preventative regimen requires appropriate asthma severity classification, the inclusion of asthma severity classification as part of routine ED evaluation may encourage physicians to address controller medications in persistent asthmatics. 相似文献
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《Pediatric pulmonology》2018,53(9):1179-1192
Background
Asthma attacks are common and have significant physical, psychological, and financial consequences. Improving the assessment of a child's risk of subsequent asthma attacks could support front‐line clinicians’ decisions on augmenting chronic treatment or specialist referral. We aimed to identify predictors for emergency department (ED) or hospital readmission for asthma from the published literature.Methods
We searched MEDLINE, EMBASE, AMED, PsycINFO, and CINAHL with no language, location, or time restrictions. We retrieved observational studies and randomized controlled trials (RCT) assessing factors (personal and family history, and biomarkers) associated with the risk of ED re‐attendance or hospital readmission for acute childhood asthma.Results
Three RCTs and 33 observational studies were included, 31 from Anglophone countries and none from Asia or Africa. There was an unclear or high risk of bias in 14 of the studies, including 2 of the RCTs. Previous history of emergency or hospital admissions for asthma, younger age, African‐American ethnicity, and low socioeconomic status increased risk of subsequent ED and hospital readmissions for acute asthma. Female sex and concomitant allergic diseases also predicted hospital readmission.Conclusion
Despite the global importance of this issue, there are relatively few high quality studies or studies from outside North America. Factors other than symptoms are associated with the risk of emergency re‐attendance for acute asthma among children. Further research is required to better quantify the risk of future attacks and to assess the role of commonly used biomarkers.18.
Teresa L. Carman Florian Gegaj 《Current treatment options in cardiovascular medicine》2010,12(2):168-184
The morbidity and mortality of venous thromboembolism remain underrecognized and underappreciated. Suspected pulmonary embolism
should be risk stratified using a validated clinical risk prediction tool; intermediate to high clinical suspicion requires
objective diagnostic testing to confirm or refute the diagnosis. Therapy with unfractionated heparin, low molecular weight
heparin, or fondaparinux should be initiated while diagnostic testing is pursued. Conversion to vitamin K antagonists requires
a minimum of 5 days’ overlap between the parenteral agent and the vitamin K antagonist. Anticoagulation should be continued
for a minimum of 3 to 6 months. Longer or even indefinite therapy may be required with a persistent hypercoagulable state.
In patients with cancer, low molecular weight heparin monotherapy for the initial 3 to 6 months is preferred. In stable patients
with normal biomarkers and a normal echocardiogram, accelerated discharge and outpatient therapy may be considered. In patients
with hemodynamic instability, systemic thrombolytic therapy, catheter-directed therapy, or surgical embolectomy may be considered.
Cancer screening and/or thrombophilia testing should be pursued only if the findings will directly affect patient therapy
or long-term care. 相似文献
19.
Hospitalization rates for asthma have been reported to be higher in males than females in children under age 15, but it is not clear whether this disparity reflects gender differences in prevalence, severity, or treatment. We performed a prospective cohort study as part of the Emergency Medicine Network. Patients aged 2-13 years who presented to the emergency department (ED) with acute asthma underwent a structured interview in the ED and another by telephone 2 weeks later. Of 1,602 patients, 61% (95% CI, 59-64%) were boys. Girls were slightly older than boys, although no material differences existed in acute presentation, chronic asthma characteristics, ED treatment, or ED course. There was no difference in admission rates for boys or girls (20% vs. 22%; P = 0.48). This finding persisted when adjusting for other factors in a multivariate logistic regression model. No sex differences were observed for relapse or ongoing exacerbation on univariate or multivariate analysis. These data suggest that asthma is not inherently more severe in boys with asthma compared to girls, and that the increased rate of hospitalizations in boys under age 13 is due to differences in prevalence, not severity. 相似文献