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941.
942.
Johan L. Heemskerk Ricardo A. Domingo Rabih G. Tawk Tito G. Vivas-Buitrago Josephine F. Huang Ashley Rogers Alfredo Quinones-Hinojosa Kingsley Abode-Iyamah William D. Freeman 《Mayo Clinic proceedings. Mayo Clinic》2021,96(6):1446-1457
ObjectivesTo compare prehospital time for patients with suspected stroke in Florida with the American Stroke Association (ASA) time benchmarks, and to investigate the effects of dispatch notification and stroke assessment scales on prehospital time.Patients and MethodsA retrospective analysis was performed using data from Florida’s Emergency Medical Services Tracking and Reporting System database. All patients with suspected stroke transported to a treatment center from January 1, 2018, through December 31, 2018, were analyzed. Time intervals from 911 call to hospital arrival were evaluated and compared with ASA benchmarks.ResultsIn 2018, 11,577 patients with suspected stroke were transported to a hospital (mean age, 71.5±15.7 years; 51.5% women). The median alarm-to-hospital time was 33.98 minutes (27.8 to 41.4), with a total emergency medical services (EMS) time of 32.30 minutes (26.5 to 39.478). The on-scene time was the largest time interval with a median of 13.28 minutes (10.0 to 17.4). Emergency medical services encounters met the ASA benchmarks for time in 58% to 62% of the EMS encounters in Florida (recommended 90%; P<.001). The total EMS time was reduced when a stroke notification was reported by the dispatch center (32.00 minutes vs 32.62 minutes; P=.006) or when a stroke assessment scale was used by the EMS personnel (31.88 minutes vs 32.96 minutes; P=.005).ConclusionThis study reveals a substantial opportunity for improvement in stroke care in Florida. Two prehospital EMS stroke interventions seem to reduce prehospital time for patients with suspected stroke. Adoption of these interventions might improve the stroke systems of care. 相似文献
943.
John Burkhardt BS W. Frank Peacock MD Charles L. Emerman MD 《Academic emergency medicine》2005,12(9):869-874
Background: Acute decompensated heart failure (adHF) is the cause of approximately 1 million annual hospital admissions. In some of these, the use of a short‐stay emergency department observation unit (EDOU) decreases 90‐day ED revisits and 90‐day rehospitalizations and, if subsequent hospitalization is required, results in shorter stays. Objectives: To determine whether laboratory and clinical parameters, available at ED arrival, predict successful EDOU discharge. Methods: This was a 19‐month retrospective analysis of adHF EDOU admissions. Details of medical history, clinical course, patient management, laboratory data, and disposition destination were gathered through review of electronic medical records. Recorded laboratory data included measurements of sodium, creatinine, blood urea nitrogen (BUN), hemoglobin, b‐type natriuretic peptide, and initial ED systolic blood pressure. Data were analyzed for ability to predict the requirement of hospital admission after EDOU management. Results: There were 385 patients were enrolled. The mean (± standard deviation) age was 69.7 (± 13.6) years, and 50.1% were female. On ED admission chest radiograph, 69.0% had evidence of pulmonary edema. Elevations in creatinine and BUN levels had statistically significant associations with admission; however, on multivariable analysis, only a BUN value >30 mg/dL significantly predicted EDOU management failure, and subsequent inpatient admission. Conclusions: These results demonstrate that a BUN level >30 mg/dL is associated with an increased likelihood of admission in patients with adHF. This provides the emergency physician with a practical prognostic tool for disposition planning in congestive heart failure patients. 相似文献
944.
945.
946.
Sheryl Zimmerman Paul R. Katz Philip D. Sloane Malaz Boustani Mallory Brown Matteo Cesari Gustavo Duque Kathryn Hyer Francesco Landi David Nace Barbara Resnick Martin Smalbrugge David A. Smith Karl E. Steinberg Ladislav Volicer Gregg Warshaw Heidi K. White 《Journal of the American Medical Directors Association》2018,19(5):375-377
947.
948.
Lisa A. Martin Jane A. Hassinger Meghan Seewald Lisa H. Harris 《Women's health issues》2018,28(1):59-67
Objectives
We report on the development of a scale measuring abortion providers’ experiences of stigma.Study Design
Using previous measures, qualitative data, and expert review, we created a 49-item question pool. We administered questions to 315 abortion providers before participation in the Providers Share Workshop. We explored the factor structure and item quality using exploratory factor analysis. We assessed reliability using Cronbach's alpha. To test construct validity, we calculated Pearson's correlation coefficients between the stigma scales, the Maslach Burnout Inventory, and the K10 measure of psychological distress. We used Stata SE/12.0 for analyses.Results
Factor analysis revealed a 35-item, five-factor model: worries about disclosure, internalized states, social judgment, social isolation, and discrimination (Cronbach's alphas 0.79–0.94). Our stigma measure was correlated with psychological distress (r = 0.40; p < .001), and with Maslach Burnout Inventory's emotional exhaustion (r = 0.27; p < .001), and depersonalization (0.23; p < .001) subscales, and was inversely correlated with Maslach Burnout Inventory's personal accomplishment subscale (r = ?0.15; p < .05).Conclusions
Psychometric analysis of this scale reveals that it is a reliable and valid tool for measuring stigma in abortion providers, and may be helpful in evaluating stigma reduction programs. 相似文献949.
Elizabeth R. Daly Benjamin P. Chan Elizabeth A. Talbot Julianne Nassif Christine Bean Steffany J. Cavallo Erin Metcalf Karen Simone Alan D. Woolf 《International journal of hygiene and environmental health》2018,221(3):569-577
Background
Per- and polyfluoroalkyl substances (PFAS) are synthetic chemicals used in manufacturing that resist environmental degradation, can leach into drinking water, and bioaccumulate in tissues. Some studies have shown associations with negative health outcomes. In May 2014, a New Hampshire public drinking water supply was found to be contaminated with PFAS from a former U.S. Air Force base.Objectives
We established a serum testing program to assess PFAS exposure in the affected community.Methods
Serum samples and demographic and exposure information were collected from consenting eligible participants. Samples were tested for PFAS at three analytical laboratories. Geometric means and 95% confidence intervals were calculated and analyzed by age and exposure variables.Results
A total of 1578 individuals provided samples for PFAS testing;?>94% were found to have perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), and perfluorohexane sulfonic acid (PFHxS) detectable in serum. Geometric mean serum concentrations of PFOS, PFOA, and PFHxS were 8.6?μg/L (95% CI:8.3–8.9), 3.1?μg/L (95% CI: 3.0–3.2), and 4.1?μg/L (95% CI: 3.9–4.3), respectively, which were statistically higher than the general U.S. population. Significant associations were observed between PFAS serum concentrations and age, time spent in the affected community, childcare attendance, and water consumption.Conclusions
PFOS, PFOA, and PFHxS were found in significantly higher levels in the affected population, consistent with PFAS drinking water contamination. Given increased recognition of PFAS contamination in the U.S, a coordinated national response is needed to improve access to biomonitoring and understand health impacts. 相似文献950.
Kimberly Narain Bevanne Bean-Mayberry Donna L. Washington Ismelda A. Canelo Jill E. Darling Elizabeth M. Yano 《Women's health issues》2018,28(3):267-272