WorldWideScience

Sample records for emergency room utilization

  1. Utilization of the emergency room: impact of geographic distance

    Directory of Open Access Journals (Sweden)

    Jae Eun Lee

    2007-05-01

    Full Text Available The aim of this study was to estimate the distance Mississippi patients must travel to access hospital-based emergency rooms (ERs and to determine whether an association exists between geographic distance and ER utilization. To that end, great circle distances between Census Block Group Centroid Points and 89 hospitals with emergency departments were calculated for the State of Mississippi. Data on the socio-demographic characteristics of each block group came from the 2000 US Census data. Logistic regression analyses were conducted to test if there was any association between ER utilization and travel distance. Compared to the national benchmark of 35.7%, more than one in two (56.7%, or 1,612,762 Mississippians visited ERs in 2003 with an estimated 6.1 miles per person annual travel for this purpose. The majority of the target population (54.9% was found to live within 5 miles of hospitals with ERs. Logistic analyses revealed that block groups associated with less miles traveled to hospitals with ERs had a higher proportion of African Americans, impoverished people, female householders, people with more than 12 years education, people older than 65 years, people with high median house values, and people without employment. Twenty-nine of the 89 hospitals (33% providing ER care in Mississippi were found to be in areas with above-average ER utilization rates. These hospitals served a smaller geographical area (28% of the total but had a greater proportion of visitors (57% and served a higher percentage (37% of the state population. People in areas served by the less utilized ERs traveled more miles to be cared for (7.1 miles vs 5.4 miles; p<0.0001. Logistic regression analysis revealed that shorter distances were associated with increased use of the ERs, even after controlling for socio-demographic factors. The conclusion is that Mississippi ERs are typically located in block groups with higher percentages of disadvantaged residents and that

  2. Sulfonylurea monotherapy and emergency room utilization among elderly patients with type 2 diabetes.

    Science.gov (United States)

    Rajpathak, Swapnil N; Fu, Chunmay; Brodovicz, Kimberley; Engel, Samuel S; Heaton, Pamela C

    2015-09-01

    In elderly Americans with type 2 diabetes, use of insulin and oral antidiabetic drugs (OADs) accounts for almost one-fourth of drug adverse event-related hospitalizations. It is not clear, however, if sulfonylureas (SUs), frequently prescribed OADs known to cause hypoglycemia, increase the risk of emergency room (ER) visits compared to other OADs. The aim of this study was to compare the emergency room utilization between US elderly patients with diabetes on SU monotherapy vs. other non-SU monotherapies. This retrospective cohort study was conducted using MarketScan(®) database (2009-10) and aimed to evaluate the association between use of SU and ER visits. The analysis included 28,533 patients (aged ≥65 years) receiving SU monotherapy at baseline and 1:1 propensity score (PS)-matched group receiving monotherapy with other OADs. ER utilization was determined during a 1-year follow-up period. The SU and non-SU groups were overall well balanced after PS matching. The mean (SD) number of ER visits during the follow-up was 0.56 among users of SU users compared to 0.49 (Pmetformin users. Elderly patients with type 2 diabetes on SU monotherapy were more likely to use ER than those on other monotherapies. Further studies are needed to confirm our findings and evaluate other factors associated with ER visits. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  3. CSN's New Emergency Room

    International Nuclear Information System (INIS)

    Sendin, P.

    2005-01-01

    During the month of July 2005 the physical renovation works and technological updating of the basic infrastructures of the CSN Emergency Room (SALEM) were finished, allowing the Room to now have greater functionality and a broader technical capacity. Nevertheless, the technological improvement process of SALEM will reach its full potential within the next few years, once the installation currently underway of the new information integration and monitoring systems and the decision making support systems have been completed. This article describes the improvements introduced to the Room and the objectives pursued in this renovation project to convert the SALEM into a new generation room in accordance with its current technological context. (Author) 4 refs

  4. [Emergency room services utilization in the province of Reggio Emilia: a comparison between immigrants and Italians].

    Science.gov (United States)

    Bonvicini, Laura; Broccoli, Serena; D'Angelo, Stefania; Candela, Silvia

    2011-01-01

    The aim of the study is to compare Italian and immigrant accesses to Emergency Room (ER) Services in the province of Reggio Emilia, with particular attention to time differences and to potentially inappropriate accesses. the database of ER accesses in the province of Reggio Emilia was analyzed for the years 2007- 2010. In the analysis of the resident population all autochthonous citizens and all immigrants from Developed Countries were considered Italians, while citizens from Developing Countries were Immigrants. Temporary Immigrants were those immigrants with residence and citizenship in a Developing Country. A descriptive analysis was conducted using demographic variables related to patients (age, gender, citizenship and residence) and variables related to access (admission emergency codes, cause of admission, hour, day of the week, month and discharge modality). Standardized access Ratios (SRs) were calculated for the resident population, together with 95%Confidence Intervals (95% CI). The SRs were calculated separately for children and for adults. In the years 2007-2010, 562,658 accesses to ER were recorded for Italians, 95,300 accesses for Immigrants and 6,800 for the Temporary Immigrants. Access rates for resident Immigrants were higher than Italian ones. In 2010, the SR for men was 1.24 (95%CI 1.22-1.27) while for women it was 1.18 (95%CI 1.15-1.27). Considering only non-urgent accesses, the SRs were even higher (SR men=1.65, 95% CI 1.58-1.72, women=1.43, 95% CI 1.36-1.50). Similar findings were observed in children. Immigrants access the ER services more than Italians do.They also show more non-urgent accesses in comparison with Italians. This finding is consistent with results of studies conducted in other European countries and it underlines the necessity to reorganize primary care in order to better meet immigrants' needs.

  5. Improving cancer patient emergency room utilization: A New Jersey state assessment.

    Science.gov (United States)

    Scholer, Anthony J; Mahmoud, Omar M; Ghosh, Debopyria; Schwartzman, Jacob; Farooq, Mohammed; Cabrera, Javier; Wieder, Robert; Adam, Nabil R; Chokshi, Ravi J

    2017-12-01

    Due to its increasing incidence and its major contribution to healthcare costs, cancer is a major public health problem in the United States. The impact across different services is not well documented and utilization of emergency departments (ED) by cancer patients is not well characterized. The aim of our study was to identify factors that can be addressed to improve the appropriate delivery of quality cancer care thereby reducing ED utilization, decreasing hospitalizations and reducing the related healthcare costs. The New Jersey State Inpatient and Emergency Department Databases were used to identify the primary outcome variables; patient disposition and readmission rates. The independent variables were demographics, payer and clinical characteristics. Multivariable unconditional logistic regression models using clinical and demographic data were used to predict hospital admission or emergency department return. A total of 37,080 emergency department visits were cancer related with the most common diagnosis attributed to lung cancer (30.0%) and the most common presentation was pain. The disposition of patients who visit the ED due to cancer related issues is significantly affected by the factors of race (African American OR=0.6, p value=0.02 and Hispanic OR=0.5, p value=0.02, respectively), age aged 65 to 75years (SNF/ICF OR 2.35, p value=0.00 and Home Healthcare Service OR 5.15, p value=0.01, respectively), number of diagnoses (OR 1.26, p value=0.00), insurance payer (SNF/ICF OR 2.2, p value=0.02 and Home Healthcare Services OR 2.85, p value=0.07, respectively) and type of cancer (breast OR 0.54, p value=0.01, prostate OR 0.56, p value=0.01, uterine OR 0.37, p value=0.02, and other OR 0.62, p value=0.05, respectively). In addition, comorbidities increased the likelihood of death, being transferred to SNF/ICF, or utilization of home healthcare services (OR 1.6, p value=0.00, OR 1.18, p value=0.00, and OR 1.16, p value=0.04, respectively). Readmission is

  6. [Hospital emergency rooms].

    Science.gov (United States)

    Tudela, Pere; Mòdol, Josep Maria

    2003-05-17

    Overuse of hospital emergency rooms (HERs) is parallel to their controversy. To understand this problem, some concepts should be first clarified. In HERs, there are some intrinsic aspects which are directly related to the emergency itself and thus cannot be modified (intermittent patient flow, need to prioritize, difficulty to achieve a rapid diagnosis, influence of time on treatment, value of clinical follow up, patient's expectations, impact of HER on the overall hospital working dynamics). On the other hand, there are some extrinsic aspects which indeed are not related to HER itself but are rather historically associated with it (precarious structure, delay on admission, lack of privacy, inadequate triage of cases, lack of professionalization); these latter aspects may be potentially modified and should be reconsidered.

  7. Emergency management of major bleeding in a case of maxillofacial trauma and anticoagulation: utility of prothrombin complex concentrates in the shock room

    Directory of Open Access Journals (Sweden)

    Alessandro Morotti

    2015-03-01

    Full Text Available Life-threatening bleeding in anticoagulation with Warfarin is an emergency challenging issue. Several approaches are available to treat bleeding in either over-anticoagulation or propeanticoagulation, including vitamin K, fresh frozen plasma and prothrombin complex concentrates (PCC administration. In coexisting trauma-induced bleeding and anticoagulation, reversal of anticoagulation must be a rapid and highly effective procedure. Furthermore the appropriate treatment must be directly available in each shock rooms to guarantee the rapid management of the emergency. PCC require a simple storage, rapid accessibility, fast administration procedures and high effectiveness. Here we report the utility of PCC in management of a craniofacial trauma in proper-anticoagulation.

  8. Operating Room Utilization at Frederick Memorial Hospital

    National Research Council Canada - National Science Library

    Edwards, Jonathan A

    2007-01-01

    .... A logistical regression analysis was used to identify the impact of variables on operating room utilization rates and therefore help explain how or why some operating rooms incurred higher utilization rates than others...

  9. Web based emergency room PACS

    International Nuclear Information System (INIS)

    Cha, Soon Joo; Cheon, Yong Kyung; Choi, Sung Woo Kim

    2005-01-01

    We wished to develop the web based Picture Archiving and Communication System in the emergency room for early decision making in emergency treatment planning at a full PACS Hospital. The program tools were Microsoft Visual Studio 6.0 - Visual C++ 6.0, and the Microsoft SQL 7.0 under the Microsoft Windows 2000 server operation system. The achievement of images was performed by an auto transport program installed in the ER and the radiology department. The average compression rates were 5:1 for CT and MR, and 20:1 for CR with JPEG 2000 lossy compression. All the images were stored on hard disk for 3 months. The patients' information was displayed for 2 weeks for reducing the security risk. For interdepartmental consultation, patient query by patient hospital number was available. Our Web based ER PACS could be useful system for early decision making for treatment planning in the emergency room because it reduces the risk factors for the security of the Web Paces by using a system independent from PACS in the hospital and minimizing the information patients

  10. Web based emergency room PACS

    Energy Technology Data Exchange (ETDEWEB)

    Cha, Soon Joo; Cheon, Yong Kyung; Choi, Sung Woo Kim [Ilsan Paik Hospital, Inje University, Seoul (Korea, Republic of)] (and others)

    2005-07-15

    We wished to develop the web based Picture Archiving and Communication System in the emergency room for early decision making in emergency treatment planning at a full PACS Hospital. The program tools were Microsoft Visual Studio 6.0 - Visual C++ 6.0, and the Microsoft SQL 7.0 under the Microsoft Windows 2000 server operation system. The achievement of images was performed by an auto transport program installed in the ER and the radiology department. The average compression rates were 5:1 for CT and MR, and 20:1 for CR with JPEG 2000 lossy compression. All the images were stored on hard disk for 3 months. The patients' information was displayed for 2 weeks for reducing the security risk. For interdepartmental consultation, patient query by patient hospital number was available. Our Web based ER PACS could be useful system for early decision making for treatment planning in the emergency room because it reduces the risk factors for the security of the Web Paces by using a system independent from PACS in the hospital and minimizing the information patients.

  11. Intrahospital teleradiology from the emergency room

    Science.gov (United States)

    Fuhrman, Carl R.; Slasky, B. S.; Gur, David; Lattner, Stefanie; Herron, John M.; Plunkett, Michael B.; Towers, Jeffrey D.; Thaete, F. Leland

    1993-09-01

    Off-hour operations of the modern emergency room presents a challenge to conventional image management systems. To assess the utility of intrahospital teleradiology systems from the emergency room (ER), we installed a high-resolution film digitizer which was interfaced to a central archive and to a workstation at the main reading room. The system was designed to allow for digitization of images as soon as the films were processed. Digitized images were autorouted to both destinations, and digitized images could be laser printed (if desired). Almost real time interpretations of nonselected cases were performed at both locations (conventional film in the ER and a workstation in the main reading room), and an analysis of disagreements was performed. Our results demonstrate that in spite of a `significant' difference in reporting, `clinically significant differences' were found in less than 5% of cases. Folder management issues, preprocessing, image orientation, and setting reasonable lookup tables for display were identified as the main limitations to the systems' routine use in a busy environment. The main limitation of the conventional film was the identification of subtle abnormalities in the bright regions of the film. Once identified on either system (conventional film or soft display), all abnormalities were visible and detectable on both display modalities.

  12. When to use the emergency room - child

    Science.gov (United States)

    Emergency room - child; Emergency department - child; Urgent care - child; ER - when to use ... How quickly does your child need care? If your child could die or be permanently disabled, it is an emergency. Call 911 to have the ...

  13. Consumer opinions of emergency room medical care.

    Science.gov (United States)

    McMillan, J R; Younger, M S; DeWine, L C

    1984-12-01

    If hospital management is to adapt successfully to an increasingly competitive environment, and to retain a viable emergency department, it well be necessary to objectively and accurately assess the hospital's image in the community served. Knowledge of the consumers' views is an essential input into the formulation of strategic plans. This article reports on a study in which consumer opinions on 15 dimensions of emergency room health care were obtained from 723 respondents using a mail questionnaire. Findings reveal that consumers view the emergency room as being more expensive than other health care providers. Except for being available or convenient, little or no advantage is perceived for the emergency room over the personal physician. Even though the emergency room has specialized staff and equipment, consumers do not believe patients receive better or faster treatment in an emergency room than would be obtained in a physician's office. Unless changed, these perceptions will diminish the role of the emergency room in the delivery of health care services.

  14. [Coma in the emergency room].

    Science.gov (United States)

    Braun, M; Ploner, C J; Lindner, T; Möckel, M; Schmidt, W U

    2017-06-01

    Coma of unknown origin (CUO) is a frequent unspecific emergency symptom associated with a high mortality. A fast diagnostic work-up is essential given the wide spectrum of underlying diagnoses that are made up of approximately 50% primary central nervous system (CNS) pathologies and approximately 50% extracerebral, almost exclusively internal medical causes. Despite the high mortality associated with this symptom, there are currently no generally accepted management guidelines for adult patients presenting with CUO. We propose an interdisciplinary standard operating procedure (SOP) for patients with acute CUO as has been established in our maximum care hospital. The SOP is triggered by simple triage criteria that are sufficient to identify CUO patients before arrival in hospital. The in-hospital response team is led by a neurologist. Collaboration with nursing staff, internal medicine, anesthesiology, neurosurgery and trauma surgery is organized along structured pathways that include standardized laboratory tests, including cerebrospinal fluid (CSF), toxicology, computed tomography (CT) and CT angiography imaging (CTA). Our data suggest that neurologists and internists need to be placed at the beginning of the diagnostic work-up. Imaging should not just be carried out depending on the clinical syndrome because sensitivity, specificity and inter-rater reliability of the latter are not sufficient and because in many cases, multiple pathologies can be detected that could each explain CUO alone. Clinical examination, imaging and laboratory testing should be regarded as components of an integrative diagnostic approach and the final aetiological classification should only be made after the diagnostic work-up is complete.

  15. Role of Magnetocardiography in Emergency Room

    International Nuclear Information System (INIS)

    Kwon, H.; Kim, K.; Kim, J. M.; Lee, Y. H.; Kim, T. E.; Lim, H. K.; Park, Y. K.; Ko, Y. G.; Chung, N.

    2006-01-01

    In emergency rooms, patients with acute chest pain should be diagnosed as quickly as possible with higher diagnostic accuracy for an appropriate therapy to the patients with acute coronary syndrome or for avoiding unnecessary hospital admissions. At present, electrocardiography(ECG) and biochemical markers are generally used to detect myocardial infarction and coronary angiography is used as a gold standard to reveal the degree of narrowing of coronary artery. Magnetocardiography(MCG) has been proposed as a novel and non-invasive diagnostic tool fur the detection of cardiac electrical abnormality associated with myocardial ischemia. In this study, we examined whether the MCG can be used fur the detection of coronary artery disease(CAD) in patients, who were admitted to the emergency room with acute chest pain. MCG was recorded from 36 patients admitted to the emergency room with suspected acute coronary syndrome. The MCG recordings were obtained using a 64-channel SQUID MCG system in a magnetically shielded room. In result, presence of CAD could be found with a sensitivity of 88.2 % in patients with acute chest pain without 57 elevation in ECG, demonstrating a possible use in the emergency room to screen CAD patients.

  16. Developing utility emergency preparedness exercises

    International Nuclear Information System (INIS)

    Sjoeblom, K.

    1986-01-01

    Utility emergency preparedness exercises constitute an important link in upgrading the response to nuclear power plant emergencies. Various emergency exercises are arranged annually at the Loviisa nuclear power plant. The on-site simulator is a practical tool in developing suitable accident scenarios and demonstrating them to the site emergency players and spectators. The exercises concentrate on emergency management and radiological activities. It is important to create a high degree of motivation. (author)

  17. Emergency room management of radiation accidents

    International Nuclear Information System (INIS)

    Rosenberg, R.; Mettler, F.A. Jr.

    1990-01-01

    Emergency room management of radioactively contaminated patients who have an associated medical injury requiring immediate attention must be handled with care. Radioactive contamination of the skin of a worker is not a medical emergency and is usually dealt with at the plant. Effective preplanning and on-the-scene triage will allow the seriously injured and contaminated patients to get the medical care they need with a minimum of confusion and interference. Immediate medical and surgical priorities always take precedence over radiation injuries and radioactive contamination. Probably the most difficult aspect of emergency management is the rarity of such accidents and hence the unfamiliarity of the medical staff with the appropriate procedures. The authors discuss how the answer to these problems is preplanning, having a simple and workable procedure and finally having 24-h access to experts

  18. Digital image display system for emergency room

    International Nuclear Information System (INIS)

    Murry, R.C.; Lane, T.J.; Miax, L.S.

    1989-01-01

    This paper reports on a digital image display system for the emergency room (ER) in a major trauma hospital. Its objective is to reduce radiographic image delivery time to a busy ER while simultaneously providing a multimodality capability. Image storage, retrieval, and display will also be facilitated with this system. The system's backbone is a token-ring network of RISC and personal computers. The display terminals are higher- function RISC computers with 1,024 2 color or gray-scale monitors. The PCs serve as administrative terminals. Nuclear medicine, CT, MR, and digitized film images are transferred to the image display system

  19. Multiple Trauma and Emergency Room Management.

    Science.gov (United States)

    Frink, Michael; Lechler, Philipp; Debus, Florian; Ruchholtz, Steffen

    2017-07-24

    The care of severely injured patients remains a challenge. Their initial treatment in the emergency room is the essential link between first aid in the field and definitive in-hospital treatment. We present important elements of the initial in-hospital care of severely injured patients on the basis of pertinent publications retrieved by a selective search in PubMed and the current German S3 guideline on the care of severely and multiply traumatized patients, which was last updated in 2016. The goal of initial emergency room care is the rapid recognition and prompt treatment of acutely life-threatening injuries in the order of their priority. The initial assessment includes physical examination and ultrasonography according to the FAST concept (Focused Assessment with Sonography in Trauma) for the recognition of intraperitoneal hemorrhage. Patients with penetrating chest injuries, massive hematothorax, and/or severe injuries of the heart and lungs undergo emergency thoracotomy; those with signs of hollow viscus perforation undergo emergency laparotomy. If the patient is hemo - dynamically stable, the most important diagnostic procedure that must be performed is computerized tomography with contrast medium. Therapeutic decision-making takes the patient's physiological parameters into account, along with the overall severity of trauma and the complexity of the individual injuries. Depending on the severity of trauma, the immediate goal can be either the prompt restoration of organ structure and function or so-called damage control surgery. The latter focuses, in the acute phase, on hemostasis and on the avoidance of secondary damage such as intra-abdominal contamination or compartment syndrome. It also involves the temporary treatment of fractures with external fixation and the planning of definitive care once the patient's organ functions have been securely stabilized. The care of the severely injured patient should be performed in structured fashion according to the

  20. Firearm Injuries Received in Emergency Room of a Nigerian ...

    African Journals Online (AJOL)

    2017-05-22

    May 22, 2017 ... the emergency room of Federal Teaching Hospital Abakaliki from January 2005 to. December 2014. Results: There were 214 ... Hospital: Analysis of Pattern, Morbidity, and Mortality. NI Omoke. Original Article ..... rapid evacuation of casualties to hospital emergency room. In this study, there was no ...

  1. Enhancement opportunities in operating room utilization; with a statistical appendix

    NARCIS (Netherlands)

    van Veen-Berkx, Elizabeth; Elkhuizen, Sylvia G.; van Logten, Sanne; Buhre, Wolfgang F.; Kalkman, Cor J.; Gooszen, Hein G.; Kazemier, Geert; Balm, Ron; Cornelisse, Diederich C. C.; Ackermans, Hub J.; Stolker, Robert Jan; Bezstarosti, Jeanne; Pelger, Rob C. M.; Schaad, Roald R.; Krooneman-Smits, Irmgard; Meyer, Peter; van Dijk-Jager, Mirjam; Broecheler, Simon A. W.; Kroese, A. Christiaan; Kanters, Jeffrey; Krabbendam, Johannes J.; Hans, Erwin W.; Veerman, Derk P.; Aij, Kjeld H.

    2015-01-01

    Background: The purpose of this study was to assess the direct and indirect relationships between first-case tardiness (or "late start"), turnover time, underused operating room (OR) time, and raw utilization, as well as to determine which indicator had the most negative impact on OR utilization to

  2. Enhancement opportunities in operating room utilization; with a statistical appendix

    NARCIS (Netherlands)

    Veen-Berkx, E. van; Elkhuizen, S.G.; Logten, S. van; Buhre, W.F.; Kalkman, C.J.; Gooszen, H.G.; Kazemier, G.

    2015-01-01

    BACKGROUND: The purpose of this study was to assess the direct and indirect relationships between first-case tardiness (or "late start"), turnover time, underused operating room (OR) time, and raw utilization, as well as to determine which indicator had the most negative impact on OR utilization to

  3. Predictors of Frequent Emergency Room Visits among a Homeless Population.

    Science.gov (United States)

    Thakarar, Kinna; Morgan, Jake R; Gaeta, Jessie M; Hohl, Carole; Drainoni, Mari-Lynn

    2015-01-01

    Homelessness, HIV, and substance use are interwoven problems. Furthermore, homeless individuals are frequent users of emergency services. The main purpose of this study was to identify risk factors for frequent emergency room (ER) visits and to examine the effects of housing status and HIV serostatus on ER utilization. The second purpose was to identify risk factors for frequent ER visits in patients with a history of illicit drug use. A retrospective analysis was performed on 412 patients enrolled in a Boston-based health care for the homeless program (HCH). This study population was selected as a 2:1 HIV seronegative versus HIV seropositive match based on age, sex, and housing status. A subgroup analysis was performed on 287 patients with history of illicit drug use. Chart data were analyzed to compare demographics, health characteristics, and health service utilization. Results were stratified by housing status. Logistic models using generalized estimating equations were used to predict frequent ER visits. In homeless patients, hepatitis C was the only predictor of frequent ER visits (OR 4.49, phomeless patients. HIV seropositivity did not predict frequent ER visits, likely because HIV seropositive HCH patients are engaged in care. In patients with history of illicit drug use, hepatitis C and mental health disorders predicted frequent ER visits. Supportive housing for patients with mental health disorders and hepatitis C may help prevent unnecessary ER visits in this population.

  4. Evaluation of the preparedness of the children's emergency rooms ...

    African Journals Online (AJOL)

    PROMOTING ACCESS TO AFRICAN RESEARCH ... Background: The Children Emergency Room (CHER) is the first point of call for many sick children. ... limitation abounds with regards to personnel, high technology infrastructure, personnel ...

  5. Measures of Rehospitalization, Emergency Room Visit, and Community Discharge

    Data.gov (United States)

    U.S. Department of Health & Human Services — Measures of the Rate of Rehospitalization, Emergency Room Visit, and Community Discharge for Medicare Beneficiaries. These rates are based on Medicare claims data.

  6. Facets of operational performance in an emergency room (ER)

    NARCIS (Netherlands)

    van der Vaart, Taco; Vastag, Gyula; Wijngaard, Jacob

    This paper, using detailed time measurements of patients complemented by interviews with hospital management and staff, examines three facets of an emergency room's (ER) operational performance: (1) effectiveness of the triage system in rationing patient treatment; (2) factors influencing ER's

  7. Comorbidity in Emergency Room: the Psychiatrist’s Perspective

    OpenAIRE

    Alice Luís

    2013-01-01

    The author puts forward some considerations about the psychiatric practice in the emergency room of a general hospital. Clinical practice in the emergency room should be highlighted by collaborative work between several medical subspecialities, in- cluding internal medicine and neurology. This is particularly true for patients with comorbidity in order to provide quality of care. Finally, the author reviews several clinical cases and suggests guidelines for their management.

  8. When to use the emergency room - adult

    Science.gov (United States)

    ... feeling or inability to move Electric shock or lightning strike Severe burn Severe chest pain or pressure ... 2016. American College of Emergency Physicians. Urgent care fact sheet. newsroom.acep.org/fact_sheets?item=30033 . ...

  9. What Happens in the Emergency Room?

    Science.gov (United States)

    ... was 4 years old, he loved to play Batman. He'd put on his Batman pajamas and pretend to fly all over the ... swollen) and he had trouble moving his arm. "Batman," she said, "We're going to the emergency ...

  10. First installation of a dual-room IVR-CT system in the emergency room.

    Science.gov (United States)

    Wada, Daiki; Nakamori, Yasushi; Kanayama, Shuji; Maruyama, Shuhei; Kawada, Masahiro; Iwamura, Hiromu; Hayakawa, Koichi; Saito, Fukuki; Kuwagata, Yasuyuki

    2018-03-05

    Computed tomography (CT) embedded in the emergency room has gained importance in the early diagnostic phase of trauma care. In 2011, we implemented a new trauma workflow concept with a sliding CT scanner system with interventional radiology features (IVR-CT) that allows CT examination and emergency therapeutic intervention without relocating the patient, which we call the Hybrid emergency room (Hybrid ER). In the Hybrid ER, all life-saving procedures, CT examination, damage control surgery, and transcatheter arterial embolisation can be performed on the same table. Although the trauma workflow realized in the Hybrid ER may improve mortality in severe trauma, the Hybrid ER can potentially affect the efficacy of other in/outpatient diagnostic workflow because one room is occupied by one severely injured patient undergoing both emergency trauma care and CT scanning for long periods. In July 2017, we implemented a new trauma workflow concept with a dual-room sliding CT scanner system with interventional radiology features (dual-room IVR-CT) to increase patient throughput. When we perform emergency surgery or interventional radiology for a severely injured or ill patient in the Hybrid ER, the sliding CT scanner moves to the adjacent CT suite, and we can perform CT scanning of another in/outpatient. We believe that dual-room IVR-CT can contribute to the improvement of both the survival of severely injured or ill patients and patient throughput.

  11. [Vertigo and dizziness in the emergency room].

    Science.gov (United States)

    Zwergal, A; Möhwald, K; Dieterich, M

    2017-06-01

    Vertigo and dizziness are among the most common chief complaints in the emergency department. Etiologies can be categorized into three subgroups: neurootological (vestibular), medical (especially cardiovascular, metabolic), and psychiatric disorders. The diagnostic approach in the emergency department is based on a systematic analysis of case history (type, time course of symptoms, modulating factors, associated symptoms), clinical examination of the vestibular, ocular motor, and cerebellar systems (head impulse test, nystagmus, skew deviation, positioning maneuver, test of gait and stance), as well as a basal monitoring (vital signs, 12-lead ECG, blood tests). For differentiation of peripheral and central etiologies in acute vestibular syndrome, the HINTS exam (head impulse test, nystagmus, test of skew) and examination of smooth pursuit and saccades should be applied. Nonselective use of neuroimaging is not indicated due to a low diagnostic yield. Cranial imaging should be done in the following constellations: (1) detection of focal neurological or central ocular motor and vestibular signs on clinical exam, (2) acute abasia with only minor ocular motor signs, (3) presence of various cardiovascular risk factors, (4) headache of unknown quality as an accompanying symptom. Besides the symptomatic therapy of vertigo and dizziness with antiemetics or analgesics, further diagnostic differentiation is urgent to guide proper treatment. Examples are the acute therapy in cerebral ischemia, the execution of positioning maneuvers in benign paroxysmal positional vertigo, the use of corticosteroids in acute unilateral vestibulopathy, as well as the readjustment of metabolic homeostasis in medical disorders.

  12. Association between air pollution and ischemic cardiovascular emergency room visits

    International Nuclear Information System (INIS)

    Lin, C.A.; Amador Pereira, L.A.; Souza onceicao, G.M. de; Kishi, H.S.; Milani, Rodolfo; Ferreira Braga, A.L.; Ascimento Saldiva, P.H.

    2003-01-01

    This study observed the relationship between air pollutants and ischemic cardiac diseases such as angina and acute myocardial infarction in a representative cardiovascular center emergency room in Sao Paulo, Brazil. Daily emergency room admissions to the Institute of the Heart of the university of Sao Paulo, as well as data concerning daily air pollutant levels and meteorological variables, were collected from January 1994 to august 1995. Generalized additive Poisson regressions were fitted to the logarithm of the expected values of total emergency room visits due to angina or acute myocardial infarction, controlling for smooth functions of season and weather and indicators for days of the week. All investigated pollutants were positively associated with ischemic cardiovascular disease emergency room visits, and the time lags were relatively short, but only CO presented in effect that was statistically significant. An interquartile range increase n CO was associated with an increase of 6.4% (95% CI: 0.7-12.1) in daily angina or acute myocardial infarction emergency room visits. This result did not change when estimates were done using linear models and natural cubic plines. This study showed that air pollution has a role in cardiovascular morbidity in Sao Paulo, reinforcing the necessity for air pollutant mission-controlling polices in urban areas

  13. Predictors of Frequent Emergency Room Visits among a Homeless Population.

    Directory of Open Access Journals (Sweden)

    Kinna Thakarar

    Full Text Available Homelessness, HIV, and substance use are interwoven problems. Furthermore, homeless individuals are frequent users of emergency services. The main purpose of this study was to identify risk factors for frequent emergency room (ER visits and to examine the effects of housing status and HIV serostatus on ER utilization. The second purpose was to identify risk factors for frequent ER visits in patients with a history of illicit drug use.A retrospective analysis was performed on 412 patients enrolled in a Boston-based health care for the homeless program (HCH. This study population was selected as a 2:1 HIV seronegative versus HIV seropositive match based on age, sex, and housing status. A subgroup analysis was performed on 287 patients with history of illicit drug use. Chart data were analyzed to compare demographics, health characteristics, and health service utilization. Results were stratified by housing status. Logistic models using generalized estimating equations were used to predict frequent ER visits.In homeless patients, hepatitis C was the only predictor of frequent ER visits (OR 4.49, p<0.01. HIV seropositivity was not predictive of frequent ER visits. In patients with history of illicit drug use, mental health (OR 2.53, 95% CI 1.07-5.95 and hepatitis C (OR 2.85, 95% CI 1.37-5.93 were predictors of frequent ER use. HIV seropositivity did not predict ER use (OR 0.45, 95% CI 0.21 - 0.97.In a HCH population, hepatitis C predicted frequent ER visits in homeless patients. HIV seropositivity did not predict frequent ER visits, likely because HIV seropositive HCH patients are engaged in care. In patients with history of illicit drug use, hepatitis C and mental health disorders predicted frequent ER visits. Supportive housing for patients with mental health disorders and hepatitis C may help prevent unnecessary ER visits in this population.

  14. Assessing inhalation injury in the emergency room

    Directory of Open Access Journals (Sweden)

    Tanizaki S

    2015-07-01

    Full Text Available Shinsuke Tanizaki Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan Abstract: Respiratory tract injuries caused by inhalation of smoke or chemical products are related to significant morbidity and mortality. While many strategies have been built up to manage cutaneous burn injuries, few logical diagnostic strategies for patients with inhalation injuries exist and almost all treatment is supportive. The goals of initial management are to ensure that the airway allows adequate oxygenation and ventilation and to avoid ventilator-induced lung injury and substances that may complicate subsequent care. Intubation should be considered if any of the following signs exist: respiratory distress, stridor, hypoventilation, use of accessory respiratory muscles, blistering or edema of the oropharynx, or deep burns to the face or neck. Any patients suspected to have inhalation injuries should receive a high concentration of supplemental oxygen to quickly reverse hypoxia and to displace carbon monoxide from protein binding sites. Management of carbon monoxide and cyanide exposure in smoke inhalation patients remains controversial. Absolute indications for hyperbaric oxygen therapy do not exist because there is a low correlation between carboxyhemoglobin levels and the severity of the clinical state. A cyanide antidote should be administered when cyanide poisoning is clinically suspected. Although an ideal approach for respiratory support of patients with inhalation injuries do not exist, it is important that they are supported using techniques that do not further exacerbate respiratory failure. A well-organized strategy for patients with inhalation injury is critical to reduce morbidity and mortality. Keywords: inhalation injury, burn, carbon monoxide poisoning, cyanide poisoning

  15. CFD analysis of the temperature field in emergency pump room in Loviisa NPP

    Energy Technology Data Exchange (ETDEWEB)

    Rämä, Tommi, E-mail: tommi.rama@fortum.com [Fortum Power and Heat, P.O.B. 100, FI-00048 Fortum (Finland); Toppila, Timo, E-mail: timo.toppila@fortum.com [Fortum Power and Heat, P.O.B. 100, FI-00048 Fortum (Finland); Kelavirta, Teemu, E-mail: teemu.kelavirta@fortum.com [Fortum Power and Heat, Loviisa Power Plant, P.O.B. 23, FI-07901 Loviisa (Finland); Martin, Pasi, E-mail: pasi.martin@fortum.com [Fortum Power and Heat, Loviisa Power Plant, P.O.B. 23, FI-07901 Loviisa (Finland)

    2014-11-15

    Highlights: • Laser scanned room geometry from Loviisa NPP was utilized for CFD simulation. • Uncertainty of CFD simulation was estimated using the Grid Convergence Index. • Measured temperature field of pump room was reproduced with CFD simulation. - Abstract: In the Loviisa Nuclear Power Plant (NPP) six emergency pumps belonging to the same redundancy are located in the same room. During a postulated accident the cooling of the room is needed as the engines of the emergency pumps generate heat. Cooling is performed with fans blowing air to the upper part of the room. Temperature limits have been given to the operating conditions of the main components in order to ensure their reliable operation. Therefore the temperature field of the room is important to know. Temperature measurements were made close to the most important components of the pump room to get a better understanding of the temperature field. For these measurements emergency pumps and cooling fan units were activated. To simulate conditions during a postulated accident additional warm-air heaters were used. Computational fluid dynamic (CFD) simulations were made to support plant measurements. For the CFD study one of the pump rooms of Loviisa NPP was scanned with a laser and this data converted to detailed 3-D geometry. Tetrahedral computation grid was created inside the geometry. Grid sensitivity studies were made, and the model was then validated against the power plant tests. With CFD the detailed temperature and flow fields of the whole room were produced. The used CFD model was able to reproduce the temperature field of the measurements. Two postulated accident cases were simulated. In the cases the operating cooling units were varied. The temperature profile of the room changes significantly depending on which units are cooling and which only circulating the air. The room average temperature stays approximately the same. The simulation results were used to ensure the acceptable operating

  16. Preparing for Sudden Death: Social Work in the Emergency Room.

    Science.gov (United States)

    Wells, Paula J.

    1993-01-01

    Provides guidelines from social work perspective on how social workers and health care professionals can provide bereavement counseling for families whose relatives have died in emergency room. Discusses providing family with privacy and accessibility; keeping family informed; using understandable terminology; speaking directly about death;…

  17. Evaluation of the preparedness of the children's emergency rooms ...

    African Journals Online (AJOL)

    2017-02-09

    Feb 9, 2017 ... beds per nurse ranges from 3-15, giving a nurse: patient ratio of 1:3-15. (Table 1) .... Emergency Rooms (CHER) in the tertiary health institu- .... vices offered in our tertiary centres must go beyond the mundane ... medical tourism abroad as most often any care beyond the basic ... of general practitioner care.

  18. Child Abuse: The Value of Systematic Screening at Emergency Rooms

    NARCIS (Netherlands)

    Sittig, J.S.

    2015-01-01

    There is no conclusive evidence that diagnostic tools detect physical child abuse among children coming to emergency rooms (ERs), but his evidence is urgently needed because both false-positive and false-negative diagnoses have serious adverse effects. This thesis describes several aspects of the

  19. Awareness and utilization of emergency contraception among ...

    African Journals Online (AJOL)

    students were aware of emergency contraception, and 211 (71.5%) had utilized them. Among those who had .... Maiduguri has been a centre of learning and commercial activity since the .... magazines, television and movies.[31] In particular ...

  20. Weather conditions influence the number of psychiatric emergency room patients

    Science.gov (United States)

    Brandl, Eva Janina; Lett, Tristram A.; Bakanidze, George; Heinz, Andreas; Bermpohl, Felix; Schouler-Ocak, Meryam

    2017-12-01

    The specific impact of weather factors on psychiatric disorders has been investigated only in few studies with inconsistent results. We hypothesized that meteorological conditions influence the number of cases presenting in a psychiatric emergency room as a measure of mental health conditions. We analyzed the number of patients consulting the emergency room (ER) of a psychiatric hospital in Berlin, Germany, between January 1, 2008, and December 31, 2014. A total of N = 22,672 cases were treated in the ER over the study period. Meteorological data were obtained from a publicly available data base. Due to collinearity among the meteorological variables, we performed a principal component (PC) analysis. Association of PCs with the daily number of patients was analyzed with autoregressive integrated moving average model. Delayed effects were investigated using Granger causal modeling. Daily number of patients in the ER was significantly higher in spring and summer compared to fall and winter (p psychiatric patients consulting the emergency room. In particular, our data indicate lower patient numbers during very cold temperatures.

  1. Health Services Utilization Patterns Associated with Emergency Department Closure

    DEFF Research Database (Denmark)

    Hansen, Kristian Schultz; Enemark, Ulrika; Foldspang, Anders

    2011-01-01

    , 1997-2003. Data were extracted from administrative registries including information on individual use of emergency services and other hospital care, contact with GPs and socioeconomic background. Health services' use by the Morsø population was measured before reduction in emergency room opening hours...... of substitute health services. By contrast, Morsø women compared to the rest of Viborg county reduced their use of GP services in terms of face-to-face visits (β = -0.08, P = 0.020), telephone consultations (β = -0.11, P = 0.007), home visits (β = -0.48, P = 0.009), and their inpatient hospital utilization (β...... = -0.12, P = 0.022) during the period when emergeny services were only available in the daytime. CONCLUSIONS: Emergency services at neighbouring hospitals (40 kilometres distance) were able to compensate, in part, for the decreased local emergency service provision. Concurrent changes in health care...

  2. Assessment of abuse-related injuries: a comparative study of forensic physicians, emergency room physicians, emergency room nurses and medical students.

    Science.gov (United States)

    Reijnders, Udo J L; Giannakopoulos, Georgios F; de Bruin, Kim H

    2008-01-01

    A comparative study was made investigating whether emergency room physicians, emergency room nurses, forensic physicians, and interns are competent in describing, recognising and determining the possible cause of injuries. The injury assessment scores varied from good--adequate--fail and remained blank in various participant groups. Forensic physicians scored significantly better than emergency room staff and interns in the assessment of abuse-related injuries. There were almost no differences noted between emergency room physicians and emergency room nurses. For the functional group with more or less than 4 to 6 years of experience, no significant differences were noted for scoring good in all 5 cases. The fact that forensic physicians scored better than the emergency room staff is probably explained by the fact that almost all practicing forensic physicians have been officially qualified. Training in this field for all professionals involved in such assessment should be mandatory.

  3. Errors in radiographic recognition in the emergency room

    International Nuclear Information System (INIS)

    Britton, C.A.; Cooperstein, L.A.

    1986-01-01

    For 6 months we monitored the frequency and type of errors in radiographic recognition made by radiology residents on call in our emergency room. A relatively low error rate was observed, probably because the authors evaluated cognitive errors only, rather than include those of interpretation. The most common missed finding was a small fracture, particularly on the hands or feet. First-year residents were most likely to make an error, but, interestingly, our survey revealed a small subset of upper-level residents who made a disproportionate number of errors

  4. Citizen utilities: The emerging power paradigm

    International Nuclear Information System (INIS)

    Green, Jemma; Newman, Peter

    2017-01-01

    The emergence of citizen-based power systems in an integrated grid has been anticipated for decades. We can reveal how this is emerging in practice due to the significant uptake of solar photovoltaics (solar PV) and now battery storage in Perth, Australia. The high cost of electricity, high radiant energy levels and easy access to cheap Chinese technology, has led to dramatic buying during Perth's recent boomtown years. The traditional uni-directional power system is rapidly disrupting and this paper assesses where this may lead and what it means for the grid. Results of detailed monitoring in a solar powered house along with the impact of a battery storage system show the impact on the traditional grid is substantial but it will still be needed and must therefore adapt to the new distributed, bi-directional energy system. Surveys and price trajectories reveal how the trends to solar power storage will continue and how a citizen utility paradigm will emerge as the future grid building block using new blockchain support systems. Responses from utilities are then see to be fight, flight or innovate. - Highlights: • Citizen based power systems are emerging in Perth, Western Australia. • Solar power and battery storage systems are disrupting traditional utilities. • The grid will still have a role in the new, distributed power system. • The new system will lead to economic localism and the democratisation of power.

  5. Improving Patients Experience in Peadiatric Emergency Waiting Room.

    Science.gov (United States)

    Ehrler, Frederic; Siebert, Johan; Wipfli, Rolf; Duret, Cyrille; Gervaix, Alain; Lovis, Christian

    2016-01-01

    When visiting the emergency department, the perception of the time spent in the waiting room before the beginning of the care, may influence patients' experience. Based on models of service evaluation, highlighting the importance of informing people about their waiting process and their place in the queue, we have developed an innovative information screen aiming at improving perception of time by patients. Following an iterative process, a group of experts including computer scientists, ergonomists and caregivers designed a solution adapted to the pediatric context. The solution includes a screen displaying five lanes representing triage levels. Patients are represented by individual avatars, drawn sequentially in the appropriate line. The interface has been designed using gamification principle, aiming at increasing acceptance, lowering learning curve and improving satisfaction. Questionnaire based evaluation results revealed high satisfaction from the 278 respondents even if the informative content was not always completely clear.

  6. Quality of emergency rooms and urgent care services: user satisfaction.

    Science.gov (United States)

    Lima, Cássio de Almeida; Santos, Bruna Tatiane Prates dos; Andrade, Dina Luciana Batista; Barbosa, Francielle Alves; Costa, Fernanda Marques da; Carneiro, Jair Almeida

    2015-01-01

    To evaluate the quality of emergency rooms and urgent care services according to the satisfaction of their users. A cross-sectional descriptive study with a quantitative approach. The sample comprised 136 users and was drawn at random. Data collection took place between October and November 2012 using a structured questionnaire. Participants were mostly male (64.7%) aged less than 30 years (55.8%), and the predominant level of education was high school (54.4%). Among the items evaluated, those that were statistically associated with levels of satisfaction with care were waiting time, confidence in the service, model of care, and the reason for seeking care related to acute complaints, cleanliness, and comfortable environment. Accessibility, hospitality, and infrastructure were considered more relevant factors for patient satisfaction than the cure itself.

  7. Frequent visitors at the psychiatric emergency room - A literature review.

    Science.gov (United States)

    Schmidt, Manuela

    2018-03-01

    Frequent visitors at the psychiatric emergency room (PER) constitute a small subgroup of patients, yet they are responsible for a disproportionate number of visits and thus claim considerable resources. Their needs are often left unmet and their repetitive visits reflect their dissatisfaction as well as that of PERs' staff. Motivated by these dilemmas, this study systematically reviews the literature about frequent visitors at PER and seeks to answer two questions: What characterizes frequent visitors at PER in the literature? and What characterizes PER in the literature? Based on 29 studies, this paper offers answers to the two questions based on a strength weakness opportunities and threats (SWOT) analysis. The results of the review and subsequent analysis of the literature revealed the multiplicity and complexity of frequent visitors' characteristics and how they appear to converge. Commonalities were more difficult to identify in PER characteristics. In some cases, this happened because the characteristics were poorly described or were context specific. As a result, it was not easy to compare the studies on PER. Based on SWOT and the findings of the analysis, the paper proposes new venues of research and suggests how the field of mental health might develop by taking into account its opportunities and threats.

  8. How do utilities respond to emergencies?

    Energy Technology Data Exchange (ETDEWEB)

    Fisher, B. [BC Hydro, Vancouver, BC (Canada). Distribution Vegetation Management

    2006-07-01

    Trees can become problematic to utilities during storms as power companies can be held liable for injuries or damage resulting from power line contact. In addition, fallen trees and branches can impact on the reliable supply of electricity. This paper outlined BC Hydro's emergency response plan with reference to vegetation management. During severe wind, snow or ice storms, vegetation coordinators and contractor crews are mobilized to assist with the removal of trees that have fallen on power lines. Circuits are prioritized according to their essential services such as hospitals, followed by areas where there are the largest numbers of customers without services. Trees accounted for 9,733 of the 18, 122 outages over the last 4.5 years in BC Hydro's distribution system alone. Estimated costs of repair for tree-caused damages were approximately $15 million. Trees can bring power lines down, break poles or cross arms, and fall across roads, blocking access to response crews. Recovery from storm damage can go on for many years following the event. Trees contacting power lines can also be a source of ignition, creating the potential for wildfires caused by line contact. Protection of the public from power line hazards is the responsibility of every utility, which is why utilities often press for adequate clearances and hazard tree removals as part of their basic programs. It was concluded that appropriate planting can be a huge factor in mitigating risks for power line contact.

  9. Modernisation of Radiation Monitoring Room as a Part of Slovenian Emergency Response Centre

    International Nuclear Information System (INIS)

    Sarvari, A.; Mitic, D.

    2003-01-01

    In the year 2002 the Slovenian Nuclear Safety Administration (SNSA) moved to the new premises therefore it had to rearrange some of its rooms for the emergency situation. SNSA does not operate with a dedicated Emergency Response Centre (ERC), instead of it the SNSA has to rearrange the existing rooms in case of an emergency. Modernisation of the equipment, with the help of government of the United Kingdom of Great Britain and Northern Ireland, for the emergency situation was carried out, especially in the monitoring room. The radiation monitoring system, which is placed in the monitoring room, continuously collects, processes and archives the incoming data of exposure to radiation and meteorological parameters on the Slovenian territory (A model national emergency response plan for radiological accidents, IAEA, Vienna, 1993. IAEA-TECDOC-718). In the emergency situation the monitoring room transforms into the room for the Dose Assessment Group (DAG), which is part of ERC (IAEA emergency response network, IAEA, Vienna, 2000, EPR-ERNET (2000)). The modernisation of monitoring room and within the DAG room with new equipment and its purpose is described in this article. Modernisation of the monitoring room and the room for DAG showed to be inevitably needed. Modernisation of the monitoring room has brought the SNSA a sophisticated and reliable system of controlling the external exposure to radiation on the Slovenian territory. The equipment, especially the equipment for the use in the emergency situation, brought novelties for the Dose Assessment Group. The group has now better and easier control of radiation situation in case of an accident. In overall this modernisation has put the Slovenian Nuclear Safety Administration a step forward in having a dedicated Emergency Response Centre, since it does not need to rearrange the room for the Dose Assessment Group. (author)

  10. Protective benefits of mindfulness in emergency room personnel.

    Science.gov (United States)

    Westphal, Maren; Bingisser, Martina-Barbara; Feng, Tianshu; Wall, Melanie; Blakley, Emily; Bingisser, Roland; Kleim, Birgit

    2015-04-01

    Recent meta-analyses have found that mindfulness practice may reduce anxiety and depression in clinical populations and there is growing evidence that mindfulness may also improve well-being and quality of care in health professionals. This study examined whether mindfulness protects against the impact of work-related stress on mental health and burnout in emergency room (ER) nurses. ER nurses (N=50) were recruited from an urban teaching hospital in Switzerland and completed a survey on work-related stressors, mindfulness, burnout, depression, and anxiety. The most frequently reported work-related stressor was interpersonal conflict. Nurses working more consecutive days since last taking time off were at greater risk for depression and those reporting more work-related interpersonal conflicts were at greater risk for burnout. Mindfulness was associated with reduced anxiety, depression, and burnout. Mindfulness was a significant predictor of anxiety, depression, and burnout and moderated the impact of work-related stressors on mental health and burnout. The sample is limited to nurses and results need to be replicated in other groups (e.g., medical staff or ambulance workers). We assessed clinical symptoms with questionnaires and it would be desirable to repeat this assessment with clinical diagnostic interviews. The findings have implications for stress management in ER nurses and health professionals working in comparable settings (e.g., urgent care). The robust associations between mindfulness and multiple indices of psychological well-being suggest that ER staff exposed to high levels of occupational stress may benefit from mindfulness practice to increase resistance to mental health problems and burnout. Copyright © 2015 Elsevier B.V. All rights reserved.

  11. International Business Potential for Analytics of Room Utilization

    OpenAIRE

    Binde, Karl Bernhoff

    2015-01-01

    Many universities worldwide have large campuses which they are trying to maintain and administer in the best way possible. Their infrastructure often includes numerous auditoriums with access to the Internet by the Wi-Fi standard. MazeMap and Cisco have developed a solution which can geographically track Wi-Fi clients within a building. This solution makes it possible to count the number of people in a room through depersonalized data. On an international level, the student numbers are increa...

  12. PAs and NPs in an emergency room-linked acute care clinic.

    Science.gov (United States)

    Currey, C J

    1984-12-01

    The use of hospital emergency rooms for nonurgent care during evenings hours often strains medical resources and may affect the quality of emergency care. One facility's effective use of an after-hours acute care clinic staffed by PAs and NPs to divert nonurgent problems away from its emergency room is outlined. PAs and NPs work during peak demand hours (evenings and weekends) under the supervision of an emergency room physician, and receive supplementary support from other emergency room personnel. Incoming patients are referred to the emergency room or acute care clinic, depending on the nature of their problems. Acute care clinic patients are then treated by the PA or NP and either released or referred to an emergency room physician, if their conditions warrant additional treatment. As a result, use of the acute care clinic has greatly reduced the amount of non-urgent medical treatment in the emergency room and has provided other advantages to both patients and staff as well. These advantages and the encouraging statistics following six months of the clinic's operation are discussed.

  13. Emergency control room design of a nuclear reactor used to produce radioisotope

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Isaac J.A.L. dos; Farias, Larissa P. de; Ponte, Luana T.L.; Goncalves, Gabriel L.; Castro, Heraclito M.; Farias, Marcos S.; Carvalho, Paulo V.R. de; Vianna Filho, Alfredo M.V., E-mail: luquetti@ien.gov.br [Instituto Engenharia Nuclear (IEN/CNEN-RJ), Rio de Janeiro, RJ (Brazil). Departamento Engenharia Nuclear

    2015-07-01

    A control room is defined as a functional entity with an associated physical structure, where the operators carry out the centralized control, monitoring and administrative responsibilities. Emergency control room acts as an alternative control room for the purpose of shutting down or maintaining the facility in a safe shutdown state when the main control room is uninhabitable. The mission of emergency control room is to provide the resources to bring the plant to a safe shutdown condition after an evacuation of the main control room. An evacuation of the main control room is assumed when there is no possibility to accomplish tasks involved in the shutdown except reactor trip. The purpose of this paper is to present a specific approach for the design of the emergency control room of a nuclear reactor used to produce radioisotope. The approach is based on human factors standards and the participation of a multidisciplinary team in the development phase of the design. Using the information gathered from standards and from the multidisciplinary team a 3D Sketch and a 3D printing of the emergency control room were created. (author)

  14. Emergency control room design of a nuclear reactor used to produce radioisotope

    International Nuclear Information System (INIS)

    Santos, Isaac J.A.L. dos; Farias, Larissa P. de; Ponte, Luana T.L.; Goncalves, Gabriel L.; Castro, Heraclito M.; Farias, Marcos S.; Carvalho, Paulo V.R. de; Vianna Filho, Alfredo M.V.

    2015-01-01

    A control room is defined as a functional entity with an associated physical structure, where the operators carry out the centralized control, monitoring and administrative responsibilities. Emergency control room acts as an alternative control room for the purpose of shutting down or maintaining the facility in a safe shutdown state when the main control room is uninhabitable. The mission of emergency control room is to provide the resources to bring the plant to a safe shutdown condition after an evacuation of the main control room. An evacuation of the main control room is assumed when there is no possibility to accomplish tasks involved in the shutdown except reactor trip. The purpose of this paper is to present a specific approach for the design of the emergency control room of a nuclear reactor used to produce radioisotope. The approach is based on human factors standards and the participation of a multidisciplinary team in the development phase of the design. Using the information gathered from standards and from the multidisciplinary team a 3D Sketch and a 3D printing of the emergency control room were created. (author)

  15. A study of consumer attitudes about health care: the role of the emergency room.

    Science.gov (United States)

    Stratmann, W C; Ullman, R

    1975-12-01

    Contrary to the traditional role of the emergency room (ER) as a care source for the treatment of urgent medical needs, it is evident that substantial numbers of people now use the ER for the treatment of nonurgent problems. In this paper, we report on public opinion about the role of the ER, the accessibility of medical care, and factors that prompt the use of the ER rather than other sources of care. The data result from a community survey of households (N = 521) in the area of Rochester, New York, representative of a population of about 580,000 people. The findings, which relate ER utilization to source of payment, use of other sources of care, demographic variables, and consumer attitudes illustrate the rationality of the patient's use of ER facilities and reflect the patient's view of the ER as a place to obtain medical treatment when other sources are not available.

  16. Development, validation and testing of a nursing home to emergency room transfer checklist.

    Science.gov (United States)

    Tsai, Hsiu-Hsin; Tsai, Yun-Fang

    2018-01-01

    To develop and test the feasibility of an instrument to support patients' nursing home to emergency room transfer. Transfers from a nursing home care facility to an acute care facility such as a hospital emergency room are common. However, the prevalence of an information gap for transferring residents' health data to acute care facility is high. An evidence-based transfer instrument, which could fill this gap, is lacking. Development of a nursing home to emergency room transfer checklist, validation of items using the Delphi method and testing the feasibility and benefits of using the nursing home to emergency room transfer checklist. Items were developed based on qualitative data from previous research. Delphi validation, retrospective chart review (baseline data) and a 6-month prospective study design were applied to test the feasibility of using the checklist. Variables for testing the feasibility of the checklist included residents' 30-day readmission rate and length of hospital stay. Development of the nursing home to emergency room transfer checklist resulted in four main parts: (i) demographic data of the nursing home resident; (ii) critical data for nursing home to emergency room transfer; (iii) contact information and (iv) critical data for emergency room to nursing home transfer. Two rounds of Delphi validation resulted in a mean score (standard deviation) ranging from 4.39 (1.13)-4.98 (.15). Time required to complete the checklist was 3-5 min. Use of the nursing home to emergency room transfer checklist resulted in a 30-day readmission rate of 13.4%, which was lower than the baseline rate of 15.9%. The nursing home to emergency room transfer checklist was developed for transferring nursing home residents to an emergency room. The instrument was found to be an effective tool for this process. Use of the nursing home to emergency room transfer checklist for nursing home transfers could fill the information gap that exists when transferring older adults

  17. Suicide Mortality of Suicide Attempt Patients Discharged from Emergency Room, Nonsuicidal Psychiatric Patients Discharged from Emergency Room, Admitted Suicide Attempt Patients, and Admitted Nonsuicidal Psychiatric Patients

    Science.gov (United States)

    Choi, Jae W.; Park, Subin; Yi, Ki K.; Hong, Jin P.

    2012-01-01

    The suicide mortality rate and risk factors for suicide completion of patients who presented to an emergency room (ER) for suicide attempt and were discharged without psychiatric admission, patients who presented to an ER for psychiatric problems other than suicide attempt and were discharged without psychiatric admission, psychiatric inpatients…

  18. Emergency fuels utilization guidebook. Alternative Fuels Utilization Program

    Energy Technology Data Exchange (ETDEWEB)

    1980-08-01

    The basic concept of an emergency fuel is to safely and effectively use blends of specification fuels and hydrocarbon liquids which are free in the sense that they have been commandeered or volunteered from lower priority uses to provide critical transportation services for short-duration emergencies on the order of weeks, or perhaps months. A wide variety of liquid hydrocarbons not normally used as fuels for internal combustion engines have been categorized generically, including limited information on physical characteristics and chemical composition which might prove useful and instructive to fleet operators. Fuels covered are: gasoline and diesel fuel; alcohols; solvents; jet fuels; kerosene; heating oils; residual fuels; crude oils; vegetable oils; gaseous fuels.

  19. Awareness and utilization of emergency contraception among ...

    African Journals Online (AJOL)

    Majority of the students, 321 (71.3%), were single. Overall, 295 ... Information from health personnel, news media and schools were the major influences of emergency contraceptive ... of its availability and advantages, women make better choices. .... where information about sex and/or contraception came from parents ...

  20. Assessment of Suicidal Behavior in a Psychiatric Emergency Room in Lisbon.

    Science.gov (United States)

    Marques, João Gama; Guerreiro, Diogo Frasquilho; Sampaio, Daniel

    2015-01-01

    Some studies alerted for the burden of suicidal attempters at emergency rooms. In this study we characterized the suicidal patients admitted to a Portuguese emergency room. For three years, all patients assessed by the first author after suicidal behaviour were included. Suicidal intentionality was evaluated with the Pierce Suicide Intent Scale. Clinical records were searched for follow-up status and satisfaction level was assessed through telephone call. From 120 included patients 70.8% were female, with mean age of 42.35 years. Pierce Suicide Intent Scale suicidal intentionality was low in 30.1%, medium in 59.3%, and high in 10.6% of the sample. The most important predictors of Pierce Suicide Intent Scale intentionality were male gender (p suicide (p Suicide Intent Scale is useful on suicidal behavior assessment at emergency rooms. Highly intentional suicidal behaviour is related to male sex, social problems and personal and familial psychiatric history. The quality of administrative records on this psychiatric emergency room setting are still unacceptable. The most important variables correlated with higher suicidal intentionality are the same described in other countries. Of the reachable patients, one fifth was satisfied with provided follow-up. We still need studies for better understanding of suicidal behaviour observed on this Portuguese emergency room.

  1. Different causes of referral to ophthalmology emergency room

    Directory of Open Access Journals (Sweden)

    Alireza Keshtkar Jafari

    2012-01-01

    Full Text Available Background: Eye-related complaints compose approximately 1-6% of complaints of patients referring to general emergency ward around the world. Eye injuries are the most common cause of referral to eye emergency ward. To understand the impact of eye injuries in Iran and to plan preventive strategies, it is important to understand the complete magnitude of the problem with regard to true population-based data and standard reproducible definitions. Aim: The main goal of this study was to identify the major causes of referrals to eye emergency ward in patients with eye-related complaints in an eye referral Hospital in Iran. Settings and Design: In a cross-sectional study, 3150 patients who referred to Farabi Hospital emergency ward, Tehran, Iran, from January to December 2007 were included in the study and their detailed information were recorded. Materials and Methods: The patients′ demographic data, medical history and final diagnosis were recorded in a questionnaire. Results: The mean age of patients was 33.2±16.8 years and 2380 patients (75.6% were males. While 299 patients (9.5% were referred for non-urgent reasons, work-related injuries were the most common cause of referral (955 patients; 30.3%. In patients referred due to trauma (1950 patients, work-related injuries occurred in 955 patients (49% and occurred accidentally (by chance in 819 patients (42%. The majority of patients referred with traumatic injuries were males (1708 patients; 87.6% versus 242 patients; 12.4%. The most common etiologies of eye trauma (1950 patients were metal filings (814 patients; 41.8%, blunt trauma (338 patients; 17.3%, fireworks (236 patients; 12.1% and sharp objects (222 patients; 11.4%. Globe injury was diagnosed in 1865 patients (95.7% of trauma cases. In patients referred due to non-traumatic reason (1200 patients, eye infection occurred in 482 patients (40.2% and 299 patients (24.9% were referred for non-urgent reasons. There was little difference

  2. Emergency room management of ureteral calculi: current practices.

    Science.gov (United States)

    Phillips, Elizabeth; Kieley, Sam; Johnson, Elizabeth B; Monga, Manoj

    2009-06-01

    To evaluate current practice patterns in U.S. emergency departments (EDs) for the diagnosis, treatment, and counseling of patients with ureteral calculi. Hospital-based ED physicians were invited by e-mail to participate in a Survey-Monkey survey. E-mails were delivered in March 2008 by Direct Medical Data using a listserv provided by the American Medical Association. Of the e-mails sent, 173 e-mails were opened, and 135 physicians responded. Physicians were compensated with a $10 Amazon.com gift card. Ninety percent of ED physicians use noncontrast CT as their initial imaging modality, and 63% use alpha-blockers for medical expulsive therapy. Only 13% of evaluated EDs have guidelines for the management of renal colic, and only 58% of these guidelines that recommend the use of an alpha-blocker. Alpha-blocker use was more common with physicians who have been practicing fewer than 5 years (81%) compared with those with more than 10 years of experience (56%). The majority of physicians used ketorolac and morphine to achieve effective analgesia. Although the average responses concerning the chance of spontaneous stone passage for stones 4 mm (44%) were close to evidence-based values, great variation in the answers was noted (standard deviations: 12% and 22%, respectively). Indeed, 38% of respondents stated that stones 95% chance of passage. Twenty-eight percent of ED physicians would arrange follow-up with a primary care physician, while the remainder would arrange follow-up with a urologist. This study establishes a need for educational opportunities for ED physicians in the management of renal colic. The development of collaborative practice guidelines between urology and emergency medicine associations may be warranted.

  3. Investigating emergency room service quality using lean manufacturing.

    Science.gov (United States)

    Abdelhadi, Abdelhakim

    2015-01-01

    The purpose of this paper is to investigate a lean manufacturing metric called Takt time as a benchmark evaluation measure to evaluate a public hospital's service quality. Lean manufacturing is an established managerial philosophy with a proven track record in industry. A lean metric called Takt time is applied as a measure to compare the relative efficiency between two emergency departments (EDs) belonging to the same public hospital. Outcomes guide managers to improve patient services and increase hospital performances. The patient treatment lead time within the hospital's two EDs (one department serves male and the other female patients) are the study's focus. A lean metric called Takt time is used to find the service's relative efficiency. Findings show that the lean manufacturing metric called Takt time can be used as an effective way to measure service efficiency by analyzing relative efficiency and identifies bottlenecks in different departments providing the same services. The paper presents a new procedure to compare relative efficiency between two EDs. It can be applied to any healthcare facility.

  4. Clinic and Emergency Room Evaluation and Testing of Headache.

    Science.gov (United States)

    Nye, Barbara L; Ward, Thomas N

    2015-10-01

    Evaluation of the headache patient in the outpatient clinic and emergency department (ED) has different focuses and goals. The focus of this paper is to review the evaluation of patients in both settings with mention of evaluation in the pediatric and pregnant patient population.  The patient's history should drive the practitioner's decision and evaluation choices. We review recommendations made by the American Board of Internal Medicine and American Headache Society through the Choosing Wisely Campaign, which has an emphasis on choosing the right imaging modality for the clinical situation and elimination/prevention of medication overuse headache, as well as the US Headache Consortium guidelines for migraine headache. We will also review focusing on ED evaluation of the pediatric patient and pregnant patient presenting with headache. At the end of the review we hope to have provided you with a framework to think about the headache patient and what is the appropriate test in the given clinical setting in order to ensure that the patient gets the right diagnosis and is set on a path to the appropriate management plan. © 2015 American Headache Society.

  5. "Boarding" Psychiatric Patients in Emergency Rooms: One Court Says "No More".

    Science.gov (United States)

    Appelbaum, Paul S

    2015-07-01

    "Boarding" involuntary psychiatric patients in medical emergency rooms is common in many parts of the United States. The practice, driven by a shortage of alternative resources, including limited inpatient capacity, can result in patients' being held for days without treatment or a hospital room, often in busy corridors or treatment rooms. A recent challenge to this practice led the Washington Supreme Court to declare it illegal and resulted in the appropriation of substantial funding to create new psychiatric beds. Centralized psychiatric crisis services, with appropriate payment models, may offer another approach to reducing the need for holding patients awaiting inpatient admission.

  6. The treatment of acute soft tissue trauma in Danish emergency rooms

    DEFF Research Database (Denmark)

    Johannsen, F; Langberg, Henning

    1997-01-01

    Rest, ice, compression, elevation (RICE) is the most recommended treatment for acute traumatic soft tissue injuries. A questionnaire was given to all Danish emergency rooms (n = 5) regarding their routines for acute treatment of ankle sprains and muscle contusions. Complete answers were received...... from 37 emergency rooms (73%), covering the treatment of 111 ankle sprains and 101 muscle contusions. Treatment with RICE was given in a minority of injuries, ice (21%), compression (32%) and elevation (58%) similarly between injury types. A complete RICE treatment was rarely applied (3%). Verbal...... information on RICE and rehabilitation was given in less than half of the cases. We conclude that the acute treatment of ankle sprains and muscle contusions in the Danish emergency rooms is not applied in accordance with consensus from international literature, and that the instruction in rehabilitation...

  7. Effect of National Football League games on small animal emergency room caseload.

    Science.gov (United States)

    Rozanski, Elizabeth A; Rondeau, Mark P; Shaw, Scott P; Rush, John E

    2009-07-01

    To evaluate whether games of popular professional football teams have an effect on small animal emergency room caseload and percentage of dogs and cats that subsequently are hospitalized, are euthanatized, or die following admission to veterinary emergency rooms located within a dedicated fan base. Prospective study. 818 dogs and cats admitted to the emergency room. During the 2007 New England Patriots (NEP) football season, small animal emergency room caseload was recorded for Sunday (4-hour blocks, 8:00 AM until 12:00 midnight) and Monday night (7:00 PM to 11:00 PM). Number of dogs and cats that subsequently were hospitalized, died, or were euthanatized was recorded. Mean game importance rating (GIR) was determined for NEP games (scale, 1 [mild] to 3 [great]). Percentage of dogs and cats admitted from 12:00 noon to 4:00 PM on Sundays during NEP games (mean GIR, 1.7) versus non-NEP games was not different. Mean +/- SD percentage of dogs and cats admitted from 4:00 PM to 8:00 PM on Sundays during NEP games (mean GIR, 2.4) versus non-NEP games was significantly different (18 +/- 5% and 25 +/- 7% of daily caseload, respectively). Percentage of dogs and cats admitted from 8:00 PM to 12:00 midnight on Sundays during NEP games (mean GIR, 2.1) versus non-NEP games was not different. Game type (NEP vs non-NEP) during emergency room admission did not influence whether dogs and cats subsequently were hospitalized, died, or were euthanatized. Professional sporting events may influence veterinary emergency room caseloads.

  8. Categorizing "frequent visitors" in the psychiatric emergency room: a semistructured interview study

    DEFF Research Database (Denmark)

    Buus, Niels

    2011-01-01

    Nurses can become demoralized and hostile toward frequent visitors in psychiatric emergency rooms because of the number of visits. The aim of this study was to develop more knowledge about the ways in which nurses categorize frequent visitors. Eleven nurses were interviewed, and their categorizing...... practices were examined from a social constructionist perspective. The results showed that the nurses did not categorize frequent visitors as particularly unlikeable or difficult to treat. Like other visitors, they could be categorized as difficult if they obstructed a smooth flow of successful referrals...... through the emergency room and/or there was poor rapport with the nurses....

  9. Child abuse inventory at emergency rooms: CHAIN-ER rationale and design

    Directory of Open Access Journals (Sweden)

    Nieuwenhuis Edward ES

    2011-10-01

    Full Text Available Abstract Background Child abuse and neglect is an important international health problem with unacceptable levels of morbidity and mortality. Although maltreatment as a cause of injury is estimated to be only 1% or less of the injured children attending the emergency room, the consequences of both missed child abuse cases and wrong suspicions are substantial. Therefore, the accuracy of ongoing detection at emergency rooms by health care professionals is highly important. Internationally, several diagnostic instruments or strategies for child abuse detection are used at emergency rooms, but their diagnostic value is still unknown. The aim of the study 'Child Abuse Inventory at Emergency Rooms' (CHAIN-ER is to assess if active structured inquiry by emergency room staff can accurately detect physical maltreatment in children presenting at emergency rooms with physical injury. Methods/design CHAIN-ER is a multi-centre, cross-sectional study with 6 months diagnostic follow-up. Five thousand children aged 0-7 presenting with injury at an emergency room will be included. The index test - the SPUTOVAMO-R questionnaire- is to be tested for its diagnostic value against the decision of an expert panel. All SPUTOVAMO-R positives and a 15% random sample of the SPUTOVAMO-R negatives will undergo the same systematic diagnostic work up, which consists of an adequate history being taken by a pediatrician, inquiry with other health care providers by structured questionnaires in order to obtain child abuse predictors, and by additional follow-up information. Eventually, an expert panel (reference test determines the true presence or absence of child abuse. Discussion CHAIN-ER will determine both positive and negative predictive value of a child abuse detection instrument used in the emergency room. We mention a benefit of the use of an expert panel and of the use of complete data. Conducting a diagnostic accuracy study on a child abuse detection instrument is also

  10. Emerging Pattern in Utilizing Electronic Information Sources by ...

    African Journals Online (AJOL)

    This is a detailed comparative analysis of electronic information sources (EIS) utilized by pharmacy lecturers in South-South universities in Nigeria. The purpose of this study is to analyze the extent to which EIS are utilized among pharmacy lecturers in South-South Nigeria. The aim is to explore the emerging pattern of ...

  11. Functions of Conflict: Perceived Utility in the Emergent Professions.

    Science.gov (United States)

    Henkin, Alan B.; And Others

    1991-01-01

    Describes perceptions of conflict as a utility (functional conflict) among 1,953 department executives in programs of social work, education, and nursing (the emergent professions); and analyzes perceptual data in terms of organizational conflict climate and demographics. Variations in terms of perceived operational utility of organizational…

  12. Improving Emergency Department flow through optimized bed utilization.

    Science.gov (United States)

    Chartier, Lucas Brien; Simoes, Licinia; Kuipers, Meredith; McGovern, Barb

    2016-01-01

    Over the last decade, patient volumes in the emergency department (ED) have grown disproportionately compared to the increase in staffing and resources at the Toronto Western Hospital, an academic tertiary care centre in Toronto, Canada. The resultant congestion has spilled over to the ED waiting room, where medically undifferentiated and potentially unstable patients must wait until a bed becomes available. The aim of this quality improvement project was to decrease the 90th percentile of wait time between triage and bed assignment (time-to-bed) by half, from 120 to 60 minutes, for our highest acuity patients. We engaged key stakeholders to identify barriers and potential strategies to achieve optimal flow of patients into the ED. We first identified multiple flow-interrupting challenges, including operational bottlenecks and cultural issues. We then generated change ideas to address two main underlying causes of ED congestion: unnecessary patient utilization of ED beds and communication breakdown causing bed turnaround delays. We subsequently performed seven tests of change through sequential plan-do-study-act (PDSA) cycles. The most significant gains were made by improving communication strategies: small gains were achieved through the optimization of in-house digital information management systems, while significant improvements were achieved through the implementation of a low-tech direct contact mechanism (a two-way radio or walkie-talkie). In the post-intervention phase, time-to-bed for the 90th percentile of high-acuity patients decreased from 120 minutes to 66 minutes, with special cause variation showing a significant shift in the weekly measurements.

  13. Suspected leaking abdominal aortic aneurysm: use of sonography in the emergency room.

    Science.gov (United States)

    Shuman, W P; Hastrup, W; Kohler, T R; Nyberg, D A; Wang, K Y; Vincent, L M; Mack, L A

    1988-07-01

    To determine the value of sonography in the emergent evaluation of suspected leaking abdominal aortic aneurysms, the authors examined 60 patients in the emergency department using sonography and a protocol involving advance radio notification from the ambulance; arrival of sonographic personnel and equipment in the triage room before patient arrival; and, during other triage activities, rapid sonographic evaluation of the aorta for aneurysm and of the paraaortic region for extraluminal blood. Sonographic findings were correlated with surgical results and clinical outcome. When performed under these circumstances, sonography was accurate in demonstrating presence or absence of aneurysm (98%), but its sensitivity for extraluminal blood was poor (4%). A combination of sonographic confirmation of aneurysm, abdominal pain, and unstable hemodynamic condition resulted in the correct decision to perform emergent surgery in 21 of 22 patients (95%). An abbreviated sonographic examination done in the emergency room can provide accurate, useful information about the presence of aneurysm; this procedure does not significantly delay triage of these patients.

  14. Otolaryngology-specific emergency room as a model for resident training.

    Science.gov (United States)

    Sethi, Rosh K V; Kozin, Elliott D; Remenschneider, Aaron K; Lee, Daniel J; Gliklich, Richard E; Shrime, Mark G; Gray, Stacey T

    2015-01-01

    There is a paucity of data on junior resident training in common otolaryngology procedures such as ear debridement, nasal and laryngeal endoscopy, epistaxis management, and peritonsillar abscess drainage. These common procedures represent a critical aspect of training and are necessary skills in general otolaryngology practice. We sought to determine how a dedicated otolaryngology emergency room (ER) staffed by junior residents and a supervising attending provides exposure to common otolaryngologic procedures. Retrospective review. Diagnostic and procedural data for all patients examined in the Massachusetts Eye and Ear Infirmary ER between January 2011 and September 2013 were evaluated. A total of 12,234 patients were evaluated. A total of 5,673 patients (46.4%) underwent a procedure. Each second-year resident performed over 450 procedures, with the majority seen Monday through Friday (75%). The most common procedures in our study included diagnostic nasolaryngoscopy (52.0%), ear debridement (34.4%), and epistaxis control (7.0%) An otolaryngology-specific ER provides junior residents with significant diagnostic and procedural volume in a concentrated period of time. This study demonstrates utility of a unique surgical education model and provides insight into new avenues of investigation for otolaryngology training. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  15. Neuroimaging of Patients with Headache in the Emergency Room: A Retrospective Analysis

    Directory of Open Access Journals (Sweden)

    ibrahim Burak Atci

    2015-03-01

    Conclusion: In the emergency department during evaluation of headache, that should be done first is the exclusion of headaches which is caused by non beningn intracranial patologies. Therefore, from the entrance of the patients evaluated in the emergency room, it is important that they must be directed to rapid diagnosis and treatment with considering the red alert findings. [Cukurova Med J 2015; 40(1.000: 86-90

  16. Therapeutic approach to patients complaining of high blood pressure in a cardiological emergency room

    Directory of Open Access Journals (Sweden)

    Miguel Gus

    1999-03-01

    Full Text Available OBJECTIVE: To evaluate the management of patients complaining of high blood pressure (BP in a cardiological emergency room. METHODS: Patients referred to the cardiological emergency room with the main complaint of high blood pressure were consecutively selected. The prescriptions and the choice of antihypertensive drugs were assessed. The classification of these patients as hypertensive emergencies or pseudoemergencies, according to the physician who provided initial care, was recorded. RESULTS: From a total of 858 patients presenting to the emergency room, 80 (9.3% complained of high BP, and 61 (76.3% received antihypertensive drugs. Sublingual nifedipine was the most commonly used drug (59%. One patient received intravenous medication, one patient was hospitalized and 6 patients (7.5% were classified as hypertensive emergencies or pseudoemergencies. CONCLUSION: High BP could seldom be classified as a hypertensive emergency or pseudoemergency, even though it was a frequent complaint (9.3% of visits. Currently, the therapeutic approach is not recommended, even in specialized clinics.

  17. [Advanced Trauma Life Support (ATLS) in the emergency room. Is it suitable as an SOP?].

    Science.gov (United States)

    Shafizadeh, S; Tjardes, T; Steinhausen, E; Balke, M; Paffrath, T; Bouillon, B; Bäthis, H

    2010-08-01

    There is clinical evidence that a standardized management of trauma patients in the emergency room improves outcome. ATLS is a training course that teaches a systematic approach to the trauma patient in the emergency room. The aims are a rapid and accurate assessment of the patient's physiologic status, treatment according to priorities, and making decisions on whether the local resources are sufficient for adequate definitive treatment of the patient or if transfer to a trauma center is necessary. Above all it is important to prevent secondary injury, to realize timing as a relevant factor in the initial treatment, and to assure a high standard of care. A standard operating procedure (SOP) exactly regulates the approach to trauma patients and determines the responsibilities of the involved faculties. An SOP moreover incorporates the organizational structure in the treatment of trauma patients as well as the necessary technical equipment and staff requirements. To optimize process and result quality, priorities are in the fields of medical fundamentals of trauma care, education, and fault management. SOPs and training courses increase the process and result quality in the treatment of the trauma patient in the emergency room. These programs should be based on the special demands of the physiology of the trauma as well as the structural specifics of the hospital. ATLS does not equal an SOP but it qualifies as a standardized concept for management of trauma patients in the emergency room.

  18. Educational paper Detection of child abuse and neglect at the emergency room

    NARCIS (Netherlands)

    Teeuw, Arianne Hélène; Derkx, Bert H. F.; Koster, Willeke A.; van Rijn, Rick R.

    2012-01-01

    The emergency room (ER) represents the main system entry for crises-based health care visits. It is estimated that 2% to 10% of children visiting the ER are victims of child abuse and neglect (CAN). Therefore, ER personnel may be the first hospital contact and opportunity for CAN victims to be

  19. Evaluation of care for traffic accidents victims made by on duty emergency physicians and surgeons in the emergency room

    Directory of Open Access Journals (Sweden)

    VLAUDIMIR DIAS MARQUES

    Full Text Available ABSTRACT Objective: to evaluate the care for victims of traffic accidents by on call emergency physicians and/or surgeons in the emergency room. Methods: we conducted a retrospective, descriptive and exploratory study on the care for traffic accidents victims in the urban area of Maringá-PR, between July 2013 and July 2014 in reference hospitals. We assessed demographics and vocational training through a questionnaire sent to the attending physicians. Results: of the 688 records evaluated, 99% of patients had a prehospital Revised Trauma Score of 12. Statistical analysis showed that in the cases conducted by the emergency physicians (n=187, the recording of the Glasgow Coma Scale and the performance of surgical procedures were less common, whereas the recording of blood pressure values was performed in greater numbers when compared with cases led by surgeons (n=501. There was a statistically significant relationship (p<0.01 between the length of hospital stay and surgical specialty, with a greater chance (crude OR=28 in the period from one to six hours for the group treated by emergency doctors. Most physicians participating in the study were young, with emergency room time of up to one to two years, and with ATLS training. Among those who had attended the ATLS course, 60% did so in the last four years. Surgeons performed 73% of hospital treatments. Conclusion: in the care of traffic victims with minor injuries, the Glasgow Coma Scale, the blood pressure levels, the type of treatment in the emergency room and hospital stay had different approaches between emergency physicians and surgeons.

  20. Coronary Computed Tomography Angiography in the Assessment of Acute Chest Pain in the Emergency Room

    Energy Technology Data Exchange (ETDEWEB)

    Prazeres, Carlos Eduardo Elias dos; Cury, Roberto Caldeira; Carneiro, Adriano Camargo de Castro [Hospital do Coração - HCor, Associação do Sanatório Sírio, São Paulo, SP (Brazil); Rochitte, Carlos Eduardo, E-mail: rochitte@cardiol.br [Hospital do Coração - HCor, Associação do Sanatório Sírio, São Paulo, SP (Brazil); Instituto do Coração - InCor - HCFMUSP, São Paulo, SP (Brazil)

    2013-12-15

    The coronary computed tomography angiography has recently emerged as an accurate diagnostic tool in the evaluation of coronary artery disease, providing diagnostic and prognostic data that correlate directly with the data provided by invasive coronary angiography. The association of recent technological developments has allowed improved temporal resolution and better spatial coverage of the cardiac volume with significant reduction in radiation dose, and with the crucial need for more effective protocols of risk stratification of patients with chest pain in the emergency room, recent evaluation of the computed tomography coronary angiography has been performed in the setting of acute chest pain, as about two thirds of invasive coronary angiographies show no significantly obstructive coronary artery disease. In daily practice, without the use of more efficient technologies, such as coronary angiography by computed tomography, safe and efficient stratification of patients with acute chest pain remains a challenge to the medical team in the emergency room. Recently, several studies, including three randomized trials, showed favorable results with the use of this technology in the emergency department for patients with low to intermediate likelihood of coronary artery disease. In this review, we show data resulting from coronary angiography by computed tomography in risk stratification of patients with chest pain in the emergency room, its diagnostic value, prognosis and cost-effectiveness and a critical analysis of recently published multicenter studies.

  1. Coronary Computed Tomography Angiography in the Assessment of Acute Chest Pain in the Emergency Room

    International Nuclear Information System (INIS)

    Prazeres, Carlos Eduardo Elias dos; Cury, Roberto Caldeira; Carneiro, Adriano Camargo de Castro; Rochitte, Carlos Eduardo

    2013-01-01

    The coronary computed tomography angiography has recently emerged as an accurate diagnostic tool in the evaluation of coronary artery disease, providing diagnostic and prognostic data that correlate directly with the data provided by invasive coronary angiography. The association of recent technological developments has allowed improved temporal resolution and better spatial coverage of the cardiac volume with significant reduction in radiation dose, and with the crucial need for more effective protocols of risk stratification of patients with chest pain in the emergency room, recent evaluation of the computed tomography coronary angiography has been performed in the setting of acute chest pain, as about two thirds of invasive coronary angiographies show no significantly obstructive coronary artery disease. In daily practice, without the use of more efficient technologies, such as coronary angiography by computed tomography, safe and efficient stratification of patients with acute chest pain remains a challenge to the medical team in the emergency room. Recently, several studies, including three randomized trials, showed favorable results with the use of this technology in the emergency department for patients with low to intermediate likelihood of coronary artery disease. In this review, we show data resulting from coronary angiography by computed tomography in risk stratification of patients with chest pain in the emergency room, its diagnostic value, prognosis and cost-effectiveness and a critical analysis of recently published multicenter studies

  2. The application of a "6S Lean" initiative to improve workflow for emergency eye examination rooms.

    Science.gov (United States)

    Nazarali, Samir; Rayat, Jaspreet; Salmonson, Hilary; Moss, Theodora; Mathura, Pamela; Damji, Karim F

    2017-10-01

    Ophthalmology residents on call at the Royal Alexandra Hospital identified workplace disorganization and lack of standardization in emergency eye examination rooms as an impediment to efficient patient treatment. The aim of the study was to use the "6S Lean" model to improve workflow in eye examination rooms at the Royal Alexandra Hospital. With the assistance of quality improvement consultants, the "6S Lean" model was applied to the current operation of the emergency eye clinic examination rooms. This model, considering 8 waste categories, was then used to recommend and implement changes to the examination rooms and to workplace protocols to enhance efficiency and safety. Eye examination rooms were improved with regards to setup, organization of supplies, inventory control, and maintenance. All targets were achieved, and the 5S audit checklist score increased by 33 points from 44 to 77. Implementation of the 6S methodology is a simple approach that removes inefficiencies from the workplace. The ophthalmology clinic removed waste from all 8 waste categories, increased audit results, mitigated patient and resident safety risks, and ultimately redirected resident time back to patient care delivery. Copyright © 2017 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

  3. Burden of emergency conditions and emergency care utilization: New estimates from 40 countries

    Science.gov (United States)

    Chang, Cindy Y.; Abujaber, Samer; Reynolds, Teri A.; Camargo, Carlos A.; Obermeyer, Ziad

    2016-01-01

    Objective To estimate the global and national burden of emergency conditions, and compare them to emergency care utilization rates. Methods We coded all 291 Global Burden of Disease 2010 conditions into three categories to estimate emergency burden: conditions that, if not addressed within hours to days of onset, commonly lead to serious disability or death; conditions with common acute decompensations that lead to serious disability or death; and non-emergencies. Emergency care utilization rates were obtained from a systematic literature review on emergency care facilities in low- and middle-income countries (LMICs), supplemented by national health system reports. Findings All 15 leading causes of death and DALYs globally were conditions with potential emergent manifestations. We identified 41 facility-based reports in 23 countries, 12 of which were in LMICs; data for 17 additional countries were obtained from national or regional reports on emergency utilization. Burden of emergency conditions was the highest in low-income countries, with median DALYs of 47,728 per 100,000 population (IQR 45,253-50,085) in low-income, 25,186 (IQR 21,982-40,480) in middle-income, and 15,691 (IQR 14,649-16,382) in high-income countries. Patterns were similar using deaths to measure burden and excluding acute decompensations from the definition of emergency conditions. Conversely, emergency utilization rates were the lowest in low-income countries, with median 8 visits per 1,000 population (IQR 6-10), 78 (IQR 25-197) in middle-income, and 264 (IQR 177-341) in high-income countries. Conclusion Despite higher burden of emergency conditions, emergency utilization rates are substantially lower in LMICs, likely due to limited access to emergency care. PMID:27334758

  4. Strategic emergency department design: An approach to capacity planning in healthcare provision in overcrowded emergency rooms.

    Science.gov (United States)

    Exadaktylos, Aristomenis K; Evangelopoulos, Dimitrios S; Wullschleger, Marcel; Bürki, Leo; Zimmermann, Heinz

    2008-11-17

    Healthcare professionals and the public have increasing concerns about the ability of emergency departments to meet current demands. Increased demand for emergency services, mainly caused by a growing number of minor and moderate injuries has reached crisis proportions, especially in the United Kingdom. Numerous efforts have been made to explore the complex causes because it is becoming more and more important to provide adequate healthcare within tight budgets. Optimisation of patient pathways in the emergency department is therefore an important factor.This paper explores the possibilities offered by dynamic simulation tools to improve patient pathways using the emergency department of a busy university teaching hospital in Switzerland as an example.

  5. Emergency Vehicle Scheduling Problem with Time Utility in Disasters

    Directory of Open Access Journals (Sweden)

    Xiaobing Gan

    2015-01-01

    Full Text Available This paper presents a flexible emergency rescue system which is chiefly composed of three parts, namely, disaster assistance center, relief vehicles, and disaster areas. A novel objective of utility maximization is used to evaluate the entire system in disasters. Considering the uncertain road conditions in the relief distribution, we implement triangular fuzzy number to calculate the vehicle velocity. As a consequence, a fuzzy mathematical model is built to maximize the utility of emergency rescue system and then converted to the crisp counterpart. Finally, the results of numerical experiments obtained by particle swarm optimization (PSO prove the validity of this proposed mathematical model.

  6. ALWR utility requirements - A technical basis for updated emergency planning

    International Nuclear Information System (INIS)

    Leaver, David E.W.; DeVine, John C. Jr.; Santucci, Joseph

    2004-01-01

    U.S. utilities, with substantial support from international utilities, are developing a comprehensive set of design requirements in the form of a Utility Requirements Document (URD) as part of an industry wide effort to establish a technical foundation for the next generation of light water reactors. A key aspect of the URD is a set of severe accident-related design requirements which have been developed to provide a technical basis for updated emergency planning for the ALWR. The technical basis includes design criteria for containment performance and offsite dose during severe accident conditions. An ALWR emergency planning concept is being developed which reflects this severe accident capability. The main conclusion from this work is that the likelihood and consequences of a severe accident for an ALWR are fundamentally different from that assumed in the technical basis for existing emergency planning requirements, at least in the U.S. The current technical understanding of severe accident risk is greatly improved compared to that available when the existing U.S. emergency planning requirements were established nearly 15 years ago, and the emerging ALWR designs have superior core damage prevention and severe accident mitigation capability. Thus, it is reasonable and prudent to reflect this design capability in the emergency planning requirements for the ALWR. (author)

  7. PM2.5 constituents and hospital emergency-room visits in Shanghai, China.

    Science.gov (United States)

    Qiao, Liping; Cai, Jing; Wang, Hongli; Wang, Weibing; Zhou, Min; Lou, Shengrong; Chen, Renjie; Dai, Haixia; Chen, Changhong; Kan, Haidong

    2014-09-02

    Although ambient PM2.5 has been linked to adverse health effects, the chemical constituents that cause harm are largely unclear. Few prior studies in a developing country have reported the health impacts of PM2.5 constituents. In this study, we examined the short-term association between PM2.5 constituents and emergency room visits in Shanghai, China. We measured daily concentrations of PM2.5, organic carbon (OC), elemental carbon (EC), and eight water-soluble ions between January 1, 2011 and December 31, 2012. We analyzed the data using overdispersed generalized linear Poisson models. During our study period, the mean daily average concentration of PM2.5 in Shanghai was 55 μg/m(3). Major contributors to PM2.5 mass included OC, EC, sulfate, nitrate, and ammonium. For a 1-day lag, an interquartile range increment in PM2.5 mass (36.47 μg/m(3)) corresponded to 0.57% [95% confidence interval (CI): 0.13%, 1.01%] increase of emergency room visits. In all the three models used, we found significant positive associations of emergency room visits with OC and EC. Our findings suggest that PM2.5 constituents from the combustion of fossil fuel (e.g., OC and EC) may have an appreciable influence on the health impact attributable to PM2.5.

  8. Alcohol and Violence in the Emergency Room: A Review and Perspectives from Psychological and Social Sciences

    Directory of Open Access Journals (Sweden)

    Cheryl Cherpitel

    2013-09-01

    Full Text Available Our objective is to present a focused review of the scientific literature on the effect of alcohol consumption on violence related-injuries assessed in the emergency room (ER and to show how psychological and behavioral sciences could lead to a better understanding of the factors contributing to alcohol-related injuries in the ER. We retrieved published literature through a detailed search in Academic Search Premier, MEDLINE with Full Text PsycARTICLES, Psychology and Behavioral Sciences Collection, PsycINFO, PUBMed and SocINDEX with Full Text for articles related to emergency rooms, medical problems and sociocognitive models addressing alcohol intoxication articles. The first search was conducted in June 2011 and updated until August 2013. Literature shows that compared to uninjured patients; injured ones have a higher probability of: (i having an elevated blood-alcohol concentration upon arrival at the ER; (ii reporting having drunk alcohol during the six hours preceding the event; and (iii suffering from drinking-related consequences that adversely affect their social life. The main neurocognitive and sociocognitive models on alcohol and aggression are also discussed in order to understand the aetiology of violence-related injuries in emergency rooms. Suggestions are made for future research and prevention.

  9. Prevalence of thyroid dysfunction in patients with acute atrial fibrillation attended at a cardiology emergency room

    Directory of Open Access Journals (Sweden)

    Juarez Neuhaus Barbisan

    Full Text Available CONTEXT: Atrial fibrillation occurs frequently in patients with thyrotoxicosis, while it has low prevalence in adults of the general population. The prevalence of thyroid dysfunction in subjects with atrial fibrillation is 0 to 24%, a wide variation that is attributed to the different methodologies applied. However, continuous use of amiodarone in patients with previous atrial fibrillation may interfere with these prevalence rates. OBJECTIVE: In this study, we present the prevalence of thyroid dysfunction in adult patients who presented at a cardiac emergency room with acute atrial fibrillation, using a sensitive thyroid-stimulating hormone (TSH assay and triiodothyronine (T3 and thyroxine (T4 determination. TYPE OF STUDY: Cross-sectional study SETTING: Emergency room of a tertiary care facility. PARTICIPANTS: A total of 72 patients with atrial fibrillation who presented at the emergency room not more than 48 hours after its onset. PROCEDURES: A standardized questionnaire and 12-lead electrocardiogram were applied, and T3, T4 and TSH were determined. MAIN MEASUREMENTS: TSH, T3 and T4 determination. RESULTS: Among these patients, 16.6% had altered thyroid function tests: 6.9% had hyperthyroidism, 5.6% hypothyroidism and 4.2% had increased T4 levels, by means of amiodarone use. CONCLUSION: The high prevalence of thyroid dysfunction in our study, especially hyperthyroidism, suggests that routine thyroid testing with sensitivethyroid-stimulating hormone assay is required in patients with acute atrial fibrillation.

  10. Effects of a training workshop on suicide prevention among emergency room nurses.

    Science.gov (United States)

    Kishi, Yasuhiro; Otsuka, Kotaro; Akiyama, Keiko; Yamada, Tomoki; Sakamoto, Yumiko; Yanagisawa, Yaeko; Morimura, Hiroshi; Kawanishi, Chiaki; Higashioka, Hiroaki; Miyake, Yasushi; Thurber, Steven

    2014-01-01

    Suicide attempts are frequently encountered by emergency department nurses. Such encounters can potentially provide a foundation for secondary suicide prevention. The aim of the present investigation was to evaluate the effect of a 7-hr training program for emergency room nursing personnel in Japan. In all, 52 nurses completed the questionnaires before the workshop and 1 month after the workshop. The nurses' understanding of and willingness to care for suicidal patients positively changed. It is feasible to provide a 7-hr, relatively short, workshop on suicidal prevention aimed at emergency medical staff and to improve attitudes during a follow-up of 1 month. It is uncertain whether the positive attitudes of emergency nurses toward suicide and/or educational interventions could impact the outcomes of these interventions. Further studies are needed to address these important questions in this field.

  11. Stroke Education in an Emergency Department Waiting Room: a Comparison of Methods

    Directory of Open Access Journals (Sweden)

    Yu-Feng Yvonne Chan1

    2015-03-01

    Full Text Available Background: Since the emergency department (ED waiting room hosts a large, captive audience of patients and visitors, it may be an ideal location for conduct-ing focused stroke education. The aim of this study was to assess the effective-ness of various stroke education methods.Methods: Patients and visitors of an urban ED waiting room were randomized into one of the following groups: video, brochure, one-to-one teaching, combi-nation of these three methods, or control group. We administered a 13-question multiple-choice test to assess stroke knowledge prior to, immediately after, and at 1 month post-education to patients and visitors in the ED waiting room.Results: Of 4 groups receiving education, all significantly improved their test scores immediately post intervention (test scores 9.4±2.5-10.3±2.0, P<0.01. At 1 month, the combination group retained the most knowledge (9.4±2.4 exceed-ing pre-intervention and control scores (both 6.7±2.6, P<0.01.Conclusion: Among the various stroke education methods delivered in the ED waiting room, the combination method resulted in the highest knowledge reten-tion at 1-month post intervention.

  12. Cervical Spine Collar Removal by Emergency Room Nurses: A Quality Improvement Project.

    Science.gov (United States)

    Fontaine, Guillaume; Forgione, Massimo; Lusignan, Francis; Lanoue, Marc-André; Drouin, Simon

    2018-05-01

    The Canadian C-Spine Rule (CCR) is a clinical decision aid to facilitate the safe removal of cervical collars in the alert, orientated, low-risk adult trauma patient. Few health care settings have assessed initiatives to train charge nurses to use the CCR. This practice improvement project conducted in a secondary trauma center in Canada aimed to (1) train charge nurses of the emergency room to use the CCR, (2) monitor its use throughout the project period, and (3) compare the assessments of the charge nurses with those of emergency physicians. The project began with the creation of an interdisciplinary team. Clinical guidelines were established by the interdisciplinary project team. Nine charge nurses of the emergency room were then trained to use the CCR (3 on each 8-hour shift). The use of the CCR was monitored throughout the project period, from June 1 to October 5, 2016. The 3 aims of this practice improvement project were attained successfully. Over a 5-month period, 114 patients were assessed with the CCR. Charge nurses removed the cervical collars for 54 of 114 patients (47%). A perfect agreement rate (114 of 114 patients, 100%) was attained between the assessments of the nurses and those of physicians. This project shows that the charge nurses of a secondary trauma center can use the CCR safely on alert, orientated, and low-risk adult trauma patients as demonstrated by the agreement in the assessments of emergency room nurses and physicians. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  13. Waiting room crowding and agitation in a dedicated psychiatric emergency service.

    Science.gov (United States)

    El-Mallakh, Rif S; Whiteley, Amanda; Wozniak, Tanya; Ashby, McCray; Brown, Shawn; Colbert-Trowel, Danya; Pennington, Tammy; Thompson, Michael; Tasnin, Rokeya; Terrell, Christina L

    2012-05-01

    Emergency department crowding is a growing problem that impacts patient care and safety. The effect of crowding has not been examined in emergency psychiatric services. The association between patient census and use of restraints, seclusion, and anti-agitation medications as needed was examined for 1 month. A total of 689 patients were seen in 31 days. The average hourly census was 6.8 ± 2.8 (range 0 to 18). There were 33 incidences of seclusion or restraint and an additional 15 instances of medications administered for agitation. The use of seclusion, restraint, or medication for agitation was significantly associated with census (r2 = 0.3, F = 5.47, P = .036). Crowding in emergency psychiatric waiting rooms may increase the need for seclusion, restraint, or medications for agitation.

  14. 76 FR 76937 - Emerging Technology and Research Advisory Committee; Notice of Partially Closed Meeting-Room Change

    Science.gov (United States)

    2011-12-09

    ... DEPARTMENT OF COMMERCE Bureau of Industry and Security Emerging Technology and Research Advisory Committee; Notice of Partially Closed Meeting--Room Change The Emerging Technology and Research Advisory... emerging technology and research activities, including those related to deemed exports. Agenda Wednesday...

  15. Assessment of chest pain in the emergency room: What is the role of multidetector CT?

    International Nuclear Information System (INIS)

    White, Charles; Read, Katrina; Kuo, Dick

    2006-01-01

    Chest pain is one of the most frequent complaints for patients seen in the emergency department. The current article describes the clinical stratification of patients who present to the emergency department with chest pain and discusses imaging options and analysis for these patients. It reviews conventional imaging approaches to assessing chest pain including chest radiography and stress testing. The main discussion focuses on the potential utility use of cross-sectional imaging, particularly multidetector CT, in the evaluation of chest pain in the emergency department

  16. Outcome of burr hole surgery in the emergency room for severe acute subdural hematoma

    International Nuclear Information System (INIS)

    Park, Young-Soo; Hironaka, Yasuhiro; Motoyama, Yasushi; Asai, Hideki; Watanabe, Tomoo; Nishio, Kenji; Nakase, Hiroyuki; Okuchi, Kazuo

    2010-01-01

    We have performed burr hole surgery in the emergency room for severe acute subdural hematoma from April 2007 in twenty five patients. All patients were deep comatose and showed cerebral herniation sign with bilateral pupillary abnormalities. Burr hole surgeries were performed as soon as possible after CT evaluation. Continually decomporresive craiectomies were followed if clinical improvements were achieved and mild baribiturate-moderate hypothermia combined (MB-MH) therapy was induced postoperatively in some cases. The mean average was 65.6 years (range 16-93). The causes of head injuries were traffic accident in 9, fall down in 13 and unknown in 3. The mean Glasgow coma scale (GCS) on admission was 4.4 (range 3-9). The mean time interval from arrival to burr hole surgery was 33.5 minutes (range 21-50 minutes). Decompressive craniectomy was indicated in 14 cases and MB-MH therapy was induced in 13 cases. The overall clinical outcome consisted of good recovery in 3, moderate disability in 2, severe disability in 3, persistent vegetative state in 3 and death in 14. Favorable results can be expected even in patients with serious acute subdural hematoma. Emergent burr hole surgery was effective to decrease intracranial pressure rapidly and to save time. So active burr hole surgery in the emergency room is strongly recommended to all cases of severe acute subdural hematoma. (author)

  17. Prevalence of substance use among trauma patients treated in a Brazilian emergency room

    Directory of Open Access Journals (Sweden)

    Reis Alessandra Diehl

    2006-01-01

    Full Text Available OBJECTIVE: Although there is a considerable amount of data in the literature regarding the association between alcohol consumption and injuries treated in emergency rooms, little is known about the relationship between such injury and the use of other substances. The objective of this study was to estimate the prevalence of substance use in patients admitted to the emergency room for non-fatal injuries. METHOD: A prospective cross-sectional study assessing all patients admitted to the emergency room within 6 hours after a non-fatal injury was conducted over a three-month period. The following were used as measures of alcohol and drug use: a standardized World Health Organization questionnaire; a self-administered questionnaire related to drug consumption within the 24 hours preceding contact; the Drug Abuse Screening Test; urine screens for cannabis, cocaine and benzodiazepines; and determination of blood alcohol concentration. Descriptive analyses were performed and the confidence interval used was 95%. RESULTS: A total of 353 patients were included. Cannabis and cocaine screens were conducted for 242 patients and benzodiazepine screens were conducted for 166. Blood alcohol concentrations reached the level of positivity in 11% (n = 39, and 10% (n = 33 presented some degree of intoxication. Among the 242 patients screened, 13.6% (n = 33 tested positive for cannabis, and 3.3% (n = 8 tested positive for cocaine, whereas 4.2% (n = 7 of the 166 patients screened tested positive for benzodiazepines. CONCLUSIONS: Substance use was highly prevalent among these individuals. In this sample, the frequency for the use of cannabis (an illicit drug was comparable to that of alcohol. More studies are needed in order to characterize such use among Brazilians and to develop proper approaches to such cases, with the aim of reducing substance use and its consequences.

  18. Poor Compliance with Sepsis Guidelines in a Tertiary Care Children’s Hospital Emergency Room

    OpenAIRE

    Benjamin Louis Moresco; Benjamin Louis Moresco; Clinton Woosley; Clinton Woosley; Morris Sauter; Utpal Bhalala; Utpal Bhalala

    2018-01-01

    ObjectivesThis study aimed to assess factors related to adherence to the Pediatric Advanced Life Support guidelines for severe sepsis and septic shock in an emergency room (ER) of a tertiary care children’s hospital.MethodsThis was a retrospective, observational study of children (0–18 years old) in The Children’s Hospital of San Antonio ER over 1 year with the International Consensus Definition Codes, version-9 (ICD-9) diagnostic codes for “severe sepsis” and “shocks.” Patients in the adhere...

  19. Clinically useful predictors for premature mortality among psychiatric patients visiting a psychiatric emergency room

    DEFF Research Database (Denmark)

    Aagaard, Jørgen; Buus, Niels; Wernlund, Andreas Glahn

    2016-01-01

    OBJECTIVE: The aim of this study was to examine changes in the distribution of causes of death and mortality rates among psychiatric patients visiting a psychiatric emergency room (PER), to determine clinically useful predictors for avoiding premature mortality among these patients and to discuss...... linked to the Cause of Death Register and the Central Psychiatric Research Register, and logistic predictor analyses for premature death were performed. RESULTS: The standardised mortality ratio (SMR) of all visitors compared to the general Danish population was approximately 5. Overall, patients...

  20. Hospital hero: a game for reducing stress and anxiety of children while waiting in emergency room

    OpenAIRE

    Tranquada, Sara Patrícia Fernandes

    2014-01-01

    This report tells a story which started as an idea that came to us to fight the battle-cry feeling commonly known as stress and anxiety. Before creating the solution of the idea, we first need to understand the feelings underneath and its effects on our well-being. Throughout the course of our lives, we experience states of weakness and fear. These feelings can arise, for instance, while we are in an emergency room. Needless to say, how much it would have imaginable effects on children,...

  1. Youth Versus Adult “Weightlifting” Injuries Presenting to United States Emergency Rooms: Accidental Versus Nonaccidental Injury Mechanisms

    OpenAIRE

    Myer, Gregory D.; Quatman, Carmen E.; Khoury, Jane; Wall, Eric J.; Hewett, Timothy E.

    2009-01-01

    Myer, GD, Quatman, CE, Khoury, J, Wall, EJ, and Hewett, TE. Youth versus adult “weightlifting” injuries presenting to united states emergency rooms: accidental versus nonaccidental injury mechanisms. J Strength Cond Res 23(7): 2054–2060, 2009—Resistance training has previously been purported to be unsafe and ineffective in children. The purpose of this investigation was to evaluate resistance training-related injuries presenting to U.S. emergency rooms by age, type, and mechanism of injury. W...

  2. [Breaking bad news in the emergency room: Suggestions and future challenges].

    Science.gov (United States)

    Landa-Ramírez, Edgar; López-Gómez, Antonio; Jiménez-Escobar, Irma; Sánchez-Sosa, Juan José

    2017-01-01

    The aim of this paper is to describe educational programs that reportedly teach how to break bad news in the emergency department. We also suggest some recommendations on how to communicate bad news based on the research of evidence available in the field. The examined evidence points toward six major components with which physicians should familiarize when communicating bad news: 1) doctor-patient empathic communication, 2) establishing a proper space to give the news, 3) identifying characteristics of the person who receives the news, 4) essential aspects for communicating the news; 5) emotional support, and 6) medical and administrative aspects of the encounter. Finally, we point out several limitations in the studies in the field and future challenges identified in the communication of bad news in emergency room facilities.

  3. Occurrence rate and clinical predictors of hypertensive pseudocrisis in emergency room care.

    Science.gov (United States)

    Sobrinho, Silvestre; Correia, Luís C L; Cruz, Constança; Santiago, Mila; Paim, Ana Catarina; Meireles, Bruno; Andrade, Mariana; Kerner, Mariana; Amoedo, Paula; de Souza, Carlos Marcílio

    2007-05-01

    To describe the prevalence of hypertensive pseudocrisis in patients treated in emergency rooms with substantially elevated blood pressure levels. To compare this prevalence in private and public hospitals. To describe the frequency of wrong treatment for this condition. To identify, during triage, independent predictors of pseudocrisis. To evaluate the prognosis of patients with pseudocrisis. Patients above the age of 18, admitted to the Emergency Rooms of two hospitals (private and public) during a 6 month timeframe, with diastolic blood pressure > or = 120 mmHg were included in the study. Hypertensive pseudocrisis was determined when none of the criteria for hypertensive crisis were present (Guidelines of the Brazilian Society of Cardiology(1)). In the 110 patients studied, the prevalence of hypertensive pseudocrisis was 48% (95% CI = 39%-58%) and prevailed in the private hospital (59% vs 37%, p=0.02). The frequency of wrong treatment was similar between the two hospitals (94% vs 95%, p=0.87). After multivariate analysis, the presence of headache upon admission (Odds Ratio=5.4; 95% CI = 5.1-13; pcrisis group (0% vs 21%, p=0.0004). There is a high prevalence of hypertensive pseudocrisis in patients when hypertensive crisis is suspected, particularly in the private hospital. The frequency of wrong treatment was similar for both the private and public hospitals. Headaches and diastolic BP levels are independent predictors for this clinical condition. Hypertensive pseudocrisis has a low rate of lethality.

  4. CT Findings of Disease with Elevated Serum D-Dimer Levels in an Emergency Room Setting

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Ji Youn; Kwon, Woo Cheol; Kim, Young Ju [Dept. of Radiology, Wonju Christian Hospital, Yensei University Wonju College of Medicine, Wonju (Korea, Republic of)

    2012-01-15

    Pulmonary embolism and deep vein thrombosis are the leading causes of elevated serum D-dimer levels in the emergency room. Although D-dimer is a useful screening test because of its high sensitivity and negative predictive value, it has a low specificity. In addition, D-dimer can be elevated in various diseases. Therefore, information on the various diseases with elevated D-dimer levels and their radiologic findings may allow for accurate diagnosis and proper management. Herein, we report the CT findings of various diseases with elevated D-dimer levels in an emergency room setting, including an intravascular contrast filling defect with associated findings in a venous thromboembolism, fracture with soft tissue swelling and hematoma formation in a trauma patient, enlargement with contrast enhancement in the infected organ of a patient, coronary artery stenosis with a perfusion defect of the myocardium in a patient with acute myocardial infarction, high density of acute thrombus in a cerebral vessel with a low density of affected brain parenchyma in an acute cerebral infarction, intimal flap with two separated lumens in a case of aortic dissection, organ involvement of malignancy in a cancer patient, and atrophy of a liver with a dilated portal vein and associated findings.

  5. CT Findings of Disease with Elevated Serum D-Dimer Levels in an Emergency Room Setting

    International Nuclear Information System (INIS)

    Choi, Ji Youn; Kwon, Woo Cheol; Kim, Young Ju

    2012-01-01

    Pulmonary embolism and deep vein thrombosis are the leading causes of elevated serum D-dimer levels in the emergency room. Although D-dimer is a useful screening test because of its high sensitivity and negative predictive value, it has a low specificity. In addition, D-dimer can be elevated in various diseases. Therefore, information on the various diseases with elevated D-dimer levels and their radiologic findings may allow for accurate diagnosis and proper management. Herein, we report the CT findings of various diseases with elevated D-dimer levels in an emergency room setting, including an intravascular contrast filling defect with associated findings in a venous thromboembolism, fracture with soft tissue swelling and hematoma formation in a trauma patient, enlargement with contrast enhancement in the infected organ of a patient, coronary artery stenosis with a perfusion defect of the myocardium in a patient with acute myocardial infarction, high density of acute thrombus in a cerebral vessel with a low density of affected brain parenchyma in an acute cerebral infarction, intimal flap with two separated lumens in a case of aortic dissection, organ involvement of malignancy in a cancer patient, and atrophy of a liver with a dilated portal vein and associated findings.

  6. Surgery of the elderly in emergency room mode. Is there a place for laparoscopy?

    Science.gov (United States)

    Michalik, Maciej; Dowgiałło-Wnukiewicz, Natalia; Lech, Paweł; Zacharz, Krzysztof

    2017-06-01

    An important yet difficult problem is qualification for surgery in elderly patients. With age the risk of comorbidities increases - multi-disease syndrome. Elderly patients suffer from frailty syndrome. Many body functions become impaired. All these factors make the elderly patient a major challenge for surgical treatment. Analysis of the possibility of developing the indications and contraindications and the criteria for surgical treatment of the elderly based on our own cases. Discussion whether there is a place for laparoscopy during surgery of the elderly in emergency room (ER) mode. The analysis was performed based on seven cases involving surgical treatment of elderly patients who were admitted to the hospital in emergency room mode. The patients were hospitalized in the General and Minimally Invasive Surgery Clinic in Olsztyn in 2016. Surgical treatment of elderly patients should be planned with multidisciplinary teams. Geriatric surgery centers should be developed to minimize the risk of overzealous treatment and potential complications. Laparoscopy should always be considered in the case of ER procedures or diagnostics. Elderly patients should not be treated as typical adults, but as a separate group of patients requiring special treatment. Due to the existing additional disease in the elderly, the frailty syndrome, any surgical intervention should be minimally invasive. The discussion about therapy should be conducted by a team of specialists from a variety of medical fields.

  7. Emergency Preparedness Education for Nurses: Core Competency Familiarity Measured Utilizing an Adapted Emergency Preparedness Information Questionnaire.

    Science.gov (United States)

    Georgino, Madeline M; Kress, Terri; Alexander, Sheila; Beach, Michael

    2015-01-01

    The purpose of this project was to measure trauma nurse improvement in familiarity with emergency preparedness and disaster response core competencies as originally defined by the Emergency Preparedness Information Questionnaire after a focused educational program. An adapted version of the Emergency Preparedness Information Questionnaire was utilized to measure familiarity of nurses with core competencies pertinent to first responder capabilities. This project utilized a pre- and postsurvey descriptive design and integrated education sessions into the preexisting, mandatory "Trauma Nurse Course" at large, level I trauma center. A total of 63 nurses completed the intervention during May and September 2014 sessions. Overall, all 8 competencies demonstrated significant (P < .001; 98% confidence interval) improvements in familiarity. In conclusion, this pilot quality improvement project demonstrated a unique approach to educating nurses to be more ready and comfortable when treating victims of a disaster.

  8. Identification and initial management of intoxication by alcohol and other drugs in the pediatric emergency room

    Directory of Open Access Journals (Sweden)

    Thiago Gatti Pianca

    Full Text Available Abstract Objective: To review the screening, diagnosis, evaluation, and treatment of intoxication by alcohol and other drugs in children and adolescents in the emergency scenario. Data source: This was a narrative literature review. Data summary: The detection of this problem in the emergency room can be a challenge, especially when its assessment is not standardized. The intentional and episodic use of large amounts of psychoactive substances by adolescents is a usual occurrence, and unintentional intoxication is more common in children younger than 12 years. The clinical picture in adolescents and children differs from that in adults and some particularities are important in the emergency scenario. After management of the acute condition, interventions targeting the adolescent at risk may be effective. Conclusion: The diagnosis and treatment of intoxication by alcohol and other drugs in adolescents and children in the emergency scenario requires a systematic evaluation of the use of these drugs. There are few specific treatments for intoxication, and the management comprehends support measures and management of related clinical complications.

  9. Identification and initial management of intoxication by alcohol and other drugs in the pediatric emergency room.

    Science.gov (United States)

    Pianca, Thiago Gatti; Sordi, Anne Orgle; Hartmann, Thiago Casarin; von Diemen, Lisia

    To review the screening, diagnosis, evaluation, and treatment of intoxication by alcohol and other drugs in children and adolescents in the emergency scenario. This was a narrative literature review. The detection of this problem in the emergency room can be a challenge, especially when its assessment is not standardized. The intentional and episodic use of large amounts of psychoactive substances by adolescents is a usual occurrence, and unintentional intoxication is more common in children younger than 12 years. The clinical picture in adolescents and children differs from that in adults and some particularities are important in the emergency scenario. After management of the acute condition, interventions targeting the adolescent at risk may be effective. The diagnosis and treatment of intoxication by alcohol and other drugs in adolescents and children in the emergency scenario requires a systematic evaluation of the use of these drugs. There are few specific treatments for intoxication, and the management comprehends support measures and management of related clinical complications. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  10. Focused Cardiac Ultrasound Using a Pocket-Size Device in the Emergency Room

    Energy Technology Data Exchange (ETDEWEB)

    Mancuso, Frederico José Neves, E-mail: frederico.mancuso@grupofleury.com.br [Disciplina de Cardiologia - Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil); Disciplina de Medicina de Urgência - Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil); Siqueira, Vicente Nicoliello; Moisés, Valdir Ambrósio [Disciplina de Cardiologia - Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil); Gois, Aécio Flavio Teixeira [Disciplina de Medicina de Urgência - Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil); Paola, Angelo Amato Vincenzo de; Carvalho, Antonio Carlos Camargo; Campos, Orlando [Disciplina de Cardiologia - Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil)

    2014-12-15

    Cardiovascular urgencies are frequent reasons for seeking medical care. Prompt and accurate medical diagnosis is critical to reduce the morbidity and mortality of these conditions. To evaluate the use of a pocket-size echocardiography in addition to clinical history and physical exam in a tertiary medical emergency care. One hundred adult patients without known cardiac or lung diseases who sought emergency care with cardiac complaints were included. Patients with ischemic changes in the electrocardiography or fever were excluded. A focused echocardiography with GE Vscan equipment was performed after the initial evaluation in the emergency room. Cardiac chambers dimensions, left and right ventricular systolic function, intracardiac flows with color, pericardium, and aorta were evaluated. The mean age was 61 ± 17 years old. The patient complaint was chest pain in 51 patients, dyspnea in 32 patients, arrhythmia to evaluate the left ventricular function in ten patients, hypotension/dizziness in five patients and edema in one patient. In 28 patients, the focused echocardiography allowed to confirm the initial diagnosis: 19 patients with heart failure, five with acute coronary syndrome, two with pulmonary embolism and two patients with cardiac tamponade. In 17 patients, the echocardiography changed the diagnosis: ten with suspicious of heart failure, two with pulmonary embolism suspicious, two with hypotension without cause, one suspicious of acute coronary syndrome, one of cardiac tamponade and one of aortic dissection. The focused echocardiography with pocket-size equipment in the emergency care may allow a prompt diagnosis and, consequently, an earlier initiation of the therapy.

  11. Focused Cardiac Ultrasound Using a Pocket-Size Device in the Emergency Room

    International Nuclear Information System (INIS)

    Mancuso, Frederico José Neves; Siqueira, Vicente Nicoliello; Moisés, Valdir Ambrósio; Gois, Aécio Flavio Teixeira; Paola, Angelo Amato Vincenzo de; Carvalho, Antonio Carlos Camargo; Campos, Orlando

    2014-01-01

    Cardiovascular urgencies are frequent reasons for seeking medical care. Prompt and accurate medical diagnosis is critical to reduce the morbidity and mortality of these conditions. To evaluate the use of a pocket-size echocardiography in addition to clinical history and physical exam in a tertiary medical emergency care. One hundred adult patients without known cardiac or lung diseases who sought emergency care with cardiac complaints were included. Patients with ischemic changes in the electrocardiography or fever were excluded. A focused echocardiography with GE Vscan equipment was performed after the initial evaluation in the emergency room. Cardiac chambers dimensions, left and right ventricular systolic function, intracardiac flows with color, pericardium, and aorta were evaluated. The mean age was 61 ± 17 years old. The patient complaint was chest pain in 51 patients, dyspnea in 32 patients, arrhythmia to evaluate the left ventricular function in ten patients, hypotension/dizziness in five patients and edema in one patient. In 28 patients, the focused echocardiography allowed to confirm the initial diagnosis: 19 patients with heart failure, five with acute coronary syndrome, two with pulmonary embolism and two patients with cardiac tamponade. In 17 patients, the echocardiography changed the diagnosis: ten with suspicious of heart failure, two with pulmonary embolism suspicious, two with hypotension without cause, one suspicious of acute coronary syndrome, one of cardiac tamponade and one of aortic dissection. The focused echocardiography with pocket-size equipment in the emergency care may allow a prompt diagnosis and, consequently, an earlier initiation of the therapy

  12. THE APPLICATION OF EVIDENCE BASED DESIGN IN EMERGENCY ROOM OF PUBLIC HOSPITAL OF DR. R. SOSODORO DJATIKOESOEMO BOJONEGORO

    Directory of Open Access Journals (Sweden)

    Noerkayatin ,

    2015-07-01

    Full Text Available The Hospital facilities built under Evidence Based Design (EBD will create a safe and comfortable environment, lower the nosocomial infection, quicken the patient recovery, lower the treatment cost, and improve staffs’ performance. The emergency room of public hospital of Dr.R.Sosodoro Djatikoesoemo Bojonegoro needs to be redesigned because the existing design does not meet physical safety. The reparation should refer to Facilities and Safety Management (FMS, Indonesian regulation, EBD concept and benchmarking to RSCM Jakarta considered as an application sample. This research applies case study with descriptive single case study design. The result of the research shows that reparation should be done that includes site and location, building components, and rooms lay out. The width of the rooms should meet minimal standard. The placing of triage room and resuscitation should be in the front area. Sinks should be located near the entrance of every room. The isolation and decontamination rooms should be provided.

  13. [Management of an elderly patient in the emergency room at the end of life : A medical ethics challenge].

    Science.gov (United States)

    Michels, G; Nies, R; Ortmann, S; Pfister, R; Salomon, F

    2018-04-01

    A 94-year-old patient with cardiogenic shock due to myocardial infarction was admitted via the emergency room. A coronary angiography and intensive care were requested. The need for care due to dementia was known. After case discussion in the interdisciplinary and multiprofessional treatment team, the decision for a palliative care concept in the form of symptom control was made in the emergency room, taking into account the patient's medical history, the current situation, and the presumed patient consent. The integration of medical ethics aspects and palliative medicine into "geriatric emergency medicine" will present a challenge in the future.

  14. [Conflictive patients in the emergency room: Definition, classification and ethical aspects].

    Science.gov (United States)

    Herreros, B; García Casasola, G; Pintor, E; Sánchez, M A

    2010-09-01

    A conflictive patient is one who provokes a problem (a conflict) by their attitude or behavior for the physician. Ethical conflicts in emergency care are common and many of them occur with these patients. Among the most common types of patients who generate personal conflicts with health professionals are overly demanding patients, those who refuse medical interventions, those who are aggressive, litigators, excessively-recurrent users of the heath system and those who go to the emergency room without an urgent condition. A patient may include several of these profiles ("mixed" patient). When they appear, the approach should be, if possible, by a team, establishing a deliberative process. If there is doubt and when possible, the ethics committee of the institution should be consulted, seeking the protocols, this best being institutional, on the subject. After that, if the decision is difficult, support must be sought from the emergency staff and even management. The whole process should be reflected in the clinical history. Specific education in bioethics and communication skills can be of great help to minimize and cope better with long-term conflicts. Copyright 2009 Elsevier España, S.L. All rights reserved.

  15. Impact of visual art on patient behavior in the emergency department waiting room.

    Science.gov (United States)

    Nanda, Upali; Chanaud, Cheryl; Nelson, Michael; Zhu, Xi; Bajema, Robyn; Jansen, Ben H

    2012-07-01

    Wait times have been reported to be one of the most important concerns for people visiting emergency departments (EDs). Affective states significantly impact perception of wait time. There is substantial evidence that art depicting nature reduces stress levels and anxiety, thus potentially impacting the waiting experience. To analyze the effect of visual art depicting nature (still and video) on patients' and visitors' behavior in the ED. A pre-post research design was implemented using systematic behavioral observation of patients and visitors in the ED waiting rooms of two hospitals over a period of 4 months. Thirty hours of data were collected before and after new still and video art was installed at each site. Significant reduction in restlessness, noise level, and people staring at other people in the room was found at both sites. A significant decrease in the number of queries made at the front desk and a significant increase in social interaction were found at one of the sites. Visual art has positive effects on the ED waiting experience. Copyright © 2012 Elsevier Inc. All rights reserved.

  16. Developing Emergency Room Key Performance Indicators: What to Measure and Why Should We Measure It?

    Science.gov (United States)

    Khalifa, Mohamed; Zabani, Ibrahim

    2016-01-01

    Emergency Room (ER) performance has been a timely topic for both healthcare practitioners and researchers. King Faisal Specialist Hospital and Research Center, Saudi Arabia worked on developing a comprehensive set of KPIs to monitor, evaluate and improve the performance of the ER. A combined approach using quantitative and qualitative methods was used to collect and analyze the data. 34 KPIs were developed and sorted into the three components of the ER patient flow model; input, throughput and output. Input indicators included number and acuity of ER patients, patients leaving without being seen and revisit rates. Throughput indicators included number of active ER beds, ratio of ER patients to ER staff and the length of stay including waiting time and treatment time. The turnaround time of supportive services, such as lab, radiology and medications, were also included. Output indicators include boarding time and available hospital beds, ICU beds and patients waiting for admission.

  17. Role Allocations and Communications of Operators during Emergency Operation in Advanced Main Control Rooms

    International Nuclear Information System (INIS)

    Lee, June Seung

    2009-01-01

    The advanced main control room (MCR) in GEN III + nuclear power plants has been designed by adapting modern digital I and C techniques and an advanced man machine interface system (MMIS). Large Display Panels (LDPs) and computer based workstations are installed in the MCR. A Computerized Procedure System (CPS) and Computerized Operation Support System (COSS) with high degrees of automation are supplied to operators. Therefore, it is necessary to set up new operation concepts in advanced MCRs that are different from those applied in conventional MCRs regarding role allocations and communications of operators. The following presents a discussion of the main differences between advanced MCRs and conventional MCRs from the viewpoint of role allocations and communications. Efficient models are then proposed on the basis of a task analysis on a series of emergency operation steps

  18. Feelings of nurses in the reception and risk classification evaluation in the emergency room

    Directory of Open Access Journals (Sweden)

    Andressa Midori Sakai

    2016-05-01

    Full Text Available Objective: to reveal feelings of nurses who host with risk assessment and classification in an emergency room of a pubic hospital. Methods: it is a qualitative research approach with 12 nurses interviewed. The data were analyzed, categorized and discussed according to the theoretical framework of work psychodynamics. Results: the nurses expressed feelings of satisfaction in meeting the user needs assistance. They reported feeling as fear, stress and fatigue due to the sharp pace of work, gaps in health care network and situations of violence. They highlighted coping strategies to reduce the burden of this assignment, how to share the completion of the screening with the nursing staff. Conclusion: the host with risk assessment and classification favors the autonomy of nurses and provide greater accountability to this professional users, but the limitations of available resources to solve the complaint of patients generate physical and psychological burden to this worker.

  19. Feelings of nurses in the reception and risk classification evaluation in the emergency room

    Directory of Open Access Journals (Sweden)

    Andressa Midori Sakai

    2016-01-01

    Full Text Available Objective: to reveal feelings of nurses who host with risk assessment and classification in an emergency room of a pubic hospital. Methods: it is a qualitative research approach with 12 nurses interviewed. The data were analyzed, categorized and discussed according to the theoretical framework of work psychodynamics. Results: the nurses expressed feelings of satisfaction in meeting the user needs assistance. They reported feeling as fear, stress and fatigue due to the sharp pace of work, gaps in health care network and situations of violence. They highlighted coping strategies to reduce the burden of this assignment, how to share the completion of the screening with the nursing staff. Conclusion: the host with risk assessment and classification favors the autonomy of nurses and provide greater accountability to this professional users, but the limitations of available resources to solve the complaint of patients generate physical and psychological burden to this worker.

  20. Associations among emergency room visits, parenting styles, and psychopathology among pediatric patients with sickle cell.

    Science.gov (United States)

    Latzman, Robert D; Shishido, Yuri; Latzman, Natasha E; Elkin, T David; Majumdar, Suvankar

    2014-10-01

    To examine associations between frequency of emergency room (ER) visits and various parenting styles, both conjointly and interactively, and psychopathological outcomes among pediatric patients with sickle cell disease (SCD). Ninety-eight parents/caregivers of 6- to 18-year-old patients with SCD completed instruments assessing parenting style, child psychopathology, and reported on the frequency of ER visits during the previous year. ER visits were found to significantly explain Withdrawn/Depressed problems and parenting styles were found to incrementally contribute to the explanation of all forms of psychopathology. Further, Permissive parenting was found to explain Rule Breaking Behavior for those patients with low ER visit frequency but not for those with high ER visit frequency. Results of the current study confirm the importance of considering both the frequency of ER visits and parenting style in the explanation of psychopathology among pediatric patients with SCD. Results have important implications for both research and treatment. © 2014 Wiley Periodicals, Inc.

  1. Predicting nonrecovery among whiplash patients in the emergency room and in an insurance company setting.

    Science.gov (United States)

    Rydman, Eric; Ponzer, Sari; Ottosson, Carin; Järnbert-Pettersson, Hans

    2017-04-01

    To construct and validate a prediction instrument for early identification of patients with a high risk of delayed recovery after whiplash injuries (PPS-WAD) in an insurance company setting. Prospective cohort study. On the basis of a historic cohort (n = 130) of patients with a whiplash injury identified in an emergency room (ER, model-building set), we used logistic regression to construct an instrument consisting of two demographic variables (i.e. questions of educational level and work status) and the patient-rated physical and mental status during the acute phase to predict self-reported nonrecovery after 6 months. We evaluated the instrument's ability to predict nonrecovery in a new cohort (n = 204) of patients originating from an insurance company setting (IC, validation set). The prediction instrument had low reproducibility when the setting was changed from the ER cohort to the IC cohort. The overall percentage of correct predictions of nonrecovery in the ER cohort was 78 % compared with 62 % in the IC cohort. The sensitivity and specificity in relation to nonrecovery were both 78 % in the ER cohort. The sensitivity and specificity in the insurance company setting was lower, 67 and 50 %. Clinical decision rules need validation before they are used in a new setting. An instrument consisting of four questions with an excellent possibility of identifying patients with a high risk of nonrecovery after a whiplash injury in the emergency room was not as useful in an insurance company setting. The importance and type of the risk factors for not recovering probably differ between the settings, as well as the individuals.

  2. Focused Cardiac Ultrasound Using a Pocket-Size Device in the Emergency Room

    Directory of Open Access Journals (Sweden)

    Frederico José Neves Mancuso

    2014-12-01

    Full Text Available Background: Cardiovascular urgencies are frequent reasons for seeking medical care. Prompt and accurate medical diagnosis is critical to reduce the morbidity and mortality of these conditions. Objective: To evaluate the use of a pocket-size echocardiography in addition to clinical history and physical exam in a tertiary medical emergency care. Methods: One hundred adult patients without known cardiac or lung diseases who sought emergency care with cardiac complaints were included. Patients with ischemic changes in the electrocardiography or fever were excluded. A focused echocardiography with GE Vscan equipment was performed after the initial evaluation in the emergency room. Cardiac chambers dimensions, left and right ventricular systolic function, intracardiac flows with color, pericardium, and aorta were evaluated. Results: The mean age was 61 ± 17 years old. The patient complaint was chest pain in 51 patients, dyspnea in 32 patients, arrhythmia to evaluate the left ventricular function in ten patients, hypotension/dizziness in five patients and edema in one patient. In 28 patients, the focused echocardiography allowed to confirm the initial diagnosis: 19 patients with heart failure, five with acute coronary syndrome, two with pulmonary embolism and two patients with cardiac tamponade. In 17 patients, the echocardiography changed the diagnosis: ten with suspicious of heart failure, two with pulmonary embolism suspicious, two with hypotension without cause, one suspicious of acute coronary syndrome, one of cardiac tamponade and one of aortic dissection. Conclusion: The focused echocardiography with pocket-size equipment in the emergency care may allow a prompt diagnosis and, consequently, an earlier initiation of the therapy.

  3. Emergency Department utilization among Deaf American Sign Language users.

    Science.gov (United States)

    McKee, Michael M; Winters, Paul C; Sen, Ananda; Zazove, Philip; Fiscella, Kevin

    2015-10-01

    Deaf American Sign Language (ASL) users comprise a linguistic minority population with poor health care access due to communication barriers and low health literacy. Potentially, these health care barriers could increase Emergency Department (ED) use. To compare ED use between deaf and non-deaf patients. A retrospective cohort from medical records. The sample was derived from 400 randomly selected charts (200 deaf ASL users and 200 hearing English speakers) from an outpatient primary care health center with a high volume of deaf patients. Abstracted data included patient demographics, insurance, health behavior, and ED use in the past 36 months. Deaf patients were more likely to be never smokers and be insured through Medicaid. In an adjusted analysis, deaf individuals were significantly more likely to use the ED (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.11-3.51) over the prior 36 months. Deaf American Sign Language users appear to be at greater odds for elevated ED utilization when compared to the general hearing population. Efforts to further understand the drivers for increased ED utilization among deaf ASL users are much needed. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. ATTENTION TO THE EMERGENCY ROOM WITH EMPHASIS ON PRE-HOSPITAL CARE: INTEGRATIVE REVIEW

    Directory of Open Access Journals (Sweden)

    B. S. Santos

    2017-08-01

    Full Text Available The study aims to identify the factors, which influence positively and negatively the implementation of public policies geared to the needs in scope of mobile, found in the publications of brazilian researchers since the implementation of the National Policy of Attention to the Emergency room in Brazil. This is a study of Integrative Literature Review. Composing the basis of methodology, have been used official documents to guide the findings that comprised the conceptual bases of the study and to guide the Integrative Review were used publications that report on the issue in question respecting all steps of the protocol review. The results show the changes in the organizational structure of the Service Mobile Emergency, given the regionalization as something positive for the growth of this service modality and discuss prematurely early articulation between the sectors that make up the public health system in Brazil. In conclusion, the policies of attention to the urgencies, in particular within mobile, have favored beneficially all of the users who require this type of care, in the meantime, make the necessary reflections about this theme in the attempt of a better understanding of the regionalization process and coordination among the municipalities that will offer the mobile care so as to ensure continuity of care through the mechanisms of reference and counter-reference

  5. Impact of implementing an exclusively dedicated respiratory isolation room in a Brazilian tertiary emergency department.

    Science.gov (United States)

    Lobo, Rômulo Rebouças; Borges, Marcos Carvalho; Neves, Fábio Fernandes; Vidal de Moura Negrini, Bento; Colleto, Francisco Antonio; Romeo Boullosa, José Luiz; Camila de Miranda Cardoso, Maria; Pazin-Filho, Antonio

    2011-09-01

    Occupational risk due to airborne disease challenges healthcare institutions. Environmental measures are effective but their cost-effectiveness is still debatable and most of the capacity planning is based on occupational rates. Better indices to plan and evaluate capacity are needed. To evaluate the impact of installing an exclusively dedicated respiratory isolation room (EDRIR) in a tertiary emergency department (ED) determined by a time-to-reach-facility method. A group of patients in need of respiratory isolation were first identified--group I (2004; 29 patients; 44.1±3.4 years) and the occupational rate and time intervals (arrival to diagnosis, diagnosis to respiratory isolation indication and indication to effective isolation) were determined and it was estimated that adding an EDRIR would have a significant impact over the time to isolation. After implementing the EDRIR, a second group of patients was gathered in the same period of the year--group II (2007; 50 patients; 43.4±1.8 years) and demographic and functional parameters were recorded to evaluate time to isolation. Cox proportional hazard models adjusted for age, gender and inhospital respiratory isolation room availability were obtained. Implementing an EDRIR decreased the time from arrival to indication of respiratory isolation (27.5±9.3 × 3.7±2.0; p=0.0180) and from indication to effective respiratory isolation (13.3±3.0 × 2.94±1.06; p=0.003) but not the respiratory isolation duration and total hospital stay. The impact on crude isolation rates was very significant (8.9 × 75.4/100.000 patients; p<0.001). The HR for effective respiratory isolation was 26.8 (95% CI 7.42 to 96.9) p<0.001 greater for 2007. Implementing an EDRIR in a tertiary ED significantly reduced the time to respiratory isolation.

  6. Water Utility Planning for an Emergency Drinking Water Supply

    Science.gov (United States)

    Reviews roles and responsibilities among various levels of government regarding emergency water supplies and seeks to encourage collaboration and partnership regarding emergency water supply planning.

  7. Barriers to formal emergency obstetric care services' utilization.

    Science.gov (United States)

    Essendi, Hildah; Mills, Samuel; Fotso, Jean-Christophe

    2011-06-01

    Access to appropriate health care including skilled birth attendance at delivery and timely referrals to emergency obstetric care services can greatly reduce maternal deaths and disabilities, yet women in sub-Saharan Africa continue to face limited access to skilled delivery services. This study relies on qualitative data collected from residents of two slums in Nairobi, Kenya in 2006 to investigate views surrounding barriers to the uptake of formal obstetric services. Data indicate that slum dwellers prefer formal to informal obstetric services. However, their efforts to utilize formal emergency obstetric care services are constrained by various factors including ineffective health decision making at the family level, inadequate transport facilities to formal care facilities and insecurity at night, high cost of health services, and inhospitable formal service providers and poorly equipped health facilities in the slums. As a result, a majority of slum dwellers opt for delivery services offered by traditional birth attendants (TBAs) who lack essential skills and equipment, thereby increasing the risk of death and disability. Based on these findings, we maintain that urban poor women face barriers to access of formal obstetric services at family, community, and health facility levels, and efforts to reduce maternal morbidity and mortality among the urban poor must tackle the barriers, which operate at these different levels to hinder women's access to formal obstetric care services. We recommend continuous community education on symptoms of complications related to pregnancy and timely referral. A focus on training of health personnel on "public relations" could also restore confidence in the health-care system with this populace. Further, we recommend improving the health facilities in the slums, improving the services provided by TBAs through capacity building as well as involving TBAs in referral processes to make access to services timely. Measures can also be

  8. Experience in the review of utility control room design review and safety parameter display system programs

    International Nuclear Information System (INIS)

    Moore, V.A.

    1985-01-01

    The Detailed Control Room Design Review (DCRDR) and the Safety Parameter Display System (SPDS) had their origins in the studies and investigations conducted as the result of the TMI-2 accident. The President's Commission (Kemeny Commission) critized NRC for not examining the man-machine interface, over-emphasizing equipment, ignoring human beings, and tolerating outdated technology in control rooms. The Commission's Special Inquiry Group (Rogovin Report) recommended greater application of human factors engineering including better instrumentation displays and improved control room design. The NRC Lessons Learned Task Force concluded that licensees should review and improve control rooms using NRC Human engineering guidelines, and install safety parameter display systems (then called the safety staff vector). The TMI Action Plan Item I.D.1 and I.D.2 were based on these recommendations

  9. Perception of stroke symptoms and utilization of emergency medical services

    Directory of Open Access Journals (Sweden)

    Maximiliano A. Hawkes

    Full Text Available ABSTRACT Lack of stroke awareness and slow activation of emergency medical services (EMS are frequently reported reasons for delayed arrival to the hospital. We evaluated these variables in our population. Methods Review of hospital records and structured telephone interviews of 100 consecutive stroke patients. Forward stepwise logistic regression was used for the statistical analysis. Results Seventy patients (75% arrived at the hospital 4.5 hours after stroke symptoms onset. The use of EMS did not improve arrival times. Most patients who recognized their symptoms did not use EMS (p < 0.02. Nineteen patients (20% were initially misdiagnosed. Eighteen of them were first assessed by non-neurologist physicians (p < 0.001. Conclusions Our population showed a low level of stroke awareness. The use of EMS did not improve arrival times at the hospital and the non-utilization of the EMS was associated with the recognition of stroke symptoms. There was a concerning rate of misdiagnosis, mostly by non-neurologist medical providers.

  10. Cost-Benefit Analysis of an Otolaryngology Emergency Room Using a Contingent Valuation Approach.

    Science.gov (United States)

    Naunheim, Matthew R; Kozin, Elliot D; Sethi, Rosh K; Ota, H Gregory; Gray, Stacey T; Shrime, Mark G

    2015-10-01

    Dedicated otolaryngology emergency rooms (ERs) provide a unique mechanism of health care delivery. Relative costs and willingness to pay (WTP) for these services have not been studied. This study aims to provide a cost-benefit analysis of otolaryngology-specific ER care. Cost-benefit analysis based on contingent valuation surveys. An otolaryngology-specific ER in a tertiary care academic medical center. Adult English-speaking patients presenting to an otolaryngology ER were included. WTP questions were used to assess patient valuations of specialty emergency care. Sociodemographic data, income, and self-reported levels of distress were assessed. State-level and institution-specific historical cost data were merged with WTP data within a cost-benefit analysis framework. The response rate was 75.6%, and 199 patients were included in the final analysis. Average WTP for otolaryngology ER services was $319 greater than for a general ER (95% CI: $261 to $377), with a median value of $200. The historical mean cost per visit at a general ER was $575, and mean cost at the specialty ER was $551 (95% CI: $529 to $574). Subtracting incremental cost from incremental WTP yielded a net benefit of $343. Dedicated otolaryngology ER services are valued by patients for acute otolaryngologic problems and have a net benefit of $343 per patient visit. They appear to be a cost-beneficial method for addressing acute otolaryngologic conditions. This study has implications for ER-based otolaryngologic care and direct-to-specialist services. © American Academy of Otolaryngology-Head and Neck Surgery Foundation 2015.

  11. Perceived Parental Care and Control among Israeli Female Adolescents Presenting to Emergency Rooms after Self-Poisoning

    Science.gov (United States)

    Diamond, Gary M.; Didner, Hila; Waniel, Ariela; Priel, Beatriz; Asherov, Jack; Arbel, Shosh

    2005-01-01

    Levels of perceived parental care and control among 24 female Israeli adolescents presenting at emergency rooms after a self-poisoning act of low lethality were compared to those found among 23 non-self-harming, community controls. Adolescents' perceived levels of parental care and control were measured via both adolescents' self-report and…

  12. [Temperature that modifies the effect of air pollution on emergency room visits for circulatory and respiratory diseases in Beijing, China].

    Science.gov (United States)

    Wang, L L; Zhang, Q; Bai, R H; Mi, B B; Yan, H

    2017-08-10

    Objective: To analyze the temperature modification effect on emergency room visits for circulatory and respiratory diseases caused by air pollution, in Beijing. Methods: Data on both circulatory and respiratory diseases in 2010 and 2011 were collected, Both meteorological and air pollutants related data were obtained from the National Scientific Data Sharing Platform for Population and Health. By using the stratified time-series models, we analyzed the effects of air pollution on emergency room visits for circulatory and respiratory diseases under different temperature zones, from 2010 to 2011, in Beijing. Results: Low temperature (daily average temperatureeffect of air pollution index (API) on emergency room visits for circulatory diseases, Under 10 units of API, the relative risks and confidence interval appeared as 1.067 (1.054-1.080). However, high (daily average temperature between 24.4 ℃ and 28.5 ℃) and extra-high temperature (daily average temperature >28.5 ℃) could enhance the effect of API on emergency room visits for respiratory diseases, Under 10 units of API, the relative risks and confidence interval were 1.021 (1.015-1.028) and 1.006 (1.003-1.008), respectively. Conclusion: Temperature seemed to have modified the association between air pollution and both circulatory and respiratory diseases.

  13. Listening to "How the Patient Presents Herself": A Case Study of a Doctor-Patient Interaction in an Emergency Room

    Science.gov (United States)

    Delbene, Roxana

    2015-01-01

    This is a case-study based on a micro-ethnography analyzing a doctor-patient interaction in an emergency room (ER) in New York City. Drawing on the framework of narrative medicine (Charon, 2006), the study examines how a phenomenological approach to listening to the patient facilitated the patient's narrative orientation not only to relevant…

  14. Perception and Attitude of Emergency Room Resident Physicians toward Middle East Respiratory Syndrome Outbreak

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    Mohammed Al Ghobain

    2017-01-01

    Full Text Available Introduction. Middle East respiratory syndrome (MERS outbreaks have had a considerable negative impact on health systems in Saudi Arabia. We aimed to study the psychological impact of a Middle East respiratory syndrome coronavirus (MERS-CoV outbreak on emergency room resident physicians (ERRPs. Methods. We assessed the MERS-related psychological impact and concerns of ERRPs using a self-report questionnaire. Results. The majority (91% of the ERRPs agreed that their work put them at risk of infection, but most (65% did not agree that they should not be looking after patients infected with MERS. Despite that, 54% of ERRPs reported being afraid of contracting the infection from infected patients and only 4.2% of them were willing to change their current job. The majority of the ERRPs (85% felt that their job would expose their families to risk of infection. Conclusions. Our study demonstrated the considerable psychological impact of MERS outbreaks on ERRPs. The ERRPs’ concerns and the psychological impact of MERS outbreaks should be considered in greater detail by hospital policymakers.

  15. Degree of agreement among sepsis diagnosis criteria in adult emergency room patients with infection

    Science.gov (United States)

    Sinto, R.; Chandra, A. T.; Lie, K. C.; Suwarto, S.

    2018-03-01

    The study on the degree of agreement among three established sepsis diagnosis criteria become the necessity to investigate the best sepsis diagnosis criteria in Indonesia further. A cross-sectional study of adult Emergency Room patients hospitalized with a diagnosis of infection in CiptoMangunkusumo Hospital, Indonesia was conducted during March and April 2017. We recorded diagnosis, gender, age, comorbidities, infection source, and origin. Every subject was classified into sepsis and non-sepsis based on 1991, 2001 and sepsis-3 criteria. Raw % and Kappa agreement coefficients (κ) were calculated according to previously established formula to measure the degree of agreement among three diagnostic criteria. As many as 278 subjects were included in this study. The raw % agreement and κ between 1991 and 2001 criteria is 69.07% and 0.34 respectively. The raw % agreement and κ between 2001 and sepsis-3 criteria is 56.12% and 0.15 respectively. The raw % agreement and κ between 1991 and sepsis-3 criteria is 48.19% and -0.02. In conclusions, there is afair agreement between 1991 and 2001 criteria, poor agreement between 2001 and sepsis-3 criteria, and poor disagreement between 1991 and sepsis-3 criteria. This necessitates further Indonesian study of the best diagnosis criteria to diagnose an infected patient with sepsis.

  16. Metabolites in Blood for Prediction of Bacteremic Sepsis in the Emergency Room.

    Directory of Open Access Journals (Sweden)

    Anna M Kauppi

    Full Text Available A metabolomics approach for prediction of bacteremic sepsis in patients in the emergency room (ER was investigated. In a prospective study, whole blood samples from 65 patients with bacteremic sepsis and 49 ER controls were compared. The blood samples were analyzed using gas chromatography coupled to time-of-flight mass spectrometry. Multivariate and logistic regression modeling using metabolites identified by chromatography or using conventional laboratory parameters and clinical scores of infection were employed. A predictive model of bacteremic sepsis with 107 metabolites was developed and validated. The number of metabolites was reduced stepwise until identifying a set of 6 predictive metabolites. A 6-metabolite predictive logistic regression model showed a sensitivity of 0.91(95% CI 0.69-0.99 and a specificity 0.84 (95% CI 0.58-0.94 with an AUC of 0.93 (95% CI 0.89-1.01. Myristic acid was the single most predictive metabolite, with a sensitivity of 1.00 (95% CI 0.85-1.00 and specificity of 0.95 (95% CI 0.74-0.99, and performed better than various combinations of conventional laboratory and clinical parameters. We found that a metabolomics approach for analysis of acute blood samples was useful for identification of patients with bacteremic sepsis. Metabolomics should be further evaluated as a new tool for infection diagnostics.

  17. Value of contrast enhanced CT scanning in the non-trauma emergency room patient

    International Nuclear Information System (INIS)

    Wood, L.P.; Parisi, M.; Finch, I.J.

    1990-01-01

    To determine the value of performing contrast CT in addition to non-contrast CT in the evaluation of acute non-traumatic central nervous system disorders, we retrospectively reviewed 322 cases originating from the emergency room at our institution. The most common indication for scanning was seizure activity (34% of total), followed by headache (30%), focal neurological deficit (10%), and altered mental status (8%). 75% of the noncontrast scans were normal. The contrast enhanced scan revealed abnormalities not evident on the non-contrast scan in only three of these cases, and the information did not alter patient management. We conclude that in the acute setting, if a non-contrast CT is normal, a contrast study is usually unnecessary. Therefore, given the additional risks of contrast infusion, the contrast study, if needed, is generally best obtained at a later date, after more careful evaluation of the patient's history and medical records. If the non-contrast CT scan is abnormal, a contrast enhanced CT scan may be beneficial, but, again, is often not needed to direct acute patient management. (orig.)

  18. Use of the emergency room in Elliot Lake, a rural community of Northern Ontario, Canada.

    Science.gov (United States)

    Harris, L; Bombin, M; Chi, F; DeBortoli, T; Long, J

    2004-01-01

    There is ample documentation that use of hospital emergency facilities for reasons other than urgencies/emergencies results in clogged services in many urban centers. However, little has been published about similar misuse of emergency rooms/departments in rural and remote areas, where the situation is usually compounded by a scarcity of healthcare professionals. In Canada there is a shortage of physicians in rural and remote areas as a consequence of misdistribution (most physicians staying in southern urban centers after residence), and there is a chronic misuse of facilities meant for urgencies/emergencies to cope with primary healthcare needs. We address the problem in Elliot Lake, a rural Northern Ontario community of 12,000 people. The economy of Elliot Lake was based on uranium mining until the mid-1990s, when it drastically changed to become a center for affordable retirement and recreational tourism. As a consequence, at the present time the proportion of seniors in Elliot Lake doubles the Canadian average. Our objectives are to elucidate the demographics of emergency room (ER) clients and the effect of the elderly population; the nature of ER use; the perceived level of urgency of clients versus health professionals; and possible alternatives offered to non-urgent/emergency visits. This is the first study of the kind in Northern Ontario, a region the size of France. The study, conducted in July 2001, used a prospective survey, completed by patients and attending clinicians at the time of a patient's presentation to the ER of St Joseph's General Hospital. This hospital is staffed by family physicians, a nurse practitioner, and registered nurses (RNs). The catchment area population (town plus surrounding areas) of the hospital is approximately 18,000 people. ER clients were interviewed verbally, and the attending health professionals responded to written questionnaires. Demographics were recorded (age, sex, employment and marital status), as was each client

  19. Patient satisfaction, preventive services, and emergency room use among African-Americans with type 2 diabetes.

    Science.gov (United States)

    Gary, Tiffany L; Maiese, Eric M; Batts-Turner, Marian; Wang, Nae-Yuh; Brancati, Fredrick L

    2005-12-01

    The aim of this study was to determine the relationship between patient satisfaction and diabetes- related preventive health care and emergency room (ER) use. We studied 542 urban African-Americans with type 2 diabetes aged > or =25 years who were enrolled in a primary carebased intervention trial to improve diabetes control and reduce adverse health events; 73% female, mean age 58 years, 35% had yearly household incomes of Consumer Assessment of Health Plans Survey (CAHPS) and use of diabetes-related preventive health care and ER were assessed by self-report. We then followed participants for 12 months to determine ER use prospectively. In general, participants gave favorable ratings of their care; over 70% reported that they had no problem getting care, over 60% reported the highest ratings on the communication and courtesy domains, and mean ratings (0-10 scale) for personal doctor and overall health care were high (8.8 and 8.4, respectively). Using poisson regression models adjusted for age, education, and self-reported rating of health, several aspects of patient satisfaction were associated with subsequent ER use. Participants who reported that medical staff were usually helpful or that doctors and nurses usually spent enough time were 0.49 and 0.37 times, respectively, less likely to use the ER (all p < 0.05). However, few aspects of patient satisfaction were associated with better preventive services. These data suggest that greater patient satisfaction was associated with lower ER use in urban African-Americans. Whether measures to improve patient satisfaction would reduce ER use requires further prospective study.

  20. Surgical exploration of hand wounds in the emergency room: Preliminary study of 80 personal injury claims.

    Science.gov (United States)

    Mouton, J; Houdre, H; Beccari, R; Tarissi, N; Autran, M; Auquit-Auckbur, I

    2016-12-01

    The SHAM Insurance Company in Lyon, France, estimated that inadequate hand wound exploration in the emergency room (ER) accounted for 10% of all ER-related personal injury claims in 2013. The objective of this study was to conduct a critical analysis of 80 claims that were related to hand wound management in the ER and led to compensation by SHAM. Eighty claims filed between 2007 and 2010 were anonymised then included into the study. To be eligible, claims had to be filed with SHAM, related to the ER management of a hand wound in an adult, and closed at the time of the study. Claims related to surgery were excluded. For each claim, we recorded 104 items (e.g., epidemiology, treatments offered, and impact on social and occupational activities) and analysed. Of the 70 patients, 60% were manual workers. The advice of a surgeon was sought in 16% of cases. The most common wound sites were the thumb (33%) and index finger (17%). Among the missed lesions, most involved tendons (74%) or nerves (29%). Many patients had more than one reason for filing a claim. The main reasons were inadequate wound exploration (97%), stiffness (49%), and dysaesthesia (41%). One third of patients were unable to return to their previous job. Mean sick-leave duration was 148 days and mean time from discharge to best outcome was 4.19%. Most claims (79%) were settled directly with the insurance company, 16% after involvement of a public mediator, and 12% in court. The mean compensatory damages award was 4595Euros. Inadequate surgical exploration of hand wounds is common in the ER, carries a risk of lasting and sometimes severe residual impairment, and generates considerable societal costs. IV. Copyright © 2016. Published by Elsevier Masson SAS.

  1. Comparative study on cases of vertigo and dizziness in the emergency room and otorhinolaryngological clinic

    International Nuclear Information System (INIS)

    Tsujimoto, Toshiya; Kawashima, Kayoko; Hashimoto, Seiko; Imai, Takao

    2011-01-01

    We recently studied the characteristics of vertigo and dizziness in 197 patients who first visited the emergency room (ER group) and in 288 patients who first visited the otorhinolaryngological clinic of Minoh City Hospital (ENT group) between January 1 and December 31 of 2009. The ER group can be regarded as representing the hyperacute phase and the ENT group as representing the acute to chronic phase. These two groups were completely distinct. We also subdivided these groups into the high risk subgroup (H subgroup) for cases with the underlying diseases of diabetes mellitus, hypertension, cerebrovascular disease and hyperlipidemia, and the normal subgroup (N subgroup).Comparison of the two groups showed that, in the ER group, a significantly larger numbers of patients had symptoms of peripheral vestibular origin except for benign paroxysmal positional vertigo (BPPV) and Meniere's disease, and a significantly larger number of patients had symptoms of unknown origin in the ENT group. Half of this group may be accounted for by patients with symptoms of peripheral vestibular origin except for BPPV and Meniere's disease in the ER group. In 8 out of 158 patients of the ER group and 1 out of 122 patients of the ENT group, cerebral lesions were not found on CT images but were found with MRI. Careful investigation is necessary in the patients with normal CT findings. Central vestibular lesions were found in 7 out of 197 patients (3.5%) of the ER group and 5 out of 288 patients (1.7%) of the ENT group. The incidence of central lesions tended to be higher in the ER group than in the ENT group. There was no significant difference in the incidence of central lesion among the H and N subgroups of both groups. Careful investigation of the central vestibular lesion is also necessary in the N subgroup. (author)

  2. Youth versus adult "weightlifting" injuries presenting to United States emergency rooms: accidental versus nonaccidental injury mechanisms.

    Science.gov (United States)

    Myer, Gregory D; Quatman, Carmen E; Khoury, Jane; Wall, Eric J; Hewett, Timothy E

    2009-10-01

    Resistance training has previously been purported to be unsafe and ineffective in children. The purpose of this investigation was to evaluate resistance training-related injuries presenting to U.S. emergency rooms by age, type, and mechanism of injury. We hypothesized that older athletes would sustain greater percentages of joint sprains and muscle strains, whereas younger athletes would sustain a greater percentage of accidental injuries that would result in an increased percentage of fractures in youths. The U.S. Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System was queried from 2002 to 2005 using the CPSC code for "Weightlifting." Subjects between the ages of 8 and 30 were grouped by age categories 8 to 13 (elementary/middle school age), 14 to 18 (high school), 19 to 22 (college), and 23 to 30 (adult). Injuries were classified as "accidental" if caused by dropped weight or improper equipment use. Multiple logistic regression was used to compare accidental injuries between age groups. The sample consisted of 4,111 patients. Accidental injuries decreased (p 14 to 18 > 19 to 22 years = 23 to 30 years. Conversely, sprain/strain injuries increased in each successive age group (p injuries (n = 2,565) showed that the oldest categories (19-22 and 23-30 yr) demonstrated a greater percentage of sprains and strains relative to younger age categories (p injuries sustained in the 8 to 13 group were to the hand and foot and were most often related to "dropping" and "pinching" in the injury descriptions, and there was an increased percentage of fractures in the 8 to 13 group relative to all other groups (p injuries are the result of accidents that are potentially preventable with increased supervision and stricter safety guidelines.

  3. Ambient temperature and emergency room admissions for acute coronary syndrome in Taiwan

    Science.gov (United States)

    Liang, Wen-Miin; Liu, Wen-Pin; Chou, Sze-Yuan; Kuo, Hsien-Wen

    2008-01-01

    Acute coronary syndrome (ACS) is an important public health problem around the world. Since there is a considerable seasonal fluctuation in the incidence of ACS, climatic temperature may have an impact on the onset of this disease. The objective of this study was to assess the relationship between the average daily temperature, diurnal temperature range and emergency room (ER) admissions for ACS in an ER in Taichung City, Taiwan. A longitudinal study was conducted which assessed the correlation of the average daily temperature and the diurnal temperature range to ACS admissions to the ER of the city’s largest hospital. Daily ER admissions for ACS and ambient temperature were collected from 1 January 2000 to 31 March 2003. The Poisson regression model was used in the analysis after adjusting for the effects of holiday, season, and air pollutant concentrations. The results showed that there was a negative significant association between the average daily temperature and ER admissions for ACS. ACS admissions to the ER increased 30% to 70% when the average daily temperature was lower than 26.2°C. A positive association between the diurnal temperature range and ACS admissions was also noted. ACS admissions increased 15% when the diurnal temperature range was over 8.3°C. The data indicate that patients suffering from cardiovascular disease must be made aware of the increased risk posed by lower temperatures and larger changes in temperature. Hospitals and ERs should take into account the increased demand of specific facilities during colder weather and wider temperature variations.

  4. Identifying Patients with Bacteremia in Community-Hospital Emergency Rooms: A Retrospective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Taro Takeshima

    Full Text Available (1 To develop a clinical prediction rule to identify patients with bacteremia, using only information that is readily available in the emergency room (ER of community hospitals, and (2 to test the validity of that rule with a separate, independent set of data.Multicenter retrospective cohort study.To derive the clinical prediction rule we used data from 3 community hospitals in Japan (derivation. We tested the rule using data from one other community hospital (validation, which was not among the three "derivation" hospitals.Adults (age ≥ 16 years old who had undergone blood-culture testing while in the ER between April 2011 and March 2012. For the derivation data, n = 1515 (randomly sampled from 7026 patients, and for the validation data n = 467 (from 823 patients.We analyzed 28 candidate predictors of bacteremia, including demographic data, signs and symptoms, comorbid conditions, and basic laboratory data. Chi-square tests and multiple logistic regression were used to derive an integer risk score (the "ID-BactER" score. Sensitivity, specificity, likelihood ratios, and the area under the receiver operating characteristic curve (i.e., the AUC were computed.There were 241 cases of bacteremia in the derivation data. Eleven candidate predictors were used in the ID-BactER score: age, chills, vomiting, mental status, temperature, systolic blood pressure, abdominal sign, white blood-cell count, platelets, blood urea nitrogen, and C-reactive protein. The AUCs was 0.80 (derivation and 0.74 (validation. For ID-BactER scores ≥ 2, the sensitivities for derivation and validation data were 98% and 97%, and specificities were 20% and 14%, respectively.The ID-BactER score can be computed from information that is readily available in the ERs of community hospitals. Future studies should focus on developing a score with a higher specificity while maintaining the desired sensitivity.

  5. [Índice de Saturación Modificado y Ambulancias (ISMA): Ambulance assignment and remote Emergency Room Bed Reservation].

    Science.gov (United States)

    Polanco-González, Carlos; Castañón-González, Jorge Alberto; Villanueva-Martínez, Sebastián; Samaniego-Mendoza, José Lino; Buhse, Thomas

    2015-01-01

    In most places all over the world–including our country–services in emergency rooms are oversaturated. This situation frequently forces the continuously arriving ambulances to be redirected to other medical units, delaying the admission of patients moved and thus adversely affecting their physical condition. To introduce an improvement to the Índicede Saturación Modificado computational system, which monitors the degree of saturation of a network of emergency medical services, to include a network of ambulances, enabling in the system: (i) the effective allocation of ambulances to the site of the accident, or severe clinical event, and (ii) the remote booking of beds in the nearest and least saturated emergency room available. The evaluation and connectivity of the computational improvement to the Índicede Saturación Modificado system was carried out with a computational test verifying these two aspects, using only differences in postal codes, for time measuring. The verification of its sustainability online showed the new Índice de Saturación Modificado y Ambulancias system (ISMA) has a robust structure capable of being adapted to mobile phones, laptops or tablets, and can efficiently administrate: (i) the quantification of excessive demand in the emergency room services of a hospital network, (ii) the allocation of ambulances attending the site of the event or contingency, and (iii) the allocation of ambulances and patients, in the best distance-time conditions, from the site of the accident or clinical event to the nearest and least saturated emergency room service. This administrative management tool is efficient and simple to use, and it optimally relates independent service networks.

  6. Focused Cardiac Ultrasound Using a Pocket-Size Device in the Emergency Room.

    Science.gov (United States)

    Mancuso, Frederico José Neves; Siqueira, Vicente Nicoliello; Moisés, Valdir Ambrósio; Gois, Aécio Flavio Teixeira; Paola, Angelo Amato Vincenzo de; Carvalho, Antonio Carlos Camargo; Campos, Orlando

    2014-10-28

    Background: Cardiovascular urgencies are frequent reasons for seeking medical care. Prompt and accurate medical diagnosis is critical to reduce the morbidity and mortality of these conditions. Objective: To evaluate the use of a pocket-size echocardiography in addition to clinical history and physical exam in a tertiary medical emergency care. Methods: One hundred adult patients without known cardiac or lung diseases who sought emergency care with cardiac complaints were included. Patients with ischemic changes in the electrocardiography or fever were excluded. A focused echocardiography with GE Vscan equipment was performed after the initial evaluation in the emergency room. Cardiac chambers dimensions, left and right ventricular systolic function, intracardiac flows with color, pericardium, and aorta were evaluated. Results: The mean age was 61 ± 17 years old. The patient complaint was chest pain in 51 patients, dyspnea in 32 patients, arrhythmia to evaluate the left ventricular function in ten patients, hypotension/dizziness in five patients and edema in one patient. In 28 patients, the focused echocardiography allowed to confirm the initial diagnosis: 19 patients with heart failure, five with acute coronary syndrome, two with pulmonary embolism and two patients with cardiac tamponade. In 17 patients, the echocardiography changed the diagnosis: ten with suspicious of heart failure, two with pulmonary embolism suspicious, two with hypotension without cause, one suspicious of acute coronary syndrome, one of cardiac tamponade and one of aortic dissection. Conclusion: The focused echocardiography with pocket-size equipment in the emergency care may allow a prompt diagnosis and, consequently, an earlier initiation of the therapy.Fundamento: As urgências cardiovasculares são causas importantes de procura por atendimento médico, sendo fundamentais a rapidez e a precisão no diagnóstico para diminuir sua morbimortalidade. Objetivo: Avaliar o uso da ecocardiografia

  7. [Neonatological emergencies in delivery room] [Article in Italian] • Il neonatologo ed alcune emergenze in sala parto

    OpenAIRE

    Antonio Boldrini; Rosa Teresa Scaramuzzo

    2014-01-01

    Introduction: In the delivery room the neonatologist may deal with emergencies, not always predictable by pre-natal diagnosis. Among these dangerous situations, we include: i) extremely preterm birth of a newborn very/extremely low birth weight and ii) shoulder dystocia in term newborns. We will discuss in details these two clinical scenarios. Methods: We reviewed the main recent papers about resuscitation of very/extremely low birth weight preterm newborns and about dystocia of shoulder repo...

  8. The emergency room at the Rotunda Hospital: evidence of an improving service over the past 3 years.

    LENUS (Irish Health Repository)

    Talukdar, S

    2014-12-01

    This is a retrospective review of the Rotunda Hospital Emergency Room (ER) documentation with respect to attendances for a 4-month period (August-November) in both 2009 and 2012. The aim was to quantify the workload and assess the quality of care offered to patients attending the ER over the two time periods and to highlight any improvements in care after changes were implemented following the initial 2009 review.

  9. Timeliness of Operating Room Case Planning and Time Utilization: Influence of First and To-Follow Cases

    Directory of Open Access Journals (Sweden)

    Konrad Meissner

    2017-04-01

    Full Text Available Resource and cost constraints in hospitals demand thorough planning of operating room schedules. Ideally, exact start times and durations are known in advance for each case. However, aside from the first case’s start, most factors are hard to predict. While the role of the start of the first case for optimal room utilization has been shown before, data for to-follow cases are lacking. The present study therefore aimed to analyze all elective surgery cases of a university hospital within 1 year in search of visible patterns. A total of 14,014 cases scheduled on 254 regular working days at a university hospital between September 2015 and August 2016 underwent screening. After eliminating 112 emergencies during regular working hours, 13,547 elective daytime cases were analyzed, out of which 4,346 ranked first, 3,723 second, and 5,478 third or higher in the daily schedule. Also, 36% of cases changed start times from the day before to 7:00 a.m., with half of these (52% resulting in a delay of more than 15 min. After 7:00 a.m., 87% of cases started more than 10 min off schedule, with 26% being early and 74% late. Timeliness was 15 ± 72 min (mean ± SD for first, 21 ± 84 min for second, and 25 ± 93 min for all to-follow cases, compared to preoperative day planning, and 21 ± 45, 23 ± 61, and 19 ± 74 min compared to 7:00 a.m. status. Start time deviations were also related to procedure duration, with cases of 61–90 min duration being most reliable (deviation 9.8 ± 67 min compared to 7:00 a.m., regardless of order. In consequence, cases following after 61–90 min long cases had the shortest deviations of incision time from schedule (16 ± 66 min. Taken together, start times for elective surgery cases deviate substantially from schedule, with first and second cases falling into the highest mean deviation category. Second cases had the largest deviations from scheduled times compared to

  10. Antimicrobial Non-Susceptibility of Escherichia coli from Outpatients and Patients Visiting Emergency Rooms in Taiwan.

    Directory of Open Access Journals (Sweden)

    Jann-Tay Wang

    Full Text Available Longitudinal nationwide surveillance data on antimicrobial non-susceptibility and prevalence of extended-spectrum β-lactamases (ESBLs as well as AmpC β-lactamases producers among Escherichia coli from different sources in the community settings are limited. Such data may impact treatment practice. The present study investigated E. coli from outpatients and patients visiting emergency rooms collected by the Taiwan Surveillance of Antimicrobial Resistance (TSAR program. A total of 3481 E. coli isolates were studied, including 2153 (61.9% from urine and 1125 (32.3% from blood samples. These isolates were collected biennially between 2002 and 2012 from a total of 28 hospitals located in different geographic regions of Taiwan. Minimum inhibitory concentrations (MIC were determined using methods recommended by the Clinical Laboratory Standards Institute (CLSI. The prevalence and factors associated with the presence of ESBL and AmpC β-lactamase-producers were determined. Significant increases in non-susceptibility to most β-lactams and ciprofloxacin occurred during the study period. By 2012, non-susceptibility to cefotaxime and ciprofloxacin reached 21.1% and 26.9%, respectively. The prevalence of ESBL- and AmpC- producers also increased from 4.0% and 5.3%, respectively, in 2002-2004, to 10.7% for both in 2010-2012 (P < 0.001. The predominant ESBL and AmpC β-lactamase genes were CTX-M and CMY-types, respectively. Non-susceptibility of urine isolates to nitrofurantoin remained at around 8% and to fosfomycin was low (0.7% but to cefazolin (based on the 2014 CLSI urine criteria increased from 11.5% in 2002-2004 to 23.9% in 2010-2012 (P <0.001. Non-susceptibility of isolates from different specimen types was generally similar, but isolates from elderly patients were significantly more resistant to most antimicrobial agents and associated with the presence of ESBL- and AmpC- β-lactamases. An additional concern is that decreased ciprofloxacin

  11. Air pollution, aeroallergens and admissions to pediatric emergency room for respiratory reasons in Turin, northwestern Italy

    Directory of Open Access Journals (Sweden)

    Roberto Bono

    2016-08-01

    Full Text Available Abstract Background Air pollution can cause respiratory symptoms or exacerbate pre-existing respiratory diseases, especially in children. This study looked at the short-term association of air pollution concentrations with Emergency Room (ER admissions for respiratory reasons in pediatric age (0–18 years. Methods Daily number of ER admissions in a children’s Hospital, concentrations of urban-background PM2.5, NO2, O3 and total aeroallergens (Corylaceae, Cupressaceae, Gramineae, Urticaceae, Ambrosia, Betula were collected in Turin, northwestern Italy, for the period 1/08/2008 to 31/12/2010 (883 days. The associations between exposures and ER admissions were estimated, at time lags between 0 and 5 days, using generalized linear Poisson regression models, adjusted for non-meteorological potential confounders. Results In the study period, 21,793 ER admissions were observed, mainly (81 % for upper respiratory tract infections. Median air pollution concentrations were 22.0, 42.5, 34.1 μg/m3 for urban-background PM2.5, NO2, and O3, respectively, and 2.9 grains/m3 for aeroallergens. We found that ER admissions increased by 1.3 % (95 % CI: 0.3-2.2 % five days after a 10 μg/m3 increase in NO2, and by 0.7 % (95 % CI: 0.1-1.2 % one day after a 10 grains/m3 increase in aeroallergens, while they were not associated with PM2.5 concentrations. ER admissions were negatively associated with O3 and aeroallergen concentrations at some time lags, but these association shifted to the null when meteorological confounders were adjusted for in the models. Conclusions Overall, these findings confirm adverse short-term health effects of air pollution on the risk of ER admission in children and encourage a careful management of the urban environment to health protection.

  12. Flooding and emergency room visits for gastrointestinal illness in Massachusetts: a case-crossover study.

    Directory of Open Access Journals (Sweden)

    Timothy J Wade

    Full Text Available INTRODUCTION: Floods and other severe weather events are anticipated to increase as a result of global climate change. Floods can lead to outbreaks of gastroenteritis and other infectious diseases due to disruption of sewage and water infrastructure and impacts on sanitation and hygiene. Floods have also been indirectly associated with outbreaks through population displacement and crowding. METHODS: We conducted a case-crossover study to investigate the association between flooding and emergency room visits for gastrointestinal illness (ER-GI in Massachusetts for the years 2003 through 2007. We obtained ER-GI visits from the State of Massachusetts and records of floods from the National Oceanic and Atmospheric Association's Storm Events Database. ER-GI visits were considered exposed if a flood occurred in the town of residence within three hazard periods of the visit: 0-4 days; 5-9 days; and 10-14 days. A time-stratified bi-directional design was used for control selection, matching on day of the week with two weeks lead or lag time from the ER-GI visit. Fixed effect logistic regression models were used to estimate the risk of ER-GI visits following the flood. RESULTS AND CONCLUSIONS: A total of 270,457 ER-GI visits and 129 floods occurred in Massachusetts over the study period. Across all counties, flooding was associated with an increased risk for ER-GI in the 0-4 day period after flooding (Odds Ratio: 1.08; 95% Confidence Interval: 1.03-1.12; but not the 5-9 days (Odds Ratio: 0.995; 95% Confidence Interval: 0.955-1.04 or the 10-14 days after (Odds Ratio: 0.966, 95% Confidence Interval: 0.927-1.01. Similar results were observed for different definitions of ER-GI. The effect differed across counties, suggesting local differences in the risk and impact of flooding. Statewide, across the study period, an estimated 7% of ER-GI visits in the 0-4 days after a flood event were attributable to flooding.

  13. Poor Compliance with Sepsis Guidelines in a Tertiary Care Children’s Hospital Emergency Room

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    Benjamin Louis Moresco

    2018-04-01

    Full Text Available ObjectivesThis study aimed to assess factors related to adherence to the Pediatric Advanced Life Support guidelines for severe sepsis and septic shock in an emergency room (ER of a tertiary care children’s hospital.MethodsThis was a retrospective, observational study of children (0–18 years old in The Children’s Hospital of San Antonio ER over 1 year with the International Consensus Definition Codes, version-9 (ICD-9 diagnostic codes for “severe sepsis” and “shocks.” Patients in the adherent group were those who met all three elements of adherence: (1 rapid vascular access with at most one IV attempt before seeking alternate access (unless already in place, (2 fluids administered within 15 min from sepsis recognition, and (3 antibiotic administration started within 1 h of sepsis recognition. Comparisons between groups with and without sepsis guideline adherence were performed using Student’s t-test (the measurements expressed as median values. The proportions were compared using chi-square test. p-Value ≤0.05 was considered significant.ResultsA total of 43 patients who visited the ER from July 2014 to July 2015 had clinically proven severe sepsis or SS ICD-9 codes. The median age was 5 years. The median triage time, times from triage to vascular access, fluid administration and antibiotic administration were 26, 48.5, 76, and 135 min, respectively. Adherence to vascular access, fluid, and antibiotic administration guidelines was 21, 26, and 34%, respectively. Appropriate fluid bolus (20 ml/kg over 15–20 min was only seen in 6% of patients in the non-adherent group versus 38% in the adherent group (p = 0.01. All of the patients in the non-adherent group used an infusion pump for fluid resuscitation. Hypotension and ≥3 organ dysfunction were more commonly observed in patients in adherent group as compared to patients in non-adherent group (38 vs. 14% p = 0.24; 63 vs. 23% p = 0.03.Conclusion

  14. A medical cost estimation with fuzzy neural network of acute hepatitis patients in emergency room.

    Science.gov (United States)

    Kuo, R J; Cheng, W C; Lien, W C; Yang, T J

    2015-10-01

    Taiwan is an area where chronic hepatitis is endemic. Liver cancer is so common that it has been ranked first among cancer mortality rates since the early 1980s in Taiwan. Besides, liver cirrhosis and chronic liver diseases are the sixth or seventh in the causes of death. Therefore, as shown by the active research on hepatitis, it is not only a health threat, but also a huge medical cost for the government. The estimated total number of hepatitis B carriers in the general population aged more than 20 years old is 3,067,307. Thus, a case record review was conducted from all patients with diagnosis of acute hepatitis admitted to the Emergency Department (ED) of a well-known teaching-oriented hospital in Taipei. The cost of medical resource utilization is defined as the total medical fee. In this study, a fuzzy neural network is employed to develop the cost forecasting model. A total of 110 patients met the inclusion criteria. The computational results indicate that the FNN model can provide more accurate forecasts than the support vector regression (SVR) or artificial neural network (ANN). In addition, unlike SVR and ANN, FNN can also provide fuzzy IF-THEN rules for interpretation. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  15. A spatial analysis of heat stress related emergency room visits in rural Southern Ontario during heat waves.

    Science.gov (United States)

    Bishop-Williams, Katherine E; Berke, Olaf; Pearl, David L; Kelton, David F

    2015-08-06

    In Southern Ontario, climate change may have given rise to an increasing occurrence of heat waves since the year 2000, which can cause heat stress to the general public, and potentially have detrimental health consequences. Heat waves are defined as three consecutive days with temperatures of 32 °C and above. Heat stress is the level of discomfort. A variety of heat stress indices have been proposed to measure heat stress (e.g., the heat stress index (HSI)), and has been shown to predict increases in morbidity and/or mortality rates in humans and other species. Maps visualizing the distribution of heat stress can provide information about related health risks and insight for control strategies. Information to inform heat wave preparedness models in Ontario was previously only available for major metropolitan areas. Hospitals in communities of fewer than 100,000 individuals were recruited for a pilot study by telephone. The number of people visiting the emergency room or 24-hour urgent care service was collected for a total of 27 days, covering three heat waves and six 3-day control periods from 2010-2012. The heat stress index was spatially predicted using data from 37 weather stations across Southern Ontario by geostatistical kriging. Poisson regression modeling was applied to determine the rate of increased number of emergency room visits in rural hospitals with respect to the HSI. During a heat wave, the average rate of emergency room visits was 1.11 times higher than during a control period (IRR = 1.11, CI95% (IRR) = (1.07,1.15), p ≤ 0.001). In a univariable model, HSI was not a significant predictor of emergency room visits, but when accounting for the confounding effect of a spatial trend polynomial in the hospital location coordinates, a one unit increase in HSI predicted an increase in daily emergency rooms visits by 0.4% (IRR = 1.004, CI95%(IRR) = (1.0005,1.007), p = 0.024) across the region. One high-risk cluster and no low risk

  16. College Student Utilization of a Comprehensive Psychiatric Emergency Program

    Science.gov (United States)

    Mitchell, Sharon L.; Kader, Mahrin; Haggerty, Melinda Z.; Bakhai, Yogesh D.; Warren, Calvert G.

    2013-01-01

    The authors sought to identify college students at risk for experiencing a mental health crisis that warranted a psychiatric evaluation at a hospital and/or a psychiatric hospitalization. A retrospective chart review of college students evaluated at a comprehensive psychiatric emergency program during a 1-year period was conducted. Demographic…

  17. A System-Wide Approach to Physician Efficiency and Utilization Rates for Non-Operating Room Anesthesia Sites.

    Science.gov (United States)

    Tsai, Mitchell H; Huynh, Tinh T; Breidenstein, Max W; O'Donnell, Stephen E; Ehrenfeld, Jesse M; Urman, Richard D

    2017-07-01

    There has been little in the development or application of operating room (OR) management metrics to non-operating room anesthesia (NORA) sites. This is in contrast to the well-developed management framework for the OR management. We hypothesized that by adopting the concept of physician efficiency, we could determine the applicability of this clinical productivity benchmark for physicians providing services for NORA cases at a tertiary care center. We conducted a retrospective data analysis of NORA sites at an academic, rural hospital, including both adult and pediatric patients. Using the time stamps from WiseOR® (Palo Alto, CA), we calculated site utilization and physician efficiency for each day. We defined scheduling efficiency (SE) as the number of staffed anesthesiologists divided by the number of staffed sites and stratified the data into three categories (SE 1). The mean physician efficiency was 0.293 (95% CI, [0.281, 0.305]), and the mean site utilization was 0.328 (95% CI, [0.314, 0.343]). When days were stratified by scheduling efficiency (SE 1), we found differences between physician efficiency and site utilization. On days where scheduling efficiency was less than 1, that is, there are more sites than physicians, mean physician efficiency (95% CI, [0.326, 0.402]) was higher than mean site utilization (95% CI, [0.250, 0.296]). We demonstrate that scheduling efficiency vis-à-vis physician efficiency as an OR management metric diverge when anesthesiologists travel between NORA sites. When the opportunity to scale operational efficiencies is limited, increasing scheduling efficiency by incorporating different NORA sites into a "block" allocation on any given day may be the only suitable tactical alternative.

  18. Seismic simulation and functional performance evaluation of a safety related, seismic category I control room emergency air cleaning system

    International Nuclear Information System (INIS)

    Manley, D.K.; Porco, R.D.; Choi, S.H.

    1985-01-01

    Under a nuclear contract MSA was required to design, manufacture, seismically test and functionally test a complete Safety Related, Seismic Category I, Control Room Emergency Air Cleaning System before shipment to the Yankee Atomic Electric Company, Yankee Nuclear Station in Rowe, Massachusetts. The installation of this system was required to satisfy the NRC requirements of NUREG-0737, Section III, D.3.4, ''Control Room Habitability''. The filter system tested was approximately 3 ft. wide by 8 ft. high by 18 ft. long and weighed an estimated 8300 pounds. It had a design flow rate of 3000 SCFM and contained four stages of filtration - prefilters, upstream and downstream HEPA filters and Type II sideload charcoal adsorber cells. The filter train design followed the guidelines set forth by ANSI/ASME N509-1980. Seismic Category I Qualification Testing consisted of resonance search testing and triaxial random multifrequency testing. In addition to ANSI/ASME N510-1980 testing, triaxial response accelerometers were placed at specific locations on designated prefilters, HEPA filters, charcoal adsorbers and test canisters along with accelerometers at the corresponding filter seal face locations. The purpose of this test was to demonstrate the integrity of the filters, filter seals, and monitor seismic response levels which is directly related to the system's ability to function during a seismic occurrence. The Control Room Emergency Air Cleaning System demonstrated the ability to withstand the maximum postulated earthquake for the plant site by remaining structurally sound and functional

  19. Emergency Department Utilization and Self-Reported Symptoms in Community-Dwelling Older Adults

    Science.gov (United States)

    Sawyer, Patricia; Kennedy, Richard; Williams, Courtney; Brown, Cynthia J.

    2016-01-01

    Background The rise in emergency department (ED) utilization among older adults is a nursing concern, because emergency nurses are uniquely positioned to positively impact the care of older adults. Symptoms have been associated with ED utilization, however, it remains unclear if symptoms are the primary reason for ED utilization. Purpose Describe the self-reported symptoms of community-dwelling older adults prior to accessing the emergency department. Examine the differences in self-reported symptoms among those who utilized the emergency department, and those who did not. Procedures A prospective longitudinal design was used. The sample included 403 community-dwelling older adults 75 years and older. Baseline in-home interviews were conducted followed by monthly telephone interviews over 15 months. Main Findings Commonly reported symptoms at baseline included pain, feeling tired, and having shortness of breath. In univariate analysis, pain, shortness of breath, fair/poor well-being, and feeling tired were significantly correlated with ED utilization. In multivariable models, problems with balance, and fair/poor well-being were significantly associated with ED utilization. Conclusions Several symptoms were common among this cohort of older adults. However, there were no significant differences in the types of symptoms reported by older adults who utilized the emergency department compared to those who did not use the emergency department. Based on these findings, symptoms among community-dwelling older adults may not be the primary reason for ED utilization. PMID:28131350

  20. Quality of care using a multidisciplinary team in the emergency room

    DEFF Research Database (Denmark)

    Christensen, Dorthea; Maaløe, Rikke; Jensen, Nanna Martin

    2011-01-01

    Bispebjerg Hospital has implemented a multidisciplinary team reception of critically ill and severely injured patients at the Emergency Department (ED), termed emergency call (EC) and trauma call (TC). The aim of this study was to describe the course, medical treatment and outcome for patients re...... received by this multidisciplinary team and to evaluate the quality of acute medical treatment of these patients....

  1. Emergency room visits due to external causes and alcohol consumption - Capitals and the Federal District, Brazil, 2011

    Directory of Open Access Journals (Sweden)

    Márcio Dênis Medeiros Mascarenhas

    2015-04-01

    Full Text Available The study objective was to describe the profile and factors related to alcohol consumption among emergency room visits by external causes. It is a cross-sectional study with data from the Survey of Violence and Injuries in Emergency between September and October 2011, in 24 state capitals and the Federal District. Statistical analysis were performed for all cases treated in selected services, comparing the characteristics of the victims, according to the statement of alcohol consumption. 33,289 visits to emergency rooms by external causes in the population above 18 years of age were included. The prevalence of self-reported statement of alcohol consumption among these services was 14.9% for the 24 capitals and the Federal District, and was significantly higher among visits by violent causes than by accidents. For both accidents and violence the associated causes were victims male, black/brown, less educated, members of specific populations, occurrences on public roads. The results support global discussions on the importance of establishing policies and legal measures to restrict the consumption of alcohol and vehicular direction, control advertising of alcoholic beverages, and laws normalizing the functioning of sales points of alcoholic beverages.

  2. Emergency room visits for work-related injuries: characteristics and associated factors - capitals and the Federal District, Brazil, 2011.

    Science.gov (United States)

    Mascarenhas, Márcio Dênis Medeiros; de Freitas, Mariana Gonçalves; Monteiro, Rosane Aparecida; da Silva, Marta Maria Alves; Malta, Deborah Carvalho; Gómez, Carlos Minayo

    2015-03-01

    Work-related injuries, often classified as occupational injuries (OI), stand out among visits due to external causes (accidents and violence) in health services. To describe the characteristics and factors associated with emergency room visits for OI, a cross-sectional study was conducted using data from the Survey of Violence and Injuries in Emergency Services (VIVA Inquérito 2011) in 24 state capitals and the Federal District. The prevalence of treatment for OI and prevalence ratios (PR) with confidence intervals of 95% (95%CI) were calculated. There were 29,463 emergency room visits due to accidental injuries in the population above 18 years of age. The prevalence of OI was 33.4% and was positively and significantly associated with the male gender, age 30-59 years old, industrial workers, agricultural sector or repair and maintenance services. The occurrence of OI was significantly higher in attendance for objects falling on people (PR = 3.37, 95% CI 2.80 to 4.05) and injuries due to perforating object (PR = 3.01, 95% CI 2.50-3.65). The results support the surveillance of external causes and direct public policies to promote occupational health.

  3. Predicting the success of noninvasive positive pressure ventilation in emergency room for patients with acute heart failure.

    Science.gov (United States)

    Shirakabe, Akihiro; Hata, Noritake; Yokoyama, Shinya; Shinada, Takuro; Kobayashi, Nobuaki; Tomita, Kazunori; Kitamura, Mitsunobu; Nozaki, Ayaka; Tokuyama, Hideo; Asai, Kuniya; Mizuno, Kyoichi

    2011-01-01

    Non-invasive positive pressure ventilation (NPPV) for acute heart failure (AHF) is increasingly used to avoid endotracheal intubation (ETI). We therefore reviewed our experience using respirator management in the emergency room for AHF, and evaluated the predictive factors in the success of NPPV in the emergency room. Three-hundred forty-three patients with AHF were analyzed. The AHF patients were assigned to either BiPAP-Synchrony (B-S; Respironics, Merrysville, PA, USA) period (2005-2007, n = 176) or BiPAP-Vision (B-V; Respironics) period (2008-2010, n = 167). The rate of carperitide use was significantly increased and dopamine use was significantly decreased in the B-V period. The total length of hospital stay was significantly shorter in the B-V period. AHF patients were also assigned to a failed trial of NPPV followed by ETI (NPPV failure group) or an NPPV success group in the emergency room for each period. NPPV was successfully used in 48 cases in the B-S period, and in 111 cases in the B-V period. Fifty-seven ETI patients included 45 direct ETI and 11 NPPV failure cases in the B-S period, and 16 ETI patients included 10 direct ETI and 6 NPPV failure cases in the B-V period. The pH values were significantly lower in the NPPV failure than in the NPPV success for both periods (7.19 ± 0.10 vs. 7.28 ± 0.11, B-S period, p successful estimates of NPPV with a high sensitivity and specificity, and the aortic blood gas level was above 7.03 pH when using the B-V system. Copyright © 2011 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  4. Manejo da asma aguda em adultos na sala de emergência: evidências atuais Management of acute asthma in adults in the emergency room: current evidence

    Directory of Open Access Journals (Sweden)

    Paulo de Tarso Roth Dalcin

    2009-01-01

    Full Text Available Asma é uma doença com uma alta prevalência em nosso meio e ao redor do mundo. Embora novas opções terapêuticas tenham sido recentemente desenvolvidas, parece haver um aumento mundial na sua morbidade e mortalidade. Em muitas instituições, as exacerbações asmáticas ainda se constituem em uma emergência médica muito comum. As evidências têm demonstrado que o manejo da asma aguda na sala de emergência concentra decisões cruciais que podem determinar o desfecho desta situação clínica. Nesta revisão, enfocaremos a avaliação e o tratamento do paciente com asma aguda na sala de emergência, descrevendo uma estratégia apropriada para o seu manejo. Serão consideradas as seguintes etapas: diagnóstico, avaliação da gravidade, tratamento, avaliação das complicações, decisão sobre onde se realizará o tratamento adicional e orientações por ocasião da alta da emergência. Espera-se que estas recomendações contribuam para que o médico clínico tome as decisões apropriadas durante o manejo da asma aguda na sala de emergência.Asthma is a disease with high prevalence in our country and worldwide. Although new therapeutic approaches have been developed recently, there seems to be a global increase in morbidity and mortality from asthma. In many institutions, asthma exacerbation is still a common medical emergency. Clinical evidence demonstrates that management of acute asthma in the emergency room entails crucial decisions that could determine the clinical outcome. In this review, the authors focus on assessment and treatment of patients with acute asthma and outline an appropriate management strategy. Diagnosis, severity assessment, treatment, complications, decision about where additional treatment will take place and orientations on discharge from the emergency will be considered. It is expected that these recommendations will help physicians to make the appropriate decisions about care of acute asthma in the emergency

  5. Profiling microbial lignocellulose degradation and utilization by emergent omics technologies.

    Science.gov (United States)

    Rosnow, Joshua J; Anderson, Lindsey N; Nair, Reji N; Baker, Erin S; Wright, Aaron T

    2017-08-01

    The use of plant materials to generate renewable biofuels and other high-value chemicals is the sustainable and preferable option, but will require considerable improvements to increase the rate and efficiency of lignocellulose depolymerization. This review highlights novel and emerging technologies that are being developed and deployed to characterize the process of lignocellulose degradation. The review will also illustrate how microbial communities deconstruct and metabolize lignocellulose by identifying the necessary genes and enzyme activities along with the reaction products. These technologies include multi-omic measurements, cell sorting and isolation, nuclear magnetic resonance spectroscopy (NMR), activity-based protein profiling, and direct measurement of enzyme activity. The recalcitrant nature of lignocellulose necessitates the need to characterize the methods microbes employ to deconstruct lignocellulose to inform new strategies on how to greatly improve biofuel conversion processes. New technologies are yielding important insights into microbial functions and strategies employed to degrade lignocellulose, providing a mechanistic blueprint in order to advance biofuel production.

  6. High users of VA emergency room facilities: are outpatients abusing the system or is the system abusing them?

    Science.gov (United States)

    Schneider, K C; Dove, H G

    1983-01-01

    A phenomenon well known to emergency room personnel is the high use of ER facilities by a small number of patients. In this study of 335 patients followed in outpatient specialty clinics at a university-affiliated VA medical center, 23% of the patients accounted for 73% of the ER visits. Although some patients may be abusing the system, the problem is difficult to correct because of congressional legislation that deters the VA from providing primary care. Thus, a small subset of patients with chronic medical problems who live close to the hospital are likely to continue to consume a disproportionate amount of ER resources.

  7. UTILIZING SAR AND MULTISPECTRAL INTEGRATED DATA FOR EMERGENCY RESPONSE

    Directory of Open Access Journals (Sweden)

    S. Havivi

    2016-06-01

    Full Text Available Satellite images are used widely in the risk cycle to understand the exposure, refine hazard maps and quickly provide an assessment after a natural or man-made disaster. Though there are different types of satellite images (e.g. optical, radar these have not been combined for risk assessments. The characteristics of different remote sensing data type may be extremely valuable for monitoring and evaluating the impacts of disaster events, to extract additional information thus making it available for emergency situations. To base this approach, two different change detection methods, for two different sensor's data were used: Coherence Change Detection (CCD for SAR data and Covariance Equalization (CE for multispectral imagery. The CCD provides an identification of the stability of an area, and shows where changes have occurred. CCD shows subtle changes with an accuracy of several millimetres to centimetres. The CE method overcomes the atmospheric effects differences between two multispectral images, taken at different times. Therefore, areas that had undergone a major change can be detected. To achieve our goals, we focused on the urban areas affected by the tsunami event in Sendai, Japan that occurred on March 11, 2011 which affected the surrounding area, coastline and inland. High resolution TerraSAR-X (TSX and Landsat 7 images, covering the research area, were acquired for the period before and after the event. All pre-processed and processed according to each sensor. Both results, of the optical and SAR algorithms, were combined by resampling the spatial resolution of the Multispectral data to the SAR resolution. This was applied by spatial linear interpolation. A score representing the damage level in both products was assigned. The results of both algorithms, high level of damage is shown in the areas closer to the sea and shoreline. Our approach, combining SAR and multispectral images, leads to more reliable information and provides a

  8. Electric utility strategies and the emerging industry structure - Part 1

    International Nuclear Information System (INIS)

    Motupalli, S.

    1991-01-01

    The electric utility industry is our most capital intensive industry by far. Over the past few decades, socioeconomic and technological forces have been quietly revolutionizing the way the industry conducts itself. During the 1980s, these changes have been particularly intense, often catching both regulators and regulated ill-prepared to develop effective and profitable strategies to deal with such change. Much has already been written about these changes: independent power producers, competitive procurement of resources, incentive-based regulation, the benefits of affiliated company structures, mergers and consolidation, customer energy conservation, and marketing strategy development are all currently highly popular article and seminar topics. The author's object in this two-part series is to facilitate development of a decision framework to put these various changes in perspective, to help develop effective strategies through better focused and equipped planning methodologies. Gaining an understanding of the role, strengths and weaknesses of the various players in an industry and the structural constraints in which they operate is a necessary precursor to developing effective operating strategies to deal with change or to manipulate industry forces in your favor. Michael Port's popular five forces model provides a convenient way to develop such an understanding. It provides a way to map the industry forces driving profitability, through a review of the strengths, weaknesses and leverage of: current industry players, suppliers to the industry, customers for the industry's product, new entrants into the market, and substitute products providing equal or better value. Part 1 of this series reviews each of these five forces along some key dimensions to determine their direction of change or influence, and whether this change impacts a utility's competitive position favorably or unfavorably

  9. If Hunters End Up in the Emergency Room: A Retrospective Analysis of Hunting Injuries in a Swiss Emergency Department

    OpenAIRE

    Bestetti, Valentina; Fisher, Emma E.; Srivastava, David S.; Ricklin, Meret E.; Exadaktylos, Aristomenis K.

    2015-01-01

    Aim. to characterize the mechanisms, patterns, and outcomes of nonfatal hunting-related injuries in patients presenting to Bern University Hospital, Switzerland, and compare these to reports of hunting injuries worldwide. Methods. patients presenting with hunting-related injuries to the Emergency Department at Bern University hospital from 2000 to 2014 were identified by retrospectively searching the department database using the keyword “hunt.” Each case was analyzed in terms of the patient...

  10. Underdosing of acetaminophen by parents and emergency department utilization.

    Science.gov (United States)

    Goldman, Ran D; Scolnik, Dennis

    2004-02-01

    Fever is a common reason for parents to seek medical attention for their children. We conducted this study to document accuracy of parental administration of acetaminophen and to identify if parents who did not give an optimal dose would have decided not to come to the emergency department (ED) if the fever had diminished at home. A cross-sectional study including 248 caregivers of children who had a chief complaint of fever and had been given acetaminophen in the preceding 24 hours were interviewed. Enrollment was 86%. One hundred parents (47%) gave acetaminophen in the recommended dose, 26 parents (12%) gave an overdose, and 87 (41%) gave an underdose of acetaminophen. Half of the parents (54%) would not have come to the ED if the fever had subsided after using the antipyretic treatment at home. Children with significantly higher maximal temperature at home would not have been taken to the ED if fever had subsided. Parents who speak English as the primary language at home gave the recommended dose of acetaminophen more frequently than non-English-speaking parents. A significant portion of our population gives an underdose of acetaminophen, reflecting lack of knowledge or misuse. Based on parental reports, the majority of visits for fever might have been prevented, if parents had been successful in their effort to reduce temperature to below of what they considered as fever, but factors other than underdosing of acetaminophen probably encourage parents of febrile children to visit the ED.

  11. Occupational dosimetry in real time hemodynamic rooms. utility of the system Dose-aware as a training tool

    International Nuclear Information System (INIS)

    Pinto Monedero, M.; Rodriguez Cobo, C.; Pifarre Martinez, X.; Ruiz Martin, J.; Barros Candelero, J. M.; Goicolea Ruigomez, J.; Diaz Blaires, G.; Garcia Lunar

    2014-01-01

    This paper presents the results from a study in a real time dosimetry system used in the catheter laboratory room of our center. The objective was to know the occupational doses per procedure, on the one hand, and, on the other hand, to evaluate its utility as a learning tool for radiation protection purposes with the simultaneous video recording of the interventions. 83 diagnostic and therapeutic procedures were analyzed, and an average dose per procedure of 0,37 μSv and 0,10 μSv for the main cardiologist and nurse were obtained, respectively. 36 of these interventions were also recorded and the images were synchronized with the dosimetric information stored and the dosimetry system. The findings were presented to the interventional cardiology team in a learning session. They showed a high level of satisfaction with this new method of optimizing the occupational doses through a customized learning session. (Author)

  12. [Domestic and family violence against women: a case-control study with victims treated in emergency rooms].

    Science.gov (United States)

    Garcia, Leila Posenato; Duarte, Elisabeth Carmen; Freitas, Lúcia Rolim Santana de; Silva, Gabriela Drummond Marques da

    2016-01-01

    This study aimed to identify factors associated with treatment of victims of domestic and family violence in emergency rooms in Brazil. This is a case-control study based on the Surveillance System for Violence and Accidents (VIVA), 2011. Women ≥ 18 years who were victims of family and domestic violence were selected as cases and compared to accident victims (controls). Adjusted odds ratios were estimated by unconditional logistic regression. 623 cases and 10,120 controls were included. Risk factors according to the adjusted analysis were younger age (18-29 years), low schooling, lack of paid work, alcohol consumption, having sought treatment in a different health service, and violence on weekends or at night or in the early morning hours. The study concludes that domestic and family violence shows alcohol consumption as a strongly associated factor. Days and hours with the highest ocurrence reveal the need to adjust emergency services to treat victims.

  13. If Hunters End Up in the Emergency Room: A Retrospective Analysis of Hunting Injuries in a Swiss Emergency Department

    Directory of Open Access Journals (Sweden)

    Valentina Bestetti

    2015-01-01

    Full Text Available Aim. to characterize the mechanisms, patterns, and outcomes of nonfatal hunting-related injuries in patients presenting to Bern University Hospital, Switzerland, and compare these to reports of hunting injuries worldwide. Methods. patients presenting with hunting-related injuries to the Emergency Department at Bern University hospital from 2000 to 2014 were identified by retrospectively searching the department database using the keyword “hunt.” Each case was analyzed in terms of the patient age and gender, the mechanism and pattern of injury, and management and patient follow-up. Results. 19 patients were identified. 16 were male with a mean age of 50 years (range: 16–74. Mechanisms of injury included firearm-related injuries, falls, and knife wounds. The most common patterns of injury were head injuries (7, followed by injuries to the upper (5 or lower limb (5 and trunk (2. Over half of the patients were admitted, and nine required emergency surgery. Conclusion. Nonfatal hunting accidents in Bern, Switzerland, are largely caused by firearms and falls and tend to occur in male hunters with a mean age of 50 years. The most common patterns of injury are orthopedic and head injuries, often requiring surgery. These findings are consistent with international studies of nonfatal hunting accidents.

  14. Analysis of bacterial contamination on surface of general radiography equipment and CT equipment in emergency room of radiology

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Dong Hee; KIm, Hyeong Gyun [Dept. of Radiological Science, Far East University, Eumseong (Korea, Republic of)

    2016-09-15

    We aim to offer basic materials about infection management through conducting bacterial contamination test about general radiography equipment and CT equipment installed in ER of three general hospitals with 100 sickbeds or more located in Gyeongsangbuk-do Province, and suggest management plan. It had been conducted from 1st December 2015 to 31st December, and objects were general radiography equipment and CT equipment of emergency room located in Gyeongsangbuk-do Province. For general radiography equipment, sources were collected from 4 places such as upper side of control box which employees use most, upper side of exposure button, whole upper side of table which is touching part of patient's skin, upper side of stand bucky's grid, and where patients put their jaws on. For CT equipment, sources were collected from 3 places such as upper side of control box which radiography room employees use most, X-ray exposure button, whole upper side of table which is touching part of patient's skin, and gantry inner. Surface contamination strain found at general radiography equipment in emergency room of radiology are Providencia stuartii(25%), Stenotrophomonas maltophilia(18%), Enterobacter cloacae(8%), Pseudomonas species(8%), Staphylococcus epidermidis(8%), Gram negative bacilli(8%), and ungrown bacteria at incubator after 48 hours of incubation (67%) which is the biggest. Most bacteria were found at upper side of stand bucky-grid and stand bucky of radiology's general radiography equipment, and most sources of CT equipment were focused at patient table, which means it is contaminated by patients who have various diseases, and patients who have strains with decreased immunity may get severe diseases. Thus infection prevention should be made through 70% alcohol disinfection at both before test and after test.

  15. Analysis of bacterial contamination on surface of general radiography equipment and CT equipment in emergency room of radiology

    International Nuclear Information System (INIS)

    Hong, Dong Hee; KIm, Hyeong Gyun

    2016-01-01

    We aim to offer basic materials about infection management through conducting bacterial contamination test about general radiography equipment and CT equipment installed in ER of three general hospitals with 100 sickbeds or more located in Gyeongsangbuk-do Province, and suggest management plan. It had been conducted from 1st December 2015 to 31st December, and objects were general radiography equipment and CT equipment of emergency room located in Gyeongsangbuk-do Province. For general radiography equipment, sources were collected from 4 places such as upper side of control box which employees use most, upper side of exposure button, whole upper side of table which is touching part of patient's skin, upper side of stand bucky's grid, and where patients put their jaws on. For CT equipment, sources were collected from 3 places such as upper side of control box which radiography room employees use most, X-ray exposure button, whole upper side of table which is touching part of patient's skin, and gantry inner. Surface contamination strain found at general radiography equipment in emergency room of radiology are Providencia stuartii(25%), Stenotrophomonas maltophilia(18%), Enterobacter cloacae(8%), Pseudomonas species(8%), Staphylococcus epidermidis(8%), Gram negative bacilli(8%), and ungrown bacteria at incubator after 48 hours of incubation (67%) which is the biggest. Most bacteria were found at upper side of stand bucky-grid and stand bucky of radiology's general radiography equipment, and most sources of CT equipment were focused at patient table, which means it is contaminated by patients who have various diseases, and patients who have strains with decreased immunity may get severe diseases. Thus infection prevention should be made through 70% alcohol disinfection at both before test and after test

  16. Identification and initial management of intoxication by alcohol and other drugs in the pediatric emergency room

    Directory of Open Access Journals (Sweden)

    Thiago Gatti Pianca

    2017-11-01

    Conclusion: The diagnosis and treatment of intoxication by alcohol and other drugs in adolescents and children in the emergency scenario requires a systematic evaluation of the use of these drugs. There are few specific treatments for intoxication, and the management comprehends support measures and management of related clinical complications.

  17. Taking on Substance Abuse in the Emergency Room: One Hospital's SBIRT Story

    Science.gov (United States)

    Parker, Gary; Libart, Dane; Fanning, Linda; Higgs, Tracy; Dirickson, Cathy

    2012-01-01

    Screening for alcohol and drugs seems to be gaining traction and is becoming more commonplace in the healthcare setting. With emergency departments often being a point of contact for many individuals needing healthcare services, it makes sense to provide screening for substance misuse within this setting. The purpose of this paper is to share how…

  18. The use of a metronome during cardiopulmonary resuscitation in the emergency room of a university hospital

    OpenAIRE

    Botelho,Renata Maria de Oliveira; Campanharo,Cássia Regina Vancini; Lopes,Maria Carolina Barbosa Teixeira; Okuno,Meiry Fernanda Pinto; Góis,Aécio Flávio Teixeira de; Batista,Ruth Ester Assayag

    2016-01-01

    ABSTRACT Objective: to compare the rate of return of spontaneous circulation (ROSC) and death after cardiac arrest, with and without the use of a metronome during cardiopulmonary resuscitation (CPR). Method: case-control study nested in a cohort study including 285 adults who experienced cardiac arrest and received CPR in an emergency service. Data were collected using In-hospital Utstein Style. The control group (n=60) was selected by matching patients considering their neurological condit...

  19. Emergency department waiting room stress: can music or aromatherapy improve anxiety scores?

    Science.gov (United States)

    Holm, Lydia; Fitzmaurice, Laura

    2008-12-01

    The aim of this study was to determine the effect of music alone, aromatherapy alone, and music in addition to aromatherapy on anxiety levels of adults accompanying children to a pediatricemergency department waiting area. The study was conducted over 28 consecutive days, assigned to 1 of 4 groups: no intervention, music, aromatherapy, and both music and aromatherapy. Adults accompanying children to the emergency department of an urban pediatric tertiary care referral center were given a survey including a Spielberger state anxiety inventory with additional questions about whether they noticed an aroma or music and if so their response to it. The music was classic ingenre with a tempo of 60 to 70 beats per minute. The aromatherapyused the essential oil Neroli dispersed using 2 aromatherapydiffusers placed in strategic airflow ends of the emergency department. The 1104 surveys were completed. There was a statistically significant decrease in anxietylevel on those days when music was playing (36.3 vs. 39.2; P = 0.017). There was no difference in anxiety levels on those days when aromatherapy was present compared with the nonaromatherapy days (37.3 vs. 38.0; P = 0.347). Music is an easy and useful way to decrease the anxiety of visitors in an emergency department waiting area. Although no difference was detected for the aromatherapy group, this could be because of environmental conditions or imprecise application of the aromatherapy; further study is needed to either prove or disprove its effectiveness in this setting.

  20. Developing a taxonomy of coordination behaviours in nuclear power plant control rooms during emergencies.

    Science.gov (United States)

    Wang, Dunxing; Gao, Qin; Li, Zhizhong; Song, Fei; Ma, Liang

    2017-12-01

    This study aims to develop a taxonomy of coordination behaviours during emergencies in nuclear power plants (NPPs). We summarised basic coordination behaviours from literature in aviation, health care and nuclear field and identified coordination behaviours specific to the nuclear domain by interviewing and surveying control crew operators. The established taxonomy includes 7 workflow stages and 24 basic coordination behaviours. To evaluate the reliability and feasibility of the taxonomy, we analysed 12 videos of operators' training sessions by coding coordination behaviours with the taxonomy and the inter-rater reliability was acceptable. Further analysis of the frequency, the duration and the direction of the coordination behaviours revealed four coordination problems. This taxonomy provides a foundation of systematic observation of coordination behaviours among NPP crews, advances researchers' understanding of the coordination mechanism during emergencies in NPPs and facilitate the possibility to deepen the understanding of the relationships between coordination behaviours and team performance. Practitioner Summary: A taxonomy of coordination behaviours during emergencies in nuclear power plants was developed. Reliability and feasibility of the taxonomy was verified through the analysis of 12 training sessions. The taxonomy can serve as an observation system for analysis of coordination behaviours and help to identify coordination problems of control crews.

  1. The changing utility workforce and the emergence of building information modeling in utilities

    Energy Technology Data Exchange (ETDEWEB)

    Saunders, A. [Autodesk Inc., San Rafael, CA (United States)

    2010-07-01

    Utilities are faced with the extensive replacement of a workforce that is now reaching retirement age. New personnel will have varying skill levels and different expectations in relation to design tools. This paper discussed methods of facilitating knowledge transfer from the retiring workforce to new staff using rules-based design software. It was argued that while nothing can replace the experiential knowledge of long-term engineers, software with built-in validations can accelerate training and building information modelling (BIM) processes. Younger personnel will expect a user interface paradigm that is based on their past gaming and work experiences. Visualization, simulation, and modelling approaches were reviewed. 3 refs.

  2. Adolescents’ Knowledge, Attitude and Utilization of Emergency Contraceptive Pills in Nigeria’s Niger Delta Region

    Science.gov (United States)

    Onasoga, Olayinka A.; Afolayan, Joel Adeleke; Asamabiriowei, Tariebi Florence; Jibril, Umar Nda; Imam, Abubakar Ayinla

    2016-01-01

    Background and Objective: Risky sexual activity among adolescents is on the increase and contraceptive prevalence rate is low which is evidenced by high rate of teenage pregnancy in Bayelsa state, Nigeria. This study assesses the adolescents’ knowledge, attitude and utilization of emergency contraceptive pills (ECP) in Amassoma Community, Bayelsa State, in the Niger Delta region of Nigeria. Methods: The study was a descriptive cross-sectional research design. A purposive sampling technique was used to select a sample of 220 respondents from the target population. Data were collected using a self-structured questionnaire. Descriptive and inferential statistics were used to analyze the data generated. Results: Majority of the respondents had high level of knowledge and positive attitude towards emergency contraceptive pills but had low level of utilization. Concerns about what others may say, parental attitude, contraceptive availability, contraceptive accessibility, and peer influences were the major factors that influenced the utilization of contraceptive pills. There was no significant relationship between knowledge and utilization of emergency contraceptive pills, as well as level of knowledge and their utilization of emergency contraceptive pills. Conclusions and Global Health Implications: Adolescents in the study were more likely to use emergency contraceptive pills, if parents and others reaction to adolescents’ contraceptive use were positive about those. Health care professionals, especially nurses, should organize enlightenment programs to educate adolescents, parents and the public on the benefits of adolescents’ contraceptives use, especially ECP. PMID:28058193

  3. Adolescents' Knowledge, Attitude and Utilization of Emergency Contraceptive Pills in Nigeria's Niger Delta Region.

    Science.gov (United States)

    Onasoga, Olayinka A; Afolayan, Joel Adeleke; Asamabiriowei, Tariebi Florence; Jibril, Umar Nda; Imam, Abubakar Ayinla

    2016-01-01

    Risky sexual activity among adolescents is on the increase and contraceptive prevalence rate is low which is evidenced by high rate of teenage pregnancy in Bayelsa state, Nigeria. This study assesses the adolescents' knowledge, attitude and utilization of emergency contraceptive pills (ECP) in Amassoma Community, Bayelsa State, in the Niger Delta region of Nigeria. The study was a descriptive cross-sectional research design. A purposive sampling technique was used to select a sample of 220 respondents from the target population. Data were collected using a self-structured questionnaire. Descriptive and inferential statistics were used to analyze the data generated. Majority of the respondents had high level of knowledge and positive attitude towards emergency contraceptive pills but had low level of utilization. Concerns about what others may say, parental attitude, contraceptive availability, contraceptive accessibility, and peer influences were the major factors that influenced the utilization of contraceptive pills. There was no significant relationship between knowledge and utilization of emergency contraceptive pills, as well as level of knowledge and their utilization of emergency contraceptive pills. Adolescents in the study were more likely to use emergency contraceptive pills, if parents and others reaction to adolescents' contraceptive use were positive about those. Health care professionals, especially nurses, should organize enlightenment programs to educate adolescents, parents and the public on the benefits of adolescents' contraceptives use, especially ECP.

  4. Emergency room nurses' pathway to turnover intention: a moderated serial mediation analysis.

    Science.gov (United States)

    Bruyneel, Luk; Thoelen, Tom; Adriaenssens, Jef; Sermeus, Walter

    2017-04-01

    The aim of this study was to explore the association between the quality of the work environment, job characteristics, demographic characteristics and a pathway of job satisfaction, emotional exhaustion and turnover intention among nurses in emergency departments and perform subgroup analyses. Turnover intention among nurses is high. Multiple causes have been described, mostly in large studies of nurses working on general wards, often without considering complementarity of conceptual models and showing scant interest in the consistency of associations across subgroups of nurses. Cross-sectional multicentre survey. Convenience sample of 294 nurses in 11 Belgian emergency departments during 2014-2015. Indirect effects in the form of mediation and serial mediation were estimated to assess the association between work environment (Magnet model), job characteristics (Job Demand Control Support model) and turnover intention via job satisfaction and emotional exhaustion. Consistency of these indirect effects across subgroups of nurses was examined using moderated mediation analysis (conditional indirect effects). Several Magnet and Job Demand Control Support dimensions were related to turnover intention, either via job dissatisfaction (mediation) or via job satisfaction and emotional exhaustion (serial mediation). In the case of social support from supervisor, these indirect effects were only significant for female nurses, among whom turnover intention was higher. Last, nurses with more years of experience were less likely to indicate turnover intention. To maximize prevention of turnover intention at emergency departments, interventions could target early career nurses, work environment and job characteristics. Female nurses in particular may also benefit from improved social support from their supervisor. © 2016 John Wiley & Sons Ltd.

  5. [Effect of dexmedetomidine on emergence agitation after general anesthesia in children undergoing odontotherapy in day-surgery operating room].

    Science.gov (United States)

    Lin, Luo; Yueming, Zhang; Meisheng, Li; Jiexue, Wang; Yang, Ji

    2017-12-01

    To study the effectiveness of dexmedetomidine used for general anesthesia maintenance in children undergoing odontotherapy in day-surgery operating room in reducing the incidence of emergence agitation (EA). Eighty children undergoing odontotherapy and under general anesthesia in day-surgery operating room were randomized into two groups, group A (n=40) and group B (n=40). Each patient in group A was administered with a bolus dose of dexmedetomidine (1.0 μg·kg⁻¹, saline diluted to 10 mL) pump-infused after intubation and a maintenance dose of 0.1-0.4 mL·(kg·h)⁻¹ followed-up until 45 min before the end of operation. Each patient in group B was administered with a bolus dose of normal saline 10 mL pump-infused after intubation and maintenance dose of 0.1-0.4 mL·(kg·h)⁻¹ followed-up until 45 min before the end of operation. Gender, age, weight, physical status according to the American Society of Anesthesiologists, perioperative heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO₂), sufentanil dosage, duration of surgery, time of extubation, time of regaining consciousness, and time to reach modified Aldrete's score≥12 were recorded. Behavior in postanesthesia care unit was rated on the four-point agitation scale. Compared with group B, decreases were observed in HR and MAP at the beginning of operation, in 10 and 30 min, 1 and 2 h after the beginning of operation, and after extubation of group A (Pgeneral anesthesia maintenance in children undergoing odontotherapy in day-surgery operating room, dexmedetomidine results in low incidence of EA during recovery and more stable vital signs.

  6. Management protocols for status epilepticus in the pediatric emergency room: systematic review article

    Directory of Open Access Journals (Sweden)

    Cheuk C. Au

    Full Text Available Abstract Objective: This systematic review of national or regional guidelines published in English aimed to better understand variance in pre-hospital and emergency department treatment of status epilepticus. Sources: Systematic search of national or regional guidelines (January 2000 to February 2017 contained within PubMed and Google Scholar databases, and article reference lists. The search keywords were status epilepticus, prolonged seizure, treatment, and guideline. Summary of findings: 356 articles were retrieved and 13 were selected according to the inclusion criteria. In all six pre-hospital guidelines, the preferred route of medication administration was to use alternatives to the intravenous route: all recommended buccal and intranasal midazolam; three also recommended intramuscular midazolam, and five recommended using rectal diazepam. All 11 emergency department guidelines described three phases in therapy. Intravenous medication, by phase, was indicated as such: initial phase - ten/11 guidelines recommended lorazepam, and eight/11 recommended diazepam; second phase - most (ten/11 guidelines recommended phenytoin, but other options were phenobarbital (nine/11, valproic acid (six/11, and either fosphenytoin or levetiracetam (each four/11; third phase - four/11 guidelines included the choice of repeating second phase therapy, whereas the other guidelines recommended using a variety of intravenous anesthetic agents (thiopental, midazolam, propofol, and pentobarbital. Conclusions: All of the guidelines share a similar framework for management of status epilepticus. The choice in route of administration and drug type varied across guidelines. Hence, the adoption of a particular guideline should take account of local practice options in health service delivery.

  7. LABORATORY BIOMARKERS TO FACILITATE DIFFERENTIAL DIAGNOSIS BETWEEN MEASLES AND KAWASAKI DISEASE IN A PEDIATRIC EMERGENCY ROOM: A RETROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Danilo Buonsenso

    2018-05-01

    Full Text Available This retrospective study was conducted to analyze clinical and laboratoristic parameters to individuate specific differences and facilitate differential diagnosis between Measles and Kawasaki Disease (KD at first evaluation in a emergency room. We found similar clinical features as duration of fever and number of KD criteria (p >0.5 but significant differences in white blood cell count, neutrophils, CRP and LDH levels (p < 0.001. LDH value ≥ 800 mg/dl had sensibility of 89% and specificity of 90% for Measles while CRP ≥ 3 mg/dl had sensibility 89% and specificity of 85% for KD. The combined use of CRP, LDH and AST showed accuracy of 86.67%.

  8. The effect of patient origin and relevance of contact on patient and caregiver satisfaction in the emergency room

    DEFF Research Database (Denmark)

    Mygind, Anna; Nørredam, Marie Louise; Nielsen, Anette S

    2008-01-01

    AIMS: This study examined (1) whether patient and caregiver satisfaction in the emergency room (ER) varies according to patient origin, and (2) whether relevance of visit can explain any variation. METHODS: Data were obtained from a questionnaire survey of walk-in patients and their caregivers...... at four ERs in Copenhagen. The patient questionnaire was available in nine languages, and addressed patient satisfaction. The caregiver questionnaire addressed caregiver satisfaction and relevance of the patient contact in the ER. A total of 3,809 patients and 3,905 caregivers responded. The response rate...... satisfaction rates when patients were of Middle Eastern compared with Danish origin. Satisfaction of both groups was associated with the relevance of the visit as assessed by the caregiver. Visits by patients of Middle Eastern origin were less often assessed as being relevant, but caregivers were less...

  9. How Multidimensional Health Locus of Control predicts utilization of emergency and inpatient hospital services.

    Science.gov (United States)

    Mautner, Dawn; Peterson, Bridget; Cunningham, Amy; Ku, Bon; Scott, Kevin; LaNoue, Marianna

    2017-03-01

    Health locus of control may be an important predictor of health care utilization. We analyzed associations between health locus of control and frequency of emergency department visits and hospital admissions, and investigated self-rated health as a potential mediator. Overall, 863 patients in an urban emergency department completed the Multidimensional Health Locus of Control instrument, and self-reported emergency department use and hospital admissions in the last year. We found small but significant associations between Multidimensional Health Locus of Control and utilization, all of which were mediated by self-rated health. We conclude that interventions to shift health locus of control may change patients' perceptions of their own health, thereby impacting utilization.

  10. The BWR [Boiling Water Reactor] Emergency Operating Procedures Tracking System (EOPTS): Evaluation by control-room operating crews

    International Nuclear Information System (INIS)

    Spurgin, A.J.; Orvis, D.D.; Spurgin, J.P.; Luna, C.J.

    1990-05-01

    This report presents the results of a project sponsored by the Electric Power Research Institute (EPRI) and Taiwan Power Company (TPC) and conducted by APG and TPC to perform evaluation of the Emergency Operating Procedures Tracking System (EOPTS). The EOPTS is an expert system employing artificial intelligence techniques developed by EPRI for Boiling Water Reactor (BWR) plants based on emergency operating procedures (EOPs). EOPTS is a computerized decision aid used to assist plant operators in efficient and reliable use of EOPs. The main objective of this project was to evaluate the EOPTS and determine how an operator aid of this type could noticeably improve the response time and the reliability of control room crews to multi-failure scenarios. A secondary objective was to collect data on how crew performance was affected. Experiments results indicate that the EOPTS measurably improves crew performance over crews using the EOP flow charts. Time-comparison measurements indicate that crews using the EOPTS perform required actions more quickly than do those using the flowcharts. The results indicate that crews using the EOPTS are not only faster and more consistent in their actions but make fewer errors. In addition, they have a higher likelihood of recovering from the errors that they do make. Use of the EOPTS in the control room should result in faster termination and mitigation of accidents and reduced risk of power plant operations. Recommendations are made towards possible applications of the EOPTS to operator training and evaluation, and for the applicability of the evaluation methodology developed for this project to the evaluation of similar operator aides. 17 refs., 14 figs., 14 tabs

  11. Ultrasound study of scrotal pathology presenting as acute scrotal pain in the emergency room setting

    International Nuclear Information System (INIS)

    Lozano, C.; Serrano, C.; Revilla, Y.; Miralles, M.; Pozo, G. del; Lopez, U.

    1998-01-01

    The purpose of this reports is to review the most significant ultrasonographic features of the clinical entries that most frequently present as acute scrotal pain in childhood. We review 145 cases of acute scrotal referred by the emergency unit to the Radiology Service over a four-year period (1992-1995). All the patients were studied by B-mode ultrasound and the great majority also underwent color duplex-Doppler ultrasound. A wide variety of diseases were recorded, comprised of epididymitis (n=38), epididymo-orchitis (n=24), hydrocele (n=26), testicular torsion (n=9), cord cyst (n=9), epididymal cyst (n=7), persisting peritoneal-vagina fistula (n=6), hydatid torsion (n=4), sheath hematoma (n=4), laceration (n=4), hematocele (n=3), varicocele (n=3), epididymal hematoma (n=2), testicular hematoma (n=2), tumor (n=2) and inguinoscrotal hernia (n=2). (Author) 20 refs

  12. Strategies for preventing excess mortality after discharge from psychiatric emergency room

    DEFF Research Database (Denmark)

    Aagaard, Jørgen; Jensen, Mikkel

    2017-01-01

    AbstractPatients with severe mental illness have increased risk for severe physical diseases. In addition, there is evidence that this patient group is less likely to receive standard levels of care for most physical diseases, which may contribute to their shortened life expectancy. Further......, illness behaviour among individuals with schizophrenia is different as they are less likely to seek medical attention, which emphasise the need for increased awareness and early intervention when visiting an emergency psychiatric facility. Adults with severe mental illness have increased rates...... of substance abuse, which adversely affect their illness and outcome. Separate and parallel mental health and substance abuse treatment systems do not offer interventions that are integrated or personalised for the presence of substance abuse concurrent with severe mental illness. Therefore, the authors...

  13. Management protocols for status epilepticus in the pediatric emergency room: systematic review article.

    Science.gov (United States)

    Au, Cheuk C; Branco, Ricardo G; Tasker, Robert C

    This systematic review of national or regional guidelines published in English aimed to better understand variance in pre-hospital and emergency department treatment of status epilepticus. Systematic search of national or regional guidelines (January 2000 to February 2017) contained within PubMed and Google Scholar databases, and article reference lists. The search keywords were status epilepticus, prolonged seizure, treatment, and guideline. 356 articles were retrieved and 13 were selected according to the inclusion criteria. In all six pre-hospital guidelines, the preferred route of medication administration was to use alternatives to the intravenous route: all recommended buccal and intranasal midazolam; three also recommended intramuscular midazolam, and five recommended using rectal diazepam. All 11 emergency department guidelines described three phases in therapy. Intravenous medication, by phase, was indicated as such: initial phase - ten/11 guidelines recommended lorazepam, and eight/11 recommended diazepam; second phase - most (ten/11) guidelines recommended phenytoin, but other options were phenobarbital (nine/11), valproic acid (six/11), and either fosphenytoin or levetiracetam (each four/11); third phase - four/11 guidelines included the choice of repeating second phase therapy, whereas the other guidelines recommended using a variety of intravenous anesthetic agents (thiopental, midazolam, propofol, and pentobarbital). All of the guidelines share a similar framework for management of status epilepticus. The choice in route of administration and drug type varied across guidelines. Hence, the adoption of a particular guideline should take account of local practice options in health service delivery. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  14. "Knife to skin" time is a poor marker of operating room utilization and efficiency in cardiac surgery.

    Science.gov (United States)

    Luthra, Suvitesh; Ramady, Omar; Monge, Mary; Fitzsimons, Michael G; Kaleta, Terry R; Sundt, Thoralf M

    2015-06-01

    Markers of operation room (OR) efficiency in cardiac surgery are focused on "knife to skin" and "start time tardiness." These do not evaluate the middle and later parts of the cardiac surgical pathway. The purpose of this analysis was to evaluate knife to skin time as an efficiency marker in cardiac surgery. We looked at knife to skin time, procedure time, and transfer times in the cardiac operational pathway for their correlation with predefined indices of operational efficiency (Index of Operation Efficiency - InOE, Surgical Index of Operational Efficiency - sInOE). A regression analysis was performed to test the goodness of fit of the regression curves estimated for InOE relative to the times on the operational pathway. The mean knife to skin time was 90.6 ± 13 minutes (23% of total OR time). The mean procedure time was 282 ± 123 minutes (71% of total OR time). Utilization efficiencies were highest for aortic valve replacement and coronary artery bypass grafting and least for complex aortic procedures. There were no significant procedure-specific or team-specific differences for standard procedures. Procedure times correlated the strongest with InOE (r = -0.98, p knife to skin is not as strong an indicator of efficiency. A statistically significant linear dependence on InOE was observed with "procedure times" only. Procedure times are a better marker of OR efficiency than knife to skin in cardiac cases. Strategies to increase OR utilization and efficiency should address procedure times in addition to knife to skin times. © 2015 Wiley Periodicals, Inc.

  15. Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study: interventions with nurses.

    Science.gov (United States)

    Le May, Sylvie; Johnston, C Celeste; Choinière, Manon; Fortin, Christophe; Kudirka, Denise; Murray, Louise; Chalut, Dominic

    2009-08-01

    Children's pain in emergency departments (EDs) is poorly managed by nurses, despite evidence that pain is one of the most commonly presenting complaints of children attending the ED. Our objectives were 2-fold: to verify if tailored educational interventions with emergency pediatric nurses would improve nurses' knowledge of pain management and nurses' pain management practices (documentation of pain, administration of analgesics, nonpharmacological interventions). This intervention study with a pre-post design (baseline, immediately after the intervention [T-2], and 6 months after intervention [T-3]) used a sample of nurses (N = 50) and retrospective chart reviews of children (N = 450; 150 charts reviewed each at baseline, T-2, and T-3) who presented themselves in the ED with a diagnosis known to generate moderate to severe pain (burns, acute abdominal pain, deep lacerations, fracture, sprain). Principal outcomes: nurses' knowledge of pain management (Pediatric Nurses Knowledge and Attitudes Survey [PNKAS] on pain) and nurses' clinical practices of pain management (Pain Management Experience Evaluation [PMEE]). Response rate on the PNKAS was 84% (42/50) at baseline and 50% (21/42) at T-2. Mean scores on PNKAS were 28.2 (SD, 4.9; max, 42.0) at baseline and 31.0 (SD, 4.6) at T-2. Results from paired t test showed significant difference between both times (t = -3.129, P = 0.005). Nurses who participated in the capsules improved their documentation of pain from baseline (59.3%) to T-2 (80.8%; chi = 12.993, P nurses increased their nonpharmacological interventions from baseline (16.7%) to T-3 (31.9%; chi = 8.623, P = 0.003). Finally, we obtained significant differences on pain documentation between the group of nurses who attended at least 1 capsule and the group of nurses who did not attend any capsule at both times (T-2 and T-3; chi = 20.424, P nurses' knowledge of pain management and some of the practices over time. We believe that an intervention tailored to nurses

  16. Reduction in laboratory turnaround time decreases emergency room length of stay

    Directory of Open Access Journals (Sweden)

    Kaushik N

    2018-04-01

    Full Text Available Nitin Kaushik,1 Victor S Khangulov,2 Matthew O’Hara,2 Ramy Arnaout3,4 1Becton, Dickinson and Company, Franklin Lakes, NJ, USA; 2Department of Health Economics and Outcomes Research, Boston Strategic Partners, Inc., Boston, MA, USA; 3Department of Pathology, 4Division of Biomedical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA USA Objective: Laboratory tests are an important contributor to treatment decisions in the emergency department (ED. Rapid turnaround of laboratory tests can optimize ED throughout by reducing the length of stay (LOS and improving patient outcomes. Despite evidence supporting the effect of shorter turnaround time (TAT on LOS and outcomes, there is still a lack of large retrospective studies examining these associations. Here, we evaluated the effect of a reduction in laboratory TAT on ED LOS using retrospective analysis of Electronic Health Records (EHR. Materials and methods: Retrospective analysis of ED encounters from a large, US-based, de-identified EHR database and a separate analysis of ED encounters from the EHR of an ED at a top-tier tertiary care center were performed. Additionally, an efficiency model calculating the cumulative potential LOS time savings and resulting financial opportunity due to laboratory TAT reduction was created, assuming other factors affecting LOS are constant. Results: Multivariate regression analysis of patients from the multisite study showed that a 1-minute decrease in laboratory TAT was associated with 0.50 minutes of decrease in LOS. The single-site analysis confirmed our findings from the multisite analysis that a positive correlation between laboratory TAT and ED LOS exists in the ED population as a whole, as well as across different patient acuity levels. In addition, based on the calculations from the efficiency model, for a 5-, 10- and 15-minute TAT reduction, the single-site ED can potentially admit a total of 127, 256 and 386 additional

  17. The use of a metronome during cardiopulmonary resuscitation in the emergency room of a university hospital

    Directory of Open Access Journals (Sweden)

    Renata Maria de Oliveira Botelho

    Full Text Available ABSTRACT Objective: to compare the rate of return of spontaneous circulation (ROSC and death after cardiac arrest, with and without the use of a metronome during cardiopulmonary resuscitation (CPR. Method: case-control study nested in a cohort study including 285 adults who experienced cardiac arrest and received CPR in an emergency service. Data were collected using In-hospital Utstein Style. The control group (n=60 was selected by matching patients considering their neurological condition before cardiac arrest, the immediate cause, initial arrest rhythm, whether epinephrine was used, and the duration of CPR. The case group (n=51 received conventional CPR guided by a metronome set at 110 beats/min. Chi-square and likelihood ratio were used to compare ROSC rates considering p≤0.05. Results: ROSC occurred in 57.7% of the cases, though 92.8% of these patients died in the following 24 hours. No statistically significant difference was found between groups in regard to ROSC (p=0.2017 or the occurrence of death (p=0.8112. Conclusion: the outcomes of patients after cardiac arrest with and without the use of a metronome during CPR were similar and no differences were found between groups in regard to survival rates and ROSC.

  18. Prognosis of emergency room stabilization of decompensated congestive heart failure with high dose lasix

    Directory of Open Access Journals (Sweden)

    Mahboob Pouraghaei

    2015-06-01

    Full Text Available Objective: Congestive heart failure (CHF has become one of the most important health care problems in western countries. This article focuses on the outpatient diagnosis and management of heart failure. We want to compare the outcome of patients who were treated with high dose diuretics in the emergency department (ED without admission with patients who were admitted to hospital for standard treatment. Methods: This was a randomized prospective clinical trial study. The patients who came to the ED from March 20, 2008 up to August 20, 2008 were divided into two groups randomly. The length of ED stay in the experimental group was documented. Also, readmission and mortality in 6 months and satisfaction in both groups were taken into consideration. All data were analyzed using SPSS 15.0. Results: In experimental group, the rate of recurrent admission, expiration, discharge, clinic visit, and clinic admission was 8%, 4%, 29%, 18%, and 0% respectively. On the other hand, in control group it was 16%, 40%, 18%, 22%, and 2% respectively. Additionally, there was a significant difference between these groups (P = 0.00. Conclusion: This study is the first regional prospective trial to comprehensively examine the therapeutic management in patients with CHF. This study, comparing the high dose diuretic efficacy in the decreasing of hospital stay and readmission; and decreasing mortality rate with routine therapy, showed that there was a significant difference between these two strategies in the mortality rate, readmission, and length of hospital stay (P = 0.00.

  19. Trauma team activation criteria in managing trauma patients at an emergency room in Thailand.

    Science.gov (United States)

    Wuthisuthimethawee, P

    2017-02-01

    Trauma team activation (TTA) criteria were first implemented in the Emergency Department (ED) of Songklanagarind Hospital in 2009 to treat severe trauma patients. To determine the efficacy of the TTA criteria on the acute trauma care process in the ED and the 28-day mortality rate. A 1-year prospective cohort study was conducted at the ED. Trauma patients who were 18 years old and over who met the TTA criteria were enrolled. Demographic data, physiologic parameters, ED length of stay (EDLOS), and the injury severity score (ISS) were recorded. Multiple logistic regression was used to determine the factors affecting 28-day mortality. Institutional review board approval was obtained from the Prince of Songkla University. A total of 80 patients (74 male and 6 female) were eligible with a mean age of 34.3 years old. Shock, penetrating torso injury, and pulse rate >120 beats per minute were the three most common criteria for trauma team consultation. At the ED, 9 patients (11.3 %) were non-survivors, 30 patients (37.5 %) needed immediate operation, and 41 patients (51.2 %) were admitted. All of the arrest patients died (p team activation criteria improved acute trauma care in the ED which was demonstrated by the decreased EDLOS and mortality rate. A high ISS is the sole parameter predicting mortality.

  20. Hemoperitoneum from Corpus Luteal Cyst Rupture: A Practical Approach in Emergency Room

    Directory of Open Access Journals (Sweden)

    Valeria Fiaschetti

    2014-01-01

    Full Text Available Corpus luteum cyst rupture with consequent hemoperitoneum is a common disorder in women in their reproductive age. This condition should be promptly recognized and treated because a delayed diagnosis may significantly reduce women’s fertility and intra-abdominal bleeding may be life-threatening. Many imaging modalities play a key role in the diagnosis of acute pelvic pain from gynecological causes. Ultrasound study (USS is usually the first imaging technique for initial evaluation. USS is used to confirm or to exclude the presence of intraperitoneal fluid but it has some limitations in the identification of the bleeding source. Contrast-enhanced computed tomography (CT is the imaging modality which could be used in the acute setting in order to recognize gynecological emergencies and to establish a correct management. Magnetic resonance imaging (MRI nowadays is the most useful technique for studying the pelvis but its low availability and the long acquisition time of the images limit its usefulness in characterization of acute gynecological complications. We report a case of a young patient with hemoperitoneum from hemorrhagic corpus luteum correctly identified by transabdominal USS and contrast-enhanced CT.

  1. [The Effects of Violence Coping Program Based on Middle-Range Theory of Resilience on Emergency Room Nurses' Resilience, Violence Coping, Nursing Competency and Burnout].

    Science.gov (United States)

    Lee, Seung Min; Sung, Kyung Mi

    2017-06-01

    The purpose of this study was to examine the effects of a violence coping program (VCP) based on Polk's middle-range theory of resilience on nursing competency, resilience, burnout, and the ability to cope with violence in nurses working in emergency rooms. A quasi-experimental study, with a nonequivalent control group and a pretest-posttest design, was conducted. Participants were 36 nurses who worked in emergency rooms and had experienced violence; 18 nurses from D hospital and 18 nurses from C hospital were assigned to the experimental and control groups, respectively. The experimental group received the VCP twice per week for 8 weeks. Levels of resilience, F=59.41, pnursing competency, F=59.41 pburnout, F=52.74, pburnout and improving resilience, active coping behavior, and nursing competency. Therefore, it would be a useful intervention for improving the quality of nursing care provided in emergency rooms. © 2017 Korean Society of Nursing Science

  2. Usefulness of technetium-99m tetrofosmin single-photon emission computed tomography for short-term risk stratification in patients with acute chest pain in the emergency room

    International Nuclear Information System (INIS)

    Kawahito, Michitomo; Kondo, Makoto; Abe, Yoshiteru

    2003-01-01

    High-risk patients with acute coronary syndrome are difficult to distinguish from low-risk patients with chest pain in the emergency room. Technetium-99 m ( 99m Tc) tetrofosmin single-photon emission computed tomography (SPECT) was investigated to exclude high-risk patients with chest pain in the emergency room. 99m Tc-tetrofosmin SPECT was evaluated using a four-point scoring system in 228 patients (144 men, 84 women, mean age 68±12 years) with chest pain. Negative was defined as the myocardial segments with a defect score (DS) of 99m Tc-tetrofosmin; no significance (NS)), 84.9% (NS) and 60.4% (p 99m Tc-tetrofosmin SPECT is a useful method to exclude high-risk patients among patients with chest pain in the emergency room. (author)

  3. One hundred injured patients a day: multicenter emergency room surveillance of trauma in Pakistan.

    Science.gov (United States)

    Hyder, A A; He, S; Zafar, W; Mir, M U; Razzak, J A

    2017-07-01

    Injuries increasingly contribute to the global burden of disease in low- and middle-income countries. This study presents results from a large-scale surveillance study on injury from several urban emergency departments (EDs) in Pakistan. The objective is to document the burden of injuries that present to the healthcare system in Pakistan and to test the feasibility of an ED-based injury and trauma surveillance system. Cross-sectional study conducted using active surveillance approach. This study included EDs of seven tertiary care hospitals in Pakistan. The data were collected between November 2010 and March 2011. All patients presenting with injuries to the participating EDs were enrolled. The study was approved by the Institutional Review Boards of the Johns Hopkins School of Public Health, Aga Khan University, and all participating sites. The study recorded 68,390 patients; 93.8% were from the public hospitals. There were seven male for every three female patients, and 50% were 20-39 years of age. About 69.3% were unintentional injuries. Among injuries with a known mechanism (19,102), 51.1% were road traffic injuries (RTIs) and 17.5% were falls. Female, patients aged 60 years or older, patients transferred by ambulance, patients who had RTIs, and patients with intentional injuries were more likely to be hospitalized. The study is the first to use standardized methods for regular collection of multiple ED data in Pakistan. It explored the pattern of injuries and the feasibility to develop and implement facility-based systems for injury and acute illness in countries like Pakistan. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  4. Association between weather conditions and the number of patients at the emergency room in an Argentine hospital

    Science.gov (United States)

    Rusticucci, Matilde; Bettolli, Laura M.; de los Angeles Harris, M.

    2002-02-01

    The aim of this paper is to study the relationships between hospital emergencies and weather conditions by analysing summer and winter cases of patients requiring attention at the emergency room of a hospital in the city of Buenos Aires, Argentina. Hospital data have been sorted into seven different diagnostic groups as follows: (1) respiratory, cardiovascular and chest-pain complaints; (2) digestive, genitourinary and abdominal complaints; (3) neurological and psychopathological disorders; (4) infections; (5) contusion and crushing, bone and muscle complaints; (6) skin and allergies and (7) miscellaneous complaints. In general, there is an increase of 16.7% in winter while, for group 2 and group 6, there are more patients in summer, 54% and 75% respectively. In summer, the total number of patients for group 6 shows a significant positive correlation with temperature and dew-point temperature, and a negative correlation with the sea-level pressure for the same day. In winter, the same relationship exists, however its correlation is not as strong. The lags observed between these three variables: maximum dew-point temperature, maximum temperature, minimum air pressure and the peaks in admissions are 1, 2 and 4 days respectively. In winter, increases in temperature and dew point and decreases in pressure are followed by a peak in admissions for group 2. In winter, there are significantly more cases in group 5 on warm, dry days and on warm, wet days in the summer.

  5. Differences between Impulsive and Non-Impulsive Suicide Attempts among Individuals Treated in Emergency Rooms of South Korea

    Science.gov (United States)

    Lim, Meerae; Lee, Soojung

    2016-01-01

    Objective A considerable proportion of suicide attempts are the result of sudden desires. Understanding such impulsive suicide attempts is necessary for effective interventions. We evaluated the impulsivity of suicide attempters treated in emergency rooms. The aim of the study was to identify the characteristics of impulsive suicide attempts by comparing these individuals to those who attempted to commit suicide in a non-impulsive manner. Methods This study analyzed suicide attempters who visited the emergency departments of seven selected university hospitals. A total of 269 medical records in which impulsivity of suicide attempt were confirmed were subject to be analyzed. The impulsivity of the suicide attempt was examined using a summative score of items 6 and 15 on the Suicide Intent Scale. Results A total of 48.0% of the participants were impelled by sudden inclinations to attempt suicide. Impulsive attempters were younger, unmarried and less physical illness than non-impulsive attempters, whereas no significant differences were found on psychiatric history and previous suicide history. Impulsive suicide attempters had suicide ideations that were not as severe (χ2=55.33, pimpulsive suicide attempts were better than non-impulsive suicide attempts (t=-3.77, psuicide attempts were the result of sudden inclinations. Impulsive attempts were made in relatively earlier stages of suicide ideation; consequently, they have less intent than non-impulsive attempts. PMID:27482239

  6. Does use of the recognition of stroke in the emergency room stroke assessment tool enhance stroke recognition by ambulance clinicians?

    Science.gov (United States)

    Fothergill, Rachael T; Williams, Julia; Edwards, Melanie J; Russell, Ian T; Gompertz, Patrick

    2013-11-01

    U.K ambulance services assess patients with suspected stroke using the Face Arm Speech Test (FAST). The Recognition Of Stroke In the Emergency Room (ROSIER) tool has been shown superior to the FAST in identifying strokes in emergency departments but has not previously been tested in the ambulance setting. We investigated whether ROSIER use by ambulance clinicians can improve stroke recognition. Ambulance clinicians used the ROSIER in place of the FAST to assess patients with suspected stroke. As the ROSIER includes all FAST elements, we calculated a FAST score from the ROSIER to enable comparisons between the two tools. Ambulance clinicians' provisional stroke diagnoses using the ROSIER and calculated FAST were compared with stroke consultants' diagnosis. We used stepwise logistic regression to compare the contribution of individual ROSIER and FAST items and patient demographics to the prediction of consultants' diagnoses. Sixty-four percent of strokes and 78% of nonstrokes identified by ambulance clinicians using the ROSIER were subsequently confirmed by a stroke consultant. There was no difference in the proportion of strokes correctly detected by the ROSIER or FAST with both displaying excellent levels of sensitivity. The ROSIER detected marginally more nonstroke cases than the FAST, but both demonstrated poor specificity. Facial weakness, arm weakness, seizure activity, age, and sex predicted consultants' diagnosis of stroke. The ROSIER was not better than the FAST for prehospital recognition of stroke. A revised version of the FAST incorporating assessment of seizure activity may improve stroke identification and decision making by ambulance clinicians.

  7. Novel Emergency Medicine Curriculum Utilizing Self-Directed Learning and the Flipped Classroom Method: Genitourinary Emergencies Small Group Module

    Directory of Open Access Journals (Sweden)

    Andrew King

    2017-07-01

    Full Text Available Audience: This curriculum, created and implemented at The Ohio State University Wexner Medical Center, was designed to educate our emergency medicine (EM residents, PGY-1 to PGY-3, as well as medical students. Introduction: In 2013, there were over 6 million Emergency Department visits in the United States which resulted in a primary diagnosis of the genitourinary system. This represents 5.2% of all Emergency Department visits.1 Residents must be proficient in the differential diagnosis and management of the wide variety of genitourinary emergencies. This flipped classroom curricular model emphasizes self-directed learning activities completed by learners, followed by small group discussions pertaining to the topic reviewed. The active learning fostered by this curriculum increases faculty and learner engagement and interaction time typically absent in traditional lecture-based formats.2-4 Studies have revealed that the application of knowledge through case studies, personal interaction with content experts, and integrated questions are effective learning strategies for emergency medicine residents.4-6 The Ohio State University Wexner Medical Center EM Residency didactic curriculum recently transitioned to a “flipped classroom” approach.7-10 We created this innovative curriculum aimed to improve our residency education program and to share educational resources with other EM residency programs. Our curriculum utilizes an 18-month curricular cycle to cover the defined emergency medicine content. The flipped classroom curriculum maximizes didactic time and resident engagement, fosters intellectual curiosity and active learning, and meets the needs of today’s learners. 3,6,11 Objectives: We aim to teach the presentation and management of genitourinary emergencies through the creation of a flipped classroom design. This unique, innovative curriculum utilizes resources chosen by education faculty and resident learners, study questions, real

  8. Novel Emergency Medicine Curriculum Utilizing Self-Directed Learning and the Flipped Classroom Method: Psychiatric Emergencies Small Group Module

    Directory of Open Access Journals (Sweden)

    Andrew King

    2017-07-01

    Full Text Available Audience: This curriculum created and implemented at The Ohio State University Wexner Medical Center was designed to educate our emergency medicine (EM residents, PGY-1 to PGY-3, as well as medical students and attending physicians. Introduction: In 2007, there were 12 million adult Emergency Department visits for mental health and substance abuse complaints. This represents 12.5% of all adult emergency department visits.1 Residents must be proficient in the differential diagnosis and management of the wide variety of psychiatric emergencies. The flipped classroom curricular model emphasizes self-directed learning activities completed by learners, followed by small group discussions pertaining to the topic reviewed. The active learning fostered by this curriculum increases faculty and learner engagement and interaction time typically absent in traditional lecture-based formats.2-4 Studies have revealed that the application of knowledge through case studies, personal interaction with content experts, and integrated questions are effective learning strategies for emergency medicine residents.4-6 The Ohio State University EM Residency didactic curriculum recently transitioned to a “flipped classroom” approach.7-10 We created this innovative curriculum aimed to improve our residency education program and to share educational resources with other EM residency programs. Our curriculum utilizes an 18-month curricular cycle to cover the defined emergency medicine content. The flipped classroom curriculum maximizes didactic time and resident engagement, fosters intellectual curiosity and active learning, and meets the needs of today’s learners. 3,6,11 Objectives: We aim to teach the presentation and management of psychiatric emergencies through the creation of a flipped classroom design. This unique, innovative curriculum utilizes resources chosen by education faculty and resident learners, study questions, real-life experiences, and small group

  9. The use of a metronome during cardiopulmonary resuscitation in the emergency room of a university hospital.

    Science.gov (United States)

    Botelho, Renata Maria de Oliveira; Campanharo, Cássia Regina Vancini; Lopes, Maria Carolina Barbosa Teixeira; Okuno, Meiry Fernanda Pinto; Góis, Aécio Flávio Teixeira de; Batista, Ruth Ester Assayag

    2016-11-21

    to compare the rate of return of spontaneous circulation (ROSC) and death after cardiac arrest, with and without the use of a metronome during cardiopulmonary resuscitation (CPR). case-control study nested in a cohort study including 285 adults who experienced cardiac arrest and received CPR in an emergency service. Data were collected using In-hospital Utstein Style. The control group (n=60) was selected by matching patients considering their neurological condition before cardiac arrest, the immediate cause, initial arrest rhythm, whether epinephrine was used, and the duration of CPR. The case group (n=51) received conventional CPR guided by a metronome set at 110 beats/min. Chi-square and likelihood ratio were used to compare ROSC rates considering p≤0.05. ROSC occurred in 57.7% of the cases, though 92.8% of these patients died in the following 24 hours. No statistically significant difference was found between groups in regard to ROSC (p=0.2017) or the occurrence of death (p=0.8112). the outcomes of patients after cardiac arrest with and without the use of a metronome during CPR were similar and no differences were found between groups in regard to survival rates and ROSC. comparar a taxa de retorno da circulação espontânea e óbito após parada cardiorrespiratória, com e sem a utilização do metrônomo durante ressuscitação cardiopulmonar. estudo caso-controle aninhado a estudo de coorte, com 285 adultos atendidos em parada cardíaca em um serviço de emergência e submetidos à ressuscitação cardiopulmonar. Os dados foram coletados por meio do In-hospital Utstein Style. O grupo controle (n=60) foi selecionado pelo pareamento dos pacientes considerando-se o estado neurológico pré-parada cardiorrespiratória, causa imediata e ritmo inicial da parada, utilização de epinefrina e duração da ressuscitação. O grupo caso (n=51) foi submetido à ressuscitação cardiopulmonar convencional com a utilização do metrônomo a 110sons/min. Para comparar

  10. Emerging Issues in the Utilization of Weblogs in Higher Education Classrooms

    Science.gov (United States)

    Ayao-ao, Shirley

    2014-01-01

    This paper examines the emerging issues in the utilization of weblogs in Philippine higher education and how these issues affect the performance of students. This study used a modified Delphi method. The Delphi panel consisted of 12 experts in the integration of technology, particularly blogs, in their teaching. The study yielded the following…

  11. Perceptions on the Impact of a Just-in-Time Room on Trainees and Supervising Physicians in a Pediatric Emergency Department.

    Science.gov (United States)

    Thomas, Anita A; Uspal, Neil G; Oron, Assaf P; Klein, Eileen J

    2016-12-01

    Just-in-time (JIT) training refers to education occurring immediately prior to clinical encounters. An in situ JIT room in a pediatric emergency department (ED) was created for procedural education. We examined trainee self-reported JIT room use, its impact on trainee self-perception of procedural competence/confidence, and the effect its usage has on the need for intervention by supervising physicians during procedures. Cross-sectional survey study of a convenience sample of residents rotating through the ED and supervising pediatric emergency medicine physicians. Outcomes included JIT room use, trainee procedural confidence, and frequency of supervisor intervention during procedures. Thirty-one of 32 supervising physicians (97%) and 122 of 186 residents (66%) completed the survey, with 71% of trainees reporting improved confidence, and 68% reporting improved procedural skills ( P  < .05, +1.4-point average skills improvement on a 5-point Likert scale). Trainees perceived no difference among supervising physicians intervening in procedures with or without JIT room use ( P  = .30, paired difference -0.0 points). Nearly all supervisors reported improved trainee procedural confidence, and 77% reported improved trainee procedural skills after JIT room use ( P  < .05, paired difference +1.8 points); 58% of supervisors stated they intervene in procedures without trainee JIT room use, compared with 42% with JIT room use ( P  < .05, paired difference -0.4 points). Use of the JIT room led to improved trainee confidence and supervisor reports of less procedural intervention. Although it carries financial and time costs, an in situ JIT room may be important for convenient JIT training.

  12. [Neonatological emergencies in delivery room] [Article in Italian] • Il neonatologo ed alcune emergenze in sala parto

    Directory of Open Access Journals (Sweden)

    Antonio Boldrini

    2014-01-01

    Full Text Available Introduction: In the delivery room the neonatologist may deal with emergencies, not always predictable by pre-natal diagnosis. Among these dangerous situations, we include: i extremely preterm birth of a newborn very/extremely low birth weight and ii shoulder dystocia in term newborns. We will discuss in details these two clinical scenarios. Methods: We reviewed the main recent papers about resuscitation of very/extremely low birth weight preterm newborns and about dystocia of shoulder reported in PubMed database. After that, we compared reported results with practice in our Unit and discussed the topics considering strategies to optimize the results and minimizing possible errors. Discussion and conclusions: In our opinion the optimization of clinical practice in Neonatology should be based on: i national or international recommendations drawn up by commissions or study groups of experts, on the basis of scientific evidence, ii local department protocols, in order to standardize staff interventions within the same unit; iii ongoing training of doctors, nurses and midwives, through simulation sessions and CRM (Crisis Resources Management. As regards shoulder dystocia, The Tuscan Group for Clinical Risk Management drawn a poster to be showed in every delivery room, in order to allow the staff to rapidly remember the correct clinical interventions. On the other hand, as regards ventilatory preterm newborns strategies, the Centro di Formazione e Simulazione NINA is working on a project of a mechatronich simulator for staff training (MERESSINA. Articoli Selezionati del “3° Convegno Pediatrico del Medio Campidano” · Guspini · 25 Maggio 2013 Guest Editor: Roberto Antonucci

  13. Novel Emergency Medicine Curriculum Utilizing Self-Directed Learning and the Flipped Classroom Method: Gastrointestinal Emergencies Small Group Module

    Directory of Open Access Journals (Sweden)

    Andrew King

    2017-01-01

    Full Text Available Audience and type of curriculum: This curriculum created and implemented at The Ohio State University Wexner Medical Center was designed to educate our emergency medicine (EM residents, PGY-1 to PGY-3, as well as medical students and attending physicians. Introduction/Background: Gastrointestinal (GI emergencies comprise approximately 12% of emergency department (ED visits.1 Residents must be proficient in the differential diagnosis and management of the wide variety of GI emergencies. The flipped classroom curricular model emphasizes self-directed learning activities completed by learners, followed by small group discussions pertaining to the topic reviewed. The active learning fostered by this curriculum increases faculty and learner engagement and interaction time typically absent in traditional lecture-based formats.2-4 Studies have revealed that the application of knowledge through case studies, personal interaction with content experts, and integrated questions are effective learning strategies for emergency medicine residents.4-6 The Ohio State University EM Residency didactic curriculum recently transitioned to a “flipped classroom” approach.7-10 We created this innovative curriculum aimed to improve our residency education program and to share educational resources with other EM residency programs. This proposed curriculum utilizes an 18-month curricular cycle. The flipped classroom curriculum maximizes didactic time and resident engagement, fosters intellectual curiosity and active learning, and meets the needs of today’s learners. 3,6,11 Objectives: We aim to teach the presentation and management of GI emergencies through the creation of a flipped classroom design. This unique, innovative curriculum utilizes resources chosen by education faculty and resident learners, study questions, real-life experiences, and small group discussions in place of traditional lectures. In doing so, a goal of the curriculum is to encourage self

  14. Youth Versus Adult “Weightlifting” Injuries Presenting to United States Emergency Rooms: Accidental Versus Nonaccidental Injury Mechanisms

    Science.gov (United States)

    Myer, Gregory D.; Quatman, Carmen E.; Khoury, Jane; Wall, Eric J.; Hewett, Timothy E.

    2014-01-01

    Myer, GD, Quatman, CE, Khoury, J, Wall, EJ, and Hewett, TE. Youth versus adult “weightlifting” injuries presenting to united states emergency rooms: accidental versus nonaccidental injury mechanisms. J Strength Cond Res 23(7): 2054–2060, 2009—Resistance training has previously been purported to be unsafe and ineffective in children. The purpose of this investigation was to evaluate resistance training-related injuries presenting to U.S. emergency rooms by age, type, and mechanism of injury. We hypothesized that older athletes would sustain greater percentages of joint sprains and muscle strains, whereas younger athletes would sustain a greater percentage of accidental injuries that would result in an increased percentage of fractures in youths. The U.S. Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System was queried from 2002 to 2005 using the CPSC code for “Weightlifting.” Subjects between the ages of 8 and 30 were grouped by age categories 8 to 13 (elementary/middle school age), 14 to 18 (high school), 19 to 22 (college), and 23 to 30 (adult). Injuries were classified as “accidental” if caused by dropped weight or improper equipment use. Multiple logistic regression was used to compare accidental injuries between age groups. The sample consisted of 4, 111 patients. Accidental injuries decreased (p 14 to 18 > 19 to 22 years = 23 to 30 years. Conversely, sprain/strain injuries increased in each successive age group (p injuries (n = 2, 565) showed that the oldest categories (19–22 and 23–30 yr) demonstrated a greater percentage of sprains and strains relative to younger age categories (p injuries sustained in the 8 to 13 group were to the hand and foot and were most often related to “dropping” and “pinching” in the injury descriptions, and there was an increased percentage of fractures in the 8 to 13 group relative to all other groups (p injuries are the result of accidents that are potentially

  15. Presence and generation of AC and DC electric fields and small ions in closed rooms as a function of building materials, utilization, and electrical installation

    International Nuclear Information System (INIS)

    Reiter, R.

    1985-01-01

    In the discussion on possible biological effects of natural atmospheric electric fields or electromagnetic radiation it is frequently overlooked that man, under normal living and working conditions in closed rooms, is also exposed to considerable fields of various types and strengths. Therefore an extensive ''inventory'' has been made of such ac and dc fields as they occur in rooms of different construction, utilization, and electrical equipment. Results are presented and discussed, also with respect to biological conditions, including some typical examples from the relevant literature

  16. Evaluation of the Recognition of Stroke in the Emergency Room (ROSIER scale in Chinese patients in Hong Kong.

    Directory of Open Access Journals (Sweden)

    Hui-lin Jiang

    Full Text Available BACKGROUND AND PURPOSE: The objective of this study was to determine the performance of the Recognition Of Stroke In the Emergency Room (ROSIER scale in risk-stratifying Chinese patients with suspected stroke in Hong Kong. METHODS: This was a prospective cohort study in an urban academic emergency department (ED over a 7-month period. Patients over 18 years of age with suspected stroke were recruited between June 2011 and December 2011. ROSIER scale assessment was performed in the ED triage area. Logistic regression analysis was used to estimate the impacts of diagnostic variables, including ROSIER scale, past history and ED characteristics. FINDINGS: 715 suspected stroke patients were recruited for assessment, of whom 371 (52% had acute cerebrovascular disease (302 ischaemic strokes, 24 transient ischaemic attacks (TIA, 45 intracerebral haemorrhages, and 344 (48% had other illnesses i.e. stroke mimics. Common stroke mimics were spinal neuropathy, dementia, labyrinthitis and sepsis. The suggested cut-off score of>0 for the ROSIER scale for stroke diagnosis gave a sensitivity of 87% (95%CI 83-90, a specificity of 41% (95%CI 36-47, a positive predictive value of 62% (95%CI 57-66, and a negative predictive value of 75% (95%CI 68-81, and the AUC was 0.723. The overall accuracy at cut off>0 was 65% i.e. (323+141/715. INTERPRETATION: The ROSIER scale was not as effective at differentiating acute stroke from stroke mimics in Chinese patients in Hong Kong as it was in the original studies, primarily due to a much lower specificity. If the ROSIER scale is to be clinically useful in Chinese suspected stroke patients, it requires further refinement.

  17. Short-term effects of ambient air pollution on emergency room admissions due to cardiovascular causes in Beijing, China

    International Nuclear Information System (INIS)

    Ma, Yuxia; Zhao, Yuxin; Yang, Sixu; Zhou, Jianding; Xin, Jinyuan; Wang, Shigong; Yang, Dandan

    2017-01-01

    Ambient air pollution has been a major global public health issue. A number of studies have shown various adverse effects of ambient air pollution on cardiovascular diseases. In the current study, we investigated the short-term effects of ambient air pollution on emergency room (ER) admissions due to cardiovascular causes in Beijing from 2009 to 2012 using a time-series analysis. A total of 82430 ER cardiovascular admissions were recorded. Different gender (male and female) and age groups (15yrs ≤ age <65 yrs and age ≥ 65 yrs) were also examined by single model and multiple-pollutant model. Three major pollutants (SO 2 , NO 2 and PM 10 ) had lag effects of 0–2 days on cardiovascular ER admissions. The relative risks (95% CI) of per 10 μg/m 3 increase in PM 10 , SO 2 and NO 2 were 1.008 (0.997–1.020), 1.008(0.999–1.018) and 1.014(1.003–1.024), respectively. The effect was more pronounced in age ≥65 and males in Beijing. We also found the stronger acute effects on the elderly and females at lag 0 than on the younger people and males at lag 2. - Highlights: • Significant associations were found between air pollution and emergency admissions of cardiovascular diseases. • Air pollutants had lag effects on age and gender groups. • Stronger effects of air pollutants were observed for age ≥65 yrs and males. • More acute effects of air pollutants were found for age ≥65 yrs and females. - Air pollutants had significant lag effects on different age and gender groups. The effects were more pronounced in age ≥65 and males in Beijing, China.

  18. Epidemiological profile of work-related accidents with biological exposure among medical students in a surgical emergency room.

    Science.gov (United States)

    Reis, Phillipe Geraldo Teixeira de Abreu; Driessen, Anna Luiza; da Costa, Ana Claudia Brenner Affonso; Nasr, Adonis; Collaço, Iwan Augusto; Tomasich, Flávio Daniel Saavedra

    2013-01-01

    To evaluate the accidents with biological material among medical students interning in a trauma emergency room and identify key related situations, attributed causes and prevention. we conducted a study with a quantitative approach. Data were collected through a questionnaire applied via internet, with closed, multiple-choice questions regarding accidents with biological material. The sample comprised 100 students. thirty-two had accidents with biological material. Higher-risk activities were local anesthesia (39.47%), suture (18.42%) and needle recapping (15.79%). The main routes of exposure to biological material were the eyes or mucosa, with 34%, and syringe needle puncture, with 45%. After contamination, only 52% reported the accident to the responsible department. The main causes of accidents and routes of exposure found may be attributed to several factors, such as lack of training and failure to use personal protective equipment. Educational and preventive actions are extremely important to reduce the incidence of accidents with biological materials and improve the conduct of post-exposure. It is important to understand the main causes attributed and situations related, so as general and effective measures can be applied.

  19. Use of the hospital anxiety and depression scale (HADS in a cardiac emergency room: chest pain unit

    Directory of Open Access Journals (Sweden)

    Gastão L. F. Soares-Filho

    2009-03-01

    Full Text Available OBJECTIVE: To determine the prevalence of anxiety and depression in patients complaining of chest pain who seek a chest pain unit attendance. INTRODUCTION: Patients arriving at a Chest Pain Unit may present psychiatric disorders not identified, isolated or co-morbid to the main illness, which may interfere in the patient prognosis. METHODOLOGY: Patients were assessed by the "Hospital Anxiety and Depression Scale" as a screening instrument wile following a systematized protocol to rule out the diagnosis of acute coronary syndrome and other potentially fatal diseases. Patients with 8 or more points in the scale were considered "probable case" of anxiety or depression. RESULTS: According to the protocol, 59 (45.4% of 130 patients studied presented Chest Pain of Determined Cause, and 71 (54.6% presented Chest Pain of Indefinite Cause. In the former group, in which 43 (33.1% had acute coronary syndrome, 33.9% were probable anxiety cases and 30.5% depression cases. In the second group, formed by patients without acute coronary syndrome or any clinical conditions involving greater morbidity and mortality risk, 53.5% were probable anxiety cases and 25.4% depression. CONCLUSION: The high anxiety and depression prevalence observed may indicate the need for early and specialized approach to these disorders. When coronary arterial disease is present, this may decrease complications and shorten hospital stay. When psychiatric disorder appears isolated, is possible to reduce unnecessary repeated visits to emergency room and increase patient's quality of life.

  20. Use of the hospital anxiety and depression scale (HADS) in a cardiac emergency room: chest pain unit.

    Science.gov (United States)

    Soares-Filho, Gastão L F; Freire, Rafael C; Biancha, Karla; Pacheco, Ticiana; Volschan, André; Valença, Alexandre M; Nardi, Antonio E

    2009-01-01

    To determine the prevalence of anxiety and depression in patients complaining of chest pain who seek a chest pain unit attendance. Patients arriving at a Chest Pain Unit may present psychiatric disorders not identified, isolated or co-morbid to the main illness, which may interfere in the patient prognosis. Patients were assessed by the 'Hospital Anxiety and Depression Scale' as a screening instrument wile following a systematized protocol to rule out the diagnosis of acute coronary syndrome and other potentially fatal diseases. Patients with 8 or more points in the scale were considered 'probable case' of anxiety or depression. According to the protocol, 59 (45.4%) of 130 patients studied presented Chest Pain of Determined Cause, and 71 (54.6%) presented Chest Pain of Indefinite Cause. In the former group, in which 43 (33.1%) had acute coronary syndrome, 33.9% were probable anxiety cases and 30.5% depression cases. In the second group, formed by patients without acute coronary syndrome or any clinical conditions involving greater morbidity and mortality risk, 53.5% were probable anxiety cases and 25.4% depression. The high anxiety and depression prevalence observed may indicate the need for early and specialized approach to these disorders. When coronary arterial disease is present, this may decrease complications and shorten hospital stay. When psychiatric disorder appears isolated, is possible to reduce unnecessary repeated visits to emergency room and increase patient's quality of life.

  1. Cortisol at the emergency room rape visit as a predictor of PTSD and depression symptoms over time.

    Science.gov (United States)

    Walsh, Kate; Nugent, Nicole R; Kotte, Amelia; Amstadter, Ananda B; Wang, Sheila; Guille, Constance; Acierno, Ron; Kilpatrick, Dean G; Resnick, Heidi S

    2013-11-01

    Dysregulation of the hypothalamic-pituitary-adrenal axis, typically reflected by alterations in cortisol responsivity, has been associated with exposure to traumatic events and the development of stress-related disorders such as posttraumatic stress disorder (PTSD) and depression. Serum cortisol was measured at the time of a post sexual assault medical exam among a sample of 323 female victims of recent sexual assault. Analyses were conducted among 235 participants who provided data regarding history of previous assault as well as PTSD and depression symptoms during at least one of the three follow-ups. Growth curve models suggested that prior history of assault and serum cortisol were positively associated with the intercept and negatively associated with the slope of PTSD and depression symptoms after controlling for covariates. Prior history of assault and serum cortisol also interacted to predict the intercept and slope of PTSD and depression symptoms such that women with a prior history of assault and lower ER cortisol had higher initial symptoms that decreased at a slower rate relative to women without a prior history and those with higher ER cortisol. Prior history of assault was associated with diminished acute cortisol responsivity at the emergency room visit. Prior assault history and cortisol both independently and interactively predicted PTSD and depression symptoms at first follow-up and over the course a 6-month follow-up. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. Short-term effects of ambient air pollution on emergency room admissions due to cardiovascular causes in Beijing, China.

    Science.gov (United States)

    Ma, Yuxia; Zhao, Yuxin; Yang, Sixu; Zhou, Jianding; Xin, Jinyuan; Wang, Shigong; Yang, Dandan

    2017-11-01

    Ambient air pollution has been a major global public health issue. A number of studies have shown various adverse effects of ambient air pollution on cardiovascular diseases. In the current study, we investigated the short-term effects of ambient air pollution on emergency room (ER) admissions due to cardiovascular causes in Beijing from 2009 to 2012 using a time-series analysis. A total of 82430 ER cardiovascular admissions were recorded. Different gender (male and female) and age groups (15yrs ≤ age pollutant model. Three major pollutants (SO 2 , NO 2 and PM 10 ) had lag effects of 0-2 days on cardiovascular ER admissions. The relative risks (95% CI) of per 10 μg/m 3 increase in PM 10 , SO 2 and NO 2 were 1.008 (0.997-1.020), 1.008(0.999-1.018) and 1.014(1.003-1.024), respectively. The effect was more pronounced in age ≥65 and males in Beijing. We also found the stronger acute effects on the elderly and females at lag 0 than on the younger people and males at lag 2. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Impact of smartphone digital photography, email, and media communication on emergency room visits post-hypospadias repair.

    Science.gov (United States)

    Chua, Michael E; Saunders, Megan A; Bowlin, Paul R; Ming, Jessica M; Lopes, Roberto Iglesias; Farhat, Walid A; Dos Santos, Joana

    2017-01-01

    Advances in communication technology are shaping our medical practice. To date, there is no clear evidence that this mode of communication will have any effect on unnecessary postoperative emergency room (ER) visits. We aim to evaluate the effect of email and media communication with application of smartphone digital photography on post-hypospadias repair ER visit rates. This prospective cohort study included all patients who underwent hypospadias repair performed by a single surgeon from October 2014 to November 2015. Patients were categorized into two groups: Group A consented for smartphone photography and email communication and Group B declined. Reason for ER visits within 30 days postoperatively was assessed by another physician, who was blinded of patient group assignment. The reasons were categorized as: unnecessary ER visit, indicated ER visit, or visit unrelated to hypospadias surgery. Chi-square test and T-test were used for statistical analysis. Relative risk (RR) and corresponding 95% confidence interval (CI) were also calculated. Statistical significance was set at pcommunication with the use of smartphone digital photography significantly reduced the number of unnecessary ER visits for post-hypospadias wound checks.

  4. A study on the drug utilization trends in the cardiovascular emergencies in a tertiary care hospital.

    Science.gov (United States)

    Pendhari, Shabbir Rafiq; Chaudhari, Devendra Ramesh; Burute, Shreyas Ramchandra; Bite, Bapurao Motiram

    2013-04-01

    To observe the cardiovascular emergencies which were most frequently treated and to quantify the drug utilization trends in the cardiovascular emergencies, in terms of the Defined Daily Doses [DDD] and the prescribing prevalence in the cardiovascular emergencies. This prescription based study was undertaken in the Medicine ICU of the government medical hospital. The age, sex, diagnosis (only cardiovascular) and the drugs which were prescribed, were recorded for each patient. Also, the brand names and the generic names of the prescribed drugs were noted. The collected data was analyzed to study the drug utilization trends. It was observed that the most commonly treated cardiovascular disease was IHD. The IHD was more in males than in females who were below 50 years of age and it was nearly equal in the age groups which were above 50 years. The use of Angiotensin Converting Enzyme (ACE) inhibitors was higher than that of the beta blockers and the calcium channel blockers. The patients with cardiovascular emergencies also had preceding associated diseases like diabetes mellitus and hypertension. The protocol of the management which was followed by the college in the treatment of cardiovascular emergencies was competent enough, as the clinical outcomes of the patients were favourable. But there was a guideline incongruent prescribing behaviour which was statistically significant, for which there is a need to undertake large scale studies.

  5. The role of utilities in enabling technology innovation: The BC hydro alternative & emerging energy strategy

    Energy Technology Data Exchange (ETDEWEB)

    Tu, Alex; Leclair, Donna; Morrison, Allison

    2010-09-15

    In order for renewable energy to play a dominant role in the global electricity supply mix, emerging renewable energy technologies - such as wave, tidal, enhanced geothermal, and 3rd generation photovoltaic technologies - must prove their technical merits and achieve cost parity with conventional sources of supply. BC Hydro, a government-owned electric utility, launched an Alternative and Emerging Energy Strategy that describes its role as an enabler of technology innovation. This paper describes BC Hydro's goal, objectives and actions to accelerate the commercialization that will yield a diversity of supply options and a growing, local clean-tech cluster.

  6. A System Dynamics Approach to Modeling the Sensitivity of Inappropriate Emergency Department Utilization

    Science.gov (United States)

    Behr, Joshua G.; Diaz, Rafael

    Non-urgent Emergency Department utilization has been attributed with increasing congestion in the flow and treatment of patients and, by extension, conditions the quality of care and profitability of the Emergency Department. Interventions designed to divert populations to more appropriate care may be cautiously received by operations managers due to uncertainty about the impact an adopted intervention may have on the two values of congestion and profitability. System Dynamics (SD) modeling and simulation may be used to measure the sensitivity of these two, often-competing, values of congestion and profitability and, thus, provide an additional layer of information designed to inform strategic decision making.

  7. Community emergency department utilization following a natural disaster (the Goderich Tornado).

    Science.gov (United States)

    Appavoo, Samuel D; Khemlin, Alexander; Appavoo, Donna M; Flynn, Candi J

    2016-01-01

    On 21 August 2011 an F3 tornado hit the Canadian town of Goderich, Ontario, leaving 40 people injured and one dead. Specific medium-term changes in utilization of health care following a disaster have not been analyzed in medical literature. Documenting the emergency department utilization through this subacute period would be helpful to enable institutions and healthcare practitioners to be better prepared for future events. A medical chart review was conducted at the Alexandra Marine and General Hospital in Goderich. All emergency department visits made during the 30 days after the Tornado in 2011 (intervention group), 30 days prior to the tornado in 2011 (primary control group), and during the similar calendar period of 30 days after the tornado in 2010 (seasonal control group) were reviewed. Medical diagnoses of all patients who presented at the emergency department were collected and compared. Fewer people presented to the emergency department following the tornado than during the control periods, and those who did were significantly older than those who presented in the control periods (pptornado in a rural Ontario community. This information serves to inform the medical community and other hospitals how to increase their level of preparedness should a comparable disaster occur again in the future.

  8. Association between birth order and emergency room visits and acute hospital admissions following pediatric vaccination: a self-controlled study.

    Science.gov (United States)

    Hawken, Steven; Kwong, Jeffrey C; Deeks, Shelley L; Crowcroft, Natasha S; Ducharme, Robin; Manuel, Douglas G; Wilson, Kumanan

    2013-01-01

    We investigated the association between a child's birth order and emergency room (ER) visits and hospital admissions following 2-,4-,6- and 12-month pediatric vaccinations. We included all children born in Ontario between April 1(st), 2006 and March 31(st), 2009 who received a qualifying vaccination. We identified vaccinations, ER visits and admissions using health administrative data housed at the Institute for Clinical Evaluative Sciences. We used the self-controlled case series design to compare the relative incidence (RI) of events among 1(st)-born and later-born children using relative incidence ratios (RIR). For the 2-month vaccination, the RIR for 1(st)-borns versus later-born children was 1.37 (95% CI: 1.19-1.57), which translates to 112 additional events/100,000 vaccinated. For the 4-month vaccination, the RIR for 1(st)-borns vs. later-borns was 1.70 (95% CI: 1.45-1.99), representing 157 additional events/100,000 vaccinated. At 6 months, the RIR for 1(st) vs. later-borns was 1.27 (95% CI: 1.09-1.48), or 77 excess events/100,000 vaccinated. At the 12-month vaccination, the RIR was 1.11 (95% CI: 1.02-1.21), or 249 excess events/100,000 vaccinated. Birth order is associated with increased incidence of ER visits and hospitalizations following vaccination in infancy. 1(st)-born children had significantly higher relative incidence of events compared to later-born children.

  9. Association between birth order and emergency room visits and acute hospital admissions following pediatric vaccination: a self-controlled study.

    Directory of Open Access Journals (Sweden)

    Steven Hawken

    Full Text Available OBJECTIVE: We investigated the association between a child's birth order and emergency room (ER visits and hospital admissions following 2-,4-,6- and 12-month pediatric vaccinations. METHODS: We included all children born in Ontario between April 1(st, 2006 and March 31(st, 2009 who received a qualifying vaccination. We identified vaccinations, ER visits and admissions using health administrative data housed at the Institute for Clinical Evaluative Sciences. We used the self-controlled case series design to compare the relative incidence (RI of events among 1(st-born and later-born children using relative incidence ratios (RIR. RESULTS: For the 2-month vaccination, the RIR for 1(st-borns versus later-born children was 1.37 (95% CI: 1.19-1.57, which translates to 112 additional events/100,000 vaccinated. For the 4-month vaccination, the RIR for 1(st-borns vs. later-borns was 1.70 (95% CI: 1.45-1.99, representing 157 additional events/100,000 vaccinated. At 6 months, the RIR for 1(st vs. later-borns was 1.27 (95% CI: 1.09-1.48, or 77 excess events/100,000 vaccinated. At the 12-month vaccination, the RIR was 1.11 (95% CI: 1.02-1.21, or 249 excess events/100,000 vaccinated. CONCLUSIONS: Birth order is associated with increased incidence of ER visits and hospitalizations following vaccination in infancy. 1(st-born children had significantly higher relative incidence of events compared to later-born children.

  10. Current practices in the management of patients with ureteral calculi in the emergency room of a university hospital

    Directory of Open Access Journals (Sweden)

    Oliver Rojas Claros

    2012-01-01

    Full Text Available OBJECTIVE: Urinary lithiasis is a common disease. The aim of the present study is to assess the knowledge regarding the diagnosis, treatment and recommendations given to patients with ureteral colic by professionals of an academic hospital. MATERIALS AND METHODS: Sixty-five physicians were interviewed about previous experience with guidelines regarding ureteral colic and how they manage patients with ureteral colic in regards to diagnosis, treatment and the information provided to the patients. RESULTS: Thirty-six percent of the interviewed physicians were surgeons, and 64% were clinicians. Forty-one percent of the physicians reported experience with ureterolithiasis guidelines. Seventy-two percent indicated that they use noncontrast CT scans for the diagnosis of lithiasis. All of the respondents prescribe hydration, primarily for the improvement of stone elimination (39.3%. The average number of drugs used was 3.5. The combination of nonsteroidal anti-inflammatory drugs and opioids was reported by 54% of the physicians (i.e., 59% of surgeons and 25.6% of clinicians used this combination of drugs (p = 0.014. Only 21.3% prescribe alpha blockers. CONCLUSION: Reported experience with guidelines had little impact on several habitual practices. For example, only 21.3% of the respondents indicated that they prescribed alpha blockers; however, alpha blockers may increase stone elimination by up to 54%. Furthermore, although a meta-analysis demonstrated that hydration had no effect on the transit time of the stone or on the pain, the majority of the physicians reported that they prescribed more than 500 ml of fluid. Dipyrone, hyoscine, nonsteroidal anti-inflammatory drugs, and opioids were identified as the most frequently prescribed drug combination. The information regarding the time for the passage of urinary stones was inconsistent. The development of continuing education programs regarding ureteral colic in the emergency room is necessary.

  11. Do we still need autopsy in times of modern multislice computed tomography?-Missed diagnoses in the emergency room.

    Science.gov (United States)

    Euler, S A; Kastenberger, T; Attal, R; Rieger, M; Blauth, M; Petri, M

    2017-01-01

    In spite of increasing quality of emergency room (ER) assessment in trauma patients and improved accuracy of modern multislice computed tomography (MSCT), the number of potentially missed diagnoses is still controversial. The aim of this study was to compare the initial findings of ER assessment and MSCT to the findings during autopsy in trauma patients not surviving the first 48 h after admission. We hypothesized that autopsy was more accurate than MSCT in diagnosing potentially fatal diagnoses. Between January 2004 and September 2007, all trauma patients undergoing ER treatment in our institution who deceased within 48 h after admission were analyzed regarding diagnoses from initial ER assessment, including MSCT, and diagnoses from autopsy. Data were prospectively collected and retrospectively analyzed. Autopsy reports were compared to diagnoses of ER assessment and MSCT. Missed diagnoses (MD) and missed potentially fatal diagnoses (MPFD) were analyzed. Seventy-three patients with a mean age of 53.2 years were included into the study. Sixty-three percent were male. Autopsy revealed at least one missed diagnosis in 25% of the patients, with the thoracic area accounting for 67% of these. At least one MPFD was found in 4.1% of the patients, all of them being located in the thorax. Total numbers of MD and MPFD were significantly lower for the newer CT generation (64 MSCT, N = 11), compared to older one (4 MSCT, N = 26). As determined by autopsy, modern multislice computed tomography is an accurate method to diagnose injuries. However, 25% of all diagnoses, and 4.1% of potentially fatal diagnoses are still missed in trauma patients, who deceased within the first 48 h after admission. Therefore, autopsy seems to be necessary to determine potentially missed diagnoses for both academic and medicolegal reasons as well as for quality control.

  12. The interaction effects of temperature and humidity on emergency room visits for respiratory diseases in Beijing, China.

    Science.gov (United States)

    Su, Qin; Liu, Hongsheng; Yuan, Xiaoling; Xiao, Yan; Zhang, Xian; Sun, Rongju; Dang, Wei; Zhang, Jianbo; Qin, Yuhong; Men, Baozhong; Zhao, Xiaodong

    2014-11-01

    Few epidemiological studies have been reported as to whether there was any interactive effect between temperature and humidity on respiratory morbidity, especially in Asian countries. The present study used time-series analysis to explore the modification effects of humidity on the association between temperature and emergency room (ER) visits for respiratory, upper respiratory tract infection (URI), pneumonia, and bronchitis in Beijing between 2009 and 2011. Results showed that an obvious joint effect of temperature and humidity was revealed on ER visits for respiratory, URI, pneumonia, and bronchitis. Below temperature threshold, the temperature effect was stronger in low humidity level and presented a trend fall with humidity level increase. The effect estimates per 1 °C increase in temperature in low humidity level were -2.88 % (95 % confidence interval (CI) -3.08, -2.67) for all respiratory, -3.24 % (-3.59, -2.88) for URI, -1.48 % (-1.93, -1.03) for pneumonia, and -3.79 % (-4.37, -3.21) for bronchitis ER visits, respectively. However, above temperature threshold, temperature effect was greater in high humidity level and trending upward with humidity level increasing. In high humidity level, a 1 °C increase in temperature, the effect estimates were 1.84 % (1.55, 2.13) for all respiratory, 1.76 % (1.41, 2.11) for URI, and 7.48 % (4.41, 10.65) for bronchitis ER visits. But, there was no statistically significant for pneumonia. This suggests that the modifying effects of the humidity should be considered when analyzing health impacts of temperature.

  13. Effects of Air Pollution on Hospital Emergency Room Visits for Respiratory Diseases: Urban-Suburban Differences in Eastern China

    Directory of Open Access Journals (Sweden)

    Peng Liu

    2016-03-01

    Full Text Available A study on the relationships between ambient air pollutants (PM2.5, SO2 and NO2 and hospital emergency room visits (ERVs for respiratory diseases from 2013 to 2014 was performed in both urban and suburban areas of Jinan, a heavily air-polluted city in Eastern China. This research was analyzed using generalized additive models (GAM with Poisson regression, which controls for long-time trends, the “day of the week” effect and meteorological parameters. An increase of 10 μg/m3 in PM2.5, SO2 and NO2 corresponded to a 1.4% (95% confidence interval (CI: 0.7%, 2.1%, 1.2% (95% CI: 0.5%, 1.9%, and 2.5% (95%: 0.8%, 4.2% growth in ERVs for the urban population, respectively, and a 1.5% (95%: 0.4%, 2.6%, 0.8% (95%: −0.7%, 2.3%, and 3.1% (95%: 0.5%, 5.7% rise in ERVs for the suburban population, respectively. It was found that females were more susceptible than males to air pollution in the urban area when the analysis was stratified by gender, and the reverse result was seen in the suburban area. Our results suggest that the increase in ERVs for respiratory illnesses is linked to the levels of air pollutants in Jinan, and there may be some urban-suburban discrepancies in health outcomes from air pollutant exposure.

  14. The Effect of Continuity of Care on Emergency Room Use for Diabetic Patients Varies by Disease Severity

    Directory of Open Access Journals (Sweden)

    Chia-Hsiang Hsu

    2016-08-01

    Full Text Available Background: Although many studies have reported that high-quality continuity of care (COC is associated with improved patient outcomes for patients with diabetes, few studies have investigated whether this positive effect of COC depends on the level of diabetes severity. Methods: A total of 3781 newly diagnosed diabetic patients selected from the 2005 National Health Insurance database were evaluated for the period 2005–2011. Generalized estimating equations combined with negative binomial estimation were used to determine the influence of COC on the overall emergency room (ER use and diabetes mellitus (DM-specific ER use. Analyses were stratified according to diabetes severity (measured using the Diabetes Complications Severity Index [DCSI], comorbidities (measured using the Charlson comorbidity score, and age. Results: COC effects varied according to diabetes severity. Stratified analysis showed that the positive effect of COC on DM-specific ER use was the highest for a DCSI of 0 (least severe, with an incidence rate ratio (IRR of 0.49 (95% CI, 0.41–0.59 in the high-COC group (reference group: low-COC group. Compared with the low-COC group, high-quality COC had a significant beneficial effect on overall ER use in younger patients (IRR 0.51; 95% CI, 0.39–0.66 for the youngest [18–40 years] group, and IRR 0.67; 95% CI, 0.59–0.76 for the oldest [>65 years] group and those with a high number of comorbidities. Conclusions: The positive effects of high-quality COC on the treatment outcomes of patient with diabetes, based on the overall and DM-specific ER use, depends on the level of disease severity. Therefore, providing health education to enhance high-quality COC when the disease severity is low may be critical for ensuring optimal positive effects during diabetes disease progression.

  15. Fine Particulate Air Pollution and Hospital Emergency Room Visits for Respiratory Disease in Urban Areas in Beijing, China, in 2013.

    Directory of Open Access Journals (Sweden)

    Qin Xu

    Full Text Available Heavy fine particulate matter (PM2.5 air pollution occurs frequently in China. However, epidemiological research on the association between short-term exposure to PM2.5 pollution and respiratory disease morbidity is still limited. This study aimed to explore the association between PM2.5 pollution and hospital emergency room visits (ERV for total and cause-specific respiratory diseases in urban areas in Beijing.Daily counts of respiratory ERV from Jan 1 to Dec 31, 2013, were obtained from ten general hospitals located in urban areas in Beijing. Concurrently, data on PM2.5 were collected from the Beijing Environmental Protection Bureau, including 17 ambient air quality monitoring stations. A generalized-additive model was used to explore the respiratory effects of PM2.5, after controlling for confounding variables. Subgroup analyses were also conducted by age and gender.A total of 92,464 respiratory emergency visits were recorded during the study period. The mean daily PM2.5 concentration was 102.1±73.6 μg/m3. Every 10 μg/m3 increase in PM2.5 concentration at lag0 was associated with an increase in ERV, as follows: 0.23% for total respiratory disease (95% confidence interval [CI]: 0.11%-0.34%, 0.19% for upper respiratory tract infection (URTI (95%CI: 0.04%-0.35%, 0.34% for lower respiratory tract infection (LRTI (95%CI: 0.14%-0.53% and 1.46% for acute exacerbation of chronic obstructive pulmonary disease (AECOPD (95%CI: 0.13%-2.79%. The strongest association was identified between AECOPD and PM2.5 concentration at lag0-3 (3.15%, 95%CI: 1.39%-4.91%. The estimated effects were robust after adjusting for SO2, O3, CO and NO2. Females and people 60 years of age and older demonstrated a higher risk of respiratory disease after PM2.5 exposure.PM2.5 was significantly associated with respiratory ERV, particularly for URTI, LRTI and AECOPD in Beijing. The susceptibility to PM2.5 pollution varied by gender and age.

  16. Fine Particulate Air Pollution and Hospital Emergency Room Visits for Respiratory Disease in Urban Areas in Beijing, China, in 2013.

    Science.gov (United States)

    Xu, Qin; Li, Xia; Wang, Shuo; Wang, Chao; Huang, Fangfang; Gao, Qi; Wu, Lijuan; Tao, Lixin; Guo, Jin; Wang, Wei; Guo, Xiuhua

    2016-01-01

    Heavy fine particulate matter (PM2.5) air pollution occurs frequently in China. However, epidemiological research on the association between short-term exposure to PM2.5 pollution and respiratory disease morbidity is still limited. This study aimed to explore the association between PM2.5 pollution and hospital emergency room visits (ERV) for total and cause-specific respiratory diseases in urban areas in Beijing. Daily counts of respiratory ERV from Jan 1 to Dec 31, 2013, were obtained from ten general hospitals located in urban areas in Beijing. Concurrently, data on PM2.5 were collected from the Beijing Environmental Protection Bureau, including 17 ambient air quality monitoring stations. A generalized-additive model was used to explore the respiratory effects of PM2.5, after controlling for confounding variables. Subgroup analyses were also conducted by age and gender. A total of 92,464 respiratory emergency visits were recorded during the study period. The mean daily PM2.5 concentration was 102.1±73.6 μg/m3. Every 10 μg/m3 increase in PM2.5 concentration at lag0 was associated with an increase in ERV, as follows: 0.23% for total respiratory disease (95% confidence interval [CI]: 0.11%-0.34%), 0.19% for upper respiratory tract infection (URTI) (95%CI: 0.04%-0.35%), 0.34% for lower respiratory tract infection (LRTI) (95%CI: 0.14%-0.53%) and 1.46% for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) (95%CI: 0.13%-2.79%). The strongest association was identified between AECOPD and PM2.5 concentration at lag0-3 (3.15%, 95%CI: 1.39%-4.91%). The estimated effects were robust after adjusting for SO2, O3, CO and NO2. Females and people 60 years of age and older demonstrated a higher risk of respiratory disease after PM2.5 exposure. PM2.5 was significantly associated with respiratory ERV, particularly for URTI, LRTI and AECOPD in Beijing. The susceptibility to PM2.5 pollution varied by gender and age.

  17. Scheduling elective surgeries: the tradeoff among bed capacity, waiting patients and operating room utilization using goal programming.

    Science.gov (United States)

    Li, Xiangyong; Rafaliya, N; Baki, M Fazle; Chaouch, Ben A

    2017-03-01

    Scheduling of surgeries in the operating rooms under limited competing resources such as surgical and nursing staff, anesthesiologist, medical equipment, and recovery beds in surgical wards is a complicated process. A well-designed schedule should be concerned with the welfare of the entire system by allocating the available resources in an efficient and effective manner. In this paper, we develop an integer linear programming model in a manner useful for multiple goals for optimally scheduling elective surgeries based on the availability of surgeons and operating rooms over a time horizon. In particular, the model is concerned with the minimization of the following important goals: (1) the anticipated number of patients waiting for service; (2) the underutilization of operating room time; (3) the maximum expected number of patients in the recovery unit; and (4) the expected range (the difference between maximum and minimum expected number) of patients in the recovery unit. We develop two goal programming (GP) models: lexicographic GP model and weighted GP model. The lexicographic GP model schedules operating rooms when various preemptive priority levels are given to these four goals. A numerical study is conducted to illustrate the optimal master-surgery schedule obtained from the models. The numerical results demonstrate that when the available number of surgeons and operating rooms is known without error over the planning horizon, the proposed models can produce good schedules and priority levels and preference weights of four goals affect the resulting schedules. The results quantify the tradeoffs that must take place as the preemptive-weights of the four goals are changed.

  18. Utilization of Emergency Medical Service Increases Chance of Thrombolytic Therapy in Patients with Acute Ischemic Stroke

    Science.gov (United States)

    Hsieh, Ming-Ju; Tang, Sung-Chun; Chiang, Wen-Chu; Huang, Kuang-Yu; Chang, Anna Marie; Ko, Patrick Chow-In; Tsai, Li-Kai; Jeng, Jiann-Shing; Ma, Matthew Huei-Ming

    2014-01-01

    Objective To determine whether utilization of emergency medical service (EMS) can expedite and improve the rate of thrombolytic therapy administration in acute ischemic stroke patients. Methods This is a prospective observational study of consecutive patients presenting to the emergency department (ED) with an ischemic stroke within 72 hours of symptom onset. Variables associated with early ED arrival (within 3 hours of stroke onset), and administration of thrombolytic therapy were analyzed. We also evaluated the factors related to onset-to-needle time in patients receiving thrombolytic therapy. Results From January 1, 2010 to July 31, 2011, there were 1081 patients (62.3% men, age 69.6 ± 13 years) included in this study. Among them, 289 (26.7%) arrived in the ED within 3 hours, and 88 (8.1%) received intravenous thrombolytic therapy. Patients who arrived to the ED by EMS (n=279, 25.8 %) were independently associated with earlier ED arrival (adjusted odds ratio [OR] = 3.68, 95% confidence interval [CI] = 2.54 to 5.33), and higher chance of receiving thrombolytic therapy (adjusted OR = 3.89, 95% CI= 1.86 to 8.17). Furthermore, utilization of EMS decreased onset-to-needle time by 26 minutes in patients receiving thrombolytic therapy. Conclusion Utilization of EMS can help acute ischemic stroke patients in early presentation to ED, facilitate thrombolytic therapy, and reduce the onset to needle time. PMID:24296308

  19. Case report: treatment of subdural hematoma in the emergency department utilizing the subdural evacuating port system.

    Science.gov (United States)

    Asfora, Wilson T; Klapper, Hendrik B

    2013-08-01

    Patients with acute or chronic subdural hematomas may present with rapidly deteriorating neurological function and are at risk for irreversible brainstem injury. In such cases, rapid surgical intervention is required to evacuate the hematoma and reverse critically elevated intracranial pressure. A variety of surgical drainage methods are in existence, none of which are clearly superior to the others. This report presents the case of a 74-year-old woman who suffered an acute-on-chronic subdural hematoma which was evacuated in the emergency department utilizing the subdural evacuating port system (SEPS). The SEPS provides for a minimally invasive technique to drain subdural hematomas and is advantageous in that it can be performed at the bedside. The SEPS is relatively simple to use and may be especially useful to emergency department staff in outlying areas where there is a shortage of neurosurgical coverage.

  20. Association between temperature and emergency room visits for cardiorespiratory diseases, metabolic syndrome-related diseases, and accidents in metropolitan Taipei.

    Science.gov (United States)

    Wang, Yu-Chun; Lin, Yu-Kai

    2014-01-01

    This study evaluated risks of the emergency room visits (ERV) for cerebrovascular diseases, heart diseases, ischemic heart disease, hypertensive diseases, chronic renal failure (CRF), diabetes mellitus (DM), asthma, chronic airway obstruction not elsewhere classified (CAO), and accidents associated with the ambient temperature from 2000 to 2009 in metropolitan Taipei. The distributed lag non-linear model was used to estimate the cumulative relative risk (RR) and confidence interval (CI) of cause-specific ERV associated with daily temperature from lag 0 to lag 3 after controlling for potential confounders. This study identified that temperatures related to the lowest risk of ERV was 26 °C for cerebrovascular diseases, 18 °C for CRF, DM, and accidents, and 30 °C for hypertensive diseases, asthma, and CAO. These temperatures were used as the reference temperatures to measure RR for the corresponding diseases. A low temperature (14°C) increased the ERV risk for cerebrovascular diseases, hypertensive diseases, and asthma, with respective cumulative 4-day RRs of 1.56 (95% CI: 1.23, 1.97), 1.78 (95% CI: 1.37, 2.34), and 2.93 (95% CI: 1.26, 6.79). The effects were greater on, or after, lag one. At 32°C, the cumulative 4-day RR for ERV was significant for CRF (RR = 2.36; 95% CI: 1.33, 4.19) and accidents (RR = 1.23; 95% CI: 1.14, 1.33) and the highest RR was seen on lag 0 for CRF (RR = 1.69; 95% CI: 1.01, 3.58), DM (RR = 1.69; 95% CI: 1.09, 2.61), and accidents (RR = 1.19; 95% CI: 1.11, 1.27). Higher temperatures are associated with the increased ERV risks for CRF, DM, and accidents and lower temperatures with the increased ERV risks for cerebrovascular diseases, hypertensive diseases, and asthma in the subtropical metropolitan.

  1. Methodology for the identification of the factors that can influence the performance of operators of nuclear power plants control room under emergency situations

    International Nuclear Information System (INIS)

    Paiva, Bernardo Spitz; Santos, Isaac J.A. Luquetti

    2009-01-01

    In order to minimize the human errors of the operators in a nuclear power plan control room, during emergency situations, it has to be considered the factors which affect the human performance. Work situations adequately projected, compatible with the necessities, capacities and human limitations, taking into consideration the factors which affect the operator performance . This paper aims to develop a methodology for identification of the factors affecting the operator performance under emergency situation, using the aspects defined by the human reliability analysis focusing the judgment done by specialists

  2. Trends in Adult Cancer-Related Emergency Department Utilization: An Analysis of Data From the Nationwide Emergency Department Sample.

    Science.gov (United States)

    Rivera, Donna R; Gallicchio, Lisa; Brown, Jeremy; Liu, Benmei; Kyriacou, Demetrios N; Shelburne, Nonniekaye

    2017-10-12

    The emergency department (ED) is used to manage cancer-related complications among the 15.5 million people living with cancer in the United States. However, ED utilization patterns by the population of US adults with cancer have not been previously evaluated or described in published literature. To estimate the proportion of US ED visits made by adults with a cancer diagnosis, understand the clinical presentation of adult patients with cancer in the ED, and examine factors related to inpatient admission within this population. Nationally representative data comprised of 7 survey cycles (January 2006-December 2012) from the Nationwide Emergency Department Sample were analyzed. Identification of adult (age ≥18 years) cancer-related visits was based on Clinical Classifications Software diagnoses documented during the ED visit. Weighted frequencies and proportions of ED visits among adult patients with cancer by demographic, geographic, and clinical characteristics were calculated. Weighted multivariable logistic regression was used to examine the associations between inpatient admission and key demographic and clinical variables for adult cancer-related ED visits. Adult cancer-related ED utilization patterns; identification of primary reason for ED visit; patient-related factors associated with inpatient admission from the ED. Among an estimated 696 million weighted adult ED visits from January 2006 to December 2012, 29.5 million (4.2%) were made by a patient with a cancer diagnosis. The most common cancers associated with an ED visit were breast, prostate, and lung cancer, and most common primary reasons for visit were pneumonia (4.5%), nonspecific chest pain (3.7%), and urinary tract infection (3.2%). Adult cancer-related ED visits resulted in inpatient admissions more frequently (59.7%) than non-cancer-related visits (16.3%) (P adults, breast, prostate, and lung cancer were the most common cancer diagnoses presenting to the ED. Pneumonia was the most common

  3. Emergency Medical Service (EMS) Utilization by Syrian Refugees Residing in Ankara, Turkey.

    Science.gov (United States)

    Altıner, Ali Osman; Yeşil, Sıdıka Tekeli

    2018-04-01

    Introduction Many Syrians have left their country and migrated to other countries since March 2011, due to the civil war. As of March 2016, a total of 2,747,946 Syrian refugees had immigrated to Turkey. Some Syrian refugees have been living in camps, while 2,475,134 have been living in metropolitan areas, such as Ankara. Study Objective This study investigated Emergency Medical Service (EMS) utilization among Syrian refugees residing in Ankara. This study was a descriptive, cross-sectional database analysis using data obtained from the Department of EMS of the Ankara Provincial Health Directorate. Five stations in the Altındağ region of Ankara responded to 42% of all calls from Syrian refugees. Prehospital EMS in Ankara have been used mostly by Syrian refugees younger than 18-years-old. Study findings also suggest that medical staff in regions where Syrian refugees are likely to be treated should be supported and provided with the ability to overcome language barriers and cultural differences. Altıner AO , Tekeli Yeşil S . Emergency Medical Service (EMS) utilization by Syrian refugees residing in Ankara, Turkey. Prehosp Disaster Med. 2018;33(2):160-164.

  4. Secure Utilization of Beacons and UAVs in Emergency Response Systems for Building Fire Hazard.

    Science.gov (United States)

    Seo, Seung-Hyun; Choi, Jung-In; Song, Jinseok

    2017-09-25

    An intelligent emergency system for hazard monitoring and building evacuation is a very important application area in Internet of Things (IoT) technology. Through the use of smart sensors, such a system can provide more vital and reliable information to first-responders and also reduce the incidents of false alarms. Several smart monitoring and warning systems do already exist, though they exhibit key weaknesses such as a limited monitoring coverage and security, which have not yet been sufficiently addressed. In this paper, we propose a monitoring and emergency response method for buildings by utilizing beacons and Unmanned Aerial Vehicles (UAVs) on an IoT security platform. In order to demonstrate the practicability of our method, we also implement a proof of concept prototype, which we call the UAV-EMOR (UAV-assisted Emergency Monitoring and Response) system. Our UAV-EMOR system provides the following novel features: (1) secure communications between UAVs, smart sensors, the control server and a smartphone app for security managers; (2) enhanced coordination between smart sensors and indoor/outdoor UAVs to expand real-time monitoring coverage; and (3) beacon-aided rescue and building evacuation.

  5. The Effect of Medicaid Expansion on Utilization in Maryland Emergency Departments.

    Science.gov (United States)

    Klein, Eili Y; Levin, Scott; Toerper, Matthew F; Makowsky, Michael D; Xu, Tim; Cole, Gai; Kelen, Gabor D

    2017-11-01

    A proposed benefit of expanding Medicaid eligibility under the Patient Protection and Affordable Care Act (ACA) was a reduction in emergency department (ED) utilization for primary care needs. Pre-ACA studies found that new Medicaid enrollees increased their ED utilization rates, but the effect on system-level ED visits was less clear. Our objective was to estimate the effect of Medicaid expansion on aggregate and individual-based ED utilization patterns within Maryland. We performed a retrospective cross-sectional study of ED utilization patterns across Maryland, using data from Maryland's Health Services Cost Review Commission. We also analyzed utilization differences between pre-ACA (July 2012 to December 2013) uninsured patients who returned post-ACA (July 2014 to December 2015). The total number of ED visits in Maryland decreased by 36,531 (-1.2%) between the 6 quarters pre-ACA and the 6 quarters post-ACA. Medicaid-covered ED visits increased from 23.3% to 28.9% (159,004 additional visits), whereas uninsured patient visits decreased from 16.3% to 10.4% (181,607 fewer visits). Coverage by other insurance types remained largely stable between periods. We found no significant relationship between Medicaid expansion and changes in ED volume by hospital. For patients uninsured pre-ACA who returned post-ACA, the adjusted visits per person during 6 quarters was 2.38 (95% confidence interval 2.35 to 2.40) for those newly enrolled in Medicaid post-ACA compared with 1.66 (95% confidence interval 1.64 to 1.68) for those remaining uninsured. There was a substantial increase in patients covered by Medicaid in the post-ACA period, but this did not significantly affect total ED volume. Returning patients newly enrolled in Medicaid visited the ED more than their uninsured counterparts; however, this cohort accounted for only a small percentage of total ED visits in Maryland. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights

  6. (Non-)utilization of pre-hospital emergency care by migrants and non-migrants in Germany.

    Science.gov (United States)

    Kietzmann, Diana; Knuth, Daniela; Schmidt, Silke

    2017-01-01

    This study was designed to explore the utilization and non-utilization of pre-hospital emergency care by migrants and non-migrants, and the factors that influence this behaviour. A cross-sectional representative German survey was conducted in a sample of 2.175 people, 295 of whom had a migration background. An additional sample of 50 people with Turkish migration background was conducted, partially in the Turkish language. Apart from socio-demographics, the utilization of emergency services and the reasons for non-utilization were assessed. Migrants had a higher utilization rate of pre-hospital emergency care (RR = 1.492) than non-migrants. Furthermore, migrants who were not born in Germany had a lower utilization rate (RR = 0.793) than migrants who were born in Germany. Regarding non-utilization, the most frequently stated reasons belonged to the categories initial misjudgment of the emergency situation and acting on one's own behalf, with the latter stated more frequently by migrants than by non-migrants. To prevent over-, under-, and lack of supply, it is necessary to transfer knowledge about the functioning of the medical emergency services, including first aid knowledge.

  7. Knowledge of the management of paediatric dental traumas by non-dental professionals in emergency rooms in South Araucanía, Temuco, Chile.

    Science.gov (United States)

    Díaz, Jaime; Bustos, Luís; Herrera, Samira; Sepulveda, Jaqueline

    2009-12-01

    The objective of this study was to investigate the level of knowledge and attitudes regarding first aid for dental trauma in children (TDI) by non-dental professionals and paramedical technicians of hospital emergency rooms in the South Araucanía Health Service, Chile, which was attained through application of a survey. Samples were collected from people with occupations in the respective emergency rooms. The participants were 82 people that were interviewed using a questionnaire regarding management of dental trauma. Paramedic technicians, general and specialist doctors, and nurses were included in this survey. The appraisal covered diverse aspects: birth date, age, sex, years of experience in the emergency room, and questions regarding specific dental trauma topics, which focused on crown fractures, luxation injuries in permanent dentition, avulsion in primary and permanent teeth, and the respective emergency treatments. Of the participants, 78.1% reported to have been presented with a TDI patient. The majority (90.2%) had not received formal training on TDI. These results revealed a wide distribution of responses. The overall dental trauma knowledge among the participants was relatively poor. For crown fractures management 54.9% indicated that they would ask the affected child about the crown remnants. In regard to transport and storage medium of avulsed permanent teeth, only 9.8% of the participants answered correctly and 43.9% of respondents stated that they would not replant an avulsed permanent tooth, since that procedure is considered the responsibility of a dentist. The majority of the respondents were not knowledgeable regarding TDI or the management and benefits of timely care, particularly in cases of avulsed permanent teeth. Therefore, formal education and training on the topic is suggested during undergraduate studies.

  8. Variables associated with emergency department and/or unplanned hospital utilization for children with epilepsy.

    Science.gov (United States)

    Patel, Anup D

    2014-02-01

    In the United States, approximately one million people are evaluated annually in an emergency department (ED) for the diagnosis of a seizure or epilepsy. The highest percentages of these patients are less than five years of age. No studies have been performed on assessing potential variables associated with recurrent ED visits and/or unplanned hospitalizations for children with epilepsy. Institutional review board approval from Nationwide Children's Hospital was obtained prior to study initiation. An accountable care organization (ACO), Partner for Kids (PFK), database was searched for patients with the highest and the lowest number of ED visits and/or unplanned hospitalizations from 2007 through 2011 using ICD-9 codes of 345.xx and 780.39. The patients were stratified into a high and a low utilizer group. The total number of visits and their associated health care costs were noted for each patient. In total, 120 patients were included for review. Information on the total number of no-shows to outpatient neurology clinic visits and telephone calls to neurology triage nursing was noted. A chart review was performed by a pediatric epileptologist to determine if each individual patient was an appropriate candidate for an emergency seizure treatment. The dose of emergency seizure medication was cross-checked to the patient's actual dose during the time of ED or hospital presentation to determine if the dose given was high, low, or accurate based on dosing recommendations. Multivariable logistic regression was used to test the effects of factors. When controlling for other factors, patients who were given an incorrect or no emergency seizure dosing had a high probability of having multiple ED visits/unplanned hospitalizations compared with patients who were given correct dosing (odds ratio=11.28, 95% CI of odds ratio=(2.42, 52.63), p valuechildren with epilepsy. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. Impact of Superstorm Sandy on Medicare Patients’ Utilization of Hospitals and Emergency Departments

    Directory of Open Access Journals (Sweden)

    Benoit Stryckman

    2017-09-01

    Full Text Available Introduction: National health security requires that healthcare facilities be prepared to provide rapid, effective emergency and trauma care to all patients affected by a catastrophic event. We sought to quantify changes in healthcare utilization patterns for an at-risk Medicare population before, during, and after Superstorm Sandy’s 2012 landfall in New Jersey (NJ. Methods: This study is a retrospective cohort study of Medicare beneficiaries impacted by Superstorm Sandy. We compared hospital emergency department (ED and healthcare facility inpatient utilization in the weeks before and after Superstorm Sandy landfall using a 20% random sample of Medicare fee-for-service beneficiaries continuously enrolled in 2011 and 2012 (N=224,116. Outcome measures were pre-storm discharges (or transfers, average length of stay, service intensity weight, and post-storm ED visits resulting in either discharge or hospital admission. Results: In the pre-storm week, hospital transfers from skilled nursing facilities (SNF increased by 39% and inpatient discharges had a 0.3 day decreased mean length of stay compared to the prior year. In the post-storm week, ED visits increased by 14% statewide; of these additional “surge” patients, 20% were admitted to the hospital. The increase in ED demand was more than double the statewide average in the most highly impacted coastal regions (35% versus 14%. Conclusion: Superstorm Sandy impacted both pre- and post-storm patient movement in New Jersey; post-landfall ED surge was associated with overall storm impact, which was greatest in coastal counties. A significant increase in the number and severity of pre-storm transfer patients, in particular from SNF, as well as in post-storm ED visits and inpatient admissions, draws attention to the importance of collaborative regional approaches to healthcare in large-scale events.

  10. Impact of Superstorm Sandy on Medicare Patients' Utilization of Hospitals and Emergency Departments.

    Science.gov (United States)

    Stryckman, Benoit; Walsh, Lauren; Carr, Brendan G; Hupert, Nathaniel; Lurie, Nicole

    2017-10-01

    National health security requires that healthcare facilities be prepared to provide rapid, effective emergency and trauma care to all patients affected by a catastrophic event. We sought to quantify changes in healthcare utilization patterns for an at-risk Medicare population before, during, and after Superstorm Sandy's 2012 landfall in New Jersey (NJ). This study is a retrospective cohort study of Medicare beneficiaries impacted by Superstorm Sandy. We compared hospital emergency department (ED) and healthcare facility inpatient utilization in the weeks before and after Superstorm Sandy landfall using a 20% random sample of Medicare fee-for-service beneficiaries continuously enrolled in 2011 and 2012 (N=224,116). Outcome measures were pre-storm discharges (or transfers), average length of stay, service intensity weight, and post-storm ED visits resulting in either discharge or hospital admission. In the pre-storm week, hospital transfers from skilled nursing facilities (SNF) increased by 39% and inpatient discharges had a 0.3 day decreased mean length of stay compared to the prior year. In the post-storm week, ED visits increased by 14% statewide; of these additional "surge" patients, 20% were admitted to the hospital. The increase in ED demand was more than double the statewide average in the most highly impacted coastal regions (35% versus 14%). Superstorm Sandy impacted both pre- and post-storm patient movement in New Jersey; post-landfall ED surge was associated with overall storm impact, which was greatest in coastal counties. A significant increase in the number and severity of pre-storm transfer patients, in particular from SNF, as well as in post-storm ED visits and inpatient admissions, draws attention to the importance of collaborative regional approaches to healthcare in large-scale events.

  11. Impact of Superstorm Sandy on Medicare Patients’ Utilization of Hospitals and Emergency Departments

    Science.gov (United States)

    Stryckman, Benoit; Walsh, Lauren; Carr, Brendan G.; Hupert, Nathaniel; Lurie, Nicole

    2017-01-01

    Introduction National health security requires that healthcare facilities be prepared to provide rapid, effective emergency and trauma care to all patients affected by a catastrophic event. We sought to quantify changes in healthcare utilization patterns for an at-risk Medicare population before, during, and after Superstorm Sandy’s 2012 landfall in New Jersey (NJ). Methods This study is a retrospective cohort study of Medicare beneficiaries impacted by Superstorm Sandy. We compared hospital emergency department (ED) and healthcare facility inpatient utilization in the weeks before and after Superstorm Sandy landfall using a 20% random sample of Medicare fee-for-service beneficiaries continuously enrolled in 2011 and 2012 (N=224,116). Outcome measures were pre-storm discharges (or transfers), average length of stay, service intensity weight, and post-storm ED visits resulting in either discharge or hospital admission. Results In the pre-storm week, hospital transfers from skilled nursing facilities (SNF) increased by 39% and inpatient discharges had a 0.3 day decreased mean length of stay compared to the prior year. In the post-storm week, ED visits increased by 14% statewide; of these additional “surge” patients, 20% were admitted to the hospital. The increase in ED demand was more than double the statewide average in the most highly impacted coastal regions (35% versus 14%). Conclusion Superstorm Sandy impacted both pre- and post-storm patient movement in New Jersey; post-landfall ED surge was associated with overall storm impact, which was greatest in coastal counties. A significant increase in the number and severity of pre-storm transfer patients, in particular from SNF, as well as in post-storm ED visits and inpatient admissions, draws attention to the importance of collaborative regional approaches to healthcare in large-scale events. PMID:29085534

  12. Conhecimento sobre anticoagulantes orais e seu manejo por médicos de pronto atendimento Emergency-room doctors' knowledge about oral anticoagulants and its management

    Directory of Open Access Journals (Sweden)

    Larissa Periotto Borlina

    2010-06-01

    Full Text Available Contexto: Desde sua descoberta, os anticoagulantes orais (AO têm sido cada vez mais estudados e aplicados em diferentes doenças. No entanto, eles apresentam reações medicamentosas com fármacos que trazem riscos ao paciente. Objetivo: Identificar o nível de conhecimento dos médicos plantonistas de pronto atendimento sobre os AO e suas interações, medicamentosas ou não, e verificar se o médico frentista está preparado para integrar o conteúdo teórico com a rotina de urgências. Método: Aplicou-se um questionário a 100 médicos atuantes em pronto atendimentos de dois hospitais públicos e três privados em Curitiba. Visou-se saber se o médico frentista questiona ao paciente sobre o uso de AO. Também, avaliou-se o conhecimento do profissional e seu interesse em saber mais sobre: AO (quais deles conhecia; exames para controle; sinergismo com AO; e manejo das complicações. Resultados: Dos 100 entrevistados, 60% declararam perguntar ao paciente sobre o uso de AO, 81% tinham conhecimento insuficiente a respeito do sinergismo de algumas substâncias apresentadas e os AO, 15% desconheciam qual exame é utilizado para acompanhamento dos pacientes anticoagulados, 50,7% não sabiam os nomes comercias dos AO, 4% desconheciam seu antídoto, e 92% manifestaram interesse em melhorar seus conhecimentos sobre os AO. Conclusão: É BAIXo o número de médicos que atende em pronto atendimentos que conhece sobre os AO e que sabe manejar pacientes anticoagulados. É alta a porcentagem de médicos que não perguntam aos pacientes sobre o uso de AO e que desconhecem princípios do sinergismo medicamentoso, sendo que a maioria se interessou em melhorar seus conhecimentos sobre os anticoagulantes.Background: Since its discovery, oral anticoagulants (OA have been increasingly studied and used to treat different diseases. However, OA may cause adverse drug interactions that bring risks for patients. Objective: To identify the emergency room doctors

  13. FRAMEWORK AND APPLICATION FOR MODELING CONTROL ROOM CREW PERFORMANCE AT NUCLEAR POWER PLANTS

    Energy Technology Data Exchange (ETDEWEB)

    Ronald L Boring; David I Gertman; Tuan Q Tran; Brian F Gore

    2008-09-01

    This paper summarizes an emerging project regarding the utilization of high-fidelity MIDAS simulations for visualizing and modeling control room crew performance at nuclear power plants. The key envisioned uses for MIDAS-based control room simulations are: (i) the estimation of human error associated with advanced control room equipment and configurations, (ii) the investigative determination of contributory cognitive factors for risk significant scenarios involving control room operating crews, and (iii) the certification of reduced staffing levels in advanced control rooms. It is proposed that MIDAS serves as a key component for the effective modeling of cognition, elements of situation awareness, and risk associated with human performance in next generation control rooms.

  14. FRAMEWORK AND APPLICATION FOR MODELING CONTROL ROOM CREW PERFORMANCE AT NUCLEAR POWER PLANTS

    International Nuclear Information System (INIS)

    Ronald L Boring; David I Gertman; Tuan Q Tran; Brian F Gore

    2008-01-01

    This paper summarizes an emerging project regarding the utilization of high-fidelity MIDAS simulations for visualizing and modeling control room crew performance at nuclear power plants. The key envisioned uses for MIDAS-based control room simulations are: (1) the estimation of human error associated with advanced control room equipment and configurations, (2) the investigative determination of contributory cognitive factors for risk significant scenarios involving control room operating crews, and (3) the certification of reduced staffing levels in advanced control rooms. It is proposed that MIDAS serves as a key component for the effective modeling of cognition, elements of situation awareness, and risk associated with human performance in next generation control rooms

  15. National Trends in the Utilization of Emergency Medical Services for Acute Myocardial Infarction and Stroke

    Directory of Open Access Journals (Sweden)

    Katie Tataris

    2014-11-01

    Full Text Available Introduction: The emergency medical services (EMS system plays a crucial role in the chain of survival for acute myocardial infarction (AMI and stroke. While regional studies have shown underutilization of the 911 system for these time-sensitive conditions, national trends have not been studied. Our objective was to describe the national prevalence of EMS use for AMI and stroke, examine trends over a six-year period, and identify patient factors that may contribute to utilization. Methods: Using the National Hospital Ambulatory Medical Care Survey-ED (NHAMCS dataset from 2003-2009, we looked at patients with a discharge diagnosis of AMI or stroke who arrived to the emergency department (ED by ambulance. We used a survey-weighted χ2 test for trend and logistic regression analysis. Results: In the study, there were 442 actual AMI patients and 220 (49.8% presented via EMS. There were 1,324 actual stroke patients and 666 (50.3% presented via EMS. There was no significant change in EMS usage for AMI or stroke over the six-year period. Factors independently associated with EMS use for AMI and stroke included age (OR 1.21; 95% CI 1.12-1.31, Non-Hispanic black race (OR 1.72; 95% CI 1.16-2.29, and nursing home residence (OR 11.50; 95% CI 6.19-21.36. Conclusion: In a nationally representative sample of ED visits from 20003-2009, there were no trends of increasing EMS use for AMI and stroke. Efforts to improve access to care could focus on patient groups that underutilize the EMS system for such conditions. [West J Emerg Med. 2014;15(7:–0.

  16. Utilization of the emergency department by older residents in Kuala Lumpur, Malaysia.

    Science.gov (United States)

    Mohd Mokhtar, Mohd Amin; Pin, Tan Maw; Zakaria, Mohd Idzwan; Hairi, Noran Naqiah; Kamaruzzaman, Shahrul Bahiyah; Vyrn, Chin Ai; Hua, Philip Poi Jun

    2015-08-01

    To determine the pattern of utilization of emergency department (ED) services by older patients in Kuala Lumpur, Malaysia, compared with younger patients in the same setting. The sociodemographics, clinical characteristics and resource utilization of consecutive patients attending the adult ED at the University Malaya Medical Center were recorded during a typical week. A total of 1649 patients were included in the study; 422/1649 (25.6%) were aged ≥60 years and 1077 (74.4%) were aged Older adult patients were more likely to be diagnosed with ischemic heart disease (12.6% vs 2.5%, P older adults remained an independent predictor of hospital admission (OR 2.75, 95% CI 2.11-3.57). The ratio of older adult patients attending our ED over the proportion of older people in the general population was 26:6, which is far higher than reported in previous published studies carried out in other countries. Older ED attenders are also more likely to require investigations, procedures and hospital admissions. With the rapidly aging population in Malaysia, reconfiguration of resources will need to occur at a compatible rate in order to ensure that the healthcare needs of our older adults are met. © 2014 Japan Geriatrics Society.

  17. Utilization of head CT during injury visits to United States emergency departments: 2012-2015.

    Science.gov (United States)

    Yun, Brian J; Borczuk, Pierre; Zachrison, Kori S; Goldstein, Joshua N; Berlyand, Yosef; Raja, Ali S

    2018-05-18

    Studies have shown increasing utilization of head computed tomography (CT) imaging of emergency department (ED) patients presenting with an injury-related visit. Multiple initiatives, including the Choosing Wisely™ campaign and evidence-based clinical decision support based on validated decision rules, have targeted head CT use in patients with injuries. Therefore, we investigated national trends in the use of head CT during injury-related ED visits from 2012 to 2015. This was a secondary analysis of data from the annual United States (U.S.) National Hospital Ambulatory Medical Care Survey from 2012 to 2015. The study population was defined as injury-related ED visits, and we sought to determine the percentage in which a head CT was ordered and, secondarily, to determine both the diagnostic yield of clinically significant intracranial findings and hospital characteristics associated with increased head CT utilization. Between 2012 and 2015, 12.25% (95% confidence interval [CI] 11.48-13.02%) of injury-related visits received at least one head CT. Overall head CT utilization showed an increased trend during the study period (2012: 11.7%, 2015: 13.23%, p = 0.09), but the results were not statistically significant. The diagnostic yield of head CT for a significant intracranial injury over the period of four years was 7.4% (9.68% in 2012 vs. 7.67% in 2015, p = 0.23). Head CT use along with diagnostic yield has remained stable from 2012 to 2015 among patients presenting to the ED for an injury-related visit. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Does Orthopaedic Outpatient Care Reduce Emergency Department Utilization After Total Joint Arthroplasty?

    Science.gov (United States)

    Chaudhary, Muhammad Ali; Lange, Jeffrey K; Pak, Linda M; Blucher, Justin A; Barton, Lauren B; Sturgeon, Daniel J; Koehlmoos, Tracey; Haider, Adil H; Schoenfeld, Andrew J

    2018-05-22

    Emergency department (ED) visits after elective surgical procedures are a potential target for interventions to reduce healthcare costs. More than 1 million total joint arthroplasties (TJAs) are performed each year with postsurgical ED utilization estimated in the range of 10%. We asked whether (1) outpatient orthopaedic care was associated with reduced ED utilization and (2) whether there were identifiable factors associated with ED utilization within the first 30 and 90 days after TJA. An analysis of adult TRICARE beneficiaries who underwent TJA (2006-2014) was performed. TRICARE is the insurance program of the Department of Defense, covering > 9 million beneficiaries. ED use within 90 days of surgery was the primary outcome and postoperative outpatient orthopaedic care the primary explanatory variable. Patient demographics (age, sex, race, beneficiary category), clinical characteristics (length of hospital stay, prior comorbidities, complications), and environment of care were used as covariates. Logistic regression adjusted for all covariates was performed to determine factors associated with ED use. We found that orthopaedic outpatient care (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.68-0.77) was associated with lower odds of ED use within 90 days. We also found that index hospital length of stay (OR, 1.07; 95% CI, 1.04-1.10), medical comorbidities (OR, 1.16; 95% CI, 1.08-1.24), and complications (OR, 2.47; 95% CI, 2.24-2.72) were associated with higher odds of ED use. When considering that at 90 days, only 3928 patients sustained a complication, a substantial number of ED visits (11,486 of 15,414 [75%]) after TJA may be avoidable. Enhancing access to appropriate outpatient care with improved discharge planning may reduce ED use after TJA. Further research should be directed toward unpacking the situations, outside of complications, that drive patients to access the ED and devise interventions that could mitigate such behavior. Level III

  19. A Patient-Centered Emergency Department Management Strategy for Sickle-Cell Disease Super-Utilizers.

    Science.gov (United States)

    Simpson, Grant G; Hahn, Hallie R; Powel, Alex A; Leverence, Robert R; Morris, Linda A; Thompson, Lara G; Zumberg, Marc S; Borde, Deepa J; Tyndall, Joseph A; Shuster, Jonathan J; Yealy, Donald M; Allen, Brandon R

    2017-04-01

    A subpopulation of sickle-cell disease patients, termed super-utilizers, presents frequently to emergency departments (EDs) for vaso-occlusive events and may consume disproportionate resources without broader health benefit. To address the healthcare needs of this vulnerable patient population, we piloted a multidisciplinary intervention seeking to create and use individualized patient care plans that alter utilization through coordinated care. Our goals were to assess feasibility primarily, and to assess resource use secondarily. We evaluated the effects of a single-site interventional study targeted at a population of adult sickle-cell disease super-utilizers using a pre- and post-implementation design. The pre-intervention period was 06/01/13 to 12/31/13 (seven months) and the post-intervention period was 01/01/14 to 02/28/15 (14 months). Our approach included patient-specific best practice advisories (BPA); an ED management protocol; and formation of a "medical home" for these patients. For 10 subjects targeted initially we developed and implemented coordinated care plans; after deployment, we observed a tendency toward reduction in ED and inpatient utilization across all measured indices. Between the annualized pre- and post-implementation periods we found the following: ED visits decreased by 16.5 visits/pt-yr (95% confidence interval [CI] [-1.32-34.2]); ED length of state (LOS) decreased by 115.3 hours/pt-yr (95% CI [-82.9-313.5]); in-patient admissions decreased by 4.20 admissions/pt-yr (95% CI [-1.73-10.1]); in-patient LOS decreased by 35.8 hours/pt-yr (95% CI [-74.9-146.7]); and visits where the patient left before treatment were reduced by an annualized total of 13.7 visits. We observed no patient mortality in our 10 subjects, and no patient required admission to the intensive care unit 72 hours following discharge. This effort suggests that a targeted approach is both feasible and potentially effective, laying a foundation for broader study.

  20. Lack of utility of a decision support system to mitigate delays in admission from the operating room to the postanesthesia care unit.

    Science.gov (United States)

    Ehrenfeld, Jesse M; Dexter, Franklin; Rothman, Brian S; Minton, Betty Sue; Johnson, Diane; Sandberg, Warren S; Epstein, Richard H

    2013-12-01

    When the phase I postanesthesia care unit (PACU) is at capacity, completed cases need to be held in the operating room (OR), causing a "PACU delay." Statistical methods based on historical data can optimize PACU staffing to achieve the least possible labor cost at a given service level. A decision support process to alert PACU charge nurses that the PACU is at or near maximum census might be effective in lessening the incidence of delays and reducing over-utilized OR time, but only if alerts are timely (i.e., neither too late nor too early to act upon) and the PACU slot can be cleared quickly. We evaluated the maximum potential benefit of such a system, using assumptions deliberately biased toward showing utility. We extracted 3 years of electronic PACU data from a tertiary care medical center. At this hospital, PACU admissions were limited by neither inadequate PACU staffing nor insufficient PACU beds. We developed a model decision support system that simulated alerts to the PACU charge nurse. PACU census levels were reconstructed from the data at a 1-minute level of resolution and used to evaluate if subsequent delays would have been prevented by such alerts. The model assumed there was always a patient ready for discharge and an available hospital bed. The time from each alert until the maximum census was exceeded ("alert lead time") was determined. Alerts were judged to have utility if the alert lead time fell between various intervals from 15 or 30 minutes to 60, 75, or 90 minutes after triggering. In addition, utility for reducing over-utilized OR time was assessed using the model by determining if 2 patients arrived from 5 to 15 minutes of each other when the PACU census was at 1 patient less than the maximum census. At most, 23% of alerts arrived 30 to 60 minutes prior to the admission that resulted in the PACU exceeding the specified maximum capacity. When the notification window was extended to 15 to 90 minutes, the maximum utility was system to mitigate

  1. Prognostic Utility of a Modified HEART Score in Chest Pain Patients in the Emergency Department.

    Science.gov (United States)

    McCord, James; Cabrera, Rafael; Lindahl, Bertil; Giannitsis, Evangelos; Evans, Kaleigh; Nowak, Richard; Frisoli, Tiberio; Body, Richard; Christ, Michael; deFilippi, Christopher R; Christenson, Robert H; Jacobsen, Gordon; Alquezar, Aitor; Panteghini, Mauro; Melki, Dina; Plebani, Mario; Verschuren, Franck; French, John; Bendig, Garnet; Weiser, Silvia; Mueller, Christian

    2017-02-01

    The TRAPID-AMI trial study (High-Sensitivity Troponin-T Assay for Rapid Rule-Out of Acute Myocardial Infarction) evaluated high-sensitivity cardiac troponin-T (hs-cTnT) in a 1-hour acute myocardial infarction (AMI) exclusion algorithm. Our study objective was to evaluate the prognostic utility of a modified HEART score (m-HS) within this trial. Twelve centers evaluated 1282 patients in the emergency department for possible AMI from 2011 to 2013. Measurements of hs-cTnT (99th percentile, 14 ng/L) were performed at 0, 1, 2, and 4 to 14 hours. Evaluation for major adverse cardiac events (MACEs) occurred at 30 days (death or AMI). Low-risk patients had an m-HS≤3 and had either hs-cTnT<14 ng/L over serial testing or had AMI excluded by the 1-hour protocol. By the 1-hour protocol, 777 (60%) patients had an AMI excluded. Of those 777 patients, 515 (66.3%) patients had an m-HS≤3, with 1 (0.2%) patient having a MACE, and 262 (33.7%) patients had an m-HS≥4, with 6 (2.3%) patients having MACEs (P=0.007). Over 4 to 14 hours, 661 patients had a hs-cTnT<14 ng/L. Of those 661 patients, 413 (62.5%) patients had an m-HS≤3, with 1 (0.2%) patient having a MACE, and 248 (37.5%) patients had an m-HS≥4, with 5 (2.0%) patients having MACEs (P=0.03). Serial testing of hs-cTnT over 1 hour along with application of an m-HS identified a low-risk population that might be able to be directly discharged from the emergency department. © 2017 American Heart Association, Inc.

  2. Demographic, Operational, and Healthcare Utilization Factors Associated with Emergency Department Patient Satisfaction

    Science.gov (United States)

    Morgan, Matthew W.; Salzman, Joshua G.; LeFevere, Robert C.; Thomas, Avis J.; Isenberger, Kurt M.

    2015-01-01

    Introduction The primary aim of this study was to determine which objectively-measured patient demographics, emergency department (ED) operational characteristics, and healthcare utilization frequencies (care factors) were associated with patient satisfaction ratings obtained from phone surveys conducted by a third-party vendor for patients discharged from our ED. Methods This is a retrospective, observational analysis of data obtained between September 2011 and August 2012 from all English- and Spanish-speaking patients discharged from our ED who were contacted by a third-party patient satisfaction vendor to complete a standardized nine-item telephone survey by a trained phone surveyor. We linked data from completed surveys to the patient’s electronic medical record to abstract additional demographic, ED operational, and healthcare utilization data. We used univariate ordinal logistic regression, followed by two multivariate models, to identify significant predictors of patient satisfaction. Results We included 20,940 patients for analysis. The overall patient satisfaction ratings were as follows: 1=471 (2%); 2=558 (3%); 3=2,014 (10%), 4=5,347 (26%); 5=12,550 (60%). Factors associated with higher satisfaction included race/ethnicity (Non-Hispanic Black; Hispanic patients), age (patients ≥65), insurance (Medicare), mode of arrival (arrived by bus or on foot), and having a medication ordered in the ED. Patients who felt their medical condition did not improve, those treated in our ED behavioral health area, and those experiencing longer wait times had reduced satisfaction. Conclusion These findings provide a basis for development and evaluation of targeted interventions that could be used to improve patient satisfaction in our ED. PMID:26265963

  3. Proposed protocol for realization of abdominal CT in patients admitted to the emergency room for trauma in HSJD

    International Nuclear Information System (INIS)

    Quesada Cascante, Lizbeth

    2013-01-01

    A protocol is established for computed tomography in trauma patients treated in emergency of Hospital San Juan de Dios. A literature review is conducted on abdominal CT protocols in specialized databases. The criteria, scanning, parameters and delay time are established for realization of abdominal CT in patients with traumatic emergencies in HSJD. Taking the thickness of the sections, the thickness of the sections in reconstruction, the quantities of contrast and the speed of injection in patients, have been standardized for the realization of abdominal CT in HSJD. Computed tomography should be preferably performed of routine in portal phase and the late from 5 minutes in patients with abdominal trauma, contributing in this phase as much information regarding the extent of abdominal injury [es

  4. Crisis Resource Management in the Delivery Room: Development of Behavioral Markers for Team Performance in Emergency Simulation.

    Science.gov (United States)

    Bracco, Fabrizio; de Tonetti, Gabriele; Masini, Michele; Passarelli, Marcello; Geretto, Francesca; Celleno, Danilo

    2018-03-03

    Human factors are the most relevant issues contributing to adverse events in obstetrics. Specific training of Crisis Resource Management (CRM) skills (i.e., problem solving and team management, resource allocation, awareness of environment, and dynamic decision-making) is now widespread and is often based on High Fidelity Simulation. In order to be used as a guideline in simulated scenarios, CRM skills need to be mapped to specific and observable behavioral markers. For this purpose, we developed a set of observable behaviors related to the main elements of CRM in the delivery room. The observational tool was then adopted in a two-days seminar on obstetric hemorrhage where teams working in obstetric wards of six Italian hospitals took part in simulations. The tool was used as a guide for the debriefing and as a peer-to-peer feedback. It was then rated for its usefulness in facilitating the reflection upon one's own behavior, its ease of use, and its usefulness for the peer-to-peer feedback. The ratings were positive, with a median of 4 on a 5-point scale. The CRM observational tool has therefore been well-received and presents a promising level of inter-rater agreement. We believe the tool could have value in facilitating debriefing and in the peer-to-peer feedback.

  5. Crisis Resource Management in the Delivery Room: Development of Behavioral Markers for Team Performance in Emergency Simulation

    Directory of Open Access Journals (Sweden)

    Fabrizio Bracco

    2018-03-01

    Full Text Available Human factors are the most relevant issues contributing to adverse events in obstetrics. Specific training of Crisis Resource Management (CRM skills (i.e., problem solving and team management, resource allocation, awareness of environment, and dynamic decision-making is now widespread and is often based on High Fidelity Simulation. In order to be used as a guideline in simulated scenarios, CRM skills need to be mapped to specific and observable behavioral markers. For this purpose, we developed a set of observable behaviors related to the main elements of CRM in the delivery room. The observational tool was then adopted in a two-days seminar on obstetric hemorrhage where teams working in obstetric wards of six Italian hospitals took part in simulations. The tool was used as a guide for the debriefing and as a peer-to-peer feedback. It was then rated for its usefulness in facilitating the reflection upon one’s own behavior, its ease of use, and its usefulness for the peer-to-peer feedback. The ratings were positive, with a median of 4 on a 5-point scale. The CRM observational tool has therefore been well-received and presents a promising level of inter-rater agreement. We believe the tool could have value in facilitating debriefing and in the peer-to-peer feedback.

  6. Simulation of emergency response operations for a static chemical spill within a building using an opportunistic resource utilization network

    NARCIS (Netherlands)

    Lilien, L.T.; Elbes, M.W.; Ben Othmane, L.; Salih, R.M.

    2013-01-01

    We investigate supporting emergency response operations with opportunistic resource utilization networks ("oppnets"), based on a network paradigm for inviting and integrating diverse devices and systems available in the environment. We simulate chemical spill on a single floor of a building and

  7. Qualitative Study to Understand Ordering of CT Angiography to Diagnose Pulmonary Embolism in the Emergency Room Setting.

    Science.gov (United States)

    Gyftopoulos, Soterios; Smith, Silas W; Simon, Emma; Kuznetsova, Masha; Horwitz, Leora I; Makarov, Danil V

    2017-10-19

    To better understand the decision making behind the ordering of CT pulmonary angiography (CTPA) for the diagnosis of pulmonary embolism (PE) in the emergency department. We conducted semistructured interviews with our institution's emergency medicine (EM) providers and radiologists who read CTPAs performed in the emergency department. We employed the Theoretical Domains Framework-a formal, structured approach used to better understand the motivations and beliefs of physicians surrounding a complex medical decision making-to categorize the themes that arose from our interviews. EM providers were identified as the main drivers of CTPA ordering. Both EM and radiologist groups perceived the radiologist's role as more limited. Experience- and gestalt-based heuristics were the most important factors driving this decision and more important, in many cases, than established algorithms for CTPA ordering. There were contrasting views on the value of d-dimer in the suspected PE workup, with EM providers finding this test less useful than radiologists. EM provider and radiologist suggestions for improving the appropriateness of CTPA ordering consisted of making this process more arduous and incorporating d-dimer tests and prediction rules into a decision support tool. EM providers were the main drivers of CTPA ordering, and there was a marginalized role for the radiologist. Experience- and gestalt-based heuristics were the main influencers of CTPA ordering. Our findings suggest that a more nuanced intervention than simply including a d-dimer and a prediction score in each preimaging workup may be necessary to curb overordering of CTPA in patients suspected of PE. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  8. Human factor analysis related to new symptom based procedures used by control room crews during treatment of emergency states

    International Nuclear Information System (INIS)

    Holy, J.

    1999-01-01

    New symptom based emergency procedures have been developed for Nuclear Power Plant Dukovany in the Czech Republic. As one point of the process of verification and validation of the procedures, a specific effort was devoted to detailed analysis of the procedures from human factors and human reliability point of view. The course and results of the analysis are discussed in this article. Although the analyzed procedures have been developed for one specific plant of WWER-440/213 type, most of the presented results may be valid for many other procedures recently developed for semi-automatic control of those technological units which are operated under measurable level of risk. (author)

  9. Tratamento da cefaléia em uma unidade de emergência da cidade de Ribeirão Preto Headache treatment in an emergency room of the city of Ribeirão Preto, Brazil

    Directory of Open Access Journals (Sweden)

    MARCELO EDUARDO BIGAL

    1999-09-01

    Full Text Available Cefaléia é dos sintomas mais comuns na prática clínica. Acarreta considerável impacto econômico e sobrecarrega as unidades de emergência. A maioria destas, em nosso país, não dispõe de triptans. O presente estudo analisa o tratamento instituído na Unidade de Emergência do Hospital das Clínicas de Ribeirão Preto. Em 1996, 1254 pacientes foram atendidos com esta queixa e 64 necessitaram de internação. Dos pacientes não internados (NI, 77% apresentavam cefaléias primárias, contra 29,7% dos pacientes internados (I. A percentagem de melhora nos pacientes com migrânea com a dipirona endovenosa foi 83,8%, com o diclofenaco intramuscular 66,7% e com a clorpromazina (endovenosa 81,8%. As percentagens de pacientes com cefaléia do tipo tensional que melhoraram, frente às mesmas drogas foram, respectivamente 77,8%, 80% e 100%. Dos NI 16,3% tiveram melhora sem qualquer tratamento medicamentoso. Concluímos que as drogas utilizadas apresentam perfis semelhantes de eficácia e custo, podendo ser utilizadas em unidades básicas de saúde. O maior inconveniente é a administração parenteral.Headache is one of the most common symptoms observed in clinical practice. It has a considerable economic impact and overburdens emergency rooms. In Brazil, most emergency rooms have no tryptans. The present study analyses the treatment provided by the Emergency Room of the University Hospital of Ribeirão Preto. In 1996, 1254 patients were treated for headache and 64 of them required hospitalization. Of the non-hospitalized (NH patients, 77% had primary headache, as opposed to 29.7% of hospitalized patients. Of the patients with migraine, 83.6% improved with intravenous dipyrone, 66.7% improved with intramuscular diclofenac and 81.8% improved with intravenous chlorpromazine. The percentages of patients with tension-type headache who improved with the same drugs were 77.8%, 80% and 100%, respectively. Among NH patients, 16.3% improved without any

  10. Emergency room visits for respiratory conditions in children increased after Guagua Pichincha volcanic eruptions in April 2000 in Quito, Ecuador Observational Study: Time Series Analysis

    Directory of Open Access Journals (Sweden)

    Jagai Jyotsna S

    2007-07-01

    Full Text Available Abstract Background This study documented elevated rates of emergency room (ER visits for acute upper and lower respiratory infections and asthma-related conditions in the children of Quito, Ecuador associated with the eruption of Guagua Pichincha in April of 2000. Methods We abstracted 5169 (43% females ER records with primary respiratory conditions treated from January 1 – December 27, 2000 and examined the change in pediatric ER visits for respiratory conditions before, during, and after exposure events of April, 2000. We applied a Poisson regression model adapted to time series of cases for three non-overlapping disease categories: acute upper respiratory infection (AURI, acute lower respiratory infection (ALRI, and asthma-related conditions in boys and girls for three age groups: 0–4, 5–9, and 10–15 years. Results At the main pediatric medical facility, the Baca Ortiz Pediatric Hospital, the rate of emergency room (ER visits due to respiratory conditions substantially increased in the three weeks after eruption (RR = 2.22, 95%CI = [1.95, 2.52] and RR = 1.72 95%CI = [1.49, 1.97] for lower and upper respiratory tract infections respectively. The largest impact of eruptions on respiratory distress was observed in children younger than 5 years (RR = 2.21, 95%CI = [1.79, 2.73] and RR = 2.16 95%CI = [1.67, 2.76] in boys and girls respectively. The rate of asthma and asthma-related diagnosis doubled during the period of volcano fumarolic activity (RR = 1.97, 95%CI = [1.19, 3.24]. Overall, 28 days of volcanic activity and ash releases resulted in 345 (95%CI = [241, 460] additional ER visits due to respiratory conditions. Conclusion The study has demonstrated strong relationship between ash exposure and respiratory effects in children.

  11. Emergency room visits for respiratory conditions in children increased after Guagua Pichincha volcanic eruptions in April 2000 in Quito, Ecuador observational study: time series analysis.

    Science.gov (United States)

    Naumova, Elena N; Yepes, Hugo; Griffiths, Jeffrey K; Sempértegui, Fernando; Khurana, Gauri; Jagai, Jyotsna S; Játiva, Edgar; Estrella, Bertha

    2007-07-24

    This study documented elevated rates of emergency room (ER) visits for acute upper and lower respiratory infections and asthma-related conditions in the children of Quito, Ecuador associated with the eruption of Guagua Pichincha in April of 2000. We abstracted 5169 (43% females) ER records with primary respiratory conditions treated from January 1-December 27, 2000 and examined the change in pediatric ER visits for respiratory conditions before, during, and after exposure events of April, 2000. We applied a Poisson regression model adapted to time series of cases for three non-overlapping disease categories: acute upper respiratory infection (AURI), acute lower respiratory infection (ALRI), and asthma-related conditions in boys and girls for three age groups: 0-4, 5-9, and 10-15 years. At the main pediatric medical facility, the Baca Ortiz Pediatric Hospital, the rate of emergency room (ER) visits due to respiratory conditions substantially increased in the three weeks after eruption (RR = 2.22, 95%CI = [1.95, 2.52] and RR = 1.72 95%CI = [1.49, 1.97] for lower and upper respiratory tract infections respectively. The largest impact of eruptions on respiratory distress was observed in children younger than 5 years (RR = 2.21, 95%CI = [1.79, 2.73] and RR = 2.16 95%CI = [1.67, 2.76] in boys and girls respectively). The rate of asthma and asthma-related diagnosis doubled during the period of volcano fumarolic activity (RR = 1.97, 95%CI = [1.19, 3.24]). Overall, 28 days of volcanic activity and ash releases resulted in 345 (95%CI = [241, 460]) additional ER visits due to respiratory conditions. The study has demonstrated strong relationship between ash exposure and respiratory effects in children.

  12. Impact of the rapid antigen detection test in diagnosis and treatment of acute pharyngotonsillitis in a pediatric emergency room.

    Science.gov (United States)

    Cardoso, Débora Morais; Gilio, Alfredo Elias; Hsin, Shieh Huei; Machado, Beatriz Marcondes; de Paulis, Milena; Lotufo, João Paulo B; Martinez, Marina Baquerizo; Grisi, Sandra Josefina E

    2013-01-01

    To evaluate the impact of the routine use of rapid antigen detection test in the diagnosis and treatment of acute pharyngotonsillitis in children. This is a prospective and observational study, with a protocol compliance design established at the Emergency Unit of the University Hospital of Universidade de São Paulo for the care of children and adolescents diagnosed with acute pharyngitis. 650 children and adolescents were enrolled. Based on clinical findings, antibiotics would be prescribed for 389 patients (59.8%); using the rapid antigen detection test, they were prescribed for 286 patients (44.0%). Among the 261 children who would not have received antibiotics based on the clinical evaluation, 111 (42.5%) had positive rapid antigen detection test. The diagnosis based only on clinical evaluation showed 61.1% sensitivity, 47.7% specificity, 44.9% positive predictive value, and 57.5% negative predictive value. The clinical diagnosis of streptococcal pharyngotonsillitis had low sensitivity and specificity. The routine use of rapid antigen detection test led to the reduction of antibiotic use and the identification of a risk group for complications of streptococcal infection, since 42.5% positive rapid antigen detection test patients would not have received antibiotics based only on clinical diagnosis.

  13. Syncope and sudden death from the emergency physician’s perspective: is there room for new biomarkers?

    Directory of Open Access Journals (Sweden)

    Rossella Marino

    2013-10-01

    Full Text Available Syncope is a transient loss of consciousness due to temporary global cerebral hypoperfusion characterized by rapid onset, short duration, and spontaneous complete recovery. Syncope represents 1-2% of emergency department (ED visits and is coupled with a high risk for mortality, prolonged hospital admission, and immediate false diagnosis. Many patients who present to the ED with aspecific symptoms are mainly hospitalized because of diagnostic uncertainty. It is always very important to immediately distinguish syncope of cardiac and non-cardiac origins. Cardiac syncope has higher risk for mortality especially for sudden cardiac death, while non-cardiac one shows risk of repeated events of syncope with poor quality of life. Sudden cardiac death is defined as rapid and unexpected natural death due to cardiac etiology. Researchers from the GREAT Network hypothesized to evaluate some novel biomarkers in order to test acute cardiac condition that can suggest the presence of heart structural diseases, heart failure, and electrical disorders. The primary objective of this study is to test the diagnostic performance from patient history, clinical judgment, and novel biomarkers in the diagnosis of cardiac syncope in patients admitted to the ED. The trial is designed as a prospective international multicenter observational study accounting for 730 patients aged over 40 admitted to the ED with syncope within the last 12 h. A multimarker approach combining markers of different origin and mode of relapse, should add diagnostic information to correctly identify the cardiac conditions and to therefore be pertinent in the early diagnosis of cardiac syncope and in the prediction of cardiac events including sudden death. Future data should be needed to confirm the hypothesis presented here.

  14. 77 FR 35962 - Utilizing Rapidly Deployable Aerial Communications Architecture in Response to an Emergency

    Science.gov (United States)

    2012-06-15

    ... Aerial Communications Architecture in Response to an Emergency AGENCY: Federal Communications Commission... deployable aerial communications architecture (DACA) in facilitating emergency response by rapidly restoring... copying during normal business hours in the FCC Reference Information Center, Portals II, 445 12th Street...

  15. A new emergency control for voltage stability utilizing the time overvoltage capability of large shunt capacitor banks

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, Carson W; Vanleuven, Allen L; Nordstrom, Jerry M [Bonneville Power Administration, Portland, OR (United States)

    1994-12-31

    Electric utilities have become increasing concerned with the possibility of voltage instability and voltage collapse. Although many countermeasures are a possible, control based countermeasures are often the most cost effective. Voltage collapse is often only a threat during unusual conditions such as very high load and major outages. For these low probability conditions, low cost emergency controls may be the only cost effective countermeasures. This paper provides details on a prototype installation by the Bonneville Power Administration of a new low cost emergency control for voltage stability named CAPS (CAPacitor bank series group Shorting). (author) 6 refs., 5 figs.

  16. Acceptability and perceived utility of drone technology among emergency medical service responders and incident commanders for mass casualty incident management.

    Science.gov (United States)

    Hart, Alexander; Chai, Peter R; Griswold, Matthew K; Lai, Jeffrey T; Boyer, Edward W; Broach, John

    2017-01-01

    This study seeks to understand the acceptability and perceived utility of unmanned aerial vehicle (UAV) technology to Mass Casualty Incidents (MCI) scene management. Qualitative questionnaires regarding the ease of operation, perceived usefulness, and training time to operate UAVs were administered to Emergency Medical Technicians (n = 15). A Single Urban New England Academic Tertiary Care Medical Center. Front-line emergency medical service (EMS) providers and senior EMS personnel in Incident Commander roles. Data from this pilot study indicate that EMS responders are accepting to deploying and operating UAV technology in a disaster scenario. Additionally, they perceived UAV technology as easy to adopt yet impactful in improving MCI scene management.

  17. The emergency department as a 'last resort': why parents seek care for their child's nontraumatic dental problems in the emergency room.

    Science.gov (United States)

    Mostajer Haqiqi, Azadeh; Bedos, Christophe; Macdonald, Mary Ellen

    2016-10-01

    Over the last two decades, there has been an increasing trend in the number of families using emergency departments (EDs) for treating their children's nontraumatic dental problems. We do not know why families use the ED in this way; to date, little research has addressed parents' decisions. The purpose of this study was to explore the reasons that lead parents to select the ED over a dental clinic for their child's nontraumatic dental problem. Using a qualitative descriptive design, we conducted semi-structured interviews with parents of children under age 10 who sought care for nontraumatic dental problems in an ED of a pediatric hospital. The interviews were audio-recorded, transcribed, and coded for thematic analysis using Grembowski's dental care process model as a sensitizing construct. Fifteen parents were recruited (ten mothers and five fathers). Three salient themes were identified: (i) parental beliefs and socioeconomic challenges which contributed to their care seeking, (ii) barriers parents faced in finding oral healthcare options for their children in their communities (e.g., poor access to care and poor quality of care), and (iii) parent's high satisfaction with the care provided through the ED. The ED was families' last resort; parents took their child to the ED because of the lack of other options in their communities rather than a belief that the ED was the best choice for dental care. The current pattern of ED use resulted in stress for these parents and repercussions for the children (e.g., pain, longer waiting, and increased complications); further, it has been shown in the literature to be an economic strain on the health system. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Single emergency room measurement of neutrophil/lymphocyte ratio for early detection of acute kidney injury (AKI).

    Science.gov (United States)

    Abu Alfeilat, Mohsen; Slotki, Itzchak; Shavit, Linda

    2017-07-29

    Neutrophil-to-lymphocyte ratio (NLR) is considered a readily available biomarker of systemic inflammation. An association between elevated NLR and adverse outcomes in a variety of medical and surgical conditions including CKD has been demonstrated in several studies. In this study, we evaluated the accuracy of single Emergency Department (ED) measurement of NLR for early diagnosis of acute kidney injury (AKI). We prospectively studied 294 patients aged 71.6 ± 17. We measured NLR at presentation to the ED. AKI is defined as a new-onset 1.5-fold or more increase in serum creatinine or a 25% decrease in estimated GFR sustained for at least 3 days despite volume resuscitation. The primary outcome is AKI. Secondary outcome is in-hospital mortality. A multivariate model and ROC analysis were performed to evaluate the association and eventual predictive capacity of NLR for the outcomes. 36 patients (12.2%) developed AKI and 26 (9%) died, 8 (22%) of the AKI group and 17 patients (7%) of the non-AKI group. The Mean NLR is significantly higher in AKI compare to non-AKI patients (11.7 ± 15.2 vs 6.45 ± 7.19, p = 0.048). A multivariate model adjusted for age, gender, blood pressure, plasma albumin and hemoglobin levels confirms that the NLR is higher in AKI patients (p = 0.031). Receiver operating characteristics curve reveals an AUC of 0.715 (95% CI 0.63-0.8) sensitivity 0.78, specificity 0.65, and OR 6.423 (CI 2.659-16.026) for a cutoff value of NLR 5.5. The relation between NLR and in-hospital mortality is not statistically significant (p = 0.92). Single ED measurement of NLR might be a useful tool for early diagnosis of AKI. This finding is particularly important in light of the low cost and widespread availability of NLR, especially compared with other biomarkers currently under study in the context of AKI.

  19. Hypoxia Room

    Data.gov (United States)

    Federal Laboratory Consortium — The Hypoxia Room is a 8x8x8 ft. clear vinyl plastic and aluminum frame construction enclosure located within USAREIM laboratory 028. The Hypoxia Room (manufactured...

  20. Utilization of emergency medical transports and hospital admissions among persons with behavioral health conditions.

    Science.gov (United States)

    Cuddeback, Gary; Patterson, P Daniel; Moore, Charity Galena; Brice, Jane H

    2010-04-01

    Emergency medical services transport and emergency department misuse among persons with behavioral health conditions is a concern. Administrative data were used to examine medical transports and hospital admissions among persons with behavioral health conditions. Data on 70,126 medical transports to emergency departments in three southeastern counties were analyzed. Compared with general medical transports, fewer behavioral health transports resulted in a hospital admission. Among behavioral health transports, persons with schizophrenia were 2.62 times more likely than those with substance use disorders to be admitted, and persons with mood disorders were 4.36 times more likely than those with substance use disorders to be admitted. Also, among behavioral health transports, rural transports were less likely than more urban transports to result in a hospital admission. More training of emergency medical services personnel and more behavioral health crisis resources, especially targeting rural areas and substance use disorders, are needed.

  1. Charting the Emergence of Corporate Procurement of Utility-Scale PV

    Energy Technology Data Exchange (ETDEWEB)

    Heeter, Jenny S. [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Cook, Jeffrey J. [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Bird, Lori A. [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2017-09-01

    Through July 2017, corporate customers contracted for more than 2,300 MW of utility-scale solar. This paper examines the benefits, challenges, and outlooks for large-scale off-site solar purchasing through four pathways: PPAs, retail choice, utility partnerships (green tariffs and bilateral contracts with utilities), and by becoming a licensed wholesale seller of electricity. Each pathway differs based on where in the United States it is available, the value provided to a corporate off-taker, and the ease of implementation. The paper concludes with a discussion of future pathway comparison, noting that to deploy more corporate off-site solar, new procurement pathways are needed.

  2. Understanding Emerging Impacts and Requirements Related to Utility-Scale Solar Development

    Energy Technology Data Exchange (ETDEWEB)

    Hartmann, Heidi M. [Argonne National Lab. (ANL), Argonne, IL (United States); Grippo, Mark A. [Argonne National Lab. (ANL), Argonne, IL (United States); Heath, Garvin A. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Macknick, Jordan [National Renewable Energy Lab. (NREL), Golden, CO (United States); Smith, Karen P. [Argonne National Lab. (ANL), Argonne, IL (United States); Sullivan, Robert G. [Argonne National Lab. (ANL), Argonne, IL (United States); Walston, Leroy J. [Argonne National Lab. (ANL), Argonne, IL (United States); Wescott, Konstance L. [Argonne National Lab. (ANL), Argonne, IL (United States)

    2016-09-01

    Utility-scale solar energy plays an important role in the nation’s strategy to address climate change threats through increased deployment of renewable energy technologies, and both the federal government and individual states have established specific goals for increased solar energy development. In order to achieve these goals, much attention is paid to making utility-scale solar energy cost-competitive with other conventional energy sources, while concurrently conducting solar development in an environmentally sound manner.

  3. Utility and assessment of non-technical skills for rapid response systems and medical emergency teams.

    Science.gov (United States)

    Chalwin, R P; Flabouris, A

    2013-09-01

    Efforts are ongoing to improve outcomes from cardiac arrest and medical emergencies. A promising quality improvement modality is use of non-technical skills (NTS) that aim to address human factors through improvements in performance of leadership, communication, situational awareness and decision-making. Originating in the airline industry, NTS training has been successfully introduced into anaesthesia, surgery, emergency medicine and other acute medical specialities. Some aspects of NTS have already achieved acceptance for cardiac arrest teams. Leadership skills are emphasised in advanced life support training and have shown favourable results when employed in simulated and clinical resuscitation scenarios. The application of NTS in medical emergency teams as part of a rapid response system attending medical emergencies is less certain; however, observations of simulations have also shown promise. This review highlights the potential benefits of NTS competency for cardiac arrest teams and, more importantly, medical emergency teams because of the diversity of clinical scenarios encountered. Discussion covers methods to assess and refine NTS and NTS training to optimise performance in the clinical environment. Increasing attention should be applied to yielding meaningful patient and organisational outcomes from use of NTS. Similarly, implementation of any training course should receive appropriate scrutiny to refine team and institutional performance. © 2013 The Authors; Internal Medicine Journal © 2013 Royal Australasian College of Physicians.

  4. Utilization of emergent aquatic plants for biomass-energy-systems development

    Energy Technology Data Exchange (ETDEWEB)

    Kresovich, S.; Wagner, C.K.; Scantland, D.A.; Groet, S.S.; Lawhon, W.T.

    1982-02-01

    A review was conducted of the available literature pertaining to the following aspects of emergent aquatic biomass: identification of prospective emergent plant species for management; evaluation of prospects for genetic manipulation; evaluation of biological and environmental tolerances; examination of current production technologies; determination of availability of seeds and/or other propagules, and projections for probable end-uses and products. Species identified as potential candidates for production in biomass systems include Arundo donax, Cyperus papyrus, Phragmites communis, Saccharum spontaneum, Spartina alterniflora, and Typha latifolia. If these species are to be viable candidates in biomass systems, a number of research areas must be further investigated. Points such as development of baseline yield data for managed systems, harvesting conceptualization, genetic (crop) improvement, and identification of secondary plant products require refinement. However, the potential pay-off for developing emergent aquatic systems will be significant if development is successful.

  5. Physician discretion is safe and may lower stress test utilization in emergency department chest pain unit patients.

    Science.gov (United States)

    Napoli, Anthony M; Arrighi, James A; Siket, Matthew S; Gibbs, Frantz J

    2012-03-01

    Chest pain unit (CPU) observation with defined stress utilization protocols is a common management option for low-risk emergency department patients. We sought to evaluate the safety of a joint emergency medicine and cardiology staffed CPU. Prospective observational trial of consecutive patients admitted to an emergency department CPU was conducted. A standard 6-hour observation protocol was followed by cardiology consultation and stress utilization largely at their discretion. Included patients were at low/intermediate risk by the American Heart Association, had nondiagnostic electrocardiograms, and a normal initial troponin. Excluded patients were those with an acute comorbidity, age >75, and a history of coronary artery disease, or had a coexistent problem restricting 24-hour observation. Primary outcome was 30-day major adverse cardiovascular events-defined as death, nonfatal acute myocardial infarction, revascularization, or out-of-hospital cardiac arrest. A total of 1063 patients were enrolled over 8 months. The mean age of the patients was 52.8 ± 11.8 years, and 51% (95% confidence interval [CI], 48-54) were female. The mean thrombolysis in myocardial infarction and Diamond & Forrester scores were 0.6% (95% CI, 0.51-0.62) and 33% (95% CI, 31-35), respectively. In all, 51% (95% CI, 48-54) received stress testing (52% nuclear stress, 39% stress echocardiogram, 5% exercise, 4% other). In all, 0.9% patients (n = 10, 95% CI, 0.4-1.5) were diagnosed with a non-ST elevation myocardial infarction and 2.2% (n = 23, 95% CI, 1.3-3) with acute coronary syndrome. There was 1 (95% CI, 0%-0.3%) case of a 30-day major adverse cardiovascular events. The 51% stress test utilization rate was less than the range reported in previous CPU studies (P < 0.05). Joint emergency medicine and cardiology management of patients within a CPU protocol is safe, efficacious, and may safely reduce stress testing rates.

  6. Charting the Emergence of Corporate Procurement of Utility-Scale PV

    Energy Technology Data Exchange (ETDEWEB)

    Heeter, Jenny S. [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Cook, Jeffrey J. [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Bird, Lori A. [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2017-09-07

    Corporations and other institutions have contracted for more than 2300 MW of off-site solar, using power purchase agreements, green tariffs, or bilateral deals with utilities. This paper examines the benefits, challenges, and outlooks for large-scale off-site solar purchasing in the United States. Pathways differ based on where they are available, the hedge value they can provide, and their ease of implementation. The paper features case studies of an aggregate PPA (Massachusetts Institute of Technology, Boston Medical Center, and Post Office Square), a corporation exiting their incumbent utility (MGM Resorts), a utility offering large scale renewables to corporate customers (Alabama Powers Renewable Procurement Program), and a company with approval to sell energy into wholesale markets (Google Energy Inc.).

  7. Well-being and employee health-how employees' well-being scores interact with demographic factors to influence risk of hospitalization or an emergency room visit.

    Science.gov (United States)

    Gandy, William M; Coberley, Carter; Pope, James E; Rula, Elizabeth Y

    2014-02-01

    The goal of this study was to determine the relationship between individual well-being and risk of a hospital event in the subsequent year. The authors hypothesized an inverse relationship in which low well-being predicts higher likelihood of hospital use. The study specifically sought to understand how well-being segments and demographic variables interact in defining risk of a hospital event (inpatient admission or emergency room visit) in an employed population. A retrospective study design was conducted with data from 8835 employees who completed a Well-Being Assessment questionnaire based on the Gallup-Healthways Well-Being Index. Cox proportional hazards models were used to examine the impact of Individual Well-Being Score (IWBS) segments and member demographics on hazard ratios (HRs) for a hospital event during the 12 months following assessment completion. Significant main effects were found for the influence of IWBS segments, sex, education, and relationship status on HRs of a hospital event, but not for age. However, further analysis revealed significant interactions between age and IWBS segments (P=0.005) and between age and sex (Pwell-being and higher risk of an event in employees ages 44 years and older is mitigated in younger age groups. These results suggest that youth attenuates the risk engendered in poor well-being; therefore, methods to maintain or improve well-being as individuals age presents a strong opportunity for reducing hospital events.

  8. Well-Being and Employee Health—How Employees' Well-Being Scores Interact with Demographic Factors to Influence Risk of Hospitalization or an Emergency Room Visit

    Science.gov (United States)

    Gandy, William M.; Coberley, Carter; Pope, James E.

    2014-01-01

    Abstract The goal of this study was to determine the relationship between individual well-being and risk of a hospital event in the subsequent year. The authors hypothesized an inverse relationship in which low well-being predicts higher likelihood of hospital use. The study specifically sought to understand how well-being segments and demographic variables interact in defining risk of a hospital event (inpatient admission or emergency room visit) in an employed population. A retrospective study design was conducted with data from 8835 employees who completed a Well-Being Assessment questionnaire based on the Gallup-Healthways Well-Being Index. Cox proportional hazards models were used to examine the impact of Individual Well-Being Score (IWBS) segments and member demographics on hazard ratios (HRs) for a hospital event during the 12 months following assessment completion. Significant main effects were found for the influence of IWBS segments, sex, education, and relationship status on HRs of a hospital event, but not for age. However, further analysis revealed significant interactions between age and IWBS segments (P=0.005) and between age and sex (Pwell-being and higher risk of an event in employees ages 44 years and older is mitigated in younger age groups. These results suggest that youth attenuates the risk engendered in poor well-being; therefore, methods to maintain or improve well-being as individuals age presents a strong opportunity for reducing hospital events. (Population Health Management 2014;17:13–20) PMID:23560493

  9. Increased Risk of Vascular Events in Emergency Room Patients Discharged Home with Diagnosis of Dizziness or Vertigo: A 3-Year Follow-Up Study

    Science.gov (United States)

    Lee, Ching-Chih; Ho, Hsu-Chueh; Su, Yu-Chieh; Chiu, Brian C-H; Su, Yung-Cheng; Lee, Yi-Da; Chou, Pesus

    2012-01-01

    Background Dizziness and vertigo symptoms are commonly seen in emergency room (ER). However, these patients are often discharged without a definite diagnosis. Conflicting data regarding the vascular event risk among the dizziness or vertigo patients have been reported. This study aims to determine the risk of developing stroke or cardiovascular events in ER patients discharged home with a diagnosis of dizziness or vertigo. Methodology A total of 25,757 subjects with at least one ER visit in 2004 were identified. Of those, 1,118 patients were discharged home with a diagnosis of vertigo or dizziness. A Cox proportional hazard model was performed to compare the three-year vascular event-free survival rates between the dizziness/vertigo patients and those without dizziness/vertigo after adjusting for confounding and risk factors. Results We identified 52 (4.7%) vascular events in patients with dizziness/vertigo and 454 (1.8%) vascular events in patients without dizziness/vertigo. ER patients discharged home with a diagnosis of vertigo or dizziness had 2-fold (95% confidence interval [CI], 1.35–2.96; pvertigo during the first year. Conclusions ER patients discharged home with a diagnosis of dizziness or vertigo were at a increased risk of developing subsequent vascular events than those without dizziness/vertigo after the onset of dizziness or vertigo. Further studies are warranted for developing better diagnostic and follow-up strategies in increased risk patients. PMID:22558272

  10. Impact of patient characteristics, education and knowledge on emergency room visits in patients with asthma and COPD: a descriptive and correlative study

    Directory of Open Access Journals (Sweden)

    Andersson Mikael

    2009-09-01

    Full Text Available Abstract Background Asthma and COPD are major health problems and an extensive burden for the patient and the health care system. Patient education has been recommended, but the influence on knowledge and health outcomes is not fully examined. Our aims were to compare patient characteristics, education and knowledge in patients who had an emergency room (ER visit, to explore factors related to disease knowledge, and to investigate patient characteristics, patient education and knowledge in relation to further ER visits over a 12 month period. Methods Eighty-four patients with asthma and 52 with COPD, who had had an ER visit, were included. They were interviewed by telephone 4 to 6 weeks after the ER visit and followed for a year. Results Patients with COPD were older, more sedentary, had had more ER visits the previous year, and had more co morbidity than patients with asthma. About 80% of the patients had received information from health professionals or participated in education/rehabilitation, but a minority ( Conclusion Patients with asthma had a better self reported knowledge of disease management and were less likely to have new exacerbations than patients with COPD. Reported level of knowledge was, however, in it self not a predictor of exacerbations. This indicates that information is not sufficient to reduce the burden of disease. Patient education focused on self-management and behavioral change should be emphasized.

  11. The performance of a glucose-ketone meter in the diagnosis of diabetic ketoacidosis in patients with type 2 diabetes in the emergency room.

    Science.gov (United States)

    Voulgari, Christina; Tentolouris, Nicholas

    2010-07-01

    Diabetic ketoacidosis (DKA) is a serious metabolic complication. One of its precipitating causes is insulin omission. DKA requires early diagnosis and strict glucose control, which increases the use of glucose meters in the Emergency Room (ER). We aimed to determine the performance of a glucose-ketone meter in the diagnosis of DKA. From 450 type 2 diabetes mellitus insulin-treated patients attending the ER with a capillary glucose level >13.9 mmol/L, 50 patients (26 men and 24 women, mean age 60.2 +/- 8.2 years) had DKA. Capillary glucose and beta-hydroxybutyrate (beta-OHB) were measured with the Precision-Xtra device (Abbott Laboratories, Abingdon, UK). Serum glucose and biochemical parameters were measured on an automatic analyzer; serum beta-OHB was determined using an enzymatic end-point spectrophotometric method. Urine ketones were determined using a semiquantitative assay (Ketodiastix, Bayer Diagnostics, Stoke Poges, Slough, UK). Serum and capillary beta-OHB values were highly correlated (r = 0.99, P 3.0 mmol/L) had the highest performance (sensitivity 99.87%, specificity 92.89%, positive predictive value 92.89%) for the diagnosis of DKA compared with serum ketonemia (sensitivity 90.45%, specificity 88.65%, positive predictive value 87.76%) or ketonuria (sensitivity 89.89%, specificity 52.73%, positive predictive value 41.87%). Implementation of measures such as home glucose and ketone monitoring can possibly decrease the number of hospital admissions due to DKA.

  12. Early effect of American Academy of Pediatrics Urinary Tract Infection Guidelines on radiographic imaging and diagnosis of vesicoureteral reflux in the emergency room setting.

    Science.gov (United States)

    Arlen, Angela M; Merriman, Laura S; Kirsch, Jared M; Leong, Traci; Scherz, Hal C; Smith, Edwin A; Broecker, Bruce H; Kirsch, Andrew J

    2015-05-01

    In 2011 the AAP revised practice parameters on febrile urinary tract infection in infants and children 2 to 24 months old. New imaging recommendations invigorated the ongoing debate regarding the diagnosis and management of vesicoureteral reflux. We compared evaluations in these patients with febrile urinary tract infection before and after guideline publication. During 2 separate 6-month periods 350 patients 2 to 24 months old were evaluated in the emergency room setting. Demographics, urine culture, renal-bladder ultrasound, voiding cystourethrogram and admission status were assessed. A total of 172 patients presented with initial febrile urinary tract infection in 2011, of whom 47 (27.3%) required hospitalization, while 42 of 178 (23.6%) were admitted in 2012. Admission by year did not significantly differ (p = 0.423). After guideline revision 41.2% fewer voiding cystourethrograms were done (72.1% of cases in 2011 vs 30.9% in 2012, p urinary tract infection. We found no relationship between renal-bladder ultrasound and abnormal voiding cystourethrogram, consistent with previous findings that call ultrasound into question as the determinant for additional imaging. Whether forgoing routine voiding cystourethrogram results in increased morbidity is the subject of ongoing study. Copyright © 2015. Published by Elsevier Inc.

  13. 10 CFR Appendix E to Part 50 - Emergency Planning and Preparedness for Production and Utilization Facilities

    Science.gov (United States)

    2010-01-01

    ... of the time required to evacuate various sectors and distances within the plume exposure pathway EPZ.... Implementing Procedures VI. Emergency Response Data System I. Introduction Each applicant for a construction... preliminary safety analysis report for a construction permit and submitted as part of the final safety...

  14. Novel Emergency Medicine Curriculum Utilizing Self-Directed Learning and the Flipped Classroom Method: Head, Eyes, Ears, Nose and Throat Emergencies Small Group Module

    Directory of Open Access Journals (Sweden)

    Andrew King

    2017-09-01

    Full Text Available Audience: This curriculum created and implemented at The Ohio State University Wexner Medical Center was designed to educate our emergency medicine (EM residents, PGY-1 to PGY-3, as well as medical students and attending physicians. Introduction: Head, Eyes, Ears, Nose and Throat (HEENT complaints are very commonly seen in the Emergency Department. Numbers vary as to exact prevalence, but sources show that there are about 2 million annual emergency department (ED visits in the United States for non-traumatic dental problems, representing 1.5% of all ED visits.1 Other sources show that symptoms referable to the throat encompass 2,496,000 visits or 1.9% of total visits.2 Notably, about 8% of the written exam in emergency medicine covers the topic of head and neck complaints, making it the second most tested topic behind cardiovascular.3 Residents must be proficient in the differential diagnosis and management of the wide variety of HEENT emergencies. The flipped classroom curricular model emphasizes self-directed learning activities completed by learners, followed by small group discussions pertaining to the topic reviewed. The active learning fostered by this curriculum increases faculty and learner engagement and interaction time typically absent in traditional lecture-based formats.4-6 Studies have revealed that the application of knowledge through case studies, personal interaction with content experts, and integrated questions are effective learning strategies for emergency medicine residents.6-8 The Ohio State University EM Residency didactic curriculum recently transitioned to a “flipped classroom” approach.9-13 We created this innovative curriculum aimed to improve our residency education program and to share educational resources with other EM residency programs. Our curriculum utilizes an 18-month curricular cycle to cover the defined emergency medicine content. The flipped classroom curriculum maximizes didactic time and resident

  15. Variação sazonal nos atendimentos de emergência por asma em Gama, Distrito Federal Seasonal variations in emergency room visits for asthma attacks in Gama, Brazil

    Directory of Open Access Journals (Sweden)

    Laércio Moreira Valença

    2006-08-01

    Full Text Available OBJETIVO: Quantificar o atendimento por asma em um serviço de emergência público e estudar a flutuação sazonal, considerando as condições climáticas locais, caracterizadas por duas estações, uma chuvosa e úmida e outra seca. MÉTODOS: Levantamento retrospectivo conduzido em um hospital geral comunitário. Um total de 37.642 consultas emergenciais por asma, bronquite, pneumonia, infecções de vias aéreas superiores e outras condições foram identificadas durante um período de dois anos. As informações constantes em cada guia de atendimento foram levantadas para posterior análise. RESULTADOS: Asma foi o segundo diagnóstico mais freqüente dentre as condições respiratórias (24%. A maioria das consultas por asma foi feita em crianças de zero a catorze anos (56,6%. A análise de regressão mostrou uma variação sazonal dos atendimentos, com concentração significativamente maior de casos de asma no mês de março (p = 0,0109 e concentração menor nos meses de agosto e setembro (p = 0,0485 e p = 0,0169, respectivamente. A correlação entre asma e clima foi mais significativa em relação à flutuação da umidade defasada de um e dois meses (p = 0,0026 e p = 0,0002, respectivamente. CONCLUSÃO: As visitas por asma ao pronto-socorro foram mais freqüentes durante a estação úmida. O aumento do número de casos cresceu um a dois meses após o aumento da umidade e diminuiu no período seco. Essa correlação positiva levanta a possibilidade de uma relação causal com a proliferação de ácaros domésticos e fungos ambientais.OBJECTIVE: To quantify the number of asthma attacks treated in the emergency room of a public hospital and to study seasonal fluctuations, taking into consideration the local climate, which is characterized by having only two seasons: a rainy/humid season and a dry season. METHODS: A retrospective survey was conducted in a community general hospital. A total of 37,642 emergency room consultations

  16. Room Acoustics

    Science.gov (United States)

    Kuttruff, Heinrich; Mommertz, Eckard

    The traditional task of room acoustics is to create or formulate conditions which ensure the best possible propagation of sound in a room from a sound source to a listener. Thus, objects of room acoustics are in particular assembly halls of all kinds, such as auditoria and lecture halls, conference rooms, theaters, concert halls or churches. Already at this point, it has to be pointed out that these conditions essentially depend on the question if speech or music should be transmitted; in the first case, the criterion for transmission quality is good speech intelligibility, in the other case, however, the success of room-acoustical efforts depends on other factors that cannot be quantified that easily, not least it also depends on the hearing habits of the listeners. In any case, absolutely "good acoustics" of a room do not exist.

  17. Utilization of underground coal gasification to provide electric power and emerging nations

    International Nuclear Information System (INIS)

    Boysen, J.E.; Beaver, F.W.; Schmit, C.R.; Daly, D.J.; Groenewold, G.H.

    1992-01-01

    Underground coal gasification (UCG) is a process conceived over a hundred years ago and used successfully, since the 1940s, to generate low-Btu gas for electric power production. The process is applicable to many coal resources that cannot, for a variety of reasons, be economically produced. While UCG cannot compete economically with conventional oil gas, and coal reserves, emerging nations requiring electric power for development of an industrial infrastructure may provide the niche market that is necessary for the commercial development of UCG. Recent UCG field testing, conducted in the United States, demonstrated that UCG could be successfully conducted without adverse environmental impact. This testing also resulted in increased understanding of the interactions between the UCG process and the local hydrogeological environment. With this knowledge, the probability of successful commercial UCG development can be increased by selecting a UCG site with hydrogeologically and economically favorable properties. And approach for commercial UCG development for producing electric power in emerging nations is presented

  18. The Feasibility of Utilizing a Comic for Education in the Emergency Department Setting.

    Science.gov (United States)

    Hanson, Aaron; Drendel, Amy L; Ashwal, Gary; Thomas, Alex

    2017-05-01

    The objective of this study was to determine the feasibility of a comic education module in the Emergency Department setting. A convenience sample of 50 injured children and their caregivers were enrolled. The comic was found to be likeable, easy to read, and provided important information to both children and their caregivers. Total time to read the comic was three minutes (SD 1.4, range 1.4-7.1). Most children (60%) read the comic independently, including all children over age 14 years. At 72-hour phone follow-up, 86% of caregivers had accurate recall of all three comic teaching points. This innovative comic educational module is feasible for use for children ages 4-18 years in the Emergency Department. Though this comic was intended to educate children, caregivers recalled all three teaching points 72 hours after discharge.

  19. Information risk in emerging utility markets: The role of commission- sponsored audits

    Energy Technology Data Exchange (ETDEWEB)

    Wirick, D.W.; Lawton, R.W.; Burns, R.E.; Lee, S.

    1996-03-01

    As public utilities and regulators begin to define their new relationship under various forms of regulations, some have questioned the continuing need for commission-sponsored audits. This study evaluates the role of such audits by examining their core purpose: the reduction of information risk (risk that a commission might make a wrong decision because of reliance on faulty information). It identifies five generic types of information that will be needed by commissions in the future and describes a cost-benefit analysis for identifying the appropriate method for mitigating information risk for state regulatory commissions.

  20. Associations of PM2.5 and Black Carbon with Hospital Emergency Room Visits during Heavy Haze Events: A Case Study in Beijing, China.

    Science.gov (United States)

    Liang, Fengchao; Tian, Lin; Guo, Qun; Westerdahl, Dane; Liu, Yang; Jin, Xiaobin; Li, Guoxing; Pan, Xiaochuan

    2017-07-05

    In January 2013, severe haze events over northeastern China sparked substantial health concerns. This study explores the associations of fine particulate matter less than 2.5 μm (PM 2.5 ) and black carbon (BC) with hospital emergency room visits (ERVs) during a haze season in Beijing. During that period, daily counts of ERVs for respiratory, cardiovascular and ocular diseases were obtained from a Level-3A hospital in Beijing from 1 December 2012 to 28 February 2013, and associations of which with PM 2.5 and BC were estimated by time-stratified case-crossover analysis in single- and two-pollutant models. We found a 27.5% (95% confidence interval (CI): 13.0, 43.9%) increase in respiratory ERV (lag02), a 19.4% (95% CI: 2.5, 39.0%) increase in cardiovascular ERV (lag0), and a 12.6% (95% CI: 0.0, 26.7%) increase in ocular ERV (lag0) along with an interquartile range (IQR) increase in the PM 2.5 . An IQR increase of BC was associated with 27.6% (95% CI: 9.6, 48.6%) (lag02), 18.8% (95% CI: 1.4, 39.2%) (lag0) and 11.8% (95% CI: -1.4, 26.8%) (lag0) increases for changes in these same health outcomes respectively. Estimated associations were consistent after adjusting SO₂ or NO₂ in two-pollutant models. This study provides evidence that improving air quality and reducing haze days would greatly benefit the population health.

  1. The association between diurnal temperature range and emergency room admissions for cardiovascular, respiratory, digestive and genitourinary disease among the elderly: a time series study.

    Science.gov (United States)

    Wang, Min-zhen; Zheng, Shan; He, Shi-lin; Li, Bei; Teng, Huai-jin; Wang, Shi-gong; Yin, Ling; Shang, Ke-zheng; Li, Tan-shi

    2013-07-01

    To evaluate the short-term effect of diurnal temperature range (DTR) on emergency room (ER) admissions among elderly adults in Beijing. After controlling the long-time and seasonal trend, weather, air pollution and other confounding factors, a semi-parametric generalized additive model (GAM) was used to analyze the exposure-effect relationship between DTR and daily ER admissions among elderly adults with different lag structures from 2009 to 2011 in Beijing. We examined the effects of DTR for stratified groups by age and gender, and conducted the modifying effect of season on DTR to test the possible interaction. Significant associations were found between DTR and four major causes of daily ER admissions among elderly adults in Beijing. A 1 °C increase in the 8-day moving average of DTR (lag 07) corresponded to an increase of 2.08% (95% CI: 0.88%-3.29%) in respiratory ER admissions and 2.14% (95% CI: 0.71%-3.59%) in digestive ER admissions. A 1 °C increase in the 3-day and 6-day moving average of DTR (lag 02 and lag 05) corresponded to a 0.76% (95% CI: 0.07%-1.46%) increase in cardiovascular ER admissions, and 1.81% (95% CI: 0.21%-3.45%) increase in genitourinary ER admissions, respectively. The people aged 75 years and older were associated more strongly with DTR than the 65-74 age group. The modifying effect of season on DTR was observed and it was various in four causes. This study strengthens the evidence that DTR is an independent risk factor for ER admissions among elderly persons. Some prevention programs that target the elderly and other high risk subgroups for impending large temperature changes may reduce the impact of DTR on people's health. Copyright © 2013 Elsevier B.V. All rights reserved.

  2. Angiotensin converting enzyme DD genotype is associated with acute coronary syndrome severity and sudden cardiac death in Taiwan: a case-control emergency room study.

    Science.gov (United States)

    Chen, Ying-Hsin; Liu, Jui-Ming; Hsu, Ren-Jun; Hu, Sheng-Chuan; Harn, Horng-Jyh; Chen, Shee-Ping; Jeng, Jing-Ren; Wu, Chieh-Lin; Ho, Jar-Yi; Yu, Cheng-Ping

    2012-02-15

    Angiotensin converting enzyme (ACE) gene insertion/deletion (I/D) polymorphisms have been associated with acute coronary syndrome (ACS); however, several controversial results have also been found in different studied populations. This hospital-based, emergency room, case-control study in Taiwan retrospectively investigated 111 ACS patients, and 195 non-coronary subjects as a control group, to study the effects of ACE I/D polymorphism in the most urgent ACS patients. ACE I/D polymorphisms were determined by polymerase chain reaction-based assays and their associations with ACS risk, severity, and sudden cardiac death were determined. The ACE DD genotype was associated with ACS incidence. The DD genotype was associated with a significant 4-fold higher risk of ACS in multivariate analysis (odds ratio (OR) = 4.295; 95% confidence interval (CI): 1.436-12.851, p = 0.009), and a 3.35-fold higher risk of acute myocardial infarction. DD genotype carriers also had more than 3-fold higher risks of stenosis in all the three coronary arteries, left anterior descending artery infarction, and anterior wall infarction. In addition, the DD genotype was also associated with a higher risk of sudden cardiac death (OR = 6.484, 95% CI: 1.036-40.598, p = 0.046). This study demonstrated that the ACE DD genotype is an independent risk factor for ACS, and in particular, for acute myocardial infarction. In addition, the ACE DD genotype is also associated with greater ACS severity and a higher risk of sudden cardiac death. ACE genotyping is recommended for patients with a history of ACS, and more intensive preventive care is suggested for patients with the DD genotype.

  3. The emergency to home project: impact of an emergency department care coordinator on hospital admission and emergency department utilization among seniors.

    Science.gov (United States)

    Bond, Christopher Matthew; Freiheit, Elizabeth A; Podruzny, Lesley; Kingsly, Alianu Akawakun; Wang, Dongmei; Davenport, Jamie; Gutscher, Abram; Askin, Cathy; Taylor, Allison; Lee, Vivian; Choo, Queenie; Lang, Eddy Samuel

    2014-01-01

    Seniors comprise 14% to 21% of all emergency department (ED) visits, yet are disproportionately larger users of ED and inpatient resources. ED care coordinators (EDCCs) target seniors at risk for functional decline and connect them to home care and other community services in hopes of avoiding hospitalization. The goal of this study was to measure the association between the presence of EDCCs and admission rates for seniors aged ≥ 65. Secondary outcomes included length of stay, recidivism at 30 days, and revisit resulting in admission at 30 days. This was a matched pairs study using administrative data from eight EDs in six Alberta cities. Four of these hospitals were intervention sites, in which patients were seen by an EDCC, while the other four sites had no EDCC presence. All seniors aged ≥ 65 with a discharge diagnosis of fall or musculoskeletal pathology were included. Cases were matched by CTAS category, age, gender, mode of arrival, and home living environment. McNemar's test for matched pairs was used to compare admission and recidivism rates at EDCC and non-EDCC hospitals. A paired t-test was used to compare length of stay between groups. There were no statistically significant differences for baseline admission rate, revisit rate at 30 days, and readmission rate at 30 days between EDCC and non-EDCC patients. This study showed no reduction in senior patients' admission rates, recidivism at 30 days, or hospital length of stay when comparing seniors seen by an EDCC with those not seen by an EDCC.

  4. Novel Emergency Medicine Curriculum Utilizing Self-Directed Learning and the Flipped Classroom Method: Obstetric and Gynecologic Emergencies Small Group Module

    Directory of Open Access Journals (Sweden)

    Jillian McGrath

    2017-09-01

    Full Text Available Audience: This curriculum, created and implemented at The Ohio State University Wexner Medical Center, was primarily designed to educate our emergency medicine (EM residents (PGY1-3 and emergency medicine/internal medicine (EM/IM residents (PGY1-5 on core obstetrics and gynecology topics in EM. Additional audience members include medical students and faculty physicians. Introduction: In 2013, there were over 1 million emergency department visits in the United States which resulted in primary obstetric or gynecologic diagnoses.1 EM Residents must be proficient in the differential diagnosis and management of the wide variety of obstetric and gynecologic emergencies. To do this, we developed a flipped classroom curricular model, which consists of self-directed learning activities completed by learners, followed by small group discussions pertaining to the topic reviewed. The active learning fostered by this type of curriculum increases faculty and learner engagement and interaction time typically absent in traditional lecture-based formats.2-4 Studies have revealed that the application of knowledge through case studies, personal interaction with content experts, and integrated questions are effective learning strategies for EM residents.4-6 The Ohio State University Wexner Medical Center EM residency didactic curriculum recently transitioned to a “flipped classroom” approach.7-10 Our didactic curriculum is delivered over the course of 18 months; however, it could easily be adapted to other academic calendar cycles. The flipped classroom curriculum maximizes didactic time and resident engagement, fosters intellectual curiosity and active learning, and meets the needs of today’s learners. 3,6,11 Objectives: We aim to teach the presentation and management of obstetric and gynecologic emergencies through the creation of a flipped classroom design. This unique, innovative curriculum utilizes resources chosen by education faculty and resident

  5. Implementation of Provider Perspectives Resulted in Proper Health Care Resource Utilization

    National Research Council Canada - National Science Library

    Mclean, Hugh

    2001-01-01

    .... One such system is Provider Perspectives. This study shows that Provider Perspectives significantly decreased Emergency Room utilization and subsequently increased the usage of primary care clinics at Martin Army Community Hospital and Winn...

  6. The utility experience of implementing the emergency operating procedure tracking system

    International Nuclear Information System (INIS)

    Chang, W.C.; Cheng, J.F.

    1990-01-01

    This report presents the experience of a project sponsored by the Electric Power Research Institute (EPRI), Taiwan Power Company (TPC) and supported by the Nuclear Software Service (NSS), General Electric Company (GE) and Science Applications International Corporation (SAIC) to implement the Emergency Operating Procedure Tracking System (EOPTS) in Kuosheng Nuclear Power Station Simulator. Before implement the EOPTS in Kuosheng Simulator, the Safety Parameter Display System (SPDS) of the Energency Response Facility Technical Data System (ERFTDS) shall be simulated, the hardware and software linkage between the simulator and ERFTDS shall be established, that include installation of a VAX-8200 computer, Gould - Vax computer hardware linkage, ERFTDS software installation, simulator source variables selection and linkage it to the ERFTDS database

  7. Utilizing Big Data and Twitter to Discover Emergent Online Communities of Cannabis Users

    Directory of Open Access Journals (Sweden)

    Peter Baumgartner

    2017-05-01

    Full Text Available Large shifts in medical, recreational, and illicit cannabis consumption in the United States have implications for personalizing treatment and prevention programs to a wide variety of populations. As such, considerable research has investigated clinical presentations of cannabis users in clinical and population-based samples. Studies leveraging big data, social media, and social network analysis have emerged as a promising mechanism to generate timely insights that can inform treatment and prevention research. This study extends a novel method called stochastic block modeling to derive communities of cannabis consumers as part of a complex social network on Twitter. A set of examples illustrate how this method can ascertain candidate samples of medical, recreational, and illicit cannabis users. Implications for research planning, intervention design, and public health surveillance are discussed.

  8. Ocorrência e preditores clínicos de pseudocrise hipertensiva no atendimento de emergência Occurrence rate and clinical predictors of hypertensive pseudocrisis in emergency room care

    Directory of Open Access Journals (Sweden)

    Silvestre Sobrinho

    2007-05-01

    Full Text Available OBJETIVOS: Descrever a prevalência de pseudocrise hipertensiva em pacientes atendidos em unidade de emergência com níveis de pressão arterial substancialmente elevados, comparando-a entre serviços privado e público; descrever a freqüência de tratamento indevido para essa condição; identificar, no momento da triagem, preditores independentes de pseudocrise; e avaliar o prognóstico dos pacientes com pseudocrise. MÉTODOS: Durante seis meses, foram incluídos pacientes com idade > 18 anos, atendidos nas Emergências de dois hospitais (privado e público, com pressão arterial diastólica > 120 mmHg. Pseudocrise hipertensiva foi definida na ausência de critérios para crise hipertensiva, segundo as Diretrizes da Sociedade Brasileira de Cardiologia. RESULTADOS: Em 110 pacientes estudados, a prevalência de pseudocrise hipertensiva foi de 48% (intervalo de confiança de 95% [IC 95%] = 39%-58%, predominando no serviço privado (59% vs 37%; p = 0,02. A freqüência de tratamento indevido foi semelhante nos dois serviços (94% vs 95%; p = 0,87. Após análise multivariada, a presença de cefaléia na admissão (odds ratio = 5,4; IC 95% = 5,1-13; p OBJECTIVES: To describe the prevalence of hypertensive pseudocrisis in patients treated in emergency rooms with substantially elevated blood pressure levels. To compare this prevalence in private and public hospitals. To describe the frequency of wrong treatment for this condition. To identify, during triage, independent predictors of pseudocrisis. To evaluate the prognosis of patients with pseudocrisis. METHODS: Patients above the age of 18, admitted to the Emergency Rooms of two hospitals (private and public during a 6 month timeframe, with diastolic blood pressure > 120 mmHg were included in the study. Hypertensive pseudocrisis was determined when none of the criteria for hypertensive crisis were present (Guidelines of the Brazilian Society of Cardiology¹. RESULTS: In the 110 patients studied

  9. Time-trends, Predictors and Outcome of Emergency Department Utilization for Gout: A Nationwide U.S. Study

    Science.gov (United States)

    Singh, Jasvinder A.; Yu, Shaohua

    2016-01-01

    Objective To assess gout-related emergency department (ED) utilization/charges and discharge disposition. Methods We used the U.S. National ED Sample (NEDS) data to examine the time-trends in total ED visits and charges and ED-related hospitalizations with gout as the primary diagnosis. We assessed multivariable-adjusted predictors of ED charges and hospitalization for gout-related visits using the 2012 NEDS data. Results There were 180,789, 201,044 and 205,152 ED visits in years 2009, 2010 and 2012 with gout as the primary diagnosis, with total ED charges of $195, $239 and $287 million, respectively; these accounted for 0.14-0.16% of all ED visits. Mean/median 2012 ED charges/visit were $1,398/$956. Of all gout-related ED visits, 7.7% were admitted to the hospital in 2012. Mean/median length of hospital stay was 3.9/2.6 days and mean/median inpatient charge/admission was $22,066/$15,912 in 2012. In multivariable-adjusted analyses, older age, female gender, highest income quartile, being uninsured, metropolitan residence, Western U.S. hospital location, heart disease, renal failure, congestive heart failure (CHF), hypertension, diabetes, osteoarthritis and chronic obstructive pulmonary disease (COPD) were associated with higher ED charges. Older age, Northeast location, Metropolitan teaching hospital, higher income quartile, heart disease, renal failure, CHF, hyperlipidemia, hypertension, diabetes, COPD, and osteoarthritis were associated with higher odds where as self-pay insurance status was associated with lower odds of hospitalization following an ED visit for gout. Conclusions Absolute ED utilization and charges for gout increased over time, but relative utilization remained stable. Modifiable comorbidity factors associated with higher gout-related utilization should be targeted to reduce morbidity and healthcare utilization. PMID:27134260

  10. Security Risks of Cloud Computing and Its Emergence as 5th Utility Service

    Science.gov (United States)

    Ahmad, Mushtaq

    Cloud Computing is being projected by the major cloud services provider IT companies such as IBM, Google, Yahoo, Amazon and others as fifth utility where clients will have access for processing those applications and or software projects which need very high processing speed for compute intensive and huge data capacity for scientific, engineering research problems and also e- business and data content network applications. These services for different types of clients are provided under DASM-Direct Access Service Management based on virtualization of hardware, software and very high bandwidth Internet (Web 2.0) communication. The paper reviews these developments for Cloud Computing and Hardware/Software configuration of the cloud paradigm. The paper also examines the vital aspects of security risks projected by IT Industry experts, cloud clients. The paper also highlights the cloud provider's response to cloud security risks.

  11. Utilization of inpatient care from private hospitals: trends emerging from Kerala, India.

    Science.gov (United States)

    Dilip, T R

    2010-09-01

    There is a gap in knowledge on the overall role and characteristics of private health care providers in India. This research is aimed at understanding changes in the consumption of inpatient care services from private hospitals between 1986 and 2004, with a particular focus on equitable outreach. Secondary analysis of National Sample Survey data on the utilization of inpatient care services in Kerala is performed for the periods 1986-87, 1995-96 and 2004. Household survey data are examined to understand the users of the private health system as there are limitations in obtaining reliable data from unregulated private health care providers. The annual hospitalization rate increased from 69 per 1000 population in 1986-87 to 126 per 1000 population by 2004. The proportion of persons seeking care from private rather than government hospitals increased from 55% in 1986-87 to 65% by 2004. Concentration indices revealed that the year 1995-96 witnessed the highest income inequality in hospitalization rates. A decline both in hospitalization rates and in the relative preference for private hospitals over government hospitals among the poorest two quintiles between 1986-87 and 1995-96 indicates that the poor avoided inpatient treatment. The rich-poor divide in care seeking from private hospitals was moderated by 2004. Improvements in the purchasing power of the population, and the strategy of private hospitals in this highly competitive market to generate revenue from the poorer quintiles by offering different pricing options, have reduced the observed rich-poor divide in the consumption of inpatient treatment from this sector. However, while this gap in utilization has closed, the burden of out-of-pocket expenditure is higher among the poor.

  12. Factors associated with the utilization of primary care emergency centers in a Spanish region with high population dispersion: a mixed-methods study.

    Science.gov (United States)

    Sanz-Barbero, Belén; Otero-García, Laura; Blasco-Hernández, Teresa; San Sebastián, Miguel

    2014-09-03

    Adequate access to primary care emergency centers is particularly important in rural areas isolated from urban centers. However, variability in utilization of emergency services located in primary care centers among inhabitants of nearby geographical areas is understudied. The objectives of this study are twofold: 1) to analyze the association between the availability of municipal emergency care centers and utilization of primary care emergency centers (PCEC), in a Spanish region with high population dispersion; and 2) to determine healthcare providers' perceptions regarding PCEC utilization. A mixed-methods study was conducted. Quantitative phase: multilevel logistic regression modeling using merged data from the 2003 Regional Health Survey of Castile and Leon and the 2001 census data (Spain). Qualitative phase:14 in-depth- interviews of rural-based PCEC providers. Having PCEC as the only emergency center in the municipality was directly associated with its utilization (p use. PCEC users were considered to be predominantly workers and students with scheduling conflicts with rural primary care opening hours. The location of emergency care centers is associated with PCEC utilization. Increasing access to primary care by extending hours may be an important step toward optimal PCEC utilization. Further research would determine whether lower PCEC use by certain groups is associated with disparities in access to care.

  13. Utilization of anti-RhD in the emergency department after blunt trauma.

    Science.gov (United States)

    Thorp, John M

    2008-02-01

    In the United States, trauma occurs in 6% to 7% of pregnancies. Its severity may range from critical injuries where the mother's life is at risk, to apparently minor injuries, which might not be associated with any worrisome symptoms. One of the risks associated with a traumatic event is fetomaternal hemorrhage--the transfer of fetal blood cells into the maternal circulation. If the maternal blood type is rhesus negative and the fetus is rhesus positive, even a small amount of blood can cause the mother to develop antibodies against the fetal Rho D antigen, thus becoming sensitized. In subsequent pregnancies, this can lead to hemolytic disease of the fetus or newborn, which, if severe, is associated with total body edema, hepatosplenomegaly and heart failure, and intrauterine death. Although there are no published studies specific to the US population, poor awareness of the risk of sensitization following trauma and underutilization of anti-RhD in the emergency department has been reported in countries such as Canada and the United Kingdom. This article reminds caregivers of the risk of rhesus sensitization following blunt trauma, in order that they can administer anti-RhD appropriately and hemolytic disease of the fetus or newborn can be prevented.

  14. Heavy precipitation and the responses within emergency management - a new approach for emergency planning and disaster prevention by utilizing fire brigade operation data

    Science.gov (United States)

    Kutschker, Thomas; Glade, Thomas

    2015-04-01

    An increase of intense rainfall events in the center regions of Europe is one of the assumed effects of climate change. Climate scenarios indicate also large seasonal and regional differences concerning the magnitude. Structural damages and financial loss resulting from heavy precipitation depend on natural parameters such as topography and vegetation cover of the specific area, but also on socio-economic parameters such as urbanized and industrialized areas, population density and the presence of critical infrastructure. In particular mudflows and floods cause damages such as flooded basements and streets, undercutting of roads or spilled sewage drains. The emergency management has to consider these effects appropriately. Commonly, this is the responsibilities is taken by the fire brigades and civil protection units. Within their daily routines, numerous data is collected, but commonly not utilized for scientific purposes. In particular fire brigade operation data can be used accordingly to describe the intensity of the aftermath when heavy precipitation strikes a certain area. One application is described in this study based on a example in Offenbach, Germany. The civil protection in Germany is based on a federal system with a bottom-up command-structure and responsibility to the local community. Therefore it is not easy to collect the overall incident data for a widespread affected area. To examine particular local effects of heavy precipitation events it is necessary to match the meteorological data provided by the German Meteorological Service (DWD) with the incident data of all effected fire brigades, which sometimes is impeded by the usual resolution of meteorological data. In this study, a method of comprehensive evaluation of meteorological data and the operation data from local fire brigades has been developed for the Rhine-Main-Area. This area is one of the largest metropolitan regions in Germany with a very high density in population as well as

  15. Recovery Room

    African Journals Online (AJOL)

    defined postoperative unit or on the hospital ward. Patients were frequently transferred from the operating room directly to the ward where they were placed close to the nursing station. In 1947 the. Anesthesia Study Commission of the Philadelphia.

  16. Emerging Utility of Virtual Reality as a Multidisciplinary Tool in Clinical Medicine.

    Science.gov (United States)

    Pourmand, Ali; Davis, Steven; Lee, Danny; Barber, Scott; Sikka, Neal

    2017-10-01

    Among the more recent products borne of the evolution of digital technology, virtual reality (VR) is gaining a foothold in clinical medicine as an adjunct to traditional therapies. Early studies suggest a growing role for VR applications in pain management, clinical skills training, cognitive assessment and cognitive therapy, and physical rehabilitation. To complete a review of the literature, we searched PubMed and MEDLINE databases with the following search terms: "virtual reality," "procedural medicine," "oncology," "physical therapy," and "burn." We further limited our search to publications in the English language. Boolean operators were used to combine search terms. The included search terms yielded 97 potential articles, of which 45 were identified as meeting study criteria, and are included in this review. These articles provide data, which strongly support the hypothesis that VR simulations can enhance pain management (by reducing patient perception of pain and anxiety), can augment clinical training curricula and physical rehabilitation protocols (through immersive audiovisual environments), and can improve clinical assessment of cognitive function (through improved ecological validity). Through computer-generated, life-like digital landscapes, VR stands to change the current approach to pain management, medical training, neurocognitive diagnosis, and physical rehabilitation. Additional studies are needed to help define best practices in VR utilization, and to explore new therapeutic uses for VR in clinical practice.

  17. The emergence of Clostridium thermocellum as a high utility candidate for consolidated bioprocessing applications

    Directory of Open Access Journals (Sweden)

    Arthur eRagauskas

    2014-08-01

    Full Text Available First isolated in 1926, Clostridium thermocellum has recently received increased attention as a high utility candidate for use in consolidated bioprocessing applications. These applications, which seek to process lignocellulosic biomass directly into useful products such as ethanol, are gaining traction as economically feasible routes towards the production of fuel and other high value chemical compounds as the shortcomings of fossil fuels become evident. This review evaluates C. thermocellum’s role in this transitory process by highlighting recent discoveries relating to its genomic, transcriptomic, proteomic, and metabolomic responses to varying biomass sources, with a special emphasis placed on providing an overview of its unique, multivariate enzyme cellulosome complex and the role that this structure performs during biomass degradation. Both naturally evolved and genetically engineered strains are examined in light of their unique attributes and responses to various biomass treatment conditions, and the genetic tools that have been employed for their creation are presented. Several future routes for potential industrial usage are presented, and it is concluded that, although there have been many advances to significantly improve C. thermocellum’s amenability to industrial use, several hurdles still remain to be overcome as this unique organism enjoys increased attention within the scientific community.

  18. Favorable bed utilization and readmission rates for emergency department observation unit heart failure patients.

    Science.gov (United States)

    Schrager, Justin; Wheatley, Matthew; Georgiopoulou, Vasiliki; Osborne, Anwar; Kalogeropoulos, Andreas; Hung, Olivia; Butler, Javed; Ross, Michael

    2013-06-01

    The objective was to compare readmission rates and hospital bed-days between acute decompensated heart failure (AHF) patients admitted or discharged following accelerated treatment protocol (ATP)-driven care in an emergency department observation unit (OU). This was a retrospective cohort study conducted at two urban university-affiliated hospitals. A total of 358 selected AHF patients received treatment on an ATP in the OU between October 1, 2007, and June 30, 2011. The comparison of interest was admission or discharge following OU treatment. The outcome of interest was readmission within 30 and 90 days of hospital discharge following care in the OU. We also examined resource use (inpatient, inpatient plus outpatient-days) between the admitted and discharged groups. Time to readmission analysis was performed with Cox proportional hazards regression. Discharged and admitted patients were similar with respect to age, race, sex, ED length of stay (LOS), and OU LOS. Patients admitted from the OU had a higher median B-type natriuretic peptide (BNP; 1,063 pg/mL [interquartile range {IQR} = 552 to 2,067 pg/mL] vs. 708 pg/mL [IQR = 254 to 1,683 pg/mL]; p = 0.002) and blood urea nitrogen (BUN; 19 mg/dL [IQR = 14 to 26 mg/dL] vs. 17 mg/dL [IQR = 13 to 23 mg/dL]) than those discharged (p = 0.04) and a lower median ejection fraction (EF; 22.5% [15% to 43%] vs. 35% [IQR 20% to 55%]; p = 0.002). In models controlling for age, race, sex, clinical site, BNP, BUN, creatinine, and EF, the 30-day readmission rate (13.8% in the study population as a whole) was not significantly different between the patients discharged or admitted following OU care (hazard ratio [HR] = 0.99; 95% confidence interval [CI] = 0.47 to 2.10). The readmission rates were also not significantly different at 90 days (HR = 1.07; 95% CI = 0.65 to 1.77). Within 30 days of discharge from the OU, patients spent a median of 1.7 days (IQR = 0.0 to 5.1 days) as inpatients, compared to 3.5 days (IQR = 2.3 to 5.8 days

  19. Emerging treatment options for the management of Hodgkin's lymphoma: clinical utility of Nivolumab

    Directory of Open Access Journals (Sweden)

    Bond DA

    2017-05-01

    Full Text Available David A Bond, Lapo Alinari Department of Internal Medicine, Division of Hematology, Arthur G James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA Abstract: Classical Hodgkin’s lymphoma (cHL is a B-cell malignancy comprised of pathologic Reed Sternberg cells with a surrounding immune-tolerant inflammatory milieu. RS cells evade immune recognition in part through programmed death ligand 1 (PD-L1 overexpression, which is genetically programmed through copy number alterations, polysomy, and amplification of the 9p24.1 locus encoding PD-L1. By engaging with PD-1+ T-cells, PD-L1 delivers a potent immune suppressive signal promoting immunologic escape of the tumor cell. Enhancing antitumor immune response by targeting PD-1 with the monoclonal antibody nivolumab has proved to be effective in multiple solid tumors, but the highest response rates to date have been reported in patients with cHL, with over 65% of treated patients achieving an objective clinical response. In this review, we will summarize the published evidence regarding the activity of nivolumab in cHL as well as its current place in therapy. We will review the pharmacology, mechanism of action, and side effects of nivolumab as well as the emerging data indicating possible increased risk of graft versus host disease in patients treated with PD-1 inhibitors either pre- or post-allogeneic stem cell transplant. Given the remarkable single-agent activity and safety profile of PD-1 inhibitors in heavily pretreated patients with cHL, the possibility of employing nivolumab in combination with other active agents and earlier in therapy is a promising area of active investigation, and we will briefly summarize current clinical trials. Keywords: nivolumab, Hodgkin’s lymphoma, pembrolizumab, checkpoint inhibitor therapy

  20. Utility of the CORD ECG Database in Evaluating ECG Interpretation by Emergency Medicine Residents

    Directory of Open Access Journals (Sweden)

    Wong, Hubert E

    2002-10-01

    Full Text Available OBJECTIVES: Electrocardiograph (ECG interpretation is a vital component of Emergency Medicine (EM resident education, but few studies have formally examined ECG teaching methods used in residency training. Recently, the Council of EM Residency Directors (CORD developed an Internet database of 395 ECGs that have been extensively peer-reviewed to incorporate all findings and abnormalities. We examined the efficacy of this database in assessing EM residents' skills in ECG interpretation. METHODS: We used the CORD ECG database to evaluate residents at our academic three-year EM residency. Thirteen residents participated, including four first-year, four second-year, and five third-year residents. Twenty ECGs were selected using 14 search criteria representing a broad range of abnormalities, including infarction, rhythm, and conduction abnormalities. Exams were scored based on all abnormalities and findings listed in the teaching points accompanying each ECG. We assigned points to each abnormal finding based on clinical relevance. RESULTS: Out of a total of 183 points in our clinically weighted scoring system, first-year residents scored an average of 99 points (54.1% [9 1- 1191, second-year residents 11 1 points (60.4% [97-1261, and third-year residents 130 points (7 1.0% [94- 1501, p = 0.12. Clinically relevant abnormalities, including anterior and inferior myocardial infarctions, were most frequently diagnosed correctly, while posterior infarction was more frequently missed. Rhythm abnormalities including ventricular and supraventricular tachycardias were most frequently diagnosed correctly, while conduction abnormalities including left bundle branch block and atrioventricular (AV block were more frequently missed. CONCLUSION: The CORD database represents a valuable resource in the assessment and teaching of ECG skills, allowing more precise identification of areas upon which instruction should be further focused or individually tailored. Our

  1. Effects of immigrant status on Emergency Room (ER) utilisation by children under age one: a population-based study in the province of Reggio Emilia (Italy).

    Science.gov (United States)

    Ballotari, Paola; D'Angelo, Stefania; Bonvicini, Laura; Broccoli, Serena; Caranci, Nicola; Candela, Silvia; Giorgi Rossi, Paolo

    2013-11-01

    The primary aim of this study was to assess the effect of immigrant status on Emergency Room (ER) utilisation by children under age one, considering all, non-urgent, very urgent, and followed by hospitalisation visits. The second aim was to investigate the role played by mother's educational level in the relationship between citizenship and ER utilisation. The cohort study included all healthy singleton live births in the years 2008-2009 and residing in the province of Reggio Emilia, followed for the first year of life in order to study their ER visits. The outcomes were the ER utilisation rate for all, non-urgent, very urgent, and followed by hospitalisation visits. The main explanatory variable was mother's citizenship. Other covariates were mother's educational level, maternal age, parity, and child gender. Multivariate analyses (negative binomial regression and zero inflated when appropriate) were performed. Adjusted utilisation Rate Ratios (RR) and their 95% Confidence Intervals (95% CI) were calculated. Trend for age in months by citizenship is depicted. There were 3,191 children (36.4%) with at least one ER visit in the first year of life. Adjusted RR show a significantly greater risk of ER visit for immigrants than for Italians: (RR 1.51; 95% CI 1.39-1.63). Immigrants also had a higher risk of non-urgent visits (RR 1.72; 95% CI 1.48-2.00) and for visits followed by hospitalizations (RR 1.58; 95% CI 1.33-1.89). For very urgent visits, the immigrants had a slightly higher risk compared to Italians (RR 1.25; 95% CI 0.98-1.59).The risk of ER visits is higher in the first two months of life (RR(1st vs 3rd-12th) 2.08; 95% CI 1.93-2.24 and RR(2nd vs 3rd-12th) 1.45; 95% CI 1.33-1.58, respectively). Considering all visits, the ER utilisation rate was inversely related with maternal education only for Italians (low educational level 44.0 and high educational level 73.9 for 100 children; p value for trend test < 0.001). Our study observed a higher use of ER

  2. Prognostic value of blood glucose in emergency room and glycosylated hemoglobin in patients who have suffered an acute cerebro-vascular event.

    Science.gov (United States)

    Ernaga Lorea, Ander; Hernández Morhain, María Cecilia; Ollero García-Agulló, María Dolores; Martínez de Esteban, Juan Pablo; Iriarte Beroiz, Ana; Gállego Culleré, Jaime

    2017-07-07

    Stress hyperglycemia has been associated with a worse prognosis in patients hospitalized in critical care units. The aim of this study is to evaluate the impact of blood glucose and glycosylated hemoglobin (HbA1c) levels on the mortality of patients suffering a acute cerebro-vascular event, and to determine if this relationship depends on the presence of diabetes. A retrospective analysis of 255 patients admitted to the ER for stroke was performed. Venous plasma glucose levels in the emergency room and HbA1c levels within the first 48hours were analyzed. The presence of diabetes was defined in terms of the patients' medical history, as well as their levels of fasting plasma glucose and HbA1c. Mortality was assessed within the first 30 months after the onset of the acute event. 28.2% of patients had diabetes. Higher mortality was observed in patients who had been admitted with plasma glucose levels≥140mg/dl (hazard ratio [HR]=2.22, 95% CI: 1.18-4.16, P=.013) after adjusting for various factors. This relationship was not confirmed in diabetic patients (HR=2.20, 95% CI: 0.66-7.40, P=.201) and was in non-diabetics (HR=2.55, 95% CI: 1.11-5.85, P=.027). In diabetics, HbA1c≥7% was not associated with poor prognosis (HR=0.68, 95% CI: 0.23-1.98, P=.475), whereas non-diabetics with admission levels of HbA1c falling within the pre-diabetes range (5.7% -6.4%) had a higher mortality (HR=2.62, 95% CI: 1.01-6.79, P=.048). Admission hyperglycemia is associated with a worse prognosis in patients without diabetes admitted for stroke, but this relationship was not seen in diabetics. In non-diabetic patients, HbA1c levels in the pre-diabetes range is associated with higher mortality. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  3. Short-term effects of fine particulate air pollution on cardiovascular hospital emergency room visits: a time-series study in Beijing, China.

    Science.gov (United States)

    Su, Chang; Breitner, Susanne; Schneider, Alexandra; Liu, Liqun; Franck, Ulrich; Peters, Annette; Pan, Xiaochuan

    2016-05-01

    The link between particulate matter (PM) and cardiovascular morbidity has been investigated in numerous studies. Less evidence exists, however, about how age, gender and season may modify this relationship. The aim of this study was to evaluate the association between ambient PM2.5 (PM ≤ 2.5 µm) and daily hospital emergency room visits (ERV) for cardiovascular diseases in Beijing, China. Moreover, potential effect modification by age, gender, season, air mass origin and the specific period with 2008 Beijing Olympic were investigated. Finally, the temporal lag structure of PM2.5 has also been explored. Daily counts of cardiovascular ERV were obtained from the Peking University Third Hospital from January 2007 to December 2008. Concurrently, data on PM2.5, PM10 (PM ≤ 10 µm), nitrogen dioxide and sulfur dioxide concentrations were obtained from monitoring networks and a fixed monitoring station. Poisson regression models adjusting for confounders were used to estimate immediate, delayed and cumulative air pollution effects. The temporal lag structure was also estimated using polynomial distributed lag (PDL) models. We calculated the relative risk (RR) for overall cardiovascular disease ERV as well as for specific causes of disease; and also investigated the potential modifying effect of age, gender, season, air mass origin and the period with 2008 Beijing Olympics. We observed adverse effects of PM2.5 on cardiovascular ERV--an IQR increase (68 μg/m(3)) in PM2.5 was associated with an overall RR of 1.022 (95% CI 0.990-1.057) obtained from PDL model. Strongest effects of PM2.5 on cardiovascular ERV were found for a lag of 7 days; the respective estimate was 1.012 (95% CI 1.002-1.022). The effects were more pronounced in females and in spring. Arrhythmia and cerebrovascular diseases showed a stronger association with PM2.5. We also found stronger PM-effects for stagnant and southern air masses and the period of Olympics modified the air pollution effects. We

  4. Patrón de consumo de alcohol en pacientes captados en salas de urgencias Alcohol consumption patterns in patients attending emergency rooms

    Directory of Open Access Journals (Sweden)

    Jorge Luis López-Jiménez

    1998-11-01

    Full Text Available Objetivo. Describir los patrones de consumo de alcohol en personas de 15 años y más, captadas en los servicios de urgencias de ocho hospitales de la Ciudad de México. Material y métodos. La información se obtuvo mediante autorreportes. El levantamiento de los datos se realizó en cada hospital durante una semana completa, las 24 horas del día. Se incluyó a los pacientes que notificaron su consumo en los últimos doce meses. Resultados. De 2 523 individuos entrevistados, 63% informó haber consumido bebidas alcohólicas, entre las que destacan los destilados y la cerveza; 56.8% informó que, al menos una vez durante el último año, se había embriagado. En el patrón de consumo predomina la ingestión de baja frecuencia y alta cantidad (46.9%; sin embargo, se encontraron variaciones por sexo y edad principalmente, y se notificaron problemas asociados. Conclusiones. La descripción de patrones de consumo de alcohol en diferentes grupos poblacionales es relevante en el estudio de problemas personales, familiares y sociales asociados con la ingesta de alcohol.Objective. To describe the alcohol consumption patterns in patients of 15 or more years of age, attending the emergency room of 8 possible hospitals in Mexico City. Material and methods. The information was obtained by self-report. Data were raised at each hospital for one whole week, 24 hours per day. It includes patients who reported alcohol consumption during the 12 months previous to the survey. Results. Of the 2 523 interviewed subjects 63% had ingested alcoholic beverages, in particular, spirits and beer; 58% admitted having been drunk at least once in the past year. The predominating alcohol consumption pattern is low frequency and high quantity (46.9%; however, variations were found according to sex and age and associated problems are reported. Conclusions. The description of alcohol consumption patterns in different population groups is relevant in the study of personal, family

  5. Leadership in the control room

    International Nuclear Information System (INIS)

    McDougall, S.J.

    2006-01-01

    This paper discusses the importance of leadership within the control rooms at nuclear power facilities. the leadership capability of control room staff has a significant influence over the improvement of human performance and the development of an 'event free' culture within the business. The development of leadership competency in the control room must be an important part of any nuclear power utility business improvement plan. (author)

  6. Leadership in the control room

    Energy Technology Data Exchange (ETDEWEB)

    McDougall, S.J. [Bruce Power, Bruce B Operations Div., Tiverton, Ontario (Canada)

    2006-07-01

    This paper discusses the importance of leadership within the control rooms at nuclear power facilities. the leadership capability of control room staff has a significant influence over the improvement of human performance and the development of an 'event free' culture within the business. The development of leadership competency in the control room must be an important part of any nuclear power utility business improvement plan. (author)

  7. Utility of Respondent Driven Sampling to Reach Disadvantaged Emerging Adults for Assessment of Substance Use, Weight, and Sexual Behaviors.

    Science.gov (United States)

    Tucker, Jalie A; Simpson, Cathy A; Chandler, Susan D; Borch, Casey A; Davies, Susan L; Kerbawy, Shatomi J; Lewis, Terri H; Crawford, M Scott; Cheong, JeeWon; Michael, Max

    2016-01-01

    Emerging adulthood often entails heightened risk-taking with potential life-long consequences, and research on risk behaviors is needed to guide prevention programming, particularly in under-served and difficult to reach populations. This study evaluated the utility of Respondent Driven Sampling (RDS), a peer-driven methodology that corrects limitations of snowball sampling, to reach at-risk African American emerging adults from disadvantaged urban communities. Initial "seed" participants from the target group recruited peers, who then recruited their peers in an iterative process (110 males, 234 females; M age = 18.86 years). Structured field interviews assessed common health risk factors, including substance use, overweight/obesity, and sexual behaviors. Established gender-and age-related associations with risk factors were replicated, and sample risk profiles and prevalence estimates compared favorably with matched samples from representative U.S. national surveys. Findings supported the use of RDS as a sampling method and grassroots platform for research and prevention with community-dwelling risk groups.

  8. Utility of the History and Physical Examination in the Detection of Acute Coronary Syndromes in Emergency Department Patients

    Directory of Open Access Journals (Sweden)

    Zachary DW Dezman

    2017-05-01

    Full Text Available Chest pain accounts for approximately 6% of all emergency department (ED visits and is the most common reason for emergency hospital admission. One of the most serious diagnoses emergency physicians must consider is acute coronary syndrome (ACS. This is both common and serious, as ischemic heart disease remains the single biggest cause of death in the western world. The history and physical examination are cornerstones of our diagnostic approach in this patient group. Their importance is emphasized in guidelines, but there is little evidence to support their supposed association. The purpose of this article was to summarize the findings of recent investigations regarding the ability of various components of the history and physical examination to identify which patients presenting to the ED with chest pain require further investigation for possible ACS. Previous studies have consistently identified a number of factors that increase the probability of ACS. These include radiation of the pain, aggravation of the pain by exertion, vomiting, and diaphoresis. Traditional cardiac risk factors identified by the Framingham Heart Study are of limited diagnostic utility in the ED. Clinician gestalt has very low predictive ability, even in patients with a non-diagnostic electrocardiogram (ECG, and gestalt does not seem to be enhanced appreciably by clinical experience. The history and physical alone are unable to reduce a patient’s risk of ACS to a generally acceptable level (<1%. Ultimately, our review of the evidence clearly demonstrates that “atypical” symptoms cannot rule out ACS, while “typical” symptoms cannot rule it in. Therefore, if a patient has symptoms that are compatible with ACS and an alternative cause cannot be identified, clinicians must strongly consider the need for further investigation with ECG and troponin measurement.

  9. Optimal timing in the privatisation of a utility in an emerging country: the case of electricity distribution in Delhi

    International Nuclear Information System (INIS)

    Ruet, Joel

    2006-01-01

    Privatisation of utilities in emerging countries is impeded by informational problems. We analyse privatisation of utilities as a process, focusing on the creation of information that arises both before and after the transfer of property. We take the example of the privatisation of electricity in Delhi (). We examine the interest in creating as much information as possible before the transfer of property, and propose a model based on a trade-off between the potential benefits of creating information prior to selling of assets, vs. facing the costs of delays associated with the risks of a state's failure in creating this information prior to privatisation. We operationalise the model in the case of Delhi and argue that, in similar conditions, it is reasonable and profitable to invest a few years in information building (). We test the robustness of this model with what risks to be the most stringent critique: the inefficiency of the state (). We conclude that this simple model is fit for a clear and transparent decision-making on privatisation and reforms

  10. Prevalencia del consumo de drogas en pacientes atendidos en urgencias de adultos Drug consumption prevalence in adult patients attending the emergency room

    Directory of Open Access Journals (Sweden)

    Sofía Piñero-De Fuentes

    1998-05-01

    Full Text Available Objetivo. Conocer la asociación entre consumo de marihuana, cocaína y/o bazuco, y causas de ingreso de pacientes al Hospital Central de Valencia, Venezuela. Material y métodos. Se estudiaron 148 individuos recibidos en el área de urgencias, debido a lesiones por agresión (LA, accidentes de tránsito (AT, accidentes de trabajo (ATB, lesión autoinfringida (LAU e intoxicaciones (INT. Se aplicó un cuestionario y un análisis toxicológicos. Resultados. Se encontró un consumo de drogas, solas y/o asociadas, de 23.6% (13.5% cocaína, 7.4% marihuana y 2.7% ambas. De los pacientes positivos para cocaína, 50% ingresaron por LA; 20% por INT; 10% por LAU; 5% por ATB, y 15% por otras causas. De los positivos para marihuana, 36.4% ingresaron por AT; 27.3% por ATB; 18% por LA; 9.09% por INT, y 9.09% por otros motivos. Los ingresos por LA fueron de 75%, y por ATB, de 25%, para drogas en combinación. El consumo alcohólico asociado a cocaína fue de 50%; a marihuana, de 9%; a combinación, de 25%. Conclusiones. Estos hallazgos demuestran que uno de cada cuatro ingresos por causa traumática está asociado al abuso de drogas, solas o en combinación, lo que revela una estrecha relación causa-efecto.Objective. To determine the association between patient admission due to trauma and the consumption of marihuana, cocaine and bazooka (basic cocaine paste at the Central Hospital of Valencia, Venezuela. Material and methods. 148 subjects were studied who had entered the emergency room due to lesions caused by aggression (AL, traffic accidents (TA, work-related accidents (WRA, self-inflicted injury (SII and intoxication (INT. A questionnaire was applied and toxicology analyses performed. Results. Drug consumption, alone or in combination, was found in 23.6% of individuals (13.5% cocaine, 7.4% marihuana and 2.7% both. Of the cocaine positive, 50% entered for AL, 20% for INT, 10% for SII, 5% for WRA and 15% for other causes. Of the marihuana positive, 36

  11. Creators Room

    DEFF Research Database (Denmark)

    Iversholt, Lene; Iversholt Toft, Karina

    2012-01-01

    Creators Room er et koncept til daginsitutioner, der indrammer og giver bud på en forståelse mellem inkluderende pædagogik og fysiske rammer. Konceptet er udviklet i et tværfagligt procesforløb, hvor formålet har været at skabe stadig bedre indendørsmiljøer for børn ved at forene pædagogiske...

  12. Residential Stability Reduces Unmet Health Care Needs and Emergency Department Utilization among a Cohort of Homeless and Vulnerably Housed Persons in Canada.

    Science.gov (United States)

    Jaworsky, Denise; Gadermann, Anne; Duhoux, Arnaud; Naismith, Trudy E; Norena, Monica; To, Matthew J; Hwang, Stephen W; Palepu, Anita

    2016-08-01

    This study examined the association of housing status over time with unmet physical health care needs and emergency department utilization among homeless and vulnerably housed persons in Canada. Homeless and vulnerably housed individuals completed interviewer-administered surveys on housing, unmet physical health care needs, health care utilization, sociodemographic characteristics, substance use, and health conditions at baseline and annually for 4 years. Generalized logistic mixed effects regression models examined the association of residential stability with unmet physical health care needs and emergency department utilization, adjusting for potential confounders. Participants were from Vancouver (n = 387), Toronto (n = 390), and Ottawa (n = 396). Residential stability was associated with lower odds of having unmet physical health needs (adjusted odds ratio (AOR), 0.82; 95 % confidence interval (CI), 0.67, 0.98) and emergency department utilization (AOR, 0.74; 95 % CI, 0.62, 0.88) over the 4-year follow-up period, after adjusting for potential confounders. Residential stability is associated with fewer unmet physical health care needs and lower emergency department utilization among homeless and vulnerably housed individuals. These findings highlight the need to address access to stable housing as a significant determinant of health disparities.

  13. Factores predictores de uso problemático de alcohol en personas atendidas en una sala de emergencia Predictive factors of alcohol use problems among patients visiting an emergency room

    Directory of Open Access Journals (Sweden)

    Fabián Fiestas

    2011-03-01

    Full Text Available Objetivos. Valorar el efecto predictivo de características claves de pacientes atendidos en salas de emergencia para detectar casos de uso problemático de alcohol. Materiales y Métodos. La muestra de estudio estuvo constituida por 371 personas atendidas en el lapso de siete días completos de enero de 2005 en el servicio de emergencia de un hospital público de Lima, Perú. Se aplicó un cuestionario demográfico, el SIDUC/CICAD para uso reciente de sustancias psicoactivas en salas de emergencias (i.e., uso dentro de las seis horas previas a la atención y el AUDIT para uso problemático de alcohol en el último año. El análisis de regresión logística simple y multivariada permitió valorar el efecto predictor de la edad, sexo, especialidad del servicio de atención, presencia de daño físico y el uso reciente de alcohol para detectar casos problemáticos de su uso. Resultados. El odds de tener uso problemático de alcohol en los varones es 26 veces el odds de tener dicho problema entre las mujeres (pObjectives. To assess the predictive effect of key individual-level characteristics to identify cases of alcohol use problems among patients visiting an emergency room. Materials and methods. The study sample was composed of 371 people attending an emergency room in a public hospital in Lima, Peru, during a period of seven complete days in January, 2005. For data gathering, we used a questionnaire for demographic information, the SIDUC/CICAD for recent use (i.e., in the last 6 hours of psychoactive substances before arriving to the emergency room, and the AUDIT, to identify alcohol use problems in the last year. Univariate and multivariate logistic regression models were used to estimate the predictive effect of age, sex, area of attention in the emergency room, presence of physical injuries and recent use of alcohol. Results. The odds of being a case of alcohol use problem for males is 26 times the odds of having that problem for females (p

  14. Criteria for preparation and evaluation of radiological emergency response plans and preparedness in support of nuclear power plants: Criteria for utility offsite planning and preparedness: Final report

    International Nuclear Information System (INIS)

    Podolak, E.M. Jr.; Sanders, M.E.; Wingert, V.L.; Donovan, R.W.

    1988-09-01

    The Nuclear Regulatory Commission (NRC) and the Federal Emergency Management Agency (FEMA) have added a supplement to NUREG-0654/FEMA-REP-1, Rev. 1 that provides guidance for the development, review, and evaluation of utility offsite radiological emergency response planning and preparedness for those situations in which state and/or local governments decline to participate in emergency planning. While this guidance primarily applies to plants that do not have full-power operating licenses, it does have relevance to operating nuclear power plants

  15. Interventions for Increasing Alcohol Treatment Utilization Among Patients with Alcohol Use Disorders from Emergency Departments: A Systematic Review.

    Science.gov (United States)

    Simioni, Nicolas; Rolland, Benjamin; Cottencin, Olivier

    2015-11-01

    Alcohol use disorders (AUDs) are characterized by low treatment coverage. Emergency departments (EDs) have great potential to increase alcohol treatment coverage. While ED-based brief interventions (BIs) are rarely effective for reducing alcohol use and related consequences in people with AUDs, utilization of formal alcohol treatment has been demonstrated to be useful. Thus we conducted a systematic review to determine efficacious interventions for increasing subsequent alcohol treatment from EDs. A systematic search of the literature up to 31 December 2013 was undertaken in three electronic databases: PubMed, PsycINFO and The Cochrane Library. Only randomized controlled trials (RCTs), controlled clinical trials (CCTs) and non-randomized controlled trials (NRCTs) were included. A meta-analysis was judged inappropriate because of substantial discrepancies in term of interventions' characteristics across studies. From the 2182 identified records, 7 studies (4RCTs, 2 CCTs, 1NRCT) met inclusion criteria. Onsite brief advice (BA) was found efficacious in comparison to no active control condition, but no evidence of efficacy was found when compared to active control conditions. Referral to post-discharge BIs was not found efficacious either used alone or in addition to onsite BA. There is evidence, albeit limited, suggesting that more intensive interventions, such as referral to extended post-discharge interventions and onsite extended BI, might be useful. Based on the available evidence, onsite BA with leaflets appears to be the minimum level of intervention since it enables to actively intervene while fitting in the time concerns experienced in EDs. Further research is needed to confirm these findings given the limited quantity and quality of existing data and to determine whether more intensive interventions could actually be useful. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Emergency radiology elective improves second-year medical students' perceived confidence and knowledge of appropriate imaging utilization.

    Science.gov (United States)

    Leschied, Jessica R; Knoepp, Ursula S; Hoff, Carrie Nicole; Mazza, Michael B; Klein, Katherine A; Mullan, Patricia B; Kelly, Aine M

    2013-09-01

    Given recent advances in and wider availability of complex imaging, physicians are expected to understand imaging appropriateness. We introduced second-year medical students to the American College of Radiology Appropriateness Criteria (ACR-AC) in an interactive case-based elective to demonstrate their use in imaging for common emergency department clinical complaints. Prospective pre- and post-test design assessed second-year medical students' performance on case-based knowledge applications and self-assessed confidence related to ACR-AC guidelines compared to second-year students participating in a different concurrent radiology elective. Students participated in a 3-day elective covering the ACR-AC, comparative effective imaging, and risks associated with imaging radiation exposure, with outcomes of perceived confidence using a 5-point Likert scale and knowledge of ACR-AC using case-based multiple choice questions. Analysis included computing mean scores and assessing effect sizes for changes in knowledge. Before the elective, 24 students scored an average of 3.45 questions correct of 8 (43.1%). On course completion, students scored an average of 5.3 questions correct of the same questions (66.3%) (P .85; effect size = 0.008). Students' confidence in ordering appropriate imaging improved nearly 2-fold from a range of 1.9 to 3.2 (on a scale of 1.0 to 5.0) to a range of 3.7 to 4.5. Following a short radiology elective, second-year medical students improved their knowledge of appropriate image utilization and perceived awareness of the indications, contraindications, and effects of radiation exposure related to medical imaging. Copyright © 2013 AUR. Published by Elsevier Inc. All rights reserved.

  17. Preparedness of Operation Teams' Non-technical Skills in a Main Control Room of Nuclear Power Plants to Manage Emergency Situations

    International Nuclear Information System (INIS)

    Yim, Ho Bin; Kim, Ar Ryum; Seong, Poong Hyun

    2012-01-01

    Human reliability is one of the important determinants for the system safety. Nuclear Energy Agency reported that approximately half of events reported by foreign nuclear industry were related with inappropriate human actions. The human error problems can be viewed in two ways: the person approach and the system approach. Other terms to represent each approach are active failures and latent conditions. Active failures are unsafe acts committed by people who are in direct contact with systems whereas latent conditions are the inevitable 'resident pathogens' within the system. To identify what kinds of non-technical skills were needed to cope with emergency conditions, a method to evaluate preparedness of task management in emergency conditions based on monitoring patterns was presented. Five characteristics were suggested to evaluate emergency task management and communication: latent mistake resistibility, latent violation resistibility, thoroughness, communication, and assertiveness. Case study was done by analyzing emergency training of 9 different real operation teams in the reference plant. The result showed that the 9 teams had their own emergency task management skills which resulted in good and bad performances

  18. Preparedness of Operation Teams' Non-technical Skills in a Main Control Room of Nuclear Power Plants to Manage Emergency Situations

    Energy Technology Data Exchange (ETDEWEB)

    Yim, Ho Bin; Kim, Ar Ryum; Seong, Poong Hyun [Korea Advanced Institute of Science and Technology, Daejeon (Korea, Republic of)

    2012-05-15

    Human reliability is one of the important determinants for the system safety. Nuclear Energy Agency reported that approximately half of events reported by foreign nuclear industry were related with inappropriate human actions. The human error problems can be viewed in two ways: the person approach and the system approach. Other terms to represent each approach are active failures and latent conditions. Active failures are unsafe acts committed by people who are in direct contact with systems whereas latent conditions are the inevitable 'resident pathogens' within the system. To identify what kinds of non-technical skills were needed to cope with emergency conditions, a method to evaluate preparedness of task management in emergency conditions based on monitoring patterns was presented. Five characteristics were suggested to evaluate emergency task management and communication: latent mistake resistibility, latent violation resistibility, thoroughness, communication, and assertiveness. Case study was done by analyzing emergency training of 9 different real operation teams in the reference plant. The result showed that the 9 teams had their own emergency task management skills which resulted in good and bad performances

  19. Occupational dosimetry in real time hemodynamic rooms. utility of the system Dose-aware as a training tool; Dosimetria ocupacional en tiempo real en salas de hemodinamica. Utilidad del Sistema Dose-Aware como herramienta formativa

    Energy Technology Data Exchange (ETDEWEB)

    Pinto Monedero, M.; Rodriguez Cobo, C.; Pifarre Martinez, X.; Ruiz Martin, J.; Barros Candelero, J. M.; Goicolea Ruigomez, J.; Diaz Blaires, G.; Garcia Lunar

    2014-02-01

    This paper presents the results from a study in a real time dosimetry system used in the catheter laboratory room of our center. The objective was to know the occupational doses per procedure, on the one hand, and, on the other hand, to evaluate its utility as a learning tool for radiation protection purposes with the simultaneous video recording of the interventions. 83 diagnostic and therapeutic procedures were analyzed, and an average dose per procedure of 0,37 {mu}Sv and 0,10 {mu}Sv for the main cardiologist and nurse were obtained, respectively. 36 of these interventions were also recorded and the images were synchronized with the dosimetric information stored and the dosimetry system. The findings were presented to the interventional cardiology team in a learning session. They showed a high level of satisfaction with this new method of optimizing the occupational doses through a customized learning session. (Author)

  20. Fatores de risco para consultas em pronto-socorro por crianças asmáticas no Sul do Brasil Asthmatic children's risk factors for emergency room visits, Brazil

    Directory of Open Access Journals (Sweden)

    Moema Chatkin

    2000-10-01

    Full Text Available OBJETIVOS: Traçar um perfil das crianças asmáticas do município de Pelotas, RS, conhecer o manejo da doença e os fatores de risco associados a consultas em pronto-socorro, motivadas por asma. MÉTODOS: Estudo transversal aninhado a um estudo de coorte, realizado na área urbana de Pelotas, cidade de médio porte do Sul do Brasil. Participaram 981 crianças de 4-5 anos, pertencentes à coorte de 1993. RESULTADOS: A prevalência de asma encontrada na amostra estudada foi de 25,4%. A morbidade por asma foi elevada: 31% das crianças asmáticas haviam procurado o pronto-socorro no último ano, 57% tinham consultado médico e 26%, de 1 a 4 anos, foram internadas por asma. Na análise geral, escolaridade e renda familiar baixas associaram-se com consultas em pronto-socorro (RO=4,1 para 0 a 4 anos de escolaridade e RO=6,5 para menos de 1 salário-mínimo. Dormir em quartos com 3 ou mais pessoas também mostrou-se associado (RO=2,2, bem como severidade das crises (RO=2,7, uso de medicamentos para asma no último ano (RO=1,9 e internações por asma (RO=3,0. CONCLUSÕES: A prevalência de asma entre crianças pré-escolares em Pelotas é alta, levando a grande morbidade. Encontraram-se como fatores preditores de consultas em pronto-socorro por asma, após análise multivariada, a baixa escolaridade das mães, severidade das crises e internação por asma.OBJECTIVES: To study a sample of asthmatic children to get to know how the disease is managed by caretakers and to identify predictive factors associated with attendance in emergency room for asthma. METHODS: A cross-sectional study nested in a cohort was undertaken in the urban area of Pelotas, Southern Brazil. 981 children aged 4-5 years, who belong to the cohort of 1993, participated in this study. RESULTS: The asthma prevalence in the children sample was 25.4%. Morbidity for asthma was quite high: 31% of the children were seen in emergency rooms in the last year, 57% attended medical clinics and

  1. At most hospitals in the state of Iowa, most surgeons' daily lists of elective cases include only 1 or 2 cases: Individual surgeons' percentage operating room utilization is a consistently unreliable metric.

    Science.gov (United States)

    Dexter, Franklin; Jarvie, Craig; Epstein, Richard H

    2017-11-01

    Percentage utilization of operating room (OR) time is not an appropriate endpoint for planning additional OR time for surgeons with high caseloads, and cannot be measured accurately for surgeons with low caseloads. Nonetheless, many OR directors claim that their hospitals make decisions based on individual surgeons' OR utilizations. This incongruity could be explained by the OR managers considering the earlier mathematical studies, performed using data from a few large teaching hospitals, as irrelevant to their hospitals. The important mathematical parameter for the prior observations is the percentage of surgeon lists of elective cases that include 1 or 2 cases; "list" meaning a combination of surgeon, hospital, and date. We measure the incidence among many hospitals. Observational cohort study. 117 hospitals in Iowa from July 2013 through September 2015. Surgeons with same identifier among hospitals. Surgeon lists of cases including at least one outpatient surgical case, so that Relative Value Units (RVU's) could be measured. Averaging among hospitals in Iowa, more than half of the surgeons' lists included 1 or 2 cases (77%; P<0.00001 vs. 50%). Approximately half had 1 case (54%; P=0.0012 vs. 50%). These percentages exceeded 50% even though nearly all the surgeons operated at just 1 hospital on days with at least 1 case (97.74%; P<0.00001 vs. 50%). The cases were not of long durations; among the 82,928 lists with 1 case, the median was 6 intraoperative RVUs (e.g., adult inguinal herniorrhaphy). Accurate confidence intervals for raw or adjusted utilizations are so wide for individual surgeons that decisions based on utilization are equivalent to decisions based on random error. The implication of the current study is generalizability of that finding from the largest teaching hospital in the state to the other hospitals in the state. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Control room philosophy: Principles of control room design and control room work

    International Nuclear Information System (INIS)

    Skriver, Jan; Ramberg, Jasmine; Allwin, Pernilla

    2006-01-01

    In order to provide insights for improvement of work in control rooms several factors have to be considered. Knowledge of principles including control room philosophies will guide the recommended improvements. In addition to knowledge about specific principles an advantage for an organization can be an understanding of similarities and policies used in other high risk industry. The report has been developed on the basis of a document analysis of international standards and other guiding documents. (NUREG 0711, ISO 11064, ISO 6385, IEC 60964). In addition to the document analysis which has strived to compare the documents to see similarities in important principals, experience from working with control room design, modifications and evaluations in other high risk industries has pervaded the report. Important principles have been identified which are recommended to be included in a control room philosophy. Many of these are similar to the principles identified in the international standards. An additional principal which is regarded as important is the utilization of Key Performance Indicators (KPI) which can be used as a measure to target preventative means. Further more it is critical that the control room philosophy is easy to access and comprehend for all users. One of the challenges that remain after having developed a control room philosophy is how to utilize it in the daily work situation. It is vital that the document remains as a living document, guiding the continual improvement of the control room in the various life cycle stages

  3. Patient Reasons for Non-Urgent Utilization of the Dwight David Eisenhower Army Medical Center Emergency Department

    National Research Council Canada - National Science Library

    Sizemore, Charles J

    2004-01-01

    .... A review of the present body of literature revealed common themes why non-urgent patients typically present at emergency departments, the impacts to hospitals, and possible initiatives that could be...

  4. Primary care emergency services utilization in German-speaking Switzerland: a population-based cross-sectional study.

    Science.gov (United States)

    Güntensperger, Urs; Pinzello-Hürlimann, Rosmarie; Martina, Benedict; Ciurea, Annette; Muff, Brigitte; Gutzwiller, Jean-Pierre

    2010-11-01

    Traditionally, emergency consultations have been done by a general practitioner (GP) in Switzerland. Over the last years, there seems to have been a shift between general practice to hospital emergency ward utilisation. There are several local initiatives of general practitioners and hospitals to change the organisation of emergency care. To plan a new organisation form of emergency care, delivery should be based on population based data. The aim of the study was to investigate the epidemiology and distribution of emergency consultations of primary care in a hospital and in a practice of general practitioners. In addition, factors of clinical performance in emergency consultations are of great public health interest. For this survey, all emergency patient contacts of general practitioners from the catchment area of Bülach, serving 27 088 inhabitants, were assessed by a questionnaire during the fourth quarter of 2006. Sex, age, time, duration of the contact and triage diagnosis were assessed. In addition, all patients seen by the emergency ward at the local hospital were assessed. Contact rates and hospitalisation rates per 100 000 inhabitants were determined. In addition, a multiple linear regression model was performed to determine factors associated with consultation time as a marker for clinical performance. Between October 1th and December 31th 2006, 1001 patient contacts were registered at the same time period in the hospital and general practice. The patient contact rate was 94.8 contacts per 100 000 inhabitants per day, and the hospitalisation rate was 9.1 patient per 100 000 inhabitants. Patients seen at the hospital were older than in general practice (41.2 ± 22.8 vs. 32.6 ± 26.3 years) and consultation and waiting time was longer in the hospital than consultation time with the GP (144.8 ± 106.5 vs. 19.6 ± 17.6 minutes). Nearly 1 out of 1000 inhabitants were looking for emergency primary care help, and 10% of the patients were seen urgently by general

  5. Computer-enhanced interventions for drug use and HIV risk in the emergency room: preliminary results on psychological precursors of behavior change.

    Science.gov (United States)

    Bonar, Erin E; Walton, Maureen A; Cunningham, Rebecca M; Chermack, Stephen T; Bohnert, Amy S B; Barry, Kristen L; Booth, Brenda M; Blow, Frederic C

    2014-01-01

    This article describes process data from a randomized controlled trial among 781 adults recruited in the emergency department who reported recent drug use and were randomized to: intervener-delivered brief intervention (IBI) assisted by computer, computerized BI (CBI), or enhanced usual care (EUC). Analyses examined differences between baseline and post-intervention on psychological constructs theoretically related to changes in drug use and HIV risk: importance, readiness, intention, help-seeking, and confidence. Compared to EUC, participants receiving the IBI significantly increased in confidence and intentions; CBI patients increased importance, readiness, confidence, and help-seeking. Both groups increased relative to the EUC in likelihood of condom use with regular partners. Examining BI components suggested that benefits of change and tools for change were associated with changes in psychological constructs. Delivering BIs targeting drug use and HIV risk using computers appears promising for implementation in healthcare settings. This trial is ongoing and future work will report behavioral outcomes. © 2013.

  6. Guidelines for the preparation of emergency operating procedures. Resolution of comments on NUREG-0799

    International Nuclear Information System (INIS)

    1982-08-01

    The purpose of this document is to identify the elements necessary for utilities to prepare and implement a program of Emergency Operating Procedures (EOPs) for use by control room personnel to assist in mitigating the consequences of a broad range of accidents and multiple equipment failures. This document applies only to the EOPs so designated; it does not address emergency preparedness or emergency planning. It also represents the resolution of comments on NUREG-0799, Draft Criteria for Preparation of Emergency Operating Procedures

  7. Written Informed Consent for Computed Tomography of the Abdomen/Pelvis is Associated with Decreased CT Utilization in Low-Risk Emergency Department Patients

    Directory of Open Access Journals (Sweden)

    Lisa H. Merck

    2015-12-01

    Full Text Available Introduction: The increasing rate of patient exposure to radiation from computerized tomography (CT raises questions about appropriateness of utilization. There is no current standard to employ informed consent for CT (ICCT. Our study assessed the relationship between informed consent and CT utilization in emergency department (ED patients. Methods: An observational multiphase before-after cohort study was completed from 4/2010-5/2011. We assessed CT utilization before and after (Time I/ Time II the implementation of an informed consent protocol. Adult patients were included if they presented with symptoms of abdominal/pelvic pathology or completed ED CT. We excluded patients with pregnancy, trauma, or altered mental status. Data on history, exam, diagnostics, and disposition were collected via standard abstraction tool. We generated a multivariate logistic model via stepwise regression, to assess CT utilization across risk groups. Logistic models, stratified by risk, were generated to include study phase and a propensity score that controlled for potential confounders of CT utilization. Results: 7,684 patients met inclusion criteria. In PHASE 2, there was a 24% (95% CI [10-36%] reduction in CT utilization in the low-risk patient group (p<0.002. ICCT did not affect CT utilization in the high-risk group (p=0.16. In low-risk patients, the propensity score was significant (p<0.001. There were no adverse events reported during the study period. Conclusion: The implementation of ICCT was associated with reduced CT utilization in low-risk ED patients. ICCT has the potential to increase informed, shared decision making with patients, as well as to reduce the risks and cost associated with CT.

  8. Flume Experiments for Optimizing the Hydraulic Performance of a Deep-Water Wetland Utilizing Emergent Vegetation and Obstructions

    Directory of Open Access Journals (Sweden)

    Shang-Shu Shih

    2016-06-01

    Full Text Available Constructed ponds and wetlands are widely used in urban areas for stormwater management, ecological conservation, and pollution treatment. The treatment efficiency of these systems is strongly related to the hydrodynamics and hydraulic residence time. In this study, we developed a physical model and used rhodamine-WT as a tracer to conduct flume experiments. An equivalent Reynolds number was assumed, and the flume was a 1/25-scale model. Emergent obstructions (EOs, submerged obstructions (SOs, and high- and low-density emergent vegetation were placed along the sides of the flume, and 49 tracer tests were performed. We altered the density, spatial extent, aspect ratio, and configurations of the obstructions and emergent vegetation to observe changes in the hydraulic efficiency of a deep-water wetland. In the cases of low-aspect-ratio obstructions, the effects of the EOs on the hydraulic efficiency were significantly stronger than those of the SOs. In contrast, in the cases of high-aspect-ratio obstructions, the improvement effects of the EOs were weaker than those of the SOs. The high-aspect-ratio EOs altered the flow direction and constrained the water conveyance area, which apparently caused a short-circuited flow phenomenon, resulting in a decrease in hydraulic efficiency. Most cases revealed that the emergent vegetation improved the hydraulic efficiency more than the EOs. The high-density emergent vegetation (HEV improved the hydraulic efficiency more than the low-density emergent vegetation (LEV. Three cases involving HEV, two cases involving LEV, and one case involving EOs attained a good hydraulic efficiency (λ > 0.75. To achieve greater water purification, aquatic planting in constructed wetlands should not be overly dense. The HEV configuration in case 3-1 achieved optimum hydraulic performance for compliance with applicable water treatment standards.

  9. Weather elements, chemical air pollutants and airborne pollen influencing asthma emergency room visits in Szeged, Hungary: performance of two objective weather classifications.

    Science.gov (United States)

    Makra, László; Puskás, János; Matyasovszky, István; Csépe, Zoltán; Lelovics, Enikő; Bálint, Beatrix; Tusnády, Gábor

    2015-09-01

    Weather classification approaches may be useful tools in modelling the occurrence of respiratory diseases. The aim of the study is to compare the performance of an objectively defined weather classification and the Spatial Synoptic Classification (SSC) in classifying emergency department (ED) visits for acute asthma depending from weather, air pollutants, and airborne pollen variables for Szeged, Hungary, for the 9-year period 1999-2007. The research is performed for three different pollen-related periods of the year and the annual data set. According to age and gender, nine patient categories, eight meteorological variables, seven chemical air pollutants, and two pollen categories were used. In general, partly dry and cold air and partly warm and humid air aggravate substantially the symptoms of asthmatics. Our major findings are consistent with this establishment. Namely, for the objectively defined weather types favourable conditions for asthma ER visits occur when an anticyclonic ridge weather situation happens with near extreme temperature and humidity parameters. Accordingly, the SSC weather types facilitate aggravating asthmatic conditions if warm or cool weather occur with high humidity in both cases. Favourable conditions for asthma attacks are confirmed in the extreme seasons when atmospheric stability contributes to enrichment of air pollutants. The total efficiency of the two classification approaches is similar in spite of the fact that the methodology for derivation of the individual types within the two classification approaches is completely different.

  10. Perceived organizational support and job involvement in the Iranian health care system: A case study of emergency room nurses in general hospitals.

    Science.gov (United States)

    Gorji, Hassan Abolghasem; Etemadi, Manal; Hoseini, Fatemeh

    2014-01-01

    Researchers believe that there are social exchanges between the employers and employees, because the employees would be interested in their organization and trust it based on how the organization values them and their welfare, comfort, and security. This belief is known as perceived organizational support that makes employees consider themselves as a part of their organization and have a commitment to it. The literature review is very limited in both variables in Iran and thus few studies also report the perceived organizational support and job involvement at the lower levels in our country. This research aimed at studying the levels of perceived organizational support and job involvement, relationship between this two, and the demographic factors relationship with both of them. This research was a descriptive analytical study conducted in 2012. The population included 123 emergency nurses in General Hospitals of Qom. Data were collected through Perceived Organizational Support and Job Involvement Questionnaires and analyzed using SPSS software, descriptive statistics and Spearman correlation and Chi-square test. Both mean scores for perceived organizational support and job involvement were in average level, 146/12 and 35/38, respectively. There was a significant relationship between perceived organizational support and age, education, tenure, organizational position, and job shift. There was also a significant relationship between job involvement and age and education and finally between perceived organizational support and job involvement (P = 0/029). The high correlation between perceived organizational support and job involvement indicates that the improvement of perceived organizational support are necessary through motivating the employees, showing interest in them, paying attention to them, respecting them, and providing development opportunity in the organization. These should be always considered by managers to improve job involvement.

  11. Euthanasia requests in a Canadian psychiatric emergency room: A case series: Part 1 of the McGill University euthanasia in psychiatry case series.

    Science.gov (United States)

    Benrimoh, David; Perreault, Antoine; Van Den Eynde, Frederique

    Euthanasia was decriminalized in Quebec in December 2015, and Canada-wide in June 2016. Both the Provincial and Federal legislation have limited the right to medical assistance in dying (MAID) to end-of-life cases; which makes MAID inaccessible to most patients solely suffering from psychiatric illness. While some end-stage anorexia nervosa or elderly patients may meet the end-of-life criterion because of their medical comorbidities or their age (Kelly et al., 2003), repeated suicide attempts or psychotic disorganization would not qualify since they would not be seen as elements of an illness leading to a foreseeable "natural death" (Canada, 2016). This is in contradiction to other jurisdictions, such as Belgium and the Netherlands as well as the eligibility criteria stated in the Supreme Court of Canada's decision in Carter v. Canada (Supreme Court of Canada, 2015). Here we analyze three cases of patients who presented to a psychiatric emergency department and requested MAID for psychiatric reasons. While none of the patients were eligible for MAID under Canadian law, we find that their demographics match closely that of patients granted MAID for psychiatric reasons in jurisdictions where that practice is allowed. Based on these cases, we comment on potentially negative consequences that may come from decriminalizing MAID for psychiatric reasons (such as an increased assessment burden on ED staff) and potentially positive consequences (such as encouraging suffering patients who had not consulted to seek care). While it is by no means our intention to take a political or moral stand on this important issue, or to conclusively weigh the negatives and positives of allowing MAID for psychiatric reasons, we do stress the importance of an active voice for psychiatry in this ongoing public debate. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. O atendimento às vítimas de violência na emergência: "prevenção numa hora dessas?" Medical care for victims of violence in emergency room: is it time for prevention?

    Directory of Open Access Journals (Sweden)

    Suely F. Deslandes

    1999-01-01

    Full Text Available Neste artigo discutem-se as possibilidades de prevenção que o setor de emergência pode desencadear diante dos casos de violências. Apóia-se nos dados de pesquisa em que se analisaram os atendimentos feitos às vítimas de "causas externas" em dois hospitais públicos de emergência no Rio de Janeiro. Optou-se, neste trabalho, por tratar de forma breve as principais "causas externas" atendidas (entre acidentes e violências, enfatizando-se os atendimentos de violência doméstica contra crianças, contra mulheres e os de tentativas de suicídios. A metodologia da pesquisa articulou o estudo descritivo de base quantitativa a uma abordagem qualitativa construída através de observação de campo e de entrevistas. A partir dos dados empíricos, trava-se uma discussão sobre o atendimento realizado e as oportunidades de prevenção possíveis e as condições necessárias para esta tarefa.This paper discusses violence prevention possibilities that could be raised in emergency. It draws on the research data that analysed medical care for the victims of "external causes" in two public emergency hospitals in Rio de Janeiro. This work deals briefly with the main "external causes" (among accidents and violence which were treated there and emphasizes the care given to the victims of child abuse, battered women and attempts of suicides. The research methodology articulates the descriptive study of quantitative base to a qualitative approach developed through field observation and interviews. Starting from the empiric data, it discusses the medical care received by the victims and the possible prevention opportunities and the necessary conditions for this task.

  13. Utilization of a state run public private emergency transportation service exclusively for childbirth: the Janani (maternal) Express program in Madhya Pradesh, India.

    Science.gov (United States)

    Sidney, Kristi; Ryan, Kayleigh; Diwan, Vishal; De Costa, Ayesha

    2014-01-01

    In 2009 the state government of Madhya Pradesh, India launched an emergency obstetric transportation service, Janani Express Yojana (JEY), to support the cash transfer program that promotes institutional delivery. JEY, a large scale public private partnership, lowers geographical access barriers to facility based care. The state contracts and pays private agencies to provide emergency transportation at no cost to the user. The objective was to study (a) the utilization of JEY among women delivering in health facilities, (b) factors associated with usage, (c) the timeliness of the service. A cross sectional facility based study was conducted in facilities that carried out > ten deliveries a month. Researchers who spent five days in each facility administered a questionnaire to all women who gave birth there to elicit socio-demographic characteristics and transport related details. 35% of women utilised JEY to reach a facility, however utilization varied between study districts. Uptake was highest among women from rural areas (44%), scheduled tribes (55%), and poorly educated women (40%). Living in rural areas and belonging to scheduled tribes were significant predictors for JEY usage. Almost 1/3 of JEY users (n = 104) experienced a transport related delay. The JEY service model complements the cash transfer program by providing transport to a facility to give birth. A study of the distribution of utilization in population subgroups suggests the intervention was successful in reaching the most vulnerable population, promoting equity in access. While 1/3 of women utilized the service and it saved them money; 30% experienced significant transport related delays in reaching a facility, which is comparable to women using public transportation. Further research is needed to understand why utilization is low, to explore if there is a need for service expansion at the community level and to improve the overall time efficiency of JEY.

  14. The conference hybrid control room

    International Nuclear Information System (INIS)

    Gieci, A.; Caucik, J.; Macko, J.

    2008-01-01

    An original concept of a hybrid control room was developed for the Mochovce-3 and Mochovce-4 reactor units which are under construction. The basic idea underlying the concept is that the control room should be a main working place for the operators (reactor operator and turbine operator) and for the shift supervisor, designed as a comprehensive unit desk shaped so that all members of the control room crew are in a face-to-face contact constantly. The main desk consists of three clearly identified areas serving the operators and the unit supervisor as their main working places. A soft control system is installed at the main working places. A separate safety-related working place, designed as a panel with classical instrumentations at the conference hybrid control room, is provided in case of abnormal conditions or emergency situation. Principles of ergonomics and cognitive engineering were taken into account when designing the new conference hybrid control room for the Mochovce-3 and -4 reactor units. The sizes, propositions, shapes and disposition of the equipment at the control room have been created and verified by using virtual reality tools. (orig.)

  15. Utilization of mesoscale atmospheric dynamic model PHYSIC as a meteorological forecast model in nuclear emergency response system

    International Nuclear Information System (INIS)

    Nagai, Haruyasu; Yamazawa, Hiromi

    1997-01-01

    It is advantageous for an emergency response system to have a forecast function to provide a time margin for countermeasures in case of a nuclear accident. We propose to apply an atmospheric dynamic model PHYSIC (Prognostic HYdroStatic model Including turbulence Closure model) as a meteorological forecast model in the emergency system. The model uses GPV data which are the output of the numerical weather forecast model of Japan Meteorological Agency as the initial and boundary conditions. The roles of PHYSIC are the interface between GPV data and the emergency response system and the forecast of local atmospheric phenomena within the model domain. This paper presents a scheme to use PHYSIC to forecast local wind and its performance. Horizontal grid number of PHYSIC is fixed to 50 x 50, whereas the mesh and domain sizes are determined in consideration of topography causing local winds at an objective area. The model performance was examined for the introduction of GPV data through initial and boundary conditions and the predictability of local wind field and atmospheric stability. The model performance was on an acceptable level as the forecast model. It was also recognized that improvement of cloud calculation was necessary in simulating atmospheric stability. (author)

  16. The association of duration of boarding in the emergency room and the outcome of patients admitted to the intensive care unit.

    Science.gov (United States)

    Al-Qahtani, Saad; Alsultan, Abdullah; Haddad, Samir; Alsaawi, Abdulmohsen; Alshehri, Moeed; Alsolamy, Sami; Felebaman, Afef; Tamim, Hani M; Aljerian, Nawfal; Al-Dawood, Abdulaziz; Arabi, Yaseen

    2017-11-09

    The demand for critical care beds is increasing out of proportion to bed availability. As a result, some critically ill patients are kept in the Emergency Department (ED boarding) awaiting bed availability. The aim of our study is to examine the impact of boarding in the ED on the outcome of patients admitted to the Intensive Care Unit(ICU). This was a retrospective analysis of ICU data collected prospectively at King Abdulaziz Medical City, Riyadh from ED between January 2010 and December 2012 and all patients admitted during this time were evaluated for their duration of boarding. Patients were stratified into three groups according to the duration of boarding from ED. Those admitted less than 6 h were classified as Group I, between 6 and 24 h, Group II and more than 24 h as Group III. We carried out multivariate analysis to examine the independent association of boarding time with the outcome adjusting for variables like age, sex, APACHE, Mechanical ventilation, Creatinine, Platelets, INR. During the study period, 940 patients were admitted from the ED to ICU, amongst whom 227 (25%) were admitted to ICU within 6 h, 358 (39%) within 6-24 h and 355 (38%) after 24 h. Patients admitted to ICU within 6 h were younger [48.7 ± 22.2(group I) years, 50.6 ± 22.6 (group II), 58.2 ± 20.9 (group III) (P = 0.04)]with less mechanical ventilation duration[5.9 ± 8.9 days (Group I), 6.5 ± 8.1 (Group II) and 10.6 ± 10.5 (Group III), P = 0.04]. There was a significant increase in hospital mortality [51(22.5), 104(29.1), 132(37.2), P = 0.0006) and the ICU length of stay(LOS) [9.55 days (Group I), 9.8 (Group II) and 10.6 (Group III), (P = 0.002)] with increase in boarding duration. In addition, the delay in admission was an independent risk factor for ICU mortality(OR for group III vs group I is 1.90, P = 0.04) and hospital mortality(OR for group III vs Group I is 2.09, P = 0.007). Boarding in the ED is associated with higher mortality. This

  17. Prepare to protect: Operating and maintaining a tornado safe room.

    Science.gov (United States)

    Herseth, Andrew; Goldsmith-Grinspoon, Jennifer; Scott, Pataya

    2017-06-01

    Operating and maintaining a tornado safe room can be critical to the effective continuity of business operations because a firm's most valuable asset is its people. This paper describes aspects of operations and maintenance (O&M) for existing tornado safe rooms as well as a few planning and design aspects that affect the ultimate operation of a safe room for situations where a safe room is planned, but not yet constructed. The information is based on several Federal Emergency Management Agency safe room publications that provide guidance on emergency management and operations, as well as the design and construction of tornado safe rooms.

  18. Utilization of Health Care Coalitions and Resiliency Forums in the United States and United Kingdom: Different Approaches to Strengthen Emergency Preparedness.

    Science.gov (United States)

    Walsh, John; Swan, Allan Graeme

    2016-02-01

    The process for developing national emergency management strategies for both the United States and the United Kingdom has led to the formulation of differing approaches to meet similar desired outcomes. Historically, the pathways for each are the result of the enactment of legislation in response to a significant event or a series of events. The resulting laws attempt to revise practices and policies leading to more effective and efficient management in preparing, responding, and mitigating all types of natural, manmade, and technological hazards. Following the turn of the 21st century, each country has experienced significant advancements in emergency management including the formation and utilization of 2 distinct models: health care coalitions in the United States and resiliency forums in the United Kingdom. Both models have evolved from circumstances and governance unique to each country. Further in-depth study of both approaches will identify strengths, weaknesses, and existing gaps to meet continued and future challenges of our respective disaster health care systems.

  19. Report of the Office of Chief Counsel on the role of the managing utility and its suppliers

    International Nuclear Information System (INIS)

    Gorinson, S.M.; Kane, K.P.

    1979-10-01

    Information is presented concerning the role of General Public Utilities Service Corp.; site change; role of Met Ed in design of TMI-2; control room design; containment isolation criteria selection; GPUSC startup and test group; commercial operation; management relationships within the utility; site management; review committees; procedures; attention to experience; NRC inspections; management approach to the emergency; and the TMI-2 recovery program

  20. Report of the Office of Chief Counsel on the role of the managing utility and its suppliers

    International Nuclear Information System (INIS)

    Gorinson, S.M.; Kane, K.P.

    1979-10-01

    Information is presented concerning the role of General Public Utilities Service Corp.; site change; role of Met Ed in design of TMI-2; control room design; containment isolation criteria selection; GPUSC startup and test group; commercial operation; managment relationships within the utility; site management; review committees; procedures; attention to experience; NRC inspections; management approach to the emergency; and the TMI-2 recovery program

  1. Poluição atmosférica devida à queima de biomassa florestal e atendimentos de emergência por doença respiratória em Rio Branco, Brasil - Setembro, 2005 Anthropogenic air pollution and respiratory disease-related emergency room visits in Rio Branco, Brazil - September, 2005

    Directory of Open Access Journals (Sweden)

    Márcio Dênis Medeiros Mascarenhas

    2008-01-01

    Full Text Available A poluição atmosférica é um importante problema de saúde pública, principalmente na Amazônia e grandes cidades brasileiras. Em setembro de 2005, observou-se elevada concentração de fumaça em Rio Branco, Acre, devido às queimadas. Para avaliar a relação entre a concentração diária de particulate matter Air pollution is a major public health problem in the Amazon forest and in large Brazilian cities. During September of 2005, high concentrations of smoke from biomass burning were observed in the city of Rio Branco. An ecological study was conducted to evaluate the relationship between daily concentrations of particulate matter < 2.5 µm (PM2.5 and the number of respiratory disease (RD-related emergency room visits. Daily PM2.5 concentrations exceeded recommended air quality limits on 23 days. The incidence of RDs was higher among children < 10 years of age. There was a significant positive correlation between PM2.5 concentrations and asthma emergency room visits.

  2. CEBAF Control Room Renovation

    International Nuclear Information System (INIS)

    Michael Spata; Anthony Cuffe; Thomas Oren

    2005-01-01

    The Machine Control Center (MCC) at Jefferson Lab's Continuous Electron Beam Accelerator Facility (CEBAF) was constructed in the early 1990s and based on proven technology of that era. Through our experience over the last 15 years and in our planning for the facilities 12 GeV upgrade we reevaluated the control room environment to capitalize on emerging visualization and display technologies and improve on work-flow processes and ergonomic attributes. The renovation was performed in two phases during the summer of 2004, with one phase occurring during machine operations and the latter, more extensive phase, occurring during our semi-annual shutdown period. The new facility takes advantage of advances in display technology, analog and video signal management, server technology, ergonomic workspace design, lighting engineering, acoustic ceilings and raised flooring solutions to provide a marked improvement in the overall environment of machine operations

  3. Room to Groove?

    DEFF Research Database (Denmark)

    Seabrooke, Leonard

    . As long as they stay within the parameters of legitimate financial practice to signal institutional isomorphism, the `groove', creditors may well allow borrowers room for change in self-determined ways. This paper maps out the historical and conceptual terrain concerning civilizing ideas about...... the legitimacy of financial practices within global capital markets, and investigates relationships between Western `civilizers' and Emerging Market Economies during the last two periods of financial globalization, the late-nineteenth/ early-twentieth centuries and the late-twentieth century.......The use of a `standard of civilization', a preferred form of socio-political organization, in global capital markets presents both constraints and opportunities for creditors and borrowers. When imposed, civilizing standards may change how a borrower would prefer to conduct their affairs. Creditors...

  4. CEBAF Control Room Renovation

    International Nuclear Information System (INIS)

    Michael Spata; Thomas Oren

    2005-01-01

    The Machine Control Center (MCC) at Jefferson Lab's Continuous Electron Beam Accelerator Facility (CEBAF) was initially constructed in the early 1990s and based on proven technology of that era. Through our experience over the last 15 years and in our planning for the facility's 12 GeV upgrade we reevaluated the control room environment to capitalize on emerging visualization and display technologies and improve workflow processes and ergonomic attributes. This effort also sets the foundation for the redevelopment of the accelerator's control system to deliver high reliability performance with improvements in beam specifications management and information flow. The complete renovation was performed over a three-week maintenance period with no interruption to beam operations. We present the results of this effort

  5. CEBAF Control Room Renovation

    International Nuclear Information System (INIS)

    Michael Spata; Thomas Oren

    2005-01-01

    The Machine Control Center at Jefferson Lab's Continuous Electron Beam Accelerator Facility was initially constructed in the early 1990s and based on proven technology of that era. Through our experience over the last 15 years and in our planning for the facilities 12 GeV upgrade we reevaluated the control room environment to capitalize on emerging visualization and display technologies and improve on workflow processes and ergonomic attributes. This effort also sets the foundation for the redevelopment of the accelerator's control system to deliver high reliability performance with improvements in beam specifications management and information flow. The complete renovation was performed over a three-week period with no interruption to beam operations. We present the results of this effort

  6. Development of a clinical prediction rule to improve peripheral intravenous cannulae first attempt success in the emergency department and reduce post insertion failure rates: the Vascular Access Decisions in the Emergency Room (VADER) study protocol.

    Science.gov (United States)

    Carr, Peter J; Rippey, James C R; Cooke, Marie L; Bharat, Chrianna; Murray, Kevin; Higgins, Niall S; Foale, Aileen; Rickard, Claire M

    2016-02-11

    Peripheral intravenous cannula (PIVC) insertion is one of the most common clinical interventions performed in emergency care worldwide. However, factors associated with successful PIVC placement and maintenance are not well understood. This study seeks to determine the predictors of first time PIVC insertion success in emergency department (ED) and identify the rationale for removal of the ED inserted PIVC in patients admitted to the hospital ward. Reducing failed insertion attempts and improving peripheral intravenous cannulation practice could lead to better staff and patient experiences, as well as improving hospital efficiency. We propose an observational cohort study of PIVC insertions in a patient population presenting to ED, with follow-up observation of the PIVC in subsequent admissions to the hospital ward. We will collect specific PIVC observational data such as; clinician factors, patient factors, device information and clinical practice variables. Trained researchers will gather ED PIVC insertion data to identify predictors of insertion success. In those admitted from the ED, we will determine the dwell time of the ED-inserted PIVC. Multivariate regression analyses will be used to identify factors associated with insertions success and PIVC failure and standard statistical validation techniques will be used to create and assess the effectiveness of a clinical predication rule. The findings of our study will provide new evidence to improve insertion success rates in the ED setting and identify strategies to reduce premature device failure for patients admitted to hospital wards. Results will unravel a complexity of factors that contribute to unsuccessful PIVC attempts such as patient and clinician factors along with the products, technologies and infusates used. ACTRN12615000588594; Pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  7. Opinion paper on utility of point-of-care biomarkers in the emergency department pathways decision making.

    Science.gov (United States)

    Di Somma, Salvatore; Zampini, Giorgio; Vetrone, Francesco; Soto-Ruiz, Karina M; Magrini, Laura; Cardelli, Patrizia; Ronco, Claudio; Maisel, Alan; Peacock, Frank W

    2014-10-01

    Overcrowding of the emergency department (ED) is rapidly becoming a global challenge and a major source of concern for emergency physicians. The evaluation of cardiac biomarkers is critical for confirming diagnoses and expediting treatment decisions to reduce overcrowding, however, physicians currently face the dilemma of choosing between slow and accurate central-based laboratory tests, or faster but imprecise assays. With improvements in technology, point-of-care testing (POCT) systems facilitate the efficient and high-throughput evaluation of biomarkers, such as troponin (cTn), brain natriuretic peptide (BNP) and neutrophil gelatinase-associated lipocalin (NGAL). In this context, POCT may help ED physicians to confirm a diagnosis of conditions, such as acute coronary syndrome, heart failure or kidney damage. Compared with classic laboratory methods, the use of cTn, BNP, and NGAL POCT has shown comparable sensitivity, specificity and failure rate, but with the potential to provide prompt and accurate diagnosis, shorten hospital stay, and alleviate the burden on the ED. Despite this potential, the full advantages of rapid delivery results will only be reached if POCT is implemented within hospital standardized procedures and ED staff receive appropriate training.

  8. Utilization of Hospital Emergency Departments for non-traumatic dental care in New Hampshire, 2001-2008.

    Science.gov (United States)

    Anderson, Ludmila; Cherala, Sai; Traore, Elizabeth; Martin, Nancy R

    2011-08-01

    Hospital Emergency Departments (ED) provide a variety of medical care, some of which is for non-urgent, chronic conditions. We describe the statewide use of hospital ED for selected non-traumatic dental conditions that occurred during 2001-2008 in New Hampshire. Using the administrative hospital discharge dataset for 2001-2007, and provisional 2008 data, we identified all visits for selected dental conditions and calculated age-adjusted rates per 10,000 New Hampshire residents by several socio-demographic characteristics. The Spearman correlation coefficient was used to assess the statistical significance for trend over time. Emergency department visits for non-traumatic dental conditions increased significantly from 11,067 in 2001 to 16,238 visits in 2007 (P dental care users. The most frequent dental complains (46%) were diseases of the teeth and supporting structures, diagnostic code ICD-9-CM-525. Dental care associated ED visits have increased in New Hampshire. Individuals seeking dental treatment in ED are not receiving definitive treatment, and they misuse limited resources. Future studies need to determine the specific barriers to timely and effective dental care in dental offices. Ongoing consistent monitoring of ED use for non-traumatic dental conditions is essential.

  9. Barriers to access and utilization of emergency obstetric care at health facilities in sub-Saharan Africa-a systematic review protocol.

    Science.gov (United States)

    Geleto, Ayele; Chojenta, Catherine; Mussa, Abdulbasit; Loxton, Deborah

    2018-04-16

    Nearly 15% of all pregnancies end in fatal perinatal obstetric complications including bleeding, infections, hypertension, obstructed labor, and complications of abortion. Between 1990 and 2015, an estimated 10.7 million women died due to obstetric complications. Almost all of these deaths (99%) happened in developing countries, and 66% of maternal deaths were attributed to sub-Saharan Africa. The majority of cases of maternal mortalities can be prevented through provision of evidence-based potentially life-saving signal functions of emergency obstetric care. However, different factors can hinder women's ability to access and use emergency obstetric services in sub-Saharan Africa. Therefore, the aim of this review is to synthesize current evidence on barriers to accessing and utilizing emergency obstetric care in sub-Saharan African. Decision-makers and policy formulators will use evidence generated from this review in improving maternal healthcare particularly the emergency obstetric care. Electronic databases including MEDLINE, CINAHL, Embase, and Maternity and Infant Care will be searched for studies using predefined search terms. Articles published in English language between 2010 and 2017 with quantitative and qualitative design will be included. The identified papers will be assessed for meeting eligibility criteria. First, the articles will be screened by examining their titles and abstracts. Then, two reviewers will review the full text of the selected articles independently. Two reviewers using a standard data extraction format will undertake data extraction from the retained studies. The quality of the included papers will be assessed using the mixed methods appraisal tool. Results from the eligible studies will be qualitatively synthesized using the narrative synthesis approach and reported using the three delays model. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist will be employed to present the findings. This

  10. Guidelines for control room design reviews

    International Nuclear Information System (INIS)

    1981-09-01

    whether the control room provides the system status information, control capabilities, feedback, and analytic aids necessary for control room operators to accomplish their functions effectively. To identify characteristics of the existing control room instrumentation, controls, other equipment, and physical arrangements that may detract from operator performance. o analyze and evaluate the problems that could arise from discrepancies of the above kinds, and to analyze means of correcting those discrepancies which could lead to substantial problems. To define and put into effect a plan of action that applies human factors principles to improve control room design and enhance operator effectiveness. Particular emphasis should be placed on improvements affecting control room design and operator performance under abnormal or emergency conditions. To integrate the control room design review with other areas of human factors inquiry identified in the NRC Task Action Plan

  11. Effect of emergency oral contraceptive use on condom utilization and sexual risk taking behaviours among university students, Northwest Ethiopia: a cross-sectional study.

    Science.gov (United States)

    Wasie, Belaynew; Belyhun, Yeshambel; Moges, Beyene; Amare, Bemnet

    2012-09-13

    Young people between the ages of 15 and 24 years are both the most at risk of HIV and the greatest hope for turning the tide against HIV/AIDS. Although various surveys have been done on sexual behaviour of youth in Ethiopia, studies assessing the effect of emergency oral contraceptives on condom utilization of university students are lacking. A cross-sectional study was conducted in two major universities of Ethiopia from January to May 2011 using structured self administered questionnaire with the aim to assess the effect of introducing oral emergency contraceptive pills on condom utilization and sexual risk taking behaviours among female university students. Study participants were selected by simple random sampling using the list from the associate registrars of each University. Data were entered, cleaned and analyzed using SPSS version 17.0. Bivariate and multiple logistic regression analyses were used to determine factors associated with condom utilization. a total of 623 students out of 660 were included giving response rate of 94.4%. A total of 103(16.5%) had history of sexual intercourse and nearly half (45.6%) of them had sex before the age of 20 years. Forty (6.4%) students had history of sexually transmitted infections (STI). Sixty seven percent of students had heard about emergency oral contraceptives. One hundred and ninety one (45.7%) of students believe that EOC is effective in preventing pregnancy. Believing that EOC is effective in preventing pregnancy (adjusted Odds ratio, AOR = 0.22 95% CI 0.06, 0.87), condom prevents STI (AOR = 10.37, 95% CI 1.73, 62.24) and younger age below 20 years (AOR = 11.68 95% CI 1.25, 109.19) were statistically significantly associated with condom use. a significant number of students had history of sexual intercourse and used emergency contraception. The belief in the effectiveness of EOC negatively affects condom use. The preference for the pill may make teenagers less prepared to practice STI protective behaviours in

  12. Effect of emergency oral contraceptive use on condom utilization and sexual risk taking behaviours among university students, Northwest Ethiopia: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Wasie Belaynew

    2012-09-01

    Full Text Available Abstract Background Young people between the ages of 15 and 24 years are both the most at risk of HIV and the greatest hope for turning the tide against HIV/AIDS. Although various surveys have been done on sexual behaviour of youth in Ethiopia, studies assessing the effect of emergency oral contraceptives on condom utilization of university students are lacking. Methods A cross-sectional study was conducted in two major universities of Ethiopia from January to May 2011 using structured self administered questionnaire with the aim to assess the effect of introducing oral emergency contraceptive pills on condom utilization and sexual risk taking behaviours among female university students. Study participants were selected by simple random sampling using the list from the associate registrars of each University. Data were entered, cleaned and analyzed using SPSS version 17.0. Bivariate and multiple logistic regression analyses were used to determine factors associated with condom utilization. Results a total of 623 students out of 660 were included giving response rate of 94.4%. A total of 103(16.5% had history of sexual intercourse and nearly half (45.6% of them had sex before the age of 20 years. Forty (6.4% students had history of sexually transmitted infections (STI. Sixty seven percent of students had heard about emergency oral contraceptives. One hundred and ninety one (45.7% of students believe that EOC is effective in preventing pregnancy. Believing that EOC is effective in preventing pregnancy (adjusted Odds ratio, AOR = 0.22 95% CI 0.06, 0.87, condom prevents STI (AOR = 10.37, 95% CI 1.73, 62.24 and younger age below 20 years (AOR = 11.68 95% CI 1.25, 109.19 were statistically significantly associated with condom use. Conclusion a significant number of students had history of sexual intercourse and used emergency contraception. The belief in the effectiveness of EOC negatively affects condom use. The preference for the

  13. Utilization of Failure Mode and Effects Analysis (FMEA) Method in Increasing the Revenue of Emergency Department; a Prospective Cohort Study.

    Science.gov (United States)

    Shahrami, Ali; Rahmati, Farhad; Kariman, Hamid; Hashemi, Behrooz; Rahmati, Majid; Baratloo, Alireza; Forouzanfar, Mohammad Mehdi; Safari, Saeed

    2013-01-01

    The balance between revenue and cost of an organization/system is essential to maintain its survival and quality of services. Emergency departments (ED) are one of the most important parts of health care delivery system. Financial discipline of EDs, by increasing the efficiency and profitability, can directly affect the quality of care and subsequently patient satisfaction. Accordingly, the present study attempts to investigate failure mode and effects analysis (FMEA) method in identifying the problems leading to the loss of ED revenue and offer solutions to help fix these problems. This prospective cohort study investigated the financial records of ED patients and evaluated the effective errors in reducing the revenue in ED of Imam Hossein hospital, Tehran, Iran, from October 2007 to November 2009. The whole department was divided into one main system and six subsystems, based on FMEA. The study was divided into two phases. In the first phase, the problems leading to the loss of revenue in each subsystem were identified and weighted into four groups using risk priority number (RPN), and the solutions for fixing them were planned. Then, in the second phase, discovered defects in the first phase were fixed according to their priority. Finally, the impact of each solution was compared before and after intervention using the repeated measure ANOVA test. 100 financial records of ED patients were evaluated during the first phase of the study. The average of ED revenue in the six months of the first phase was 73.1±3.65 thousand US dollars/month. 12 types of errors were detected in the predefined subsystems. ED revenue rose from 73.1 to 153.1, 207.06, 240, and 320 thousand US dollars/month after solving first, second, third, and fourth priority problems, respectively (337.75% increase in two years) (pFMEA could be considered as an efficient model for increasing the revenue of emergency department. According to this model, not recording the services by the nursing unit

  14. Utilization of Failure Mode and Effects Analysis (FMEA Method in Increasing the Revenue of Emergency Department; a Prospective Cohort Study

    Directory of Open Access Journals (Sweden)

    Ali Shahrami

    2013-12-01

    Full Text Available Introduction: The balance between revenue and cost of an organization/system is essential to maintain its survival and quality of services. Emergency departments (ED are one of the most important parts of health care delivery system. Financial discipline of EDs, by increasing the efficiency and profitability, can directly affect the quality of care and subsequently patient satisfaction. Accordingly, the present study attempts to investigate failure mode and effects analysis (FMEA method in identifying the problems leading to the loss of ED revenue and offer solutions to help fix these problems. Methods: This prospective cohort study investigated the financial records of ED patients and evaluated the effective errors in reducing the revenue in ED of Imam Hossein hospital, Tehran, Iran, from October 2007 to November 2009. The whole department was divided based on FMEA into one main system and six subsystems. The study was divided in two phases. In the first phase, the problems leading to the loss in the revenue in each subsystem were identified and weighted to four groups using risk priority number (RPN, and the solutions for fixing them were planned. Then, at the second phase discovered defects in the first phase were fixed according to their priority. Finally, the impact of each solution was compared before and after interventions using the repeated measure ANOVA test. Results: At last, 100 financial records of ED patients were evaluated during the first phase of the study. The average of ED revenue in the six months of the first phase was 73.1±3.65 thousands US dollar/month. 12 types of errors were detected in the predefined subsystems. ED revenue rose from 73.1 to 153.1, 207.06, 240, and 320 thousands US dollar/month after solving of first, second, third, and fourth priority problems, respectively (337.75% increase in two years (p<0.001. 111.0% increase in the ED revenue after solving of first priority problems reveals that they were

  15. Utilization of Failure Mode and Effects Analysis (FMEA Method in Increasing the Revenue of Emergency Department; a Prospective Cohort Study

    Directory of Open Access Journals (Sweden)

    Ali Shahrami

    2015-05-01

    Full Text Available Introduction: The balance between revenue and cost of an organization/system is essential to maintain its survival and quality of services. Emergency departments (ED are one of the most important parts of health care delivery system. Financial discipline of EDs, by increasing the efficiency and profitability, can directly affect the quality of care and subsequently patient satisfaction. Accordingly, the present study attempts to investigate failure mode and effects analysis (FMEA method in identifying the problems leading to the loss of ED revenue and offer solutions to help fix these problems. Methods: This prospective cohort study investigated the financial records of ED patients and evaluated the effective errors in reducing the revenue in ED of Imam Hossein hospital, Tehran, Iran, from October 2007 to November 2009. The whole department was divided based on FMEA into one main system and six subsystems. The study was divided in two phases. In the first phase, the problems leading to the loss in the revenue in each subsystem were identified and weighted to four groups using risk priority number (RPN, and the solutions for fixing them were planned. Then, at the second phase discovered defects in the first phase were fixed according to their priority. Finally, the impact of each solution was compared before and after interventions using the repeated measure ANOVA test. Results: At last, 100 financial records of ED patients were evaluated during the first phase of the study. The average of ED revenue in the six months of the first phase was 73.1±3.65 thousands US dollar/month. 12 types of errors were detected in the predefined subsystems. ED revenue rose from 73.1 to 153.1, 207.06, 240, and 320 thousands US dollar/month after solving of first, second, third, and fourth priority problems, respectively (337.75% increase in two years (p<0.001. 111.0% increase in the ED revenue after solving of first priority problems reveals that they were

  16. Psychiatric status, somatisation, and health care utilization of frequent attenders at the emergency department: a comparison with routine attenders.

    Science.gov (United States)

    Williams, E R; Guthrie, E; Mackway-Jones, K; James, M; Tomenson, B; Eastham, J; McNally, D

    2001-03-01

    Seventy-seven frequent attenders at an emergency department (ED) in an inner-city hospital in the UK (defined as seven or more visits in the previous 12 months) were compared with 182 patients who were attending the same department on a routine basis. Patients completed the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and the Short Form (SF)-36. Information was obtained on 64% of the frequent attenders and 45% underwent a detailed psychiatric assessment. Of the frequent attenders, 45% had psychiatric disorder and 49% had some form of an alcohol-related disorder. Compared with routine attenders, frequent attenders reported lower health status, had more psychiatric disorder (odds ratio: OR=8.2, 95% confidence interval: CI=3.8--18.1), had more general hospital admissions (OR=19.9, 95% CI=8.3--47.8), more psychiatric admissions (OR=167.5, 95% CI=9.5--2959.0), and more GP visits (95% CI for difference=-10.2 to -5.7). There was no evidence that frequent attenders had more somatisation than routine attenders. Specific treatment and management strategies need to be developed for this group of patients, although a substantial proportion may be difficult to engage in the treatment process.

  17. Utilizing community-based participatory research to adapt a mental health intervention for African American emerging adults.

    Science.gov (United States)

    Mance, Gishawn A; Mendelson, Tamar; Byrd, Benjamin; Jones, Jahon; Tandon, Darius

    2010-01-01

    Adapting mental health interventions to heighten their cultural and contextual appropriateness may be critical for engaging ethnic/racial groups that have been traditionally excluded or marginalized. Community-based participatory research (CBPR) is a collaborative research approach that highlights unique strengths and expertise of those involved. Although intervention adaptations have garnered much attention there is little previous work specifically describing the adaptation process of mental health interventions using CBPR. This article summarizes the use of a CBPR approach to adapt a mental health intervention for urban adolescents and young adults disconnected from school and work, a population at elevated risk for poor mental health owing to the presence of numerous chronic stressors. We describe the process undertaken to modify the content and delivery format of an evidence-based intervention. Unique challenges of working with urban African American adolescents and young adults in a job training program are highlighted. By incorporating principles of co-learning and shared responsibility, this partnership was able to achieve positive outcomes. Our experience suggests that a CBPR approach can be used effectively to adapt a mental health intervention in collaboration with African American adolescents and emerging adults in a job training program.

  18. Improving operating room safety

    Directory of Open Access Journals (Sweden)

    Garrett Jill

    2009-11-01

    Full Text Available Abstract Despite the introduction of the Universal Protocol, patient safety in surgery remains a daily challenge in the operating room. This present study describes one community health system's efforts to improve operating room safety through human factors training and ultimately the development of a surgical checklist. Using a combination of formal training, local studies documenting operating room safety issues and peer to peer mentoring we were able to substantially change the culture of our operating room. Our efforts have prepared us for successfully implementing a standardized checklist to improve operating room safety throughout our entire system. Based on these findings we recommend a multimodal approach to improving operating room safety.

  19. Computed Tomography Profile and its Utilization in Head Injury Patients in Emergency Department: A Prospective Observational Study

    Directory of Open Access Journals (Sweden)

    Archana Waganekar

    2018-01-01

    Full Text Available Context: Based on Glasgow Coma Scale (GCS, head injury can be classified as minor (GCS 13–15, moderate (GCS 9–12, and severe (GCS 3–8. There is a lot of controversy in the use of computed tomography (CT in head injury patients. Aims: This study was intended to estimate the rate of CT positivity in head injury patients and to define the criteria for doing CT in head injury patients. Settings and Design: This was a prospective observational study in the emergency department (ED over a 12-month period. Subjects and Methods: Study involved all head injury patients attending ED. Risk factors studied were a loss of consciousness (LOC, vomiting, seizures, ear bleed, nosebleed, external injuries, and alcohol intoxication. Statistical Analysis Used: Comparison of CT positivity with the patient's demographics and clinical characteristics was carried out using Chi-square. Results: A total of 1782 patients were included in this study. Overall CT positivity was 50.9%. In minor head injury (MHI, CT positivity rate was 38%. The study showed significant association of CT positivity with five variables: LOC >5 min, vomiting, seizures, ear bleed, and nosebleed. Conclusions: From the study, we recommend following: CT is indicated in all patients with moderate and severe head injury (GCS ≤12. Low threshold for taking CT is advisable in elderly and alcohol-intoxicated patients. In MHI, CT is indicated if any one of the following risk factors are present: LOC >5 min, history of vomiting, history of seizures, history of ear bleed, and history of nosebleed.

  20. Selective chest imaging for blunt trauma patients: The national emergency X-ray utilization studies (NEXUS-chest algorithm).

    Science.gov (United States)

    Rodriguez, Robert M; Hendey, Gregory W; Mower, William R

    2017-01-01

    Chest imaging plays a prominent role in blunt trauma patient evaluation, but indiscriminate imaging is expensive, may delay care, and unnecessarily exposes patients to potentially harmful ionizing radiation. To improve diagnostic chest imaging utilization, we conducted 3 prospective multicenter studies over 12years to derive and validate decision instruments (DIs) to guide the use of chest x-ray (CXR) and chest computed tomography (CT). The first DI, NEXUS Chest x-ray, consists of seven criteria (Age >60years; rapid deceleration mechanism; chest pain; intoxication; altered mental status; distracting painful injury; and chest wall tenderness) and exhibits a sensitivity of 99.0% (95% confidence interval [CI] 98.2-99.4%) and a specificity of 13.3% (95% CI, 12.6%-14.0%) for detecting clinically significant injuries. We developed two NEXUS Chest CT DIs, which are both highly reliable in detecting clinically major injuries (sensitivity of 99.2%; 95% CI 95.4-100%). Designed primarily to focus on detecting major injuries, the NEXUS Chest CT-Major DI consists of six criteria (abnormal CXR; distracting injury; chest wall tenderness; sternal tenderness; thoracic spine tenderness; and scapular tenderness) and exhibits higher specificity (37.9%; 95% CI 35.8-40.1%). Designed to reliability detect both major and minor injuries (sensitivity 95.4%; 95% CI 93.6-96.9%) with resulting lower specificity (25.5%; 95% CI 23.5-27.5%), the NEXUS CT-All rule consists of seven elements (the six NEXUS CT-Major criteria plus rapid deceleration mechanism). The purpose of this review is to synthesize the three DIs into a novel, cohesive summary algorithm with practical implementation recommendations to guide selective chest imaging in adult blunt trauma patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Three-dimensional point-cloud room model in room acoustics simulations

    DEFF Research Database (Denmark)

    Markovic, Milos; Olesen, Søren Krarup; Hammershøi, Dorte

    2013-01-01

    acquisition and its representation with a 3D point-cloud model, as well as utilization of such a model for the room acoustics simulations. A room is scanned with a commercially available input device (Kinect for Xbox360) in two different ways; the first one involves the device placed in the middle of the room...... and rotated around the vertical axis while for the second one the device is moved within the room. Benefits of both approaches were analyzed. The device's depth sensor provides a set of points in a three-dimensional coordinate system which represents scanned surfaces of the room interior. These data are used...... to build a 3D point-cloud model of the room. Several models are created to meet requirements of different room acoustics simulation algorithms: plane fitting and uniform voxel grid for geometric methods and triangulation mesh for the numerical methods. Advantages of the proposed method over the traditional...

  2. Three-dimensional point-cloud room model for room acoustics simulations

    DEFF Research Database (Denmark)

    Markovic, Milos; Olesen, Søren Krarup; Hammershøi, Dorte

    2013-01-01

    acquisition and its representation with a 3D point-cloud model, as well as utilization of such a model for the room acoustics simulations. A room is scanned with a commercially available input device (Kinect for Xbox360) in two different ways; the first one involves the device placed in the middle of the room...... and rotated around the vertical axis while for the second one the device is moved within the room. Benefits of both approaches were analyzed. The device's depth sensor provides a set of points in a three-dimensional coordinate system which represents scanned surfaces of the room interior. These data are used...... to build a 3D point-cloud model of the room. Several models are created to meet requirements of different room acoustics simulation algorithms: plane fitting and uniform voxel grid for geometric methods and triangulation mesh for the numerical methods. Advantages of the proposed method over the traditional...

  3. O impacto do uso de álcool em pacientes admitidos em um pronto-socorro geral universitário The impact of alcohol use in patients attended in the emergency room of a university general hospital

    Directory of Open Access Journals (Sweden)

    Maria Luiza Segatto

    2008-01-01

    emergency. OBJECTIVES: To describe the patterns of alcohol use among patients attended at the Emergency Department and to investigate the association of patterns of alcohol use and the reasons for seeking the emergency health care. METHODS: It is a transversal study. A sample was made of 418 patients who seek treatment at the emergency room of Federal University of Uberlândia (HCUFU/MG, from October 2003 through March 2004. The procedures consisted of gathering some socio demographic figures, general figures about the main reasons to search for health service and a tracing questionnaire for alcohol abuse developed by World Health Organization, the AUDIT - The Alcohol Use Disorders Identification Test. RESULTS: The prevalence of harmful alcohol use among the sample was 36.2% (N = 151. Higher rates of alcohol abuse were found among run over victims (60%, (N = 9, victims of motor accidents (40%, (N = 40, victims of general accidents (44%, (N = 51, and were related to being male, single, and aged 18 to 44. The analysis of logistic regression indicated that, though harmful alcohol use is associated with all trauma groups investigated, this relation was particularly significant for run over victims (OR = 1,05 IC 95%: 1,01-1,09 and victims of general accidents (OR = 1,03 IC 95%: 1,00-1,05. DISCUSSION: Alcohol consumption is high among patients seen at emergency rooms due motor vehicle and other kinds of accidents, particularly for run over victims. In this sense it is of paramount importance to implement preventive measures to decrease individual and social costs that alcohol consumption imposes to its users.

  4. Room temperature superconductors

    International Nuclear Information System (INIS)

    Sleight, A.W.

    1995-01-01

    If the Holy Grail of room temperature superconductivity could be achieved, the impact on could be enormous. However, a useful room temperature superconductor for most applications must possess a T c somewhat above room temperature and must be capable of sustaining superconductivity in the presence of magnetic fields while carrying a significant current load. The authors will return to the subject of just what characteristics one might seek for a compound to be a room temperature superconductor. 30 refs., 3 figs., 1 tab

  5. Suspected acute coronary syndrome in the emergency room: Limited added value of heart type fatty acid binding protein point of care or ELISA tests: The FAME-ER (Fatty Acid binding protein in Myocardial infarction Evaluation in the Emergency Room) study.

    Science.gov (United States)

    Bank, Ingrid Em; Dekker, Marieke S; Hoes, Arno W; Zuithoff, Nicolaas Pa; Verheggen, Peter Whm; de Vrey, Evelyn A; Wildbergh, Thierry X; Timmers, Leo; de Kleijn, Dominique Pv; Glatz, Jan Fc; Mosterd, Arend

    2016-08-01

    Timely recognition of acute coronary syndrome remains a challenge as many biomarkers, including troponin, remain negative in the first hours following the onset of chest pain. We assessed the diagnostic accuracy of heart-type fatty acid binding protein (H-FABP), a cardiac biomarker with potential value immediately post symptom onset. Prospective monocentre diagnostic accuracy study of H-FABP bedside point of care (CardioDetect®) and ELISA tests in acute coronary syndrome suspected patients presenting within 24 hours of symptom onset to the emergency department, in addition to clinical findings, electrocardiography and the currently recommended biomarker high sensitivity troponin-T (hs-cTnT). The final diagnosis of acute coronary syndrome was adjudicated by two independent cardiologists, blinded to H-FABP results. Acute coronary syndrome was diagnosed in 149 (32.9%) of 453 unselected patients with suspected acute coronary syndrome (56% men, mean age 62.6 years). Negative predictive values were similar for H-FABP point of care and ELISA tests (79% vs. 78% respectively), but inferior to initial hs-cTnT (negative predictive value 86%). The addition of H-FABP point of care results to hs-cTnT increased the negative predictive value to 89%. In a multivariable logistic regression model, H-FABP point of care and ELISA tests yielded relevant diagnostic information in addition to clinical findings and ECG (likelihood ratio test pacute coronary syndrome presenting to the emergency department, H-FABP testing improves diagnostic accuracy in addition to clinical findings and electrocardiography. H-FABP, however, has no additional diagnostic value when hs-cTnT measurements are also available. © The European Society of Cardiology 2015.

  6. Application of National Emergency X-Ray Utilizations Study low-risk c-spine criteria in high-risk geriatric falls.

    Science.gov (United States)

    Evans, Daniel; Vera, Luis; Jeanmonod, Donald; Pester, Jonathan; Jeanmonod, Rebecca

    2015-09-01

    We sought to validate National Emergency X-Radiography Utilizations Study low-risk cervical spine (C spine) criteria in a geriatric trauma population. We sought to determine whether patients' own baseline mental status (MS) could substitute for Glasgow Coma Scale (GCS) to meet the criteria "normal alertness." We further sought to refine the definition of "distracting injury." This is a retrospective review of geriatric fall patients presenting to a level 1 trauma center and triaged to the trauma bay. We queried our database from 2008 to 2013. Abstractors recorded GCS, deviation from baseline MS, midline neck tenderness, intoxication, focal deficit, signs of trauma, and presence of other injury. Patients were considered at baseline MS if specific documentation was present on the chart, or if their GCS was 15. Six hundred sixty elderly fall patients were trauma alerts during the study period. Seventeen were excluded for incomplete records/death before imaging, leaving 647. The median age was 81 (interquartile range, 74-87). Fifty patients (8.0%) had C spine or cord injury. Two hundred ninety-four (44.5%) had baseline MS (including GCS 13-15), no spine tenderness, no intoxication, and no focal neurologic deficit. Of these, 18 had C-spine injury. Using physical findings of head trauma as the only "distracting injury," no injury would have been missed (sensitivity, 100% [confidence interval, 91.1-100]; specificity, 14.2%). Our study suggests that National Emergency X-Radiography Utilizations Study can be safely applied in elderly fall patients who are at their personal baseline MS. Furthermore, our data support a more narrow definition of distracting injury to include only patients with signs of trauma to the head. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Patient Motivators for Emergency Department Utilization: A Pilot Cross-Sectional Survey of Uninsured Admitted Patients at a University Teaching Hospital.

    Science.gov (United States)

    Lozano, Karla; Ogbu, Uzor C; Amin, Alpesh; Chakravarthy, Bharath; Anderson, Craig L; Lotfipour, Shahram

    2015-08-01

    During the past several decades, emergency department (ED) increasing volume has proven to be a difficult challenge to address. With the advent of the Affordable Care Act, there is much speculation on the impact that health care coverage expansion will have on ED usage across the country. It is currently unclear what the effects of Medicaid expansion and a decreased number of uninsured patients will have on ED usage. We sought to identify the motivators behind ED use in patients who were admitted to a university teaching hospital in order to project the possible impact of health care reform on ED utilization. We surveyed a convenience sample of uninsured patients who presented to the ED and were subsequently admitted to the inpatient setting. Our respondents sought care in the ED primarily because they perceived their condition to be a medical emergency. Their lack of insurance and associated costs of care resulted in delays in seeking care, in reduced access, and a limited ability to manage chronic health conditions. Thus, contributing to their admission. Affordability will reduce financial barriers to health care insurance coverage. However, efficient and timely access to primary care is a stronger determinant of ED usage in our sample. Health insurance coverage does not guarantee improved health care access. Patients may continue to experience significant challenges in managing chronic health conditions. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. The Obstetrics Gynecology and Children's Hospital Emergency ...

    African Journals Online (AJOL)

    EB

    The efficiency of emergency rooms is becoming increasingly important and has been addressed by legislation. Prompt emergency room service is expected when patients present to an emergency room with urgent health problems. However, depending on various factors, the wait times for access to health services can be ...

  9. Utilizations and Perceptions of Emergency Medical Services by Patients with ST-Segments Elevation Acute Myocardial Infarction in Abu Dhabi: A Multicenter Study.

    Science.gov (United States)

    Callachan, Edward Lance; Alsheikh-Ali, Alawi A; Nair, Satish Chandrasekhar; Bruijns, Stevan; Wallis, Lee A

    2016-01-01

    Data on the use of emergency medical services (EMS) by patients with cardiac conditions in the Gulf region are scarce, and prior studies have suggested underutilization. Patient perception and knowledge of EMS care is critical to proper utilization of such services. To estimate utilization, knowledge, and perceptions of EMS among patients with ST-elevation myocardial infarction (STEMI) in the Emirate of Abu Dhabi. We conducted a multicenter prospective study of consecutive patients admitted with STEMI in four government-operated hospitals in Abu Dhabi. Semi-structured interviews were conducted with patients to assess the rationale for choosing their prehospital mode of transport and their knowledge of EMS services. Of 587 patients with STEMI (age 51 ± 11 years, male 95%), only 15% presented through EMS, and the remainder came via private transport. Over half of the participants (55%) stated that they did not know the telephone number for EMS. The most common reasons stated for not using EMS were that private transport was quicker (40%) or easier (11%). A small percentage of participants (7%) did not use EMS because they did not think their symptoms were cardiac-related or warranted an EMS call. Stated reasons for not using EMS did not significantly differ by age, gender, or primary language of the patients. EMS care for STEMI is grossly underutilized in Abu Dhabi. Patient knowledge and perceptions may contribute to underutilization, and public education efforts are needed to raise their perception and knowledge of EMS.

  10. Utilizations and Perceptions of Emergency Medical Services by Patients with ST-Segments Elevation Acute Myocardial Infarction in Abu Dhabi: A Multicenter Study

    Science.gov (United States)

    Callachan, Edward Lance; Alsheikh-Ali, Alawi A.; Nair, Satish Chandrasekhar; Bruijns, Stevan; Wallis, Lee A.

    2016-01-01

    Background: Data on the use of emergency medical services (EMS) by patients with cardiac conditions in the Gulf region are scarce, and prior studies have suggested underutilization. Patient perception and knowledge of EMS care is critical to proper utilization of such services. Objectives: To estimate utilization, knowledge, and perceptions of EMS among patients with ST-elevation myocardial infarction (STEMI) in the Emirate of Abu Dhabi. Methods: We conducted a multicenter prospective study of consecutive patients admitted with STEMI in four government-operated hospitals in Abu Dhabi. Semi-structured interviews were conducted with patients to assess the rationale for choosing their prehospital mode of transport and their knowledge of EMS services. Results: Of 587 patients with STEMI (age 51 ± 11 years, male 95%), only 15% presented through EMS, and the remainder came via private transport. Over half of the participants (55%) stated that they did not know the telephone number for EMS. The most common reasons stated for not using EMS were that private transport was quicker (40%) or easier (11%). A small percentage of participants (7%) did not use EMS because they did not think their symptoms were cardiac-related or warranted an EMS call. Stated reasons for not using EMS did not significantly differ by age, gender, or primary language of the patients. Conclusions: EMS care for STEMI is grossly underutilized in Abu Dhabi. Patient knowledge and perceptions may contribute to underutilization, and public education efforts are needed to raise their perception and knowledge of EMS. PMID:27512532

  11. Coordination of wind and water power. Better utilization of network and room for more wind power; Samkoeyring av vind- og vasskraft. Betre utnytting av nett og plass til meir vindkraft

    Energy Technology Data Exchange (ETDEWEB)

    Stensby, Kjell Erik; Hamnaberg, Haavard (eds.)

    2011-01-15

    The report describes the results of the simulation of coordination of wind power with Guolas hydro power plants in Troms. The simulations have been carried out by SINTEF Energy Research, and the purpose has been to consider to what degree it is possible to make room for more wind power in grid if the hydroelectric plant was driven with regard to wind power production. The results show that it is possible to make room for more wind power if it is granted 'priority' in the power grid. (AG)

  12. Control room philosophy: Principles of control room design and control room work; Kontrollrumsfilosofi: Principer foer kontrollrumsutformning och kontrollrumsarbete

    Energy Technology Data Exchange (ETDEWEB)

    Skriver, Jan; Ramberg, Jasmine; Allwin, Pernilla [Scandpower Risk Management AB, Uppsala (Sweden)

    2006-01-15

    In order to provide insights for improvement of work in control rooms several factors have to be considered. Knowledge of principles including control room philosophies will guide the recommended improvements. In addition to knowledge about specific principles an advantage for an organization can be an understanding of similarities and policies used in other high risk industry. The report has been developed on the basis of a document analysis of international standards and other guiding documents. (NUREG 0711, ISO 11064, ISO 6385, IEC 60964). In addition to the document analysis which has strived to compare the documents to see similarities in important principals, experience from working with control room design, modifications and evaluations in other high risk industries has pervaded the report. Important principles have been identified which are recommended to be included in a control room philosophy. Many of these are similar to the principles identified in the international standards. An additional principal which is regarded as important is the utilization of Key Performance Indicators (KPI) which can be used as a measure to target preventative means. Further more it is critical that the control room philosophy is easy to access and comprehend for all users. One of the challenges that remain after having developed a control room philosophy is how to utilize it in the daily work situation. It is vital that the document remains as a living document, guiding the continual improvement of the control room in the various life cycle stages.

  13. Acidentes e violências: caracterização dos atendimentos no pronto-socorro de um hospital universitário Accidents and violence: characteristics of the medical cares in the emergency room's university hospital

    Directory of Open Access Journals (Sweden)

    José Luís Guedes dos Santos

    2008-09-01

    Full Text Available Este artigo, de caráter exploratório-descritivo, tem como objetivo caracterizar os atendimentos por acidentes e violências realizados no pronto-socorro de um hospital universitário localizado no interior do Rio Grande do Sul (RS. Os dados foram obtidos a partir dos registros de um sistema de vigilância, denominado "Observatório de Acidentes e Violência", existente nos serviços de urgência e emergência no RS, que atuam como sentinela desses agravos. Os resultados mostraram que os adultos jovens, com baixo nível de instrução e não-trabalhadores são as principais vítimas de acidentes e violências. Quanto ao tipo de ocorrência, destacaram-se os acidentes de trânsito e acidentes domésticos, gerando como agravos mais constantes ferimentos na cabeça e fraturas de fêmur. Com relação ao sexo, embora para alguns tipos de acidentes e violências a predominância tenha variado entre eles, o conjunto dos dados mostrou maior vulnerabilidade masculina, em especial nos casos de violência interpessoal. Nesse sentido, as consequências dos acidentes e violências para o sistema de saúde e para a sociedade apontam a necessidade de aprimoramento dos sistemas de informações de morbimortalidade por causas externas, visando subsidiar políticas públicas de prevenção e melhoria no atendimento às vítimas.This article, of an exploratory-descriptive character, aims to characterize the medical care provided in cases of accidents and violence in the emergency room of a university hospital, located in the interior of the state of Rio Grande do Sul (RS. The data were obtained from the registers of a monitoring system called "Observatório de Acidentes e Violência" (Observatory of Accidents and Violence, which exists in the urgency and emergency services in RS and acts as a sentry of these injuries. The results showed that young adults who are non-workers and have low schooling are the main victims of accidents and violence. The most frequent

  14. Resource utilization in the emergency department of a tertiary care university-based hospital in Tokyo before and after the 2011 Great East Japan earthquake and tsunami.

    Science.gov (United States)

    Shimada, Mai; Tanabe, Aska; Gunshin, Masataka; Riffenburgh, Robert H; Tanen, David A

    2012-12-01

    The objective of this study was to determine the resource utilization of a tertiary care Japanese emergency department (ED) that was not immediately adjacent to the area of the 2011 Great East Japan earthquake and tsunami. A retrospective chart review was performed at a tertiary care university-based urban ED located approximately 290 km from the primary site of destruction secondary to an earthquake measuring 9.0 on the Richter Scale and the resulting tsunami. All patients who presented for a period of twelve days before and twelve days after the disaster were included. Data were collected using preformed data collection sheets, and stored in an Excel file. Abstracted data included gender, time in the ED, intravenous fluid administration, blood transfusion, oxygen, laboratories, electrocardiograms (ECGs), radiographs, ultrasound, diagnoses, surgical and medical referrals, and prescriptions written. Ten percent of the charts were reviewed for accuracy, and an error rate reported. Data were analyzed using 2-tailed t-tests, Fisher's exact tests or rank sum tests. Bonferroni correction was used to adjust P values for multiple comparisons. Charts for 1193 patients were evaluated. The error rate for the abstracted data was 3.2% (95% CI, 2.4%-4.1%). Six hundred fifty-seven patients (53% male) were evaluated in the ED after the earthquake, representing a 23% increase in patient volume. Mean patient time spent in the ED decreased from 61 minutes to 52 minutes (median decrease from 35 minutes to 32 minutes; P = .005). Laboratory utilization decreased from 51% to 43% (P = .006). The percentage of patients receiving prescriptions increased from 48% to 54% (P = .002). There was no change in the number of patients evaluated for surgical complaints, but there was an increase in the number treated for medical or psychiatric complaints. There was a significant increase in the number of people utilizing the ED in Tokyo after the Great East Japan earthquake and tsunami. Time spent

  15. Detecção de maus-tratos contra a criança: oportunidades perdidas em serviços de emergência na cidade do Rio de Janeiro, Brasil Detection of child abuse: missed opportunities in emergency rooms in Rio de Janeiro, Brazil

    Directory of Open Access Journals (Sweden)

    Anna Tereza Miranda Soares de Moura

    2008-12-01

    Full Text Available O enfrentamento da violência contra a criança é considerado um desafio nos serviços de emergência, onde a rotina atribulada pode dificultar a detecção dos casos. O presente estudo estimou a magnitude da violência contra crianças atendidas em dois hospitais de emergência no Rio de Janeiro, Brasil. Também avaliou o grau de sub-registro de casos, comparando a casuística notificada pelas equipes com aquela estimada pelo estudo. Para aferição da violência foi utilizado o instrumento Conflict Tactics Scales: Parent-Child (CTSPC, aplicado em 524 acompanhantes de crianças atendidas nos hospitais entre janeiro e março de 2005. Foram avaliadas todas as notificações originadas da identificação de casos pelas equipes em 2004. De acordo com a CTSPC, a prevalência de violência psicológica, negligência e violência física foi de 94,8% (IC95%: 92,9-96,2, 60,3% (IC95%: 55,9-64,7 e 47,2% (IC95%: 42,7-51,8, respectivamente. Já estas estimativas segundo as notificações foram de 0,007% (IC95%: 0,003-0,013, 0,24% (IC95%: 0,22-0,27 e 0,03% (IC95%: 0,02-0,04. Essa considerável diferença entre as estimativas do estudo e as relativas aos casos notificados sugere que as estratégias de identificação e notificação de casos de violência contra a criança nos serviços de emergência sejam reavaliadas.Emergency rooms require special consideration since their often-distressful routines may hamper the detection and handling of family violence cases. This study estimated the magnitude of violence against children reported by users of two emergency hospitals in Rio de Janeiro, Brazil. It also evaluated the degree of underreporting by contrasting the present findings to cases reported routinely. 524 parents/guardians of children under 12 treated at the hospitals from January to March 2005 were interviewed. Twelve-month prevalence of family violence was measured with the Conflict Tactics Scales: Parent-Child (CTSPC. All cases reported by staff

  16. Decreased health care utilization and health care costs in the inpatient and emergency department setting following initiation of ketogenic diet in pediatric patients: The experience in Ontario, Canada.

    Science.gov (United States)

    Whiting, Sharon; Donner, Elizabeth; RamachandranNair, Rajesh; Grabowski, Jennifer; Jetté, Nathalie; Duque, Daniel Rodriguez

    2017-03-01

    To assess the change in inpatient and emergency department utilization and health care costs in children on the ketogenic diet for treatment of epilepsy. Data on children with epilepsy initiated on the ketogenic diet (KD) Jan 1, 2000 and Dec 31, 2010 at Ontario pediatric hospitals were linked to province wide inpatient, emergency department (ED) data at the Institute for Clinical Evaluative Sciences. ED and inpatient visits and costs for this cohort were compared for a maximum of 2 years (730days) prior to diet initiation and for a maximum of 2 years (730days) following diet initiation. KD patient were compared to matched group of children with epilepsy who did not receive the ketogenic diet (no KD). Children on the KD experienced a mean decrease in ED visits of 2.5 visits per person per year [95% CI (1.5-3.4)], and a mean decrease of 0.8 inpatient visits per person per year [95% CI (0.3-1.3)], following diet initiation. They had a mean decrease in ED costs of $630 [95% CI (249-1012)] per person per year and a median decrease in inpatient costs of $1059 [IQR: 7890; pdiet experienced a mean reduction of 2.1 ED visits per child per year [95% CI (1.0-3.2)] and a mean decrease of 0.6 [95% CI (0.1-1.1)] inpatient visits per child per year. Patients on the KD experienced a reduction of $442 [95% CI (34.4-850)] per child per year more in ED costs than the matched group. The ketogenic diet group had greater median decrease in inpatient costs per child per year than the matched group [pketogenic diet, experienced decreased ED and inpatient visits as well as costs following diet initiation in Ontario, Canada. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Epidemiologia das fraturas de face em crianças num pronto-socorro de uma metrópole tropical Epidemiology of children's facial fractures in the emergency room of a tropical metropolis

    Directory of Open Access Journals (Sweden)

    Daniel Falbo Martins de Souza

    2010-01-01

    Full Text Available OBJETIVO: Realizar um estudo epidemiológico das fraturas de face em crianças em um serviço de urgência. MÉTODOS: Estudo retrospectivo de quarenta e dois pacientes com idades variando entre zero a 17 anos, portadores de fraturas de face, tratados no Setor de Cirurgia Buco-Maxilo-Facial da Santa Casa de São Paulo, no período de janeiro de 2000 a dezembro de 2003. Os dados foram tabulados através das informações colhidas dos prontuários dos pacientes, tais como: idade, gênero, tipo de fratura, etiologia e sazonalidade. RESULTADOS: Entre os resultados encontrados, houve predominância do gênero masculino com 81% da casuística, a fratura de mandíbula foi a mais prevalente, com mais de 70% dos casos, os acidentes de trânsito e as quedas foram os agentes etiológicos que mais causaram fraturas. O verão foi a época do ano com mais casos de fratura e mais de 80% destas necessitaram de intervenção cirúrgica para o seu tratamento. CONCLUSÃO: É necessária uma política de prevenção com uma atenção especial aos acidentes de trânsito e às quedas, que foram os agentes etiológicos que mais causaram fraturas faciais.OBJECTIVE: To conduct an epidemiological study of facial fractures in children in an emergency room. METHODS: A retrospective study of forty-two patients, aged zero to 17 years, with facial fractures treated at the Department of Oral and Maxillofacial Surgery, Santa Casa de São Paulo, from January 2000 to December 2003. The data were tabulated from information retrieved from patient files, such as age, gender, type of fracture, etiology and season of occurrence. RESULTS: Among the results were a predominance of males, accounting for 81% of all cases; jaw fracture was the most prevalent, constituting more than 70% of cases; and traffic accidents and falls were the etiologic agents that caused the most fractures. Summer was the season with the greatest number of cases of fracture and more than 80% required surgical

  18. Methodology for the identification of the factors that can influence the performance of operators of nuclear power plants control room under emergency situations; Metodologia para identificacao dos fatores que afetam o desempenho dos operadores de salas de controle de plantas nucleares, em situacoes de emergencia

    Energy Technology Data Exchange (ETDEWEB)

    Paiva, Bernardo Spitz; Santos, Isaac J.A. Luquetti, E-mail: bernardo_spitz@hotmail.co, E-mail: luquetti@ien.gov.b [Instituto de Engenharia Nuclear (IEN/CNEN-RJ), Rio de Janeiro, RJ (Brazil)

    2009-07-01

    In order to minimize the human errors of the operators in a nuclear power plan control room, during emergency situations, it has to be considered the factors which affect the human performance. Work situations adequately projected, compatible with the necessities, capacities and human limitations, taking into consideration the factors which affect the operator performance . This paper aims to develop a methodology for identification of the factors affecting the operator performance under emergency situation, using the aspects defined by the human reliability analysis focusing the judgment done by specialists

  19. Causes of drug-related problems in the emergency room of a hospital in southern Brazil Problemas relacionados con medicamentos en el servicio de urgencias de un hospital en el sur de Brasil

    Directory of Open Access Journals (Sweden)

    Roberta Simone Andreazza

    2011-12-01

    Full Text Available Objective: To assess the frequency and types of drug-related problems (DRPs in patients seeking emergency care in a teaching hospital in southern Brazil and to identify the possible causes and drugs involved in these problems. Method: A cross-sectional study was performed, using a structured questionnaire for data collection. Multivariate logistic regression was used to control for possible confounding factors and to establish an independent association between the presence of DRPs and the amount of medication, patient's age and their educational level. Results: A total of 350 patients were interviewed. The frequency of DRPs was 31.6%. Quantitative ineffectiveness was observed in 30.9% of DRPs and the main cause of the DRP was an inadequate dosing regimen. Sixty-six DRPs (53.7% were caused by the health system or the health professionals. Factors independently influencing the development of DRPs were educational level and the number of drugs being taken. Conclusions: Our data suggest that one-third of the patients attending the emergency room of our hospital had a drug-related problem, highlighting the importance of considering drugs as a possible cause of health problems and the need for their more rational use.Objetivo: Evaluar la frecuencia y el tipo de problemas relacionados con medicamentos que presentan los pacientes que acuden al servicio de urgencias en un hospital universitario del sur de Brasil, e identificar las posibles causas y los fármacos involucrados. Método: La investigación siguió el modelo de estudio transversal, con una encuesta estructurada para la recogida de los datos. Se empleó el análisis de regresión logística múltiple para controlar posibles factores de confusión y establecer una asociación independiente entre la presencia de problemas relacionados con medicamentos y el número de éstos, la edad y el nivel educativo. Resultados: Se entrevistaron 350 pacientes y la frecuencia de problemas relacionados con

  20. Assessing Healthcare Utilization for Influenza-like Illness at an Emergency Department and a Student Health Service during the 2009–2010 H1N1 Pandemic

    Directory of Open Access Journals (Sweden)

    Ruchi Bhandari

    2013-01-01

    Full Text Available Estimates of healthcare utilization during an influenza pandemic are needed in order to plan for the allocation of staff and resources. The aim of this study was to assess the number, age, and arrival time of patients with influenza-like-illness (ILI, and associations between their symptoms during the 2009–2010 H1N1 pandemic. We conducted a cross-sectional analysis of electronic health records from the student health service (SHS and an emergency department (ED in Morgantown, West Virginia, between January 2009 and December 2010. During the 2009–2010 H1N1 pandemic, patient arrivals at SHS and ED varied over the week. SHS patients arrived early in the week and primarily in the afternoon. ED patient arrivals were more evenly distributed, with busier evenings and weekends. Those with fever were more likely to experience cough, sore throat, vomiting/nausea, chills, congestion, headache, and body-ache. These results can assist health professionals in preparing for an influenza pandemic.

  1. Virtual Seminar Room

    DEFF Research Database (Denmark)

    Forchhammer, Søren Otto; Fosgerau, Anders; Hansen, Peter Søren Kirk

    1999-01-01

    The initial design considerations and research goals for an ATM network based virtual seminar room with 5 sites are presented.......The initial design considerations and research goals for an ATM network based virtual seminar room with 5 sites are presented....

  2. Operating room manager game

    NARCIS (Netherlands)

    Hans, Elias W.; Nieberg, T.

    2007-01-01

    The operating room (OR) department of a hospital forms the heart of the organization, where the single largest cost is incurred. This document presents and reports on the “Operating Room Manager Game,” developed to give insight into managing a large hospital's OR department at various levels of

  3. Guidelines for control room systems design. Working material. Report

    International Nuclear Information System (INIS)

    1993-01-01

    This report contains comprehensive technical and methodological information and recommendations for the benefit of Member States for advice and assistance in ''NPP control room systems'' design backfitting existing nuclear power plants and design for future stations. The term ''Control Room Systems'' refers to the entire human/machine interface for the nuclear stations - including the main control room, back-ups control room and the emergency control rooms, local panels, technical support centres, operating staff, operating procedures, operating training programs, communications, etc. Refs, figs and tabs

  4. Resource utilization and cost-effectiveness of counselor- vs. provider-based rapid point-of-care HIV screening in the emergency department.

    Directory of Open Access Journals (Sweden)

    Rochelle P Walensky

    Full Text Available Routine HIV screening in emergency department (ED settings may require dedicated personnel. We evaluated the outcomes, costs and cost-effectiveness of HIV screening when offered by either a member of the ED staff or by an HIV counselor.We employed a mathematical model to extend data obtained from a randomized clinical trial of provider- vs. counselor-based HIV screening in the ED. We compared the downstream survival, costs, and cost-effectiveness of three HIV screening modalities: 1 no screening program; 2 an ED provider-based program; and 3 an HIV counselor-based program. Trial arm-specific data were used for test offer and acceptance rates (provider offer 36%, acceptance 75%; counselor offer 80%, acceptance 71%. Undiagnosed HIV prevalence (0.4% and linkage to care rates (80% were assumed to be equal between the screening modalities. Personnel costs were derived from trial-based resource utilization data. We examined the generalizability of results by conducting sensitivity analyses on offer and acceptance rates, undetected HIV prevalence, and costs.Estimated HIV screening costs in the provider and counselor arms averaged $8.10 and $31.00 per result received. The Provider strategy (compared to no screening had an incremental cost-effectiveness ratio of $58,700/quality-adjusted life year (QALY and the Counselor strategy (compared to the Provider strategy had an incremental cost-effectiveness ratio of $64,500/QALY. Results were sensitive to the relative offer and acceptance rates by strategy and the capacity of providers to target-screen, but were robust to changes in undiagnosed HIV prevalence and programmatic costs.The cost-effectiveness of provider-based HIV screening in an emergency department setting compares favorably to other US screening programs. Despite its additional cost, counselor-based screening delivers just as much return on investment as provider based-screening. Investment in dedicated HIV screening personnel is justified in

  5. Resource utilization and cost-effectiveness of counselor- vs. provider-based rapid point-of-care HIV screening in the emergency department.

    Science.gov (United States)

    Walensky, Rochelle P; Morris, Bethany L; Reichmann, William M; Paltiel, A David; Arbelaez, Christian; Donnell-Fink, Laurel; Katz, Jeffrey N; Losina, Elena

    2011-01-01

    Routine HIV screening in emergency department (ED) settings may require dedicated personnel. We evaluated the outcomes, costs and cost-effectiveness of HIV screening when offered by either a member of the ED staff or by an HIV counselor. We employed a mathematical model to extend data obtained from a randomized clinical trial of provider- vs. counselor-based HIV screening in the ED. We compared the downstream survival, costs, and cost-effectiveness of three HIV screening modalities: 1) no screening program; 2) an ED provider-based program; and 3) an HIV counselor-based program. Trial arm-specific data were used for test offer and acceptance rates (provider offer 36%, acceptance 75%; counselor offer 80%, acceptance 71%). Undiagnosed HIV prevalence (0.4%) and linkage to care rates (80%) were assumed to be equal between the screening modalities. Personnel costs were derived from trial-based resource utilization data. We examined the generalizability of results by conducting sensitivity analyses on offer and acceptance rates, undetected HIV prevalence, and costs. Estimated HIV screening costs in the provider and counselor arms averaged $8.10 and $31.00 per result received. The Provider strategy (compared to no screening) had an incremental cost-effectiveness ratio of $58,700/quality-adjusted life year (QALY) and the Counselor strategy (compared to the Provider strategy) had an incremental cost-effectiveness ratio of $64,500/QALY. Results were sensitive to the relative offer and acceptance rates by strategy and the capacity of providers to target-screen, but were robust to changes in undiagnosed HIV prevalence and programmatic costs. The cost-effectiveness of provider-based HIV screening in an emergency department setting compares favorably to other US screening programs. Despite its additional cost, counselor-based screening delivers just as much return on investment as provider based-screening. Investment in dedicated HIV screening personnel is justified in situations

  6. Suicide attempts and substance use in an emergency room sample Tentativas de suicídio e o uso de substâncias em uma amostra de pronto-socorro

    Directory of Open Access Journals (Sweden)

    Alessandra Diehl

    2009-01-01

    Full Text Available OBJECTIVE: Describe suicide attempts assisted in an emergency room (ER and acute substance consumption or dependence on these individuals. METHODS: Descriptive epidemiologic study was carried out during one year, evaluating suicide attempts assisted at Embu das Artes ER, São Paulo, Brazil. Patients were scheduled to a non structured psychiatric interview. Main outcomes measures were: socio demographic data, suicide attempt method, drugs or alcohol acute use in the six hours prior to attempt, patients with ICD-10 substance dependence diagnosis. The descriptive analyses and chi-square test (p OBJETIVO: Descrever as tentativas de suicídio atendidas em um pronto-socorro (PS e o consumo agudo ou dependência de substâncias nestes indivíduos. MÉTODOS: O estudo epidemiológico descritivo foi conduzido durante um ano para avaliação de tentativas de suicídio assistidas em um PS de Embu das Artes, SP. Os pacientes foram agendados para uma entrevista psiquiátrica não estruturada. As principais variáveis de desfecho foram: dados sociodemográficos, métodos da tentativa de suicídio, uso de álcool ou drogas seis horas antes da tentativa, pacientes com diagnóstico de dependência de substância pela CID-10. Utilizaram-se a análise descritiva e o teste qui-quadrado (p < 0,05 para verificar associações entre as diversas variáveis estudadas. RESULTADOS: A amostra constituiu-se de 80 casos, cujos participantes tinham idade média de 26,9 anos (DP = 8,91, predominantemente de mulheres (72,5%, 21,2% de adolescentes. A maioria das tentativas de suicídio foi por ingesta de medicação (62,5%. Aproximadamente 21,2% e 7,5% relataram ter feito uso de álcool e de drogas ilícitas, respectivamente, nas seis horas que antecederam a tentativa e 10% da amostra têm dependência de substâncias. Todos os dependentes de substâncias já tentaram suicídio anteriormente (p-valor = 0,4. Houve associação significativa entre a forma da tentativa de suic

  7. Intraoperative and recovery room outcome | Edomwonyi | East ...

    African Journals Online (AJOL)

    Objectives: To identify and quantitate anaesthesia related complications in the intraoperative period and in the post anaesthesia recovery room. Design: A prospective study. Setting: University of Benin Teaching Hospital; a University - affiliated tertiary centre. Subjects: Patients scheduled for elective and emergency surgery ...

  8. Emergency Medical Services - Multiple Languages

    Science.gov (United States)

    ... Well-Being 11 - Emergency Room - Amarɨñña / አማርኛ (Amharic) MP3 Siloam Family Health Center Arabic (العربية) Expand Section ... Well-Being 11 - Emergency Room - myanma bhasa (Burmese) MP3 Siloam Family Health Center Dari (دری) Expand Section ...

  9. The Virtual Dressing Room

    DEFF Research Database (Denmark)

    Holte, Michael Boelstoft; Gao, Yi; Petersson, Eva

    2015-01-01

    This paper presents the design and evaluation of a usability and user experience test of a virtual dressing room. First, we motivate and introduce our recent developed prototype of a virtual dressing room. Next, we present the research and test design grounded in related usability and user...... experience studies. We give a description of the experimental setup and the execution of the designed usability and user experience test. To this end, we report interesting results and discuss the results with respect to user-centered design and development of a virtual dressing room....

  10. Films and dark room

    International Nuclear Information System (INIS)

    Abdul Nassir Ibrahim; Azali Muhammad; Ab. Razak Hamzah; Abd. Aziz Mohamed; Mohamad Pauzi Ismail

    2008-01-01

    After we know where the radiographic come from, then we must know about the film and also dark room. So, this chapter 5 discusses the two main components for radiography work that is film and dark room, places to process the film. Film are structured with three structured that are basic structured, emulsion and protection structured. So, this film can be classified either with their speed, screen and standard that used. The process to wash the film must be done in dark room otherwise the radiographer cannot get what are they inspected. The processing of film will be discussed briefly in next chapter.

  11. Room Acoustical Fields

    CERN Document Server

    Mechel, Fridolin

    2013-01-01

    This book presents the theory of room acoustical fields and revises the Mirror Source Methods for practical computational use, emphasizing the wave character of acoustical fields.  The presented higher methods include the concepts of “Mirror Point Sources” and “Corner sources which allow for an excellent approximation of complex room geometries and even equipped rooms. In contrast to classical description, this book extends the theory of sound fields describing them by their complex sound pressure and the particle velocity. This approach enables accurate descriptions of interference and absorption phenomena.

  12. Universal health coverage in emerging economies: findings on health care utilization by older adults in China, Ghana, India, Mexico, the Russian Federation, and South Africa.

    Science.gov (United States)

    Peltzer, Karl; Williams, Jennifer Stewart; Kowal, Paul; Negin, Joel; Snodgrass, James Josh; Yawson, Alfred; Minicuci, Nadia; Thiele, Liz; Phaswana-Mafuya, Nancy; Biritwum, Richard Berko; Naidoo, Nirmala; Chatterji, Somnath

    2014-01-01

    The achievement of universal health coverage (UHC) in emerging economies is a high priority within the global community. This timely study uses standardized national population data collected from adults aged 50 and older in China, Ghana, India, Mexico, the Russian Federation, and South Africa. The objective is to describe health care utilization and measure association between inpatient and outpatient service use and patient characteristics in these six low- and middle-income countries. Secondary analysis of data from the World Health Organization's Study on global AGEing and adult health Wave 1 was undertaken. Country samples are compared by socio-demographic characteristics, type of health care, and reasons for use. Logistic regressions describe association between socio-demographic and health factors and inpatient and outpatient service use. In the pooled multi-country sample of over 26,000 adults aged 50-plus, who reported getting health care the last time it was needed, almost 80% of men and women received inpatient or outpatient care, or both. Roughly 30% of men and women in the Russian Federation used inpatient services in the previous 3 years and 90% of men and women in India used outpatient services in the past year. In China, public hospitals were the most frequently used service type for 52% of men and 51% of women. Multivariable regression showed that, compared with men, women were less likely to use inpatient services and more likely to use outpatient services. Respondents with two or more chronic conditions were almost three times as likely to use inpatient services and twice as likely to use outpatient services compared with respondents with no reported chronic conditions. This study provides a basis for further investigation of country-specific responses to UHC.

  13. Short- and Long-Term Prognostic Utility of the HEART Score in Patients Evaluated in the Emergency Department for Possible Acute Coronary Syndrome.

    Science.gov (United States)

    Jain, Tarun; Nowak, Richard; Hudson, Michael; Frisoli, Tiberio; Jacobsen, Gordon; McCord, James

    2016-06-01

    The HEART score is a risk-stratification tool that was developed and validated for patients evaluated for possible acute coronary syndrome (ACS) in the emergency department (ED). We sought to determine the short-term and long-term prognostic utility of the HEART score. A retrospective single-center analysis of 947 patients evaluated for possible ACS in the ED in 1999 was conducted. Patients were followed for major adverse cardiac events (MACEs) at 30 days: death, acute myocardial infarction, or revascularization procedure. All-cause mortality was assessed at 5 years. The HEART score was compared with the Thrombolysis in Myocardial Infarction (TIMI) score. At 30 days, 14% (135/947) of patients had an MACE: 48 deaths (5%), 84 acute myocardial infarctions (9%), and 48 (5%) revascularization procedures. The MACE rate in patients with HEART score ≤3 was 0.6% (1/175) involving a revascularization procedure, 9.5% (53/557) in patients with HEART score between 4 and 6, and 38% (81/215) with HEART score ≥7. The C-statistic for the HEART score was 0.82 and 0.68 for the TIMI score for predicting 30-day MACE (P < 0.05). Patients with HEART score ≤3 had lower 5-year mortality rate compared with those with TIMI score of 0 (10.6% vs. 20.5%, P = 0.02). The HEART score is a valuable risk-stratification tool in predicting not only short-term MACE but also long-term mortality in patients evaluated for possible ACS in the ED. The HEART score had a superior prognostic value compared with the TIMI score.

  14. Variabilidad en la utilización de los servicios de urgencias hospitalarios del Sistema Nacional de Salud Variability in Spanish National Health System hospital emergency services utilization

    Directory of Open Access Journals (Sweden)

    Salvador Peiró

    2010-01-01

    Full Text Available Objetivo: Los objetivos de este estudio fueron estimar las tasas de frecuentación a los servicios de urgencias hospitalarios (SUH del Sistema Nacional de Salud (SNS por áreas de salud, el porcentaje de ingresos, las razones estandarizadas de utilización de urgencias y analizar la relación con los recursos hospitalarios. Métodos: Estudio ecológico combinando información de diversas fuentes (Encuesta de Establecimientos Sanitarios con Régimen de Internado 2006 y Conjunto Mínimo de Datos Básicos 2006 para estimar la frecuentación a los SUH y el porcentaje de ingresos asociado en 164 áreas de salud de 14 comunidades autónomas (CC.AA.. Resultados: Los 35,3 millones de habitantes de las 164 áreas de salud incluidas realizaron 16,2 millones de visitas (45,7 por 100 habitantes a los SUH del SNS, y de ellos ingresaron algo más de 2 millones (12,6%. Excluyendo el 5% de áreas extremas por cada cola, la frecuentación osciló entre 31,6 y 78,7 urgencias/100 habitantes y el porcentaje de ingresos entre el 7,6% y el 27,9%. Estas diferencias apenas se atenuaron al estandarizar. El factor CC.AA. explicó un 29% de la varianza en frecuentación y un 82% en ingresos. La frecuentación no se asoció al volumen poblacional de camas o médicos de plantilla, aunque sí al de médicos de urgencias, hospitales de menor tamaño y no docentes. Conclusiones: Las áreas de salud del SNS mantienen una gran variabilidad en frecuentación a urgencias e ingresos por urgencias, que parece asociarse a un uso diferencial por problemas de menor entidad.Objective: The aims of this study were to estimate the rate of hospital emergency services (HES visits per health area, the associated percentage of admissions and the standardized HES utilization ratio, and to analyze their relationship with hospital resources. Methods: We performed an ecological study that combined information from distinct sources (Survey of Health Care Hospitalization Establishments 2006 and

  15. Our Urban Living Room

    DEFF Research Database (Denmark)

    Hjortshøj, Rasmus

    2016-01-01

    Our Urban Living Room is an exhibition and a book, created by Cobe. The theme is based on Cobe’s ten years of practice, grounded in social livability and urban democracy, and our aim to create buildings and spaces that invite Copenhageners to use and define them; as an extended living room, where...... the boundaries between private and public space become fluid. Based on specific Cobe projects, Our Urban Living Room tells stories about the architectural development of Copenhagen, while exploring the progression of the Danish Capital - from an industrial city into an urban living room, known as one...... of the world’s most livable places. Photography by Rasmus Hjortshøj....

  16. Light Water Reactor Sustainability Program A Reference Plan for Control Room Modernization: Planning and Analysis Phase

    Energy Technology Data Exchange (ETDEWEB)

    Jacques Hugo; Ronald Boring; Lew Hanes; Kenneth Thomas

    2013-09-01

    The U.S. Department of Energy’s Light Water Reactor Sustainability (LWRS) program is collaborating with a U.S. nuclear utility to bring about a systematic fleet-wide control room modernization. To facilitate this upgrade, a new distributed control system (DCS) is being introduced into the control rooms of these plants. The DCS will upgrade the legacy plant process computer and emergency response facility information system. In addition, the DCS will replace an existing analog turbine control system with a display-based system. With technology upgrades comes the opportunity to improve the overall human-system interaction between the operators and the control room. To optimize operator performance, the LWRS Control Room Modernization research team followed a human-centered approach published by the U.S. Nuclear Regulatory Commission. NUREG-0711, Rev. 3, Human Factors Engineering Program Review Model (O’Hara et al., 2012), prescribes four phases for human factors engineering. This report provides examples of the first phase, Planning and Analysis. The three elements of Planning and Analysis in NUREG-0711 that are most crucial to initiating control room upgrades are: • Operating Experience Review: Identifies opportunities for improvement in the existing system and provides lessons learned from implemented systems. • Function Analysis and Allocation: Identifies which functions at the plant may be optimally handled by the DCS vs. the operators. • Task Analysis: Identifies how tasks might be optimized for the operators. Each of these elements is covered in a separate chapter. Examples are drawn from workshops with reactor operators that were conducted at the LWRS Human System Simulation Laboratory HSSL and at the respective plants. The findings in this report represent generalized accounts of more detailed proprietary reports produced for the utility for each plant. The goal of this LWRS report is to disseminate the technique and provide examples sufficient to

  17. Developing control room operator selection procedures

    International Nuclear Information System (INIS)

    Bosshardt, M.J.; Bownas, D.A.

    1979-01-01

    PDRI is performing a two-year study to identify the tasks performed and attributes required in electric power generating plant operating jobs, and focusing on the control room operator position. Approximately 65 investor-owned utilities are participating in the study

  18. Anticipating urgent surgery in operating room departments

    NARCIS (Netherlands)

    van der Lans, M.; Hans, Elias W.; Hurink, Johann L.; Wullink, Gerhard; van Houdenhoven, M.; Kazemier, G.

    2005-01-01

    Operating Room (OR) departments need to create robust surgical schedules that anticipate urgent surgery, while minimizing urgent surgery waiting time and overtime, and maximizing utilization. We consider two levels of planning and control to anticipate urgent surgery. At the tactical level, we study

  19. Reducing start time delays in operating rooms

    NARCIS (Netherlands)

    Does, R.J.M.M.; Vermaat, T.M.B.; Verver, J.P.S.; Bisgaard, S.; van den Heuvel, J.

    2009-01-01

    Problem: Health care today is facing serious problems: quality of care does not meet patients’ needs and costs are exploding. Inefficient utilization of expensive operating rooms is one of the major problems in many hospitals worldwide. A benchmark study of 13 hospitals in the Netherlands and

  20. An approach to enhanced control room crew performance

    International Nuclear Information System (INIS)

    Frye, S.R.

    1988-01-01

    The function of a nuclear power plant control room team is similar to that of an airline cockpit crew or a critical task military team such as a flight crew, tank crew, combat squad or platoon. These teams encounter many of the same problems or challenges in their environments when dealing with abnormal or emergency situations. The competency of these teams in bringing about successful conclusions in situations depends on their ability to coordinate their actions. This is often referred to as teamwork and includes the interactions between team members which must occur during highly critical situations. The purpose of this paper is to present team skills training and the advances made in this crucial area by utilizing both classroom and high fidelity simulator training

  1. Surgical resource utilization in urban terrorist bombing: a computer simulation.

    Science.gov (United States)

    Hirshberg, A; Stein, M; Walden, R

    1999-09-01

    The objective of this study was to analyze the utilization of surgical staff and facilities during an urban terrorist bombing incident. A discrete-event computer model of the emergency room and related hospital facilities was constructed and implemented, based on cumulated data from 12 urban terrorist bombing incidents in Israel. The simulation predicts that the admitting capacity of the hospital depends primarily on the number of available surgeons and defines an optimal staff profile for surgeons, residents, and trauma nurses. The major bottlenecks in the flow of critical casualties are the shock rooms and the computed tomographic scanner but not the operating rooms. The simulation also defines the number of reinforcement staff needed to treat noncritical casualties and shows that radiology is the major obstacle to the flow of these patients. Computer simulation is an important new tool for the optimization of surgical service elements for a multiple-casualty situation.

  2. Real-time web-based assessment of total population risk of future emergency department utilization: statewide prospective active case finding study.

    Science.gov (United States)

    Hu, Zhongkai; Jin, Bo; Shin, Andrew Y; Zhu, Chunqing; Zhao, Yifan; Hao, Shiying; Zheng, Le; Fu, Changlin; Wen, Qiaojun; Ji, Jun; Li, Zhen; Wang, Yong; Zheng, Xiaolin; Dai, Dorothy; Culver, Devore S; Alfreds, Shaun T; Rogow, Todd; Stearns, Frank; Sylvester, Karl G; Widen, Eric; Ling, Xuefeng B

    2015-01-13

    An easily accessible real-time Web-based utility to assess patient risks of future emergency department (ED) visits can help the health care provider guide the allocation of resources to better manage higher-risk patient populations and thereby reduce unnecessary use of EDs. Our main objective was to develop a Health Information Exchange-based, next 6-month ED risk surveillance system in the state of Maine. Data on electronic medical record (EMR) encounters integrated by HealthInfoNet (HIN), Maine's Health Information Exchange, were used to develop the Web-based surveillance system for a population ED future 6-month risk prediction. To model, a retrospective cohort of 829,641 patients with comprehensive clinical histories from January 1 to December 31, 2012 was used for training and then tested with a prospective cohort of 875,979 patients from July 1, 2012, to June 30, 2013. The multivariate statistical analysis identified 101 variables predictive of future defined 6-month risk of ED visit: 4 age groups, history of 8 different encounter types, history of 17 primary and 8 secondary diagnoses, 8 specific chronic diseases, 28 laboratory test results, history of 3 radiographic tests, and history of 25 outpatient prescription medications. The c-statistics for the retrospective and prospective cohorts were 0.739 and 0.732 respectively. Integration of our method into the HIN secure statewide data system in real time prospectively validated its performance. Cluster analysis in both the retrospective and prospective analyses revealed discrete subpopulations of high-risk patients, grouped around multiple "anchoring" demographics and chronic conditions. With the Web-based population risk-monitoring enterprise dashboards, the effectiveness of the active case finding algorithm has been validated by clinicians and caregivers in Maine. The active case finding model and associated real-time Web-based app were designed to track the evolving nature of total population risk, in a

  3. Randomized Controlled Trial of Electronic Care Plan Alerts and Resource Utilization by High Frequency Emergency Department Users with Opioid Use Disorder

    Directory of Open Access Journals (Sweden)

    Niels Rathlev, MD

    2016-01-01

    Full Text Available Introduction: There is a paucity of literature supporting the use of electronic alerts for patients with high frequency emergency department (ED use. We sought to measure changes in opioid prescribing and administration practices, total charges and other resource utilization using electronic alerts to notify providers of an opioid-use care plan for high frequency ED patients. Methods: This was a randomized, non-blinded, two-group parallel design study of patients who had 1 opioid use disorder and 2 high frequency ED use. Three affiliated hospitals with identical electronic health records participated. Patients were randomized into “Care Plan” versus “Usual Care groups”. Between the years before and after randomization, we compared as primary outcomes the following: 1 opioids (morphine mg equivalents prescribed to patients upon discharge and administered to ED and inpatients; 2 total medical charges, and the numbers of; 3 ED visits, 4 ED visits with advanced radiologic imaging (computed tomography [CT] or magnetic resonance imaging [MRI] studies, and 5 inpatient admissions. Results: A total of 40 patients were enrolled. For ED and inpatients in the “Usual Care” group, the proportion of morphine mg equivalents received in the post-period compared with the pre-period was 15.7%, while in the “Care Plan” group the proportion received in the post-period compared with the pre-period was 4.5% (ratio=0.29, 95% CI [0.07-1.12]; p=0.07. For discharged patients in the “Usual Care” group, the proportion of morphine mg equivalents prescribed in the post-period compared with the pre-period was 25.7% while in the “Care Plan” group, the proportion prescribed in the post-period compared to the pre-period was 2.9%. The “Care Plan” group showed an 89% greater proportional change over the periods compared with the “Usual Care” group (ratio=0.11, 95% CI [0.01-0.092]; p=0.04. Care plans did not change the total charges, or, the numbers

  4. Relación entre consultas a urgencias por enfermedad respiratoria y contaminación atmosférica en Ciudad Juárez, Chihuahua Relationship between emergency room visits for respiratory disease and atmospheric pollution in Ciudad Juárez, Chihuahua

    Directory of Open Access Journals (Sweden)

    Leticia Hernández-Cadena

    2000-08-01

    Full Text Available OBJETIVO: Analizar la relación entre las concentraciones ambientales de partículas de diámetro OBJECTIVE: To assess the relationship of <=10 µm particles (PM10 and atmospheric ozone concentrations, with the daily number of emergency visits due to asthma and acute respiratory diseases, among children aged under 15, living in Ciudad Juarez, Chihuahua, Mexico. MATERIAL AND METHODS: Between 1998 and 1999, an ecologic study was conducted. Atmospheric data were obtained from the Environmental Protection Agency (EPA, from eight monitoring stations located in Ciudad Juarez, Chihuahua, and El Paso, Texas. From July 1997 to December 1998, data from emergency room visits for respiratory illness were abstracted from existing medical records of two Mexican Institute of Social Security (IMSS hospitals in Ciudad Juarez. Diagnoses were classified into two groups: a asthma, and b upper respiratory infections (URI, according to the International Classification of Diseases (ICD-9 and/or IDC-10. Statistical analysis was carried out using the Poisson regression time series method. RESULTS: During the study period, the mean 24-hour PM10 level was 34.46 µg/m³ (SD=17.99 and the mean ozone level was 51.60 ppb (SD=20.70. The model shows that an increase of 20 µg/m³ in the mean 24-hour exposure to PM10 was related to an increase of 4.97% (95% CI 0.97-9.13 in emergency visits for asthma, with a 5-day lag, as well as to an increase of 9% (95% CI 1.8-16.8 when a cumulative 5-day exposure was considered. URI increased 2.95% as a cause of emergency room visits, for each 20 µg/m³ increase in the mean 24-hour exposure to PM10. The impact of PM10 on emergency visits for asthma was greater on days with ozone ambient levels exceeded 49 ppb (median value. CONCLUSIONS: A positive association was found between environmental PM10 and ozone concentrations and the daily number of emergency room visits due to asthma and acute respiratory diseases, even with levels lower than the

  5. Test Room Stability Plan

    International Nuclear Information System (INIS)

    1993-01-01

    This plan documents the combination of designs, installations, programs, and activities that ensures that the underground excavations at the Waste Isolation Pilot Plant (WIPP), in which transuranic (TRU) waste may be emplaced during the Test Phase, will remain sufficiently stable and safe during that time. The current ground support systems installed at the WIPP are the result of over ten years of data collection from hundreds of geomechanical instruments and thousands of hours of direct observation of the changing conditions of the openings. In addition, some of the world's most respected experts on salt rock mechanics have provided input in the design process and concurrence on the suitability of the final design. The general mine rockbolt pattern and the ground support system for the test rooms are designed to specifically address the fracture and deformation geometries observed today at the WIPP. After an introductory chapter, this plan describes the general underground design, then proceeds to an account of general ground support performance, and finally focuses on the details of the special test room ground support systems. One such system already installed in Room 1, Panel 1, is described in comprehensive detail. Other test rooms in Panel 1, whether full-size or smaller, will be equipped with systems that ensure stability to the same or equivalent extent. They will benefit from the experience gained in the first test room, which in turn benefitted from the data and knowledge accumulated during previous stages (e.g., the Site and Preliminary Design Validation program) of the project

  6. Control room design

    International Nuclear Information System (INIS)

    Zinke, H.

    1980-01-01

    To control a 1300 megawatt nuclear power plant, about 15000 plant parameters must be collected together to control and operate the plant. The control room design therefore is of particular importance. The main design criteria are: Required functions of the power plant process - Level of Automation - Ergonomics - Available Technology. Extensive analysis has resulted in a control room design method. This ensures that an objective solution will be reached. Resulting from this methodical approach are: 1. Scope, position and appearance of the instrumentation. 2. Scope, position and appearance of the operator controls. Process analysis dictates what instrumentation and operator controls are needed. The priority and importance of the control and instrumentation (this we define as the utilisation areas), dictates the rough layout of the control room. (orig./RW)

  7. Room for caring

    DEFF Research Database (Denmark)

    Timmermann, Connie; Uhrenfeldt, Lisbeth; Birkelund, Regner

    2015-01-01

    Aim This study explores how seriously ill hospitalized patients' experience and assign meaning to their patient room. Background Modern hospitals and the rational underlying care and treatment of today have their emphasis on diagnosis, cure and treatment. Consequently, aesthetics in the patient...... rooms such as a view of nature or natural light entering the room are often neglected in caring for these patients. Method A phenomenological-hermeneutic study design was applied and data was collected through multiple qualitative interviews combined with observations at a teaching hospital in Denmark......-being, relief and hope for the patients during serious illness. Therefore, these sensory impressions should be thought of as holding palliative potential and should be included as a part of caring for the seriously ill patients....

  8. New technologies for control room habitability assessment

    International Nuclear Information System (INIS)

    Lahti, G.P.; Muraida, J.E.; Perchiazzi, W.T.; Harden, P.A.

    1994-01-01

    Older nuclear power plants typically considered only a nominal amount of unfiltered inleakage (typically 10 cfm) impacting their postaccident control room habitability. However, recent measurements of unfiltered inleakage show values in excess of the nominal 10 cfm. A reassessment for two of these ''older'' stations has been completed recently to show that the measured inleakage did not jeopardize the safety of the control room occupants. Recent concerns at the Zion Station and the Palisades Station about control room habitability in the event of a loss-of-coolant accident have led to an extensive effort to increase control room habitability margin. The heating, ventilating and air-conditioning (HVAC) system servicing each of the control rooms has the potential for unfiltered in-leakage through many locations. For example, at the Palisades Station, the current limiting control room habitability analysis allows for 25 cfm unfiltered in-leakage through its normal outside air intake louvered isolation dampers during emergency mode into the control room envelope. This leakage value was not thought to be achievable with the existing as-built configuration. Repairing the system was considered a potential solution; however, this would be costly and could negatively affect plant operation. In addition, the system would still be required to meet the low specified unfiltered in-leakage. An alternate approach was to review the analysis and reassess the most important parameters. The key effort was to determine the atmospheric dispersion factors (χ/Qs) through wind tunnel tests using scale models of the stations. The results of the wind tunnel testing could yield more realistic χ/Qs for control room habitability than previously employed methods. The wind tunnel study options were selected based on their ease of implementation, realistic results, and low cost. More importantly, the results of the studies would allow more realistic values of unfiltered inleakage

  9. The Virtual Dressing Room

    DEFF Research Database (Denmark)

    Holte, Michael Boelstoft

    2013-01-01

    This paper presents a review of recent developments and future perspectives, addressing the problem of creating a virtual dressing room. First, we review the current state-of-the-art of exiting solutions and discuss their applicability and limitations. We categorize the exiting solutions into three...... kinds: (1) virtual real-time 2D image/video techniques, where the consumer gets to superimpose the clothes on their real-time video to visualize themselves wearing the clothes. (2) 2D and 3D mannequins, where a web-application uses the body measurements provided by the customer, to superimpose...... and their demands to a virtual dressing room....

  10. Birth room images

    DEFF Research Database (Denmark)

    Bowden, Calida; Sheehan, Athena; Foureur, Maralyn Jean

    2016-01-01

    Objective: this study examined images of birth rooms in developed countries to analyse the messages and visual discourse being communicated through images. Design: a small qualitative study using Kress and van Leeuwen's (2006) social semiotic theoretical framework for image analysis, a form...... and implications for practice: as images on the Internet inform and persuade society about stereotypical behaviours, the trends of our time and sociocultural norms, it is important to recognise images of the technological birth room on the Internet may be influential in dictating women's attitudes, choices...

  11. The changing sensory room

    DEFF Research Database (Denmark)

    2018-01-01

    In 2017 the kindergarten The Milky Way in the city Vejle in Denmark made a sensory room that has the special ability change whenever wanted by the children and social educators. Kjetil Sandvik (to the right) from Copenhagen University and Klaus Thestrup from Aarhus University reflects upon what...... they saw, took part in and talked with the social educators about. Jacob Knudsen from VIFIN filmed the two gentlemen and organised the project. it is a room composed around common experiments, many self-made objects, open narrative structures. and a combination of digital and analogue elements....

  12. The operating room of the future: observations and commentary.

    Science.gov (United States)

    Satava, Richard M

    2003-09-01

    The Operating Room of the Future is a construct upon which to develop the next generation of operating environments for the patient, surgeon, and operating team. Analysis of the suite of visions for the Operating Room of the Future reveals a broad set of goals, with a clear overall solution to create a safe environment for high-quality healthcare. The vision, although planned for the future, is based upon iteratively improving and integrating current systems, both technology and process. This must become the Operating Room of Today, which will require the enormous efforts described. An alternative future of the operating room, based upon emergence of disruptive technologies, is also presented.

  13. PS Control Room

    CERN Multimedia

    CERN PhotoLab

    1963-01-01

    The good old PS Control Room, all manual. For each parameter, a knob or a button to control it; for each, a light or meter or oscilloscope to monitor it; carefully written pages serve as the data bank; phones and intercom for communication. D.Dekkers is at the microphone, M.Valvini sits in front.

  14. Room for iodo therapy

    International Nuclear Information System (INIS)

    Pinto, A.L.A.; Derivi, A.; Bacelar, A.; Ramos, F.R.; Dias, T.M.; Baptista, I.S.

    1996-01-01

    A description of rules to assemble, to install and to maintain a room for iodo therapy is presented. The necessities of the patients and procedures to meet the norms of radiologic protection established by the Comissao Nacional de Energia Nuclear (CNEN), Rio de Janeiro, RJ (Brazil) are highlighted

  15. Local control room

    CERN Multimedia

    CERN PhotoLab

    1972-01-01

    Local control room in the ejection building : all electronics pertaining to proton distribution and concomitants such as beam gymnastics and diagnostics at high energies will eventually be gathered here. Shown is the first of two rows of fast ejection electronic racks. It includes only what is necessary for operation.

  16. DSS / Press Room

    Science.gov (United States)

    Defense Security Service, U.S. Department of Defense Site Map | A-Z Index | Facebook | Twitter Locations Press Room Organizational Structure Careers at DSS Doing Business with DSS Frequently Asked Classification System (NCCS) National Industrial Security System (NISS) ODAA Business Management System (OBMS

  17. Controlling the clean room atmosphere

    International Nuclear Information System (INIS)

    Meeks, R.F.

    1979-01-01

    Several types of clean rooms are commonly in use. They include the conventional clean room, the horizontal laminar flow clean room, the vertical laminar flow clean room and a fourth type that incorporates ideas from the previous types and is known as a clean air bench or hood. These clean rooms are briefly described. The origin of contamination and methods for controlling the contamination are discussed

  18. Importância da proteína C-reativa no diagnóstico e no prognóstico intra-hospitalar em pacientes com dor torácica na sala de emergência C-reactive protein diagnostic and prognostic value in patients presenting at the emergency room with chest pain

    Directory of Open Access Journals (Sweden)

    Alfredo Antonio Potsch

    2006-09-01

    patients admitted to the emergency room (ER with chest pain (CP without ST-segment elevation on the electrocardiogram (ECG. METHODS: From January 2002 to December 2003, 980 patients were consecutively seen in the ER with CP suggestive of acute coronary syndrome (ACS (age = 64.9 ± 14.3, men = 55%, diabetic = 18%, normal ECG = 84%. Serial CRP, creatine kinase MB mass (CKMB-mass and troponin I determinations were performed on admission, in addition to serial ECG. CRP measurements were standardized (s-CRP by the upper limit of normal (ULN of the test used (3.0 mg/L for high-sensitivity C-reactive protein [hs-CRP] and 0.1 mg/dL for titrated CRP [t-CRP]. RESULTS: One hundred and twenty-five patients were diagnosed with acute myocardial infarction (AMI, and their s-CRP values were 1.31 ± 2.90 (median = 0.47 compared to 0.79 ± 1.39 (0.30 in no-AMI patients (p = 0.031. The s-CRP > 1.0 showed 30% sensitivity and 80% specificity, plus negative and positive predictive values of 6.1% and 96.7%, respectively, for AMI diagnosis. There were forty in-hospital cardiac events (16 deaths, 22 urgent revascularizations, and 2 acute myocardial infarction. In the first quartile of the s-CRP ( 0.93 15 events (p = 0.003 occurred. In the logistic regression model, masculine gender and s-CRP > 0.32 (odds ratio 7.6, 2.8 and 2.2, respectively were independent predictors of cardiac events and left ventricular failure. CONCLUSION: In patients with chest pain presenting at the emergency room, s-CRP was not a good marker of AMI, although this diagnosis is virtually excluded by a normal value; in addition, values one-third above the upper limit of normal (>1 mg/L for hs-CRP or >0.33 mg/dL for t-CRP were predictive of in-hospital adverse cardiac events.

  19. Emergency preparedness

    International Nuclear Information System (INIS)

    1998-01-01

    According the conception of the Emergency Response Centre (ERC) of the Nuclear Regulatory Authority of the Slovak Republic (NRA), and the obtained experience from exercises, and as well as on the basis of recommendations of international missions, the NRA SR started, in 1997 the ERC extension. The new room enable the work for radiation protection group, reactor safety and logistic group separately. At the same time special room was build for work of the NECRA Technical Support Group of the Emergency Commission for Radiation Accidents of the SR.This group co-operates closely with ERC while evaluation the situation, and by using the information system of the NRA and database of ERC to generate the conditions of nuclear facilities in once of emergency. Extension of the mentioned rooms was carried out. The financing by the European Union helped to build the project RAMG. In this way the NRA gained a working site which, with its equipment and parameters belongs to the top working sites of regulatory bodies of developed European countries. The NRA preparation of exercise and special staff education was carried out in 1997, for employees of the NRA and members of Emergency Headquarters (EH) for work in ERC in case of nuclear installation accident. The task of education of member of EH was their preparation for carrying out three exercises. These exercises are described. In the area of emergency preparedness, in accordance with inspection plan of the Office, 7 team inspections were carried out in individual localities; in NPP Bohunice, two in NPP Mochovce and one in Bohunice Conditioning Centre for radioactive wastes. Solution of the task of development of science and technology in the area of 'Development of technical and programme means for analyses of accidents and solutions of crisis situations'continued in 1997. Another regulations were elaborated for activity of members of EH of the NRA. The following was was carried out: selection of data for transfer and the

  20. Multinodal control room envelope model used for habitability analysis

    International Nuclear Information System (INIS)

    Blumberg, W.M.; Gore, D.E.

    1995-01-01

    This work analyzes the habitability of the control room envelope (CRE) during an off-normal ventilation system condition. The most limiting design basis accident utilized for this analysis is the postulated loss-of-coolant accident. The off-normal condition assumes two rooms within the CRE are at pressures that are lower than adjoining rooms outside the CRE. This pressure differential allows unfiltered in-leakage to enter the CRE through the doors and penetrations in these rooms. This paper quantifies the maximum unfiltered in-leakage

  1. Expected utility without utility

    OpenAIRE

    Castagnoli, E.; Licalzi, M.

    1996-01-01

    This paper advances an interpretation of Von Neumann–Morgenstern’s expected utility model for preferences over lotteries which does not require the notion of a cardinal utility over prizes and can be phrased entirely in the language of probability. According to it, the expected utility of a lottery can be read as the probability that this lottery outperforms another given independent lottery. The implications of this interpretation for some topics and models in decision theory are considered....

  2. Developing an active emergency medical service system based on WiMAX technology.

    Science.gov (United States)

    Li, Shing-Han; Cheng, Kai-An; Lu, Wen-Hui; Lin, Te-Chang

    2012-10-01

    The population structure has changed with the aging of population. In the present, elders account for 10.63% of the domestic population and the percentage is still gradually climbing. In other words, the demand for emergency services among elders in home environment is expected to grow in the future. In order to improve the efficiency and quality of emergency care, information technology should be effectively utilized to integrate medical systems and facilities, strengthen human-centered operation designs, and maximize the overall performance. The improvement in the quality and survival rate of emergency care is an important basis for better life and health of all people. Through integrated application of medical information systems and information communication technology, this study proposes a WiMAX-based emergency care system addressing the public demands for convenience, speed, safety, and human-centered operation of emergency care. This system consists of a healthcare service center, emergency medical service hospitals, and emergency ambulances. Using the wireless transmission capability of WiMAX, patients' physiological data can be transmitted from medical measurement facilities to the emergency room and emergency room doctors can provide immediate online instructions on emergency treatment via video and audio transmission. WiMAX technology enables the establishment of active emergency medical services.

  3. Control room habitability study: findings and recommendations

    International Nuclear Information System (INIS)

    Driscoll, J.W.

    1986-01-01

    The Advisory Committee on Reactor Safeguards (ACRS) has raised a number of concerns related to control room habitability and has recommended actions which they believe could alleviate these concerns. As a result of the ACRS's concerns, the US Nuclear Regulatory Commission's (NRC) Office of Nuclear Reactor Regulation (NRR) in conjunction with the Offices of Research and Inspection and Enforcement, and the NRC regional offices, embarked upon a program to reevaluate Control Room Habitability. Argonne National Laboratory was contracted by the NRC to perform a Control Room Habitability Study on twelve licensed power reactors. The plants selected for the study were chosen based upon architect engineer, nuclear steam system supplier, utility, and plant location. Participants in the study review the plant design as contained in the Updated Safety Analysis Report, Technical Specifications, Three Mile Island action item III.D.3.4 submittal on Control Room Habitability, NRC staff evaluation of the III.D.3.4 submittal, appropriate plant operating procedures, system drawings, and significant Licensee Event Reports on Loss of Cooling to the Control Room Envelope. A two-day visit is then made to the plant to determine if the as-built systems are built, operated, and surveillance performed as described in the documentation reviewed prior to the visit. The major findings of this study are included in this report along with generic recommendations of the review team that apply to control room HVAC systems. Although the study is not complete, at the time of publication of this report, the results obtained to date should be useful to persons responsible for Control Room Habitability in evaluating their own systems

  4. Control room habitability study - findings and recommendations

    International Nuclear Information System (INIS)

    Driscoll, J.W.

    1987-01-01

    The Advisory Committee on Reactor Safeguards (ACRS) has raised a number of concerns related to control room habitability and has recommended actions which they believe could alleviate these concerns. As a result of the ACRS's concerns, the US Nuclear Regulatory Commission's (NRC) Office of Nuclear Reactor Regulation (NRR) in conjunction with the Offices of Research and Inspection and Enforcement, and the NRC regional offices, embarked upon a program to reevaluate Control Room Habitability. Argonne National Laboratory was contracted by the NRC to perform a Control Room Habitability Study on twelve licensed power reactors. The plants selected for the study were chosen based upon architect engineer, nuclear steam system supplier, utility, and plant location. The major findings of this study are included in this report along with generic recommendations of the review team that apply to control room HVAC systems. Although the study is not complete, at the time of publication of this report, the results obtained to date should be useful to persons responsible for Control Room Habitability in evaluating their own systems

  5. Clean room actuators

    Energy Technology Data Exchange (ETDEWEB)

    Higuchi, Toshiro

    1987-06-01

    This report explains on the present status of the clean room actuators including the author's research results. In a clean room, there exists a possibility of dust generation, even when a direct human work is eliminated by the use of robots or automatic machines, from the machines themselves. For this, it is important to develop such clean robots and transfer/positioning mechanism that do not generate dusts, and to develop an actuator and its control technique. Topics described in the report are as follows: 1. Prevention of dust diffusion by means of sealing. 2. Elimination of mechanical contact (Linear induction motor and pneumatic float, linear motor and magnetic attraction float, linear motor and air bearing, and magnetic bearing). 3. Contactless actuator having a positioning mechanism (Use of linear step motor and rotary contactless actuator). (15 figs, 11 refs)

  6. Parametric Room Acoustic Workflows

    DEFF Research Database (Denmark)

    Parigi, Dario; Svidt, Kjeld; Molin, Erik

    2017-01-01

    The paper investigates and assesses different room acoustics software and the opportunities they offer to engage in parametric acoustics workflow and to influence architectural designs. The first step consists in the testing and benchmarking of different tools on the basis of accuracy, speed...... and interoperability with Grasshopper 3d. The focus will be placed to the benchmarking of three different acoustic analysis tools based on raytracing. To compare the accuracy and speed of the acoustic evaluation across different tools, a homogeneous set of acoustic parameters is chosen. The room acoustics parameters...... included in the set are reverberation time (EDT, RT30), clarity (C50), loudness (G), and definition (D50). Scenarios are discussed for determining at different design stages the most suitable acoustic tool. Those scenarios are characterized, by the use of less accurate but fast evaluation tools to be used...

  7. Air Distribution in Rooms

    DEFF Research Database (Denmark)

    Nielsen, Peter V.

    The research on air distribution in rooms is often done as full-size investigations, scale-model investigations or by Computational Fluid Dynamics (CFD). New activities have taken place within all three areas and this paper draws comparisons between the different methods. The outcome of the l......EA sponsored research "Air Flow Pattern within Buildings" is used for comparisons in some parts of the paper because various types of experiments and many countries are involved....

  8. Planets in a Room

    Science.gov (United States)

    Giacomini, l.; Aloisi, F.; De Angelis, I.

    2017-09-01

    Teaching planetary science using a spherical projector to show the planets' surfaces is a very effective but usually very expensive idea. Whatsmore, it usually assumes the availability of a dedicated space and a trained user. "Planets in a room" is a prototypal low cost version of a small, spherical projector that teachers, museum, planetary scientists and other individuals can easily build and use on their own, to show and teach the planets The project of "Planets in a Room" was made by the italian non-profit association Speak Science with the collaboration of INAF-IAPS of Rome and the Roma Tre University (Dipartimento di Matematica e Fisica). This proposal was funded by the Europlanet Outreach Funding Scheme in 2016. "Planets in a room" will be presented during EPSC 2017 to give birth to the second phase of the project, when the outreach and research community will be involved and schools from all over Europe will be invited to participate with the aim of bringing planetary science to a larger audience.

  9. Room with a View: Ethical Encounters in Room 13

    Science.gov (United States)

    Grube, Vicky

    2012-01-01

    In this article, the author describes ethical encounters in Room 13, a schoolroom where children made what they wanted, posed their own questions, and ran an art room like a small business. In Room 13 children had the responsibility to maintain all aspects of the art studio. Specific decisions fell to an annually elected management team, a small…

  10. Differences in the prevalence of hospitalizations and utilization of emergency outpatient services for ambulatory care sensitive conditions between asylum-seeking children and children of the general population: a cross-sectional medical records study (2015

    Directory of Open Access Journals (Sweden)

    Célina Lichtl

    2017-11-01

    Full Text Available Abstract Background Hospitalizations for ambulatory care sensitive (ACS conditions are established indicators for the availability and quality of ambulatory care. We aimed to assess the differences between asylum-seeking children and children of the general population in a German city with respect to (i the prevalence of ACS hospitalizations, and (ii the utilization of emergency outpatient services for ACS conditions. Methods Using anonymous account data, all children admitted to the University Hospital Heidelberg in 2015 were included in our study. A unique cost unit distinguished asylum seekers residing in a nearby reception center (exposed from the children of the general population. We adapted international lists of ACS conditions and calculated the prevalence of ACS hospitalizations and the utilization of emergency outpatient services for ACS conditions, attributable fractions among the exposed (Afe and the population attributable fraction among total admissions (PAF for each outcome. Differences in the prevalence of each outcome between exposed and controls were analyzed in logistic regression models adjusted for sex, age group and quarterly admission. Results Of the 32,015 admissions in 2015, 19.9% (6287 were from inpatient and 80.1% (25,638 from outpatient care. In inpatient care, 9.8% (622 of all admissions were hospitalizations for ACS conditions. The Afe of ACS hospitalizations was 46.57%, the PAF was 1.12%. Emergency service use for ACS conditions could be identified in 8.3% (3088 of all admissions (Afe: 79.57%, PAF: 5.08%. The odds ratio (OR of asylum-seeking children being hospitalized for ACS conditions in comparison to the control group was 1.81 [95% confidence interval, CI: 1.02; 3.2]. The OR of the asylumseeking population compared to the general population for the utilization of emergency service use for ACS conditions was 4.93 [95% CI: 4.11; 5.91]. Conclusions Asylum-seeking children had significantly higher odds of ACS

  11. Control room human engineering influences on operator performance

    International Nuclear Information System (INIS)

    Finlayson, F.C.

    1977-01-01

    Three general groups of factors influence operator performance in fulfilling their responsibilities in the control room: (1) control room and control system design, informational data displays (operator inputs) as well as control board design (for operator output); (2) operator characteristics, including those skills, mental, physical, and emotional qualities which are functions of operator selection, training, and motivation; (3) job performance guides, the prescribed operating procedures for normal and emergency operations. This paper presents some of the major results of an evaluation of the effect of human engineering on operator performance in the control room. Primary attention is given to discussion of control room and control system design influence on the operator. Brief observations on the influences of operator characteristics and job performance guides (operating procedures) on performance in the control room are also given. Under the objectives of the study, special emphasis was placed on the evaluation of the control room-operator relationships for severe emergency conditions in the power plant. Consequently, this presentation is restricted largely to material related to emergency conditions in the control room, though it is recognized that human engineering of control systems is of equal (or greater) importance for many other aspects of plant operation

  12. An observational study of emergency department utilization among enrollees of Minnesota Health Care Programs: financial and non-financial barriers have different associations

    OpenAIRE

    Shippee, Nathan D; Shippee, Tetyana P; Hess, Erik P; Beebe, Timothy J

    2014-01-01

    Background Emergency department (ED) use is costly, and especially frequent among publicly insured populations in the US, who also disproportionately encounter financial (cost/coverage-related) and non-financial/practical barriers to care. The present study examines the distinct associations financial and non-financial barriers to care have with patterns of ED use among a publicly insured population. Methods This observational study uses linked administrative-survey data for enrollees of Minn...

  13. Safety measures in exposure room

    International Nuclear Information System (INIS)

    Muhammad Jamal Md Isa

    2004-01-01

    The contents of this chapter are follows - The exposure room: location and dimension, material and thickness, windows, doors and other openings; Position of the Irradiating Apparatus, Use of Space Adjoining the Room, Warning Signs/Light, Dark Room. Materials and Apparatus: Classification of Areas, Local Rules, Other General Safety Requirements

  14. Radiation Protection Elephants in the Room

    International Nuclear Information System (INIS)

    Vetter, R. J.

    2004-01-01

    As our system of radiological protection evolves, several significant issues loom within radiation protection discussions and publications. These issues influence the nature of epidemiological and radiobiological research and the establishment of radiation protection recommendations, standards, and regulations. These issues are like the proverbial e lephants in the room . They are large, and it is unwise to ignore them. This paper discusses the impact of three young elephants as they make their presence increasingly obvious: increased cancer susceptibility from early-life exposure to radiation, terrorism and fear of radiation, and patient safety. Increased cancer susceptibility from early-life exposure to radiation is emerging as a discussion topic related to the safety of computed tomography (CT) and other medical modalities. Shortly after publication of CT dose data, manufacturers were helping to reduce doses to children by increasing flexibility for adjustment of technique factors. Also, radiation epidemiological data are being used in the development of guidance on exposure to chemical carcinogens during early life. Re-emergence of public fear of radiation has been fueled by threats of radiological dispersion devises and confusing messages about personal decontamination, emergency room acceptance or rejection of contaminated victims, and environmental clean-up. Finally, several professional publications have characterized risk of medical radiation exposure in terms of patient deaths even though epidemiological data do not support such conclusions. All three of these elephants require excellent science and sophisticated data analysis to coax them from the room. Anecdotal communications that confuse the public should be avoided. These are not the only elephants in the room, but these three are making their presence increasingly obvious. This paper discusses the need for radiation protection professionals to rely on good science in the evolution of the system of

  15. Room for a rethink?

    Energy Technology Data Exchange (ETDEWEB)

    Walker, S. [Independent Editorial and Technical Services, Oxford (United Kingdom)

    2000-05-01

    Room-and-pillar has traditionally satisfied the need for a low-cost, flexible coal mining system. Its downside can be low resource recovery. With accessible reserves falling steadily, can mining companies afford to accept this? Simon Walker looks into this problem using evidence presented recently on the US experience by Richard Bonskorski of the US Energy Information Administration, Dr Michael Karmis of Virgina Tech, Roger O'Quinn from Eimco, an equipment manufacturer, and Larry Howe from J H Fletcher. An urgent need is identified to develop new systems to allow significant gains in extraction, using novel concepts such as remote mining. 2 refs., 1 fig., 4 photos.

  16. Room for improvement

    DEFF Research Database (Denmark)

    Sandal, Louise F; Thorlund, Jonas B; Moore, Andrew J

    2018-01-01

    -reported outcomes and qualitative findings supported the primary finding, while improvements in muscle strength and aerobic capacity did not differ between exercise groups. CONCLUSION: Results suggest that the physical environment contributes to treatment response. Matching patients' preferences to treatment rooms...... significance (p=0.07). Waitlist group reported no improvement (-0.05 95% CI -0.5 to 0.4). In interviews, participants from the standard environment expressed greater social cohesion and feeling at home. Qualitative themes identified; reflection, sense of fellowship and transition. Secondary patient...... may improve patient-reported outcomes. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier: NCT02043613....

  17. Making room for volunteers

    DEFF Research Database (Denmark)

    Nielsen, Rasmus Kleis

    2012-01-01

    If campaigns do not accommodate this view, all but a hard core of regulars and fired-up partisans will drift away, leaving it for staffers and hired hands to do all the hard work of identifying voters, canvassing people by foot and by phone, and turning out the vote. [...] ironically, a campaign...... that is singleminded in its instrumental pursuit of victory can thus be less effective than one that is more accommodating- a campaign that makes room for volunteers by accepting that, unlike staffers, they come to politics with a different perspective and conception of what is and ought to be going on....

  18. On The Living Room

    Directory of Open Access Journals (Sweden)

    Thomas Richards

    2013-03-01

    Full Text Available This text discusses the work The Living Room, directed by the author, and reflects on its meanings and functions. The article confronts problems performance raises in relation to contemporary social life, bringing forward the isolation of life today and the possibilities performance offers to fight it. We problematise the crisis experienced by the author and the consequent creation of the work as a mobile performative device in relation to the staging space. Finally, the work questions the forms of interaction and type of participation possible in performance.

  19. Emergency management

    International Nuclear Information System (INIS)

    1996-01-01

    In 1995, major efforts of the Nuclear Regulatory Authority of the Slovak Republic (NRA SR) were focused on tasks associated with completion and incorporation of the Emergency Response Centre (ERC) of NRA SR in emergency planning and crisis management. Construction of the ERC had begun based on NRA SR's knowledge, as well as recommendations of Regulatory Assistance Management Group (RAMG) International Mission in 1993 and follow-up missions in 1994. Early in 1994, re-construction of selected rooms had been done and early in 1995, supported by the UK and U.S.A. Government's funding, technical equipment was purchased. The equipment was necessary for ERC operation as tools to improve NRA SR readiness for the management of emergency situations at nuclear installations. NRA SR commenced operation of the Centre in April 1995. The Centre has been on-line connected to a teledosimetric system of Radiation Monitoring Laboratory in Trnava. The basic software for assessment of radiation consequences of a NPP accident was supplied were also focused on cooperation with state administration authorities and organizations which were involved in an emergency planning structure. In September 1995, staffing of the ERC was completed and parallel, the first document concerning the ERC prime task, i.e. activities and procedures of of NRA SR Crisis crew in case of an accident at a nuclear installation on the territory of the Slovak Republic, was approved by the NRA SR's Management. In the period that is being assessed, NRA SR made significant progress in events classification and emergency planning terminology in order to unify the above between both the Slovak NPPs

  20. Emergency procedures

    International Nuclear Information System (INIS)

    Abd Nasir Ibrahim; Azali Muhammad; Ab Razak Hamzah; Abd Aziz Mohamed; Mohammad Pauzi Ismail

    2004-01-01

    The following subjects are discussed - Emergency Procedures: emergency equipment, emergency procedures; emergency procedure involving X-Ray equipment; emergency procedure involving radioactive sources

  1. Health care utilization of refugee children after resettlement.

    Science.gov (United States)

    Watts, Delma-Jean; Friedman, Jennifer F; Vivier, Patrick M; Tompkins, Christine E A; Alario, Anthony J

    2012-08-01

    Refugee children can have significant health problems. Our objective was to describe health status and health care utilization of refugee children after resettlement. A retrospective chart review of refugee children was performed. Initial laboratory data was extracted. Primary care visits, emergency room visits, and subspecialty referrals in the first 15 months from arrival were recorded. The sample included 198 refugees, many with positive initial screening tests. After arrival, 21% had an emergency department visit, 40% had a primary care sick visit, and 71% had a primary care follow-up. Mean number of visits ranged from 0.3 for emergency department to 1.9 for follow-up. Fifty-seven percent were referred to at least one subspecialist. Refugee children had substantial disease burden at arrival. Most had primary care follow-up visits and subspecialty referral after resettlement. These visits were largely for problems identified on initial screening and for general pediatric illnesses.

  2. Validation of the Excited Component of the Positive and Negative Syndrome Scale (PANSS-EC) in a naturalistic sample of 278 patients with acute psychosis and agitation in a psychiatric emergency room.

    Science.gov (United States)

    Montoya, Alonso; Valladares, Amparo; Lizán, Luis; San, Luis; Escobar, Rodrigo; Paz, Silvia

    2011-03-29

    Despite the wide use of the Excited Component of the Positive and Negative Syndrome Scale (PANSS-EC) in a clinical setting to assess agitated patients, a validation study to evaluate its psychometric properties was missing. Data from the observational NATURA study were used. This research describes trends in the use of treatments in patients with acute psychotic episodes and agitation seen in emergency departments. Exploratory principal component factor analysis was performed. Spearman's correlation and regression analyses (linear regression model) as well as equipercentile linking of Clinical Global Impression of Severity (CGI-S), Agitation and Calmness Evaluation Scale (ACES) and PANSS-EC items were conducted to examine the scale's diagnostic validity. Furthermore, reliability (Cronbach's alpha) and responsiveness were evaluated. Factor analysis resulted in one factor being retained according to eigenvalue ≥1. At admission, the PANSS-EC and CGI-S were found to be linearly related, with an average increase of 3.4 points (p agitated patients.

  3. PFP Emergency Lighting Study

    International Nuclear Information System (INIS)

    BUSCH, M.S.

    2000-01-01

    NFPA 101, section 5-9 mandates that, where required by building classification, all designated emergency egress routes be provided with adequate emergency lighting in the event of a normal lighting outage. Emergency lighting is to be arranged so that egress routes are illuminated to an average of 1.0 footcandle with a minimum at any point of 0.1 footcandle, as measured at floor level. These levels are permitted to drop to 60% of their original value over the required 90 minute emergency lighting duration after a power outage. The Plutonium Finishing Plant (PFP) has two designations for battery powered egress lights ''Emergency Lights'' are those battery powered lights required by NFPA 101 to provide lighting along officially designated egress routes in those buildings meeting the correct occupancy requirements. Emergency Lights are maintained on a monthly basis by procedure ZSR-12N-001. ''Backup Lights'' are battery powered lights not required by NFPA, but installed in areas where additional light may be needed. The Backup Light locations were identified by PFP Safety and Engineering based on several factors. (1) General occupancy and type of work in the area. Areas occupied briefly during a shiftly surveillance do not require backup lighting while a room occupied fairly frequently or for significant lengths of time will need one or two Backup lights to provide general illumination of the egress points. (2) Complexity of the egress routes. Office spaces with a standard hallway/room configuration will not require Backup Lights while a large room with several subdivisions or irregularly placed rooms, doors, and equipment will require Backup Lights to make egress safer. (3) Reasonable balance between the safety benefits of additional lighting and the man-hours/exposure required for periodic light maintenance. In some plant areas such as building 236-Z, the additional maintenance time and risk of contamination do not warrant having Backup Lights installed in all rooms

  4. Tactical and strategic decision-making aids for nuclear power plant emergency response

    International Nuclear Information System (INIS)

    Cain, D.G.

    1987-01-01

    This paper examines the prospective role of computer-based decision aids for nuclear power plant emergency response. The role of these systems is subordinate to human activities, but in a complementary manner these systems process decision logic more accurately and foster a more thorough understanding of emergency situations than might other wise be possible. Within this context two decision support systems being developed are discussed. Both of these systems utilize technology derived from artificial intelligence, focussing on two different facets of emergency response. An automated emergency operating procedures (EOP) tracking expert system is described as a tactical aid for control room operator response. A reactor emergency action level monitor (REALM) expert system is proposed as a strategic decision aid for site emergency response. The discrimination between tactical and strategic decision-making is an intrinsic part of this examination

  5. Atendimento à crise psíquica no pronto-socorro: visão de profissionais de enfermagem La atención a la crisis psíquica en la unidad de urgencias: la visión del equipo de enfermería Psychic crisis care in the emergency room: nursing staff's view

    Directory of Open Access Journals (Sweden)

    Leandro da Rosa Borges

    2012-09-01

    Full Text Available O objetivo do estudo foi conhecer a visão da equipe de enfermagem sobre o atendimento à crise psíquica em uma unidade de emergência de um Pronto-Socorro. Trata-se de um estudo de abordagem qualitativa que utilizou, como técnica para coleta de dados, a aplicação de entrevistas semiestruturadas com dois enfermeiros e três técnicos de enfermagem que trabalhavam na unidade de emergência durante o turno da manhã e tarde. A análise dos dados foi orientada a partir da análise de conteúdo com formação das seguintes categorias temáticas, que permitiram a melhor visualização dos resultados: o conceito de crise para a equipe do pronto-socorro e as diferentes expressões do sofrimento e os recursos terapêuticos para o enfrentamento e a minimização dos encargos da crise. Evidenciou-se que a equipe de enfermagem costuma justificar as dificuldades de atendimento à crise psíquica pela falta de tempo, inadequação do espaço físico e despreparo da mesma.El presente estudio tuvo como objetivo conocer la visión del equipo de enfermería sobre la atención a la crisis psíquica en una unidad de urgencias. Se trata de un estudio de abordaje cualitativo que utilizó, como técnica de recolección de datos, entrevistas semiestructuradas. Participaron de la investigación dos enfermeras y tres técnicos de enfermería que trabajaban en la unidad de urgencias durante las mañanas y las tardes. El análisis de datos fue orientado a partir de las siguientes temáticas: el concepto de crisis para el equipo de una unidad de urgencias y las diferentes expresiones del sufrimiento y los recursos terapéuticos para el enfrentamiento y disminución de los encargos de la crisis. Suele justificar las dificultades de atención a la crisis por la falta de tiempo, inadecuación de espacio físico y la falta de preparación de la misma.This study was aimed at finding out the nursing staff's view about psychic crisis care in an emergency room unit. This is a

  6. Ontario Power Generation Fukushima emergency response drill strengthens and lessons learned - Ontario Power Generation Fukushima Emergency Response Drill Highlights

    International Nuclear Information System (INIS)

    Miller, David W.

    2014-01-01

    Japan's Fukushima Daiichi severe nuclear accident in March 2011 has resulted in a reassessment of nuclear emergency response and preparedness in Canada. On May 26, 27 and 28, 2014 Ontario Power Generation (OPG) conducted the first North American full scale nuclear emergency response exercise designed to include regional, provincial and federal bodies as well as the utility. This paper describes the radiological aspects of the OPG Exercise Unified Response (ExUR) with emphasis on deployment of new Fukushima equipment on the Darlington site, management of emergency workers deplored in the vicinity of Darlington to collect environmental samples and radiation measurements, performance of dose calculations, communication of dose projections and protective actions to local, provincial and federal agencies and conduct of vehicle, truck and personnel monitoring and decontamination facilities. The ExUR involved more than 1000 personnel from local, provincial and federal bodies. Also, 200 OPG employees participated in the off-site emergency response duties. The objective of the ExUR was to test and enhance the preparedness of the utility (OPG), government and non-government agencies and communities to respond to a nuclear emergency. The types of radiological instrumentation and mobile facilities employed are highlighted in the presentation. The establishment of temporary emergency rooms with 8 beds and treatment facilities to manage potentially contaminated injuries from the nuclear emergency is also described. (author)

  7. A gestão da atenção às urgências e o protagonismo federal Management of attention to emergency rooms and the federal role

    Directory of Open Access Journals (Sweden)

    Gisele O'Dwyer

    2010-08-01

    Full Text Available O atendimento às urgências/emergências tem sido alvo de críticas e o Estado brasileiro, a partir de 2002, assume o esforço de normatizar esse nível de atenção. Este estudo objetivou analisar a política de urgência a partir dos documentos e portarias, baseando-se na teoria da estruturação (Giddens, que relaciona a mobilização de recursos alocativos e autoritários como dimensões da estrutura em interação, o que justificaria a legitimação exercida a partir da sanção das normas. A Política Nacional de Urgência (PNAU teve como marcos o financiamento federal, a regionalização, a capacitação dos profissionais, a gestão por comitês de urgência e a expansão da rede. Identifiquei a densidade das propostas documentais como a vertente facilitadora do recurso estrutural, inovadora pelas propostas de regionalização e de responsabilização dos diversos atores e pela pretensa centralidade no usuário. O financiamento do SUS, apesar do seu persistente estado de constrangimento, não teve ação coerciva sobre o investimento tecnológico. Na atual gestão, houve uma vigorosa expansão e estruturação da rede, que só foi possível por um forte aporte de recursos federais. A gestão pelos comitês precisa ser investigada e aponta-se como fragilidade a gestão do trabalho.Attention to the emergency care has been criticized, and since 2002 the Brazilian State has assumed the efforts to standardize the level of attention. It was proposed the analysis of documents and acts based on the Structuration Theory that considers the mobilization of allocative and authoritarian resources as dimensions of structure in interaction, which would justify the legitimacy exercised since the establishment of regulations. The National Emergency Plan (PNAU had as guides: the federal funding, regionalization, professional education, management by urgency committees, and the expansion of the network. It was identified the density of the documental

  8. "Same Room, Safe Place".

    Science.gov (United States)

    Keene Woods, Nikki

    2017-04-01

    There are many different professional stances on safe sleep and then there is the reality of caring for a newborn. There is a debate among professionals regarding safe sleep recommendations. The continum of recommendations vary from the American Academy of Pediatrics (AAP) Safe Sleep Guidelines to the bed-sharing recommendations from the Mother-Baby Behavioral Sleep Laboratory. The lack of consistent and uniform safe sleep recommendations from health professionals has been confusing for families but has more recently raised a real professional ethical dilemma. Despite years of focused safe sleep community education and interventions, sleep-related infant deaths are on the rise in many communities. This commentary calls for a united safe sleep message from all health professionals to improve health for mothers and infants most at-risk, "Same Room, Safe Place."

  9. Hotel room suicide.

    Science.gov (United States)

    Zarkowski, Paul; Avery, David

    2006-10-01

    The objective of our research was to quantify the increased risk of suicide associated with registering in local hotels/motels. Medical examiner case files of suicide in King County, Washington, were reviewed for years 2002-2004. The incidence of suicide in local residents registering in local hotels/motels was 223/100,000 which is significantly greater than the incidence of suicide in the general population of King County (11.7/100,000 p Hotel/motel guests from outside Washington had a significantly reduced incidence of suicide (3.9/100,000 p = 0.002). The study results suggest that there is an increased risk of suicide in local residents who register in local hotel rooms.

  10. Binaural room simulation

    Science.gov (United States)

    Lehnert, H.; Blauert, Jens; Pompetzki, W.

    1991-01-01

    In every-day listening the auditory event perceived by a listener is determined not only by the sound signal that a sound emits but also by a variety of environmental parameters. These parameters are the position, orientation and directional characteristics of the sound source, the listener's position and orientation, the geometrical and acoustical properties of surfaces which affect the sound field and the sound propagation properties of the surrounding fluid. A complete set of these parameters can be called an Acoustic Environment. If the auditory event perceived by a listener is manipulated in such a way that the listener is shifted acoustically into a different acoustic environment without moving himself physically, a Virtual Acoustic Environment has been created. Here, we deal with a special technique to set up nearly arbitrary Virtual Acoustic Environments, the Binaural Room Simulation. The purpose of the Binaural Room Simulation is to compute the binaural impulse response related to a virtual acoustic environment taking into account all parameters mentioned above. One possible way to describe a Virtual Acoustic Environment is the concept of the virtual sound sources. Each of the virtual sources emits a certain signal which is correlated but not necessarily identical with the signal emitted by the direct sound source. If source and receiver are non moving, the acoustic environment becomes a linear time-invariant system. Then, the Binaural Impulse Response from the source to a listener' s eardrums contains all relevant auditory information related to the Virtual Acoustic Environment. Listening into the simulated environment can easily be achieved by convolving the Binaural Impulse Response with dry signals and representing the results via headphones.

  11. The role of the control room operator

    International Nuclear Information System (INIS)

    Williams, M.C.

    A control room operator at an Ontario Hydro nuclear power plant operates a reactor-turbine unit according to approved procedures within imposed constraints to meet the objectives of the organization. A number of operating and administrative tasks make up this role. Control room operators spend approximately six percent of their time physically operating equipment exclusive of upset conditions, and another one percent operating in upset conditions. Testing occupies five percent of an operator's time. Operators must be trained to recognize the entire spectrum of inputs available to them and use them all effectively. Any change in system or unit state is always made according to an approved procedure. Extensive training is required; operators must be taught and pracised in what to do, and must know the reasons behind their actions. They are expected to memorize emergency procedures, to know when to consult operating procedures, and to have sufficient understanding and practice to perform these procedures reliably

  12. On the improvement of the response capability of the control room operator in a pressurized water reactor nuclear power plant in a severe earthquake through the use of emergency response guidelines

    International Nuclear Information System (INIS)

    Lee, S.

    1989-01-01

    Recent probabilistic risk assessment studies indicate that potential accidents initiated by large earthquakes are among the major contributors to public risk from nuclear power plants. During a severe earthquake, the symptoms presented to operators may be unreliable and may endanger the validity of actions in emergency response guidelines (ERGs). The objective of the present study is to improve the operator capability of responding to seismic damage through the use of ERGS. The methods used are to deterministically identify the possible weakness of ERGs, given a severe earthquake, and to probabilistically evaluate those identified weaknesses. Several cases are postulated. Each of them contains system failures with or without indicator failures and leads the core to meltdown conditions if the operator follows the ERGs strictly without any deviation. The likelihood of each case is estimated. A LISP program is developed to estimate the plant seismic risk with which the relative risk contribution of each postulated case is estimated. As a result, ten cases are postulated and possible remedies for each case are discussed. The likelihood of each case is estimated to be not negligible. The identified indicator failures should be considered in future refinement of the ERGS. The development of an expert system to provide remedial procedures should be considered after a more thorough study in which many more cases are postulated

  13. Make room for DSM

    International Nuclear Information System (INIS)

    Meade, W.; Roseman, E.

    1992-01-01

    This article examines the potential effect of demand side management (DSM) on the economics of the independent power industry. The topics of the article include the contribution of DSM to future resource needs, integrated resource planning, DSM incentives, DSM bidding, measuring DSM success, DSM as a part of future utility planning, and strategic responses to DSM

  14. Utility of multiple rule out CT screening of high-risk atraumatic patients in an emergency department-a feasibility study

    DEFF Research Database (Denmark)

    Pries-Heje, Mia M; Hasselbalch, Rasmus B; Raaschou, Henriette

    2018-01-01

    malignant tumors in 10 (10%) cases. The mean size specific radiation dose was 15.9 mSv (± 3.1 mSv). CONCLUSION: Screening with a multi-rule out CT scan of high-risk patients in an ED is feasible and result in discovery of clinically unrecognized diagnoses and malignant tumors, but at the cost of radiation......BACKGROUND: Several large trials have evaluated the effect of CT screening based on specific symptoms, with varying outcomes. Screening of patients with CT based on their prognosis alone has not been examined before. For moderate-to-high risk patients presenting in the emergency department (ED......), the potential gain from a CT scan might outweigh the risk of radiation exposure. We hypothesized that an accelerated "multiple rule out" CT screening of moderate-to-high risk patients will detect many clinically unrecognized diagnoses that affect change in treatment. METHOD: Patients ≥ 40 years, triaged as high...

  15. A HUMAN FACTORS META MODEL FOR U.S. NUCLEAR POWER PLANT CONTROL ROOM MODERNIZATION

    Energy Technology Data Exchange (ETDEWEB)

    Joe, Jeffrey C.

    2017-03-01

    Over the last several years, the United States (U.S.) Department of Energy (DOE) has sponsored human factors research and development (R&D) and human factors engineering (HFE) activities through its Light Water Reactor Sustainability (LWRS) program to modernize the main control rooms (MCR) of commercial nuclear power plants (NPP). Idaho National Laboratory (INL), in partnership with numerous commercial nuclear utilities, has conducted some of this R&D to enable the life extension of NPPs (i.e., provide the technical basis for the long-term reliability, productivity, safety, and security of U.S. NPPs). From these activities performed to date, a human factors meta model for U.S. NPP control room modernization can now be formulated. This paper discusses this emergent HFE meta model for NPP control room modernization, with the goal of providing an integrated high level roadmap and guidance on how to perform human factors R&D and HFE for those in the U.S. nuclear industry that are engaging in the process of upgrading their MCRs.

  16. Modern control room for AHWR

    International Nuclear Information System (INIS)

    Verghese, Clement C.; Joseph, Jose; Biswas, B.B.; Patil, R.K.

    2005-01-01

    Advanced Heavy Water Reactor (AHWR) is a next generation nuclear power plant being developed by Bhabha Atomic Research Centre. A modern control room has been conceived for operation and monitoring of the plant in tune with the advanced features of the reactor. A state of the art C and I architecture based on extensive use of computers and networking has been conceived for this plant. This architecture enables the implementation of a fully computerised operator friendly control room with soft HMIs. Features of the modern control room and control room and concept of soft HMI based operator interfaces have been described in the paper. (author)

  17. Human-Like Room Segmentation for Domestic Cleaning Robots

    Directory of Open Access Journals (Sweden)

    David Fleer

    2017-11-01

    Full Text Available Autonomous mobile robots have recently become a popular solution for automating cleaning tasks. In one application, the robot cleans a floor space by traversing and covering it completely. While fulfilling its task, such a robot may create a map of its surroundings. For domestic indoor environments, these maps often consist of rooms connected by passageways. Segmenting the map into these rooms has several uses, such as hierarchical planning of cleaning runs by the robot, or the definition of cleaning plans by the user. Especially in the latter application, the robot-generated room segmentation should match the human understanding of rooms. Here, we present a novel method that solves this problem for the graph of a topo-metric map: first, a classifier identifies those graph edges that cross a border between rooms. This classifier utilizes data from multiple robot sensors, such as obstacle measurements and camera images. Next, we attempt to segment the map at these room–border edges using graph clustering. By training the classifier on user-annotated data, this produces a human-like room segmentation. We optimize and test our method on numerous realistic maps generated by our cleaning-robot prototype and its simulated version. Overall, we find that our method produces more human-like room segmentations compared to mere graph clustering. However, unusual room borders that differ from the training data remain a challenge.

  18. More room for ISOLDE

    CERN Multimedia

    2005-01-01

    To meet the needs of the new ISOLDE experiments, a new extension has been added to the facility's Building 170. The new extension to Building 170. Moving around the ISOLDE hall was almost like an obstacle course until now. The facility's Building 170 simply didn't have an inch to spare and the ISOLDE team's need to set up new experiments, whose installation could have created difficulties from the safety point of view, only exacerbated the problem. "We had ambitious plans to develop new experiments but no room for them", says Mats Lindroos, ISOLDE's technical coordinator. The only solution was to extend the existing building". This was how a new building saw the light of day. Measuring 24 metres long, 20 metres wide and 12 metres high, it is an extension to the existing Building 170 and should be ready for use this year. The new structure makes use of the existing infrastructure, with part of the end wall of Building 170 being kept as a support for steel platforms. The top of this wall had to be cut away ...

  19. Telemedicine Physical Examination Utilizing a Consumer Device Demonstrates Poor Concordance with In-Person Physical Examination in Emergency Department Patients with Sore Throat: A Prospective Blinded Study.

    Science.gov (United States)

    Akhtar, Moneeb; Van Heukelom, Paul G; Ahmed, Azeemuddin; Tranter, Rachel D; White, Erinn; Shekem, Nathaniel; Walz, David; Fairfield, Catherine; Vakkalanka, J Priyanka; Mohr, Nicholas M

    2018-02-22

    Telemedicine allows patients to connect with healthcare providers remotely. It has recently expanded to evaluate low-acuity illnesses such as pharyngitis by using patients' personal communication devices. The purpose of our study was to compare the telemedicine-facilitated physical examination with an in-person examination in emergency department (ED) patients with sore throat. This was a prospective, observational, blinded diagnostic concordance study of patients being seen for sore throat in a 60,000-visit Midwestern academic ED. A telemedicine and a face-to-face examination were performed independently by two advanced practice providers (APP), blinded to the results of the other evaluator. The primary outcome was agreement on pharyngeal redness between the evaluators, with secondary outcomes of agreement and inter-rater reliability on 14 other aspects of the pharyngeal physical examination. We also conducted a survey of patients and providers to evaluate perceptions and preferences for sore throat evaluation using telemedicine. Sixty-two patients were enrolled, with a median tonsil size of 1.0. Inter-rater agreement (kappa) for tonsil size was 0.394, which was worse than our predetermined concordance threshold. Other kappa values ranged from 0 to 0.434, and telemedicine was best for detecting abnormal coloration of the palate and tender superficial cervical lymph nodes (anterior structures), but poor for detecting abnormal submandibular lymph nodes or asymmetry of the posterior pharynx (posterior structures). In survey responses, telemedicine was judged easier to use and more comfortable for providers than patients; however, neither patients nor providers preferred in-person to telemedicine evaluation. Telemedicine exhibited poor agreement with the in-person physical examination on the primary outcome of tonsil size, but exhibited moderate agreement on coloration of the palate and cervical lymphadenopathy. Future work should better characterize the importance of

  20. A cross-sectional study of emergency care utilization and associated costs of violent-related (assault) injuries in the United States.

    Science.gov (United States)

    Monuteaux, Michael C; Fleegler, Eric W; Lee, Lois K

    2017-11-01

    Violent-related (assault) injuries are a leading cause of death and disability in the United States. Many violent injury victims seek treatment in the emergency department (ED). Our objectives were to (1) estimate rates of violent-related injuries evaluated in United States EDs, (2) estimate linear trends in ED visits for violent-related injuries from 2000 to 2010, and (3) to determine the associated health care and work-loss costs. We examined adults 18 years and older from a nationally representative survey (the National Hospital Ambulatory Medical Care Survey) of ED visits, from 2000 to 2010. Violent injury was defined using International Classification of Diseases-9th Rev.-Clinical Modification, diagnosis and mechanism of injury codes. We calculated rates of ED visits for violent injuries. Medical and work-loss costs accrued by these injuries were calculated for 2005, inflation-adjusted to 2011 dollars using the WISQARS Cost of Injury Reports. An annual average of 1.4 million adults were treated for violent injuries in EDs from 2000 to 2010, comprising 1.6% (95% confidence interval, 1.5%-1.6%) of all US adult ED visits. Young adults (18-25 years), men, nonwhites, uninsured or publically insured patients, and those residing in high poverty urban areas were at increased risk for ED visits for violent injury. The 1-year, inflation-adjusted medical and w