[The evaluation of academic emergency department design].

Science.gov (United States)

Deniz, Turgut; Aydinuraz, Kuzey; Oktay, Cem; Saygun, Meral; Ağalar, Fatih

2007-01-01

In our study which was based upon a questionnaire, the inner and outer architectural designs of emergency services of Emergency Medicine Departments were investigated. In this descriptive study, a standard questionnaire was sent to 26 Emergency Medicine Departments which were operating at that time. In the questionnaire, the internal, external architectural and functional features were questioned. Answers of 22 Emergency Medicine Departments were analysed. Two Emergency Medicine Departments that were not operating at that time were not included in the study. The analysis of the replies revealed that only 59% (n=13) of the Emergency Medicine Departments were designed as an emergency service prior to the construction. The ambulance parking areas were not suitable in 77% of the emergency units while only 54.5% (n=12) had protection against adverse weather conditions. In only 59% (n=13) of the emergency units, a triage unit was present and in only one of the in only one (4.5%), a decontamination room was available. It was understood that only 32% (n=8) of the emergency units were appropriate in enlarging their capacity taking the local risk factors into consideration. There was a toilette for disabled patients in only 18% (n=4) of the units as well. Considering a 12-year of history of the Emergency Medicine in Turkey, the presence of a lecture room is still 68% (n=15) in emergency departments which reflects that academic efforts in this field is emerging in challenging physical conditions. The results of our study revealed that emergency service architecture was neglected in Turkey and medical care given was precluded by the insufficient architecture. The design of emergency services has to be accomplished under guidance of scientific data and rules taking advices of architects who have knowledge and experience on this field.

Priorities for emergency department syncope research

NARCIS (Netherlands)

Sun, Benjamin C.; Costantino, Giorgio; Barbic, Franca; Bossi, Ilaria; Casazza, Giovanni; Dipaola, Franca; McDermott, Daniel; Quinn, James; Reed, Matthew; Sheldon, Robert S.; Solbiati, Monica; Thiruganasambandamoorthy, Venkatesh; Krahn, Andrew D.; Beach, Daniel; Bodemer, Nicolai; Brignole, Michele; Casagranda, Ivo; Duca, Piergiorgio; Falavigna, Greta; Ippoliti, Roberto; Montano, Nicola; Olshansky, Brian; Raj, Satish R.; Ruwald, Martin H.; Shen, Win-Kuang; Stiell, Ian; Ungar, Andrea; van Dijk, J. Gert; van Dijk, Nynke; Wieling, Wouter; Furlan, Raffaello

2014-01-01

There is limited evidence to guide the emergency department (ED) evaluation and management of syncope. The First International Workshop on Syncope Risk Stratification in the Emergency Department identified key research questions and methodological standards essential to advancing the science of

Fire Department Emergency Response

International Nuclear Information System (INIS)

Blanchard, A.; Bell, K.; Kelly, J.; Hudson, J.

1997-09-01

In 1995 the SRS Fire Department published the initial Operations Basis Document (OBD). This document was one of the first of its kind in the DOE complex and was widely distributed and reviewed. This plan described a multi-mission Fire Department which provided fire, emergency medical, hazardous material spill, and technical rescue services

Welcome to the Irish Journal of Paramedicine

Directory of Open Access Journals (Sweden)

Alan M Batt

2016-06-01

Full Text Available Welcome to the first issue of the Irish Journal of Paramedicine (IJP. It gives me great pleasure to launch this journal, a first for Irish paramedics, and pre-hospital care in Ireland. I am also honoured to announce that the IJP has been adopted as the official journal of the Irish College of Paramedics, the professional body for prehospital emergency care practitioners in Ireland.               A newly emerging profession, paramedicine is now poised at  a crossroads. Previously alluded to with  colleagues from around the globe, the role of the paramedic is one that is rapidly evolving, and yet paramedicine as a discipline has yet to figure out where it belongs.(1 Are we public safety professionals, first responders or healthcare professionals? Williams has previously stated that the road less travelled requires the paramedic profession to pursue identity as a healthcare profession and not as emergency responders, EMS workers, or ambulance drivers, which we are so commonly identified as.(2 Initiatives within Ireland such as the Centre for Prehospital Research national research agenda, the move to higher education for paramedics in University College Dublin and the University of Limerick, and the publication of high-quality peer-reviewed research, undertaken for paramedics, led by paramedics, and published in paramedicine journals are key components in this pursuit of professionalism. It is our hope that the Irish Journal of Paramedicine will play its part as a vehicle in this endeavour. It is important however to point out that the Irish Journal of Paramedicine is not exclusively for paramedics. Within Ireland, and around the world, there are many other prehospital care providers, including community responders, volunteer first responders, EMT practitioners, nurses, physicians and others who deliver high quality patient care and are as committed to their personal and professional development as any paramedic. This journal is for

A pilot cross-sectional study of patients presenting with cellulitis to emergency departments.

LENUS (Irish Health Repository)

Quirke, M

2014-11-01

To characterise the Emergency Department (ED) prevalence of cellulitis, factors predicting oral antibiotic therapy and the utility of the Clinical Resource Efficiency Support Team (CREST) guideline in predicting patient management in the ED setting, a prospective, cross-sectional study of consecutive adult patients presenting to 3 Irish EDs was performed. The overall prevalence of cellulitis was 12 per 1,000 ED visits. Of 59 patients enrolled, 45.8% were discharged. Predictors of treatment with oral antibiotics were: CREST, Class 1 allocation (odds ratio (OR) 6.81, 95% Cl =1.5-30.1, p=0.012), patient self-referral (OR= 6.2, 95% Cl 1.9- 20.0, p=0.03) and symptom duration longer than 48 hours (OR 1.2, 95% Cl = 1.0-1.5,p=0.049). In conflict with guideline recommendation, 43% of patients in CREST Class 1 received IV therapy. Treatment with oral antibiotics was predicted by CREST Class 1 allocation, self-referral, symptom duration of more than 48 hours and absence of pre-EO antibiotic therapy.

The Irish Wind Atlas

Energy Technology Data Exchange (ETDEWEB)

Watson, R [Univ. College Dublin, Dept. of Electronic and Electrical Engineering, Dublin (Ireland); Landberg, L [Risoe National Lab., Meteorology and Wind Energy Dept., Roskilde (Denmark)

1999-03-01

The development work on the Irish Wind Atlas is nearing completion. The Irish Wind Atlas is an updated improved version of the Irish section of the European Wind Atlas. A map of the irish wind resource based on a WA{sup s}P analysis of the measured data and station description of 27 measuring stations is presented. The results of previously presented WA{sup s}P/KAMM runs show good agreement with these results. (au)

The Roman-Irish Bath: Medical/health history as therapeutic assemblage.

Science.gov (United States)

Foley, Ronan

2014-04-01

The invention of a new form of hot-air bath in Blarney, Ireland in 1856, variously known in its lifetime as the Roman-Irish or Turkish Bath, acted as the starting point for a the production of a globalised therapeutic landscape. Tracking the diffusion of the Roman-Irish bath template from its local invention in Ireland to a global reach across the Victorian world and recognizing its place within a wider hydrotherapeutic history, this paper frames that diffusion as a valuable empirical addition to assemblage theory. The specific empirical history of the spread of the Roman-Irish/Turkish bath idea is drawn from primary archival and secondary historical sources. It is then discussed and, drawing from work on assemblage theory, analyzed against three broad themes: mobile networks, socio-material practices and contested emergence. The emergent relational geographies of the Roman-Irish Bath identify important roles for the diffusion and transformation of specific medical settings, identities and functions. These were linked in turn to competing social-healing pathways wherein bodies were technologically and morally managed, to produce a more inhabited form of therapeutic assemblage. In all cases the differential diffusion of the bath idea, it's shifting and fractured material forms and multiple inhabitations and discourses were contested and mobile and spoke to an assemblage approach which has ripe potential for exploration across a range of medical/health geography settings. Copyright © 2014 Elsevier Ltd. All rights reserved.

Irish Literature in Austria.

Science.gov (United States)

Faerber, Gerda

After a brief description of some historical and cultural interchanges between Ireland and Austria, the paper examines Irish fiction that has been translated into German and Irish plays that have been performed in Vienna over the past 25 years. The paper also describes German translations of Irish children's fiction, including classics like…

Performance Of Irish Potato Varieties Under Aeroponic Conditions In ...

African Journals Online (AJOL)

cntaganda

1Department of Crop Science, Faculty of Agriculture, National University of Rwanda. (NUR) ... Though Irish potato is very important in Rwanda, average yields ... One plausible solution to this problem is to adopt a soil-less seed production.

Perceptions of Emergency Department Physicians Toward Collaborative Practice With Nurse Practitioners in an Emergency Department Setting

National Research Council Canada - National Science Library

Wingert, Tracy

1998-01-01

Once considered reserved for life-threatening disease or illness, emergency departments in the United States are now described as the primary care clinic and the social work department for many Americans (Grumback, Keane & Bindman, 1993...

Six months in an Irish emergency department: the experience of a senior house officer.

LENUS (Irish Health Repository)

Baker, J F

2009-09-01

Emergency Medicine (EM) is a challenging specialty to work within and forms part of a number of training programs. The Emergency Medicine experience at non-consultant hospital doctor (NCHD) level in Ireland has not been reported.

Asthma Medication Ratio Predicts Emergency Depart...

Data.gov (United States)

U.S. Department of Health & Human Services — According to findings reported in Asthma Medication Ratio Predicts Emergency Department Visits and Hospitalizations in Children with Asthma, published in Volume 3,...

Emergency Department Management of Trauma

DEFF Research Database (Denmark)

MacKenzie, Colin; Lippert, Freddy

1999-01-01

services (EMS) response times and advanced prehospital care increase the number of critically injured patients surviving sufficiently long to reach a hospital “in extremis.” Both scenarios provide challenges in the management of traumatized patients. This article addresses the management of severely......Initial assessment and management of severely injured patients may occur in a specialized area of an emergency department or in a specialized area of a trauma center. The time from injury until definitive management is of essence for survival of life-threatening trauma. The initial care delivered...... injured patients after these patients reach a hospital emergency department or a trauma center....

HCUP State Emergency Department Databases (SEDD) - Restricted Access File

Data.gov (United States)

U.S. Department of Health & Human Services — The State Emergency Department Databases (SEDD) contain the universe of emergency department visits in participating States. Restricted access data files are...

HCUP Nationwide Emergency Department Database (NEDS) Restricted Access File

Data.gov (United States)

U.S. Department of Health & Human Services — The Nationwide Emergency Department Sample (NEDS) was created to enable analyses of emergency department (ED) utilization patterns and support public health...

Evaluation of Performance Indexes of Emergency Department

Directory of Open Access Journals (Sweden)

Alireza Baratloo

2015-02-01

Full Text Available Introduction: The importance of evaluating performance indicators in the emergency department, as one of the most important departments of hospital, is obvious to everyone. Therefore, in this study we aimed to appraise the five performance indicators, approved by the ministry of health, in Shohadaye Tajrish hospital, Tehran, Iran. Methods: In a descriptive cross-sectional study based on the profiles of all the patients admitted to the emergency department, performance indicators in the emergency department were evaluated. The study was divided into 2 parts about the establishment of emergency medicine system and training the medical staff: the first 6 months of 1392 and the second. Then these 2 periods were compared using Mann-Whitney U test while P< 0.05 was considered as the level of significance. Results: Of the studied indicators, mean triage time was 6.04 minutes in the first 6 months which was reduced to 1.5 minutes in the second 6 months (p=0.016. In addition, the percentage of patients who moved out of the department in 12 hours was lowered from 97.3% in the first period to 90.4% in the second (p=0.004. While, the percentage of patients who were decided upon in 6 hours (p=0.2, unsuccessful CPR percentage (p=0.34 and patients discharged against medical advice (p=0.42 showed no significant difference. Conclusion: The results of this study showed that the establishment of the emergency medicine system in the emergency department could lead to more efficient triage. Due to the differences made after their establishment including: different pattern of the patients admitted, increased stay of the patients in the department due to their need for prolonged intensive care, a raise in patient referral to the hospital by pre-hospital services and a higher percentage of occupied hospital beds, other indicators have not shown a significant improvement.

Time series modelling and forecasting of emergency department overcrowding.

Science.gov (United States)

Kadri, Farid; Harrou, Fouzi; Chaabane, Sondès; Tahon, Christian

2014-09-01

Efficient management of patient flow (demand) in emergency departments (EDs) has become an urgent issue for many hospital administrations. Today, more and more attention is being paid to hospital management systems to optimally manage patient flow and to improve management strategies, efficiency and safety in such establishments. To this end, EDs require significant human and material resources, but unfortunately these are limited. Within such a framework, the ability to accurately forecast demand in emergency departments has considerable implications for hospitals to improve resource allocation and strategic planning. The aim of this study was to develop models for forecasting daily attendances at the hospital emergency department in Lille, France. The study demonstrates how time-series analysis can be used to forecast, at least in the short term, demand for emergency services in a hospital emergency department. The forecasts were based on daily patient attendances at the paediatric emergency department in Lille regional hospital centre, France, from January 2012 to December 2012. An autoregressive integrated moving average (ARIMA) method was applied separately to each of the two GEMSA categories and total patient attendances. Time-series analysis was shown to provide a useful, readily available tool for forecasting emergency department demand.

Workplace violence against nurses in Indonesian emergency departments.

Science.gov (United States)

Noorana Zahra, Anggri; Feng, Jui-Ying

2018-02-01

The objective of this study was to examine the experiences of violent incidents by nurses in Indonesian emergency departments. The World Health Organization's structured questionnaire on workplace violence in the health sector was modified and translated into Bahasa. The study participants were 169 nurses working in emergency departments in six hospitals in Jakarta and Bekasi, Indonesia. The gathered data were analyzed using descriptive and multivariate logistic regression. Ten percent of emergency nurses reported experiencing physical violence, perpetrated mostly by patients, whereas more than half of emergency nurses (54.6%) reported experiencing non-physical violence, with patients' relative as the main perpetrators. A majority of nurses (55.6%) did not have encouragement to report workplace violence, and very few nurses (10.1%) had received any information or training about workplace violence. The findings of this study highlighted the seriousness of violence in Indonesian emergency departments. Support from management, encouragement to report violence, and access to workplace violence training were expected to mitigate and manage violence against nurses in emergency departments. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

Forecasting the Emergency Department Patients Flow.

Science.gov (United States)

Afilal, Mohamed; Yalaoui, Farouk; Dugardin, Frédéric; Amodeo, Lionel; Laplanche, David; Blua, Philippe

2016-07-01

Emergency department (ED) have become the patient's main point of entrance in modern hospitals causing it frequent overcrowding, thus hospital managers are increasingly paying attention to the ED in order to provide better quality service for patients. One of the key elements for a good management strategy is demand forecasting. In this case, forecasting patients flow, which will help decision makers to optimize human (doctors, nurses…) and material(beds, boxs…) resources allocation. The main interest of this research is forecasting daily attendance at an emergency department. The study was conducted on the Emergency Department of Troyes city hospital center, France, in which we propose a new practical ED patients classification that consolidate the CCMU and GEMSA categories into one category and innovative time-series based models to forecast long and short term daily attendance. The models we developed for this case study shows very good performances (up to 91,24 % for the annual Total flow forecast) and robustness to epidemic periods.

Representing Sikhism: essays in memory of the Irish scholar Max Arthur Macauliffe

OpenAIRE

Shackle, Christopher; Bocking, Brian

2017-01-01

This is an introduction, by the guest editors, to the special issue of JISASR (Vol 4, 2017) entitled 'Representing Sikhism: Essays in Memory of the Irish Scholar Max Arthur Macauliffe'. The genesis of this special issue lies in pioneering work on Macauliffe's Irish identity and personal and scholarly life undertaken by Professor Tadhg Foley (Galway). The active interest and support of members of the Sikh community in Ireland led to a conference, hosted by the Study of Religions Department at ...

Who breaches the four-hour emergency department wait time target? A retrospective analysis of 374,000 emergency department attendances between 2008 and 2013 at a type 1 emergency department in England.

Science.gov (United States)

Bobrovitz, Niklas; Lasserson, Daniel S; Briggs, Adam D M

2017-11-02

The four-hour target is a key hospital emergency department performance indicator in England and one that drives the physical and organisational design of the ED. Some studies have identified time of presentation as a key factor affecting waiting times. Few studies have investigated other determinants of breaching the four-hour target. Therefore, our objective was to describe patterns of emergency department breaches of the four-hour wait time target and identify patients at highest risk of breaching. This was a retrospective cohort study of a large type 1 Emergency department at an NHS teaching hospital in Oxford, England. We analysed anonymised individual level patient data for 378,873 emergency department attendances, representing all attendances between April 2008 and April 2013. We examined patient characteristics and emergency department presentation circumstances associated with the highest likelihood of breaching the four-hour wait time target. We used 374,459 complete cases for analysis. In total, 8.3% of all patients breached the four-hour wait time target. The main determinants of patients breaching the four-hour wait time target were hour of arrival to the ED, day of the week, patient age, ED referral source, and the types of investigations patients receive (p target were older, presented at night, presented on Monday, received multiple types of investigation in the emergency department, and were not self-referred (p target including patient age, ED referral source, the types of investigations patients receive, as well as the hour, day, and month of arrival to the ED. Efforts to reduce the number of breaches could explore late-evening/overnight staffing, access to diagnostic tests, rapid discharge facilities, and early assessment and input on diagnostic and management strategies from a senior practitioner.

Patient satisfaction with physiotherapy in the emergency department.

Science.gov (United States)

Sheppard, Lorraine A; Anaf, Sophie; Gordon, Jane

2010-10-01

This research aims to explore patient satisfaction with ED physiotherapy within the Australian context by providing a qualitative perspective with in-depth exploration of the factors underlying patients' satisfaction. The physiotherapist was part of the Emergency Department Allied Health Team of social worker and occupational therapist. A qualitative, interpretive, field-based study using face-to-face interviews were carried out post-physiotherapy treatment within the emergency department, followed-up 2-3 weeks later with telephone interviews. Twenty two participants took part in the face-to-face interviews and 15 in the follow-up interviews. Of the 22 participants who took part in the initial interviews 19 were over 65 years of age, with a mean age of 78 years. Within the category 'Physiotherapy in the emergency department' the themes were; expectations, bedside manner, physiotherapy management (i.e. assessment, advice, hands-on, exercise, follow-up/referral) and satisfaction. The physiotherapist at the Australian emergency department appeared to make an impact on patients' experiences in the emergency department through his thorough subjective assessment of the patients' home environment, coping skills and social supports, his assessment of functional mobility, his provision of exercises, advice and hands-on treatment, as well as his involvement in organising follow-up or referral to other services. The physiotherapist's bedside manner shaped patients' perceptions throughout their assessment and treatment, reassuring and comforting patients within the emergency environment. Participants were satisfied with the experience of attending the physiotherapist in the emergency department and commented the blend of skills of the physiotherapists enhanced the service provision and self reported patient outcomes. Copyright © 2009 Elsevier Ltd. All rights reserved.

Designing a data-driven decision support tool for nurse scheduling in the emergency department: a case study of a southern New Jersey emergency department.

Science.gov (United States)

Otegbeye, Mojisola; Scriber, Roslyn; Ducoin, Donna; Glasofer, Amy

2015-01-01

A health system serving Burlington and Camden Counties, New Jersey, sought to improve labor productivity for its emergency departments, with emphasis on optimizing nursing staff schedules. Using historical emergency department visit data and operating constraints, a decision support tool was designed to recommend the number of emergency nurses needed in each hour for each day of the week. The pilot emergency department nurse managers used the decision support tool's recommendations to redeploy nurse hours from weekends into a float pool to support periods of demand spikes on weekdays. Productivity improved significantly, with no unfavorable impact on patient throughput, and patient and staff satisfaction. Today's emergency department manager can leverage the increasing ease of access to the emergency department information system's data repository to successfully design a simple but effective tool to support the alignment of its nursing schedule with demand patterns. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

The other "Irish question".

Science.gov (United States)

Browne, H

1992-05-01

The influence of the Roman Catholic Church on Irish society makes it difficult for sex and health educators and HIV/AIDS prevention efforts. Divorce, abortion, consensual sex between consenting adult men, and contraception for those under 18 years is banned in Ireland. Public opinions and recent court decisions do appear to bring a measure of hope for more lenient attitudes. The trends vary from the recent Supreme Court case of the 14-year old rape victim being permitted an abortion because she was suicidal to a radio talk show host, Father Michael Cleary who suspected she was "set-up" to test the ban on abortion. Father Cleary also outraged health educators by stating inaccurately that condoms did not prevent AIDS. It is estimated that 500 Irish women have abortions each year in Britain; there have been 262 reported AIDS cases and estimates of up to 10,000 HIV infected out of a population of 3.5 million. An AIDS education campaign was mounted in 1987, but in the 37-minute Department of Health video only 1 minute was devoted to condoms and no sex was promoted as the only safe sex. Access is limited to consenting pharmacies and clinics for people 18 years of older; rural chemists may exercise discretion and refuse sales. In 1991, the government proposed lowering the age to 17 years for condom availability and assigning the regional health boards, the responsibility of determining who sells contraceptives. A university lecturer reported that inaction on this bill was close to "criminal inactivity." Challenges in February 1991 were made by the Irish Family Planning Association (IFPA) in setting up a condom sales kiosk in Dublin. The IFPA was fined, but opinion polls indicated that 57% supported condom availability for 16 year olds. On Valentines Day in 1992, condom vending machines, which are illegal, were installed in pubs and nightclubs, police action has been cautious. A new health minister is concerned about AIDS prevention and the republic's first woman President

Child maltreatment, parents & the emergency department

NARCIS (Netherlands)

Hoytema van Konijnenburg, E.M.M.

2015-01-01

The research described in this thesis focuses on the evaluation of several methods of screening for child maltreatment at the emergency department, with an emphasis on screening based on parental risk factors (‘child check’). The use of a screening checklist (mandatory in all Dutch emergency

Simulation and the emergency department overcrowding problem

OpenAIRE

Nahhas, A.; Awaldi, A.; Reggelin, T.

2017-01-01

In this paper, a brief review on the emergency department overcrowding problem and its associated solution methodologies is presented. In addition, a case study of an urgent care center is investigated that demonstrates different simulation-based solution strategies to deal with the Emergency Department overcrowding problem. More precisely, a simulation study is conducted to identify critical aspects and propose possible scenarios to configure an urgent care center. Based on statistical data ...

FAST scanning in the developing world emergency department ...

African Journals Online (AJOL)

FAST scanning in the developing world emergency department. ZA Smith, N Postma, D Wood. Abstract. Objectives. To assess the utility of an existing ultrasound machine for the purposes of focused assessment sonography in trauma (FAST) scanning in a developing world emergency department (ED). Design. Prospective ...

Implementation of Electronic Whiteboards at Two Emergency Departments

DEFF Research Database (Denmark)

Rasmussen, Rasmus; Fleron, Benedicte Frederikke Rex; Hertzum, Morten

2010-01-01

We report from a case study of the implementation of an electronic whiteboard system at two emergency departments at Danish hospitals. The purpose of such whiteboards is to support the clinicians in maintaining an overview of the patients at the department. The electronic whiteboard system...... was designed in collaboration with clinicians from the departments, present more information, and allow some automated updating, as compared to the existing dry-erase whiteboard. Based on observations supported by interviews we describe the implementation of the whiteboard at the two emergency departments...

Understanding the Experience of Miscarriage in the Emergency Department.

Science.gov (United States)

MacWilliams, Kate; Hughes, Jean; Aston, Megan; Field, Simon; Moffatt, Faith Wight

2016-11-01

Up to 20% of pregnancies end in miscarriage, which can be a significant life event for women with psychological implications. Because the only preventative measure for a miscarriage is risk factor modification, the treatment focuses on confirming the miscarriage has occurred and medical management of symptoms. Although women experiencing a miscarriage are frequently directed to seek medical care in emergency departments, the patients are often triaged as nonemergent patients unless they are unstable, which exposes women to potentially prolonged wait times. Research about miscarriages and emergency departments predominantly focus on medical management with little understanding of how emergency care shapes the experience of miscarriage for women. Seeking to describe the experiences of women coming to the emergency department for care while having a miscarriage, interpretive phenomenology-a form of qualitative research-guided this study. Eight women were recruited to participate in semi-structured face-to-face interviews of 60 to 90 minutes in length. Data were analyzed using hermeneutics and thematic analysis. Five themes emerged: "Pregnant/Life: Miscarriage/Death"; "Deciding to go to the emergency department: Something's wrong"; "Not an illness: A different kind of trauma"; "Need for acknowledgement"; and "Leaving the emergency department: What now?". Participants believed their losses were not acknowledged but instead dismissed. These experiences, combined with a perceived lack of discharge education and clarity regarding follow-up, created experiences of marginalization. This study describes the experience of miscarrying in emergency departments and provides insights regarding how nursing and physician care may affect patient perceptions of marginalization. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

Primary medical care in Irish prisons

OpenAIRE

ALLWRIGHT, SHANE PATRICIA ANN; DARKER, CATHERINE; BARRY, JOSEPH; O'DOWD, THOMAS

2010-01-01

PUBLISHED Background: An industrial dispute between prison doctors and the Irish Prison Service (IPS) took place in 2004. Part of the resolution of that dispute was that an independent review of prison medical and support services be carried out by a University Department of Primary Care. The review took place in 2008 and we report here on the principal findings of that review. Methods: This study utilised a mixed methods approach. An independent expert medical evaluator (one of ...

The impact of an emergency fee increase on the composition of patients visiting emergency departments.

Science.gov (United States)

Jung, Hyemin; Do, Young Kyung; Kim, Yoon; Ro, Junsoo

2014-11-01

This study aimed to test our hypothesis that a raise in the emergency fee implemented on March 1, 2013 has increased the proportion of patients with emergent symptoms by discouraging non-urgent emergency department visits. We conducted an analysis of 728 736 patients registered in the National Emergency Department Information System who visited level 1 and level 2 emergency medical institutes in the two-month time period from February 1, 2013, one month before the raise in the emergency fee, to March 31, 2013, one month after the raise. A difference-in-difference method was used to estimate the net effects of a raise in the emergency fee on the probability that an emergency visit is for urgent conditions. The percentage of emergency department visits in urgent or equivalent patients increased by 2.4% points, from 74.2% before to 76.6% after the policy implementation. In a group of patients transferred using public transport or ambulance, who were assumed to be least conscious of cost, the change in the proportion of urgent patients was not statistically significant. On the other hand, the probability that a group of patients directly presenting to the emergency department by private transport, assumed to be most conscious of cost, showed a 2.4% point increase in urgent conditions (pfee implemented on March 1, 2013 increased the proportion of urgent patients in the total emergency visits by reducing emergency department visits by non-urgent patients.

Conflicts between managed care organizations and emergency departments in California.

OpenAIRE

Johnson, L A; Derlet, R W

1996-01-01

To control costs, managed care organizations have begun to restrict the use of hospital emergency departments by their enrollees. They are doing this by educating enrollees, providing better access to 24-hour urgent care, denying preauthorizations for care for some patients who do present to emergency departments, and retrospectively denying payment for certain patients who use emergency services. Changing traditional use of emergency departments has resulted in conflicts between managed care...

Music Therapy Through Irish Eyes: A Student Therapist’s Experience of Irish Traditional Music

OpenAIRE

Ruth Armstrong

2008-01-01

This article outlines my personal experience of Irish traditional music and considers how it can inform music therapy practice. The use of Irish music may be particularly meaningful for some clients and help them connect with their culture and identity. Music therapy can also draw on specific features; including the melodic, rhythmic and social aspects of the music. The melody is prominent in Irish traditional music, and its expression is very important. The word draíoght (meaning "spell" or ...

Emergency department crowding in Singapore: Insights from a systems thinking approach.

Science.gov (United States)

Schoenenberger, Lukas K; Bayer, Steffen; Ansah, John P; Matchar, David B; Mohanavalli, Rajagopal L; Lam, Sean Sw; Ong, Marcus Eh

2016-01-01

Emergency Department crowding is a serious and international health care problem that seems to be resistant to most well intended but often reductionist policy approaches. In this study, we examine Emergency Department crowding in Singapore from a systems thinking perspective using causal loop diagramming to visualize the systemic structure underlying this complex phenomenon. Furthermore, we evaluate the relative impact of three different policies in reducing Emergency Department crowding in Singapore: introduction of geriatric emergency medicine, expansion of emergency medicine training, and implementation of enhanced primary care. The construction of the qualitative causal loop diagram is based on consultations with Emergency Department experts, direct observation, and a thorough literature review. For the purpose of policy analysis, a novel approach, the path analysis, is applied. The path analysis revealed that both the introduction of geriatric emergency medicine and the expansion of emergency medicine training may be associated with undesirable consequences contributing to Emergency Department crowding. In contrast, enhancing primary care was found to be germane in reducing Emergency Department crowding; in addition, it has apparently no negative side effects, considering the boundary of the model created. Causal loop diagramming was a powerful tool for eliciting the systemic structure of Emergency Department crowding in Singapore. Additionally, the developed model was valuable in testing different policy options.

Partial dependency parsing for Irish

OpenAIRE

Uí Dhonnchadha, Elaine; van Genabith, Josef

2010-01-01

In this paper we present a partial dependency parser for Irish, in which Constraint Grammar (CG) rules are used to annotate dependency relations and grammatical functions in unrestricted Irish text. Chunking is performed using a regular-expression grammar which operates on the dependency tagged sentences. As this is the first implementation of a parser for unrestricted Irish text (to our knowledge), there were no guidelines or precedents available. Therefore deciding what constitutes a syntac...

Workloads in Australian emergency departments a descriptive study.

Science.gov (United States)

Lyneham, Joy; Cloughessy, Liz; Martin, Valmai

2008-07-01

This study aimed to identify the current workload of clinical nurses, managers and educators in Australian Emergency Departments according to the classification of the department Additionally the relationship of experienced to inexperienced clinical staff was examined. A descriptive research method utilising a survey distributed to 394 Australian Emergency departments with a 21% response rate. Nursing workloads were calculated and a ratio of nurse to patient was established. The ratios included nurse to patient, management and educators to clinical staff. Additionally the percentage of junior to senior clinical staff was also calculated. Across all categories of emergency departments the mean nurse:patient ratios were 1:15 (am shift), 1:7 (pm shift) and 1:4 (night shift). During this period an average of 17.1% of attendances were admitted to hospital. There were 27 staff members for each manager and 23.3 clinical staff for each educator. The percentage of junior staff rostered ranged from 10% to 38%. Emergency nurses cannot work under such pressure as it may compromise the care given to patients and consequently have a negative effect on the nurse personally. However, emergency nurses are dynamically adjusting to the workload. Such conditions as described in this study could give rise to burnout and attrition of experienced emergency nurses as they cannot resolve the conflict between workload and providing quality nursing care.

Screening of the frail patient in the emergency department

DEFF Research Database (Denmark)

Jørgensen, Rasmus; Brabrand, Mikkel

2017-01-01

to detect frailty in patients. ≥. 65. years by their ability to identify the risk of adverse outcomes. Methods: An extensive medical literature search of Embase and PubMed was conducted, to identify studies using frailty screening scales in the emergency department. Data was subsequently extracted...... and evaluated from the results of the included studies. Results: Four studies met the exact inclusion criteria. Four different frailty screening scales: Clinical Frailty Scale, Deficit Accumulation Index, Identification of Seniors At Risk and The Study of Osteoporotic Fracture frailty index used...... emergency department visit. Frailty does however not predict increased risk of 30. day emergency department revisit. Further research highlighting the value of screening for frailty level in elderly emergency department patients is needed. Learning points: Although frail elders in need of further geriatric...

Advertising Emergency Department Wait Times

OpenAIRE

Weiner, Scott G

2013-01-01

Advertising emergency department (ED) wait times has become a common practice in the United States. Proponents of this practice state that it is a powerful marketing strategy that can help steer patients to the ED. Opponents worry about the risk to the public health that arises from a patient with an emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standard definition of the reported time, and directing lower acuity patients to the higher cost ED se...

Primary medical care in Irish prisons

OpenAIRE

Barry, Joe M; Darker, Catherine D; Thomas, David E; Allwright, Shane PA; O'Dowd, Tom

2010-01-01

Abstract Background An industrial dispute between prison doctors and the Irish Prison Service (IPS) took place in 2004. Part of the resolution of that dispute was that an independent review of prison medical and support services be carried out by a University Department of Primary Care. The review took place in 2008 and we report here on the principal findings of that review. Methods This study utilised a mixed methods approach. An independent expert medical evaluator (one of the authors, DT)...

A “New Irish Woman” Emerges: Subverting Femininity in Maeve Kelly’s A Life of Her Own

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Ángela Rivera Izquierdo

2017-03-01

Full Text Available Women in Irish fiction have been largely the creation of male writers, and the embodiment of religious virtues such as purity and passivity, conventionally regarded as “feminine.” Not only the Roman Catholic Church but also the State progressively contributed to the social construct of Irish womanhood as inferior and, above all, domestic. From the 1960s onwards many women writers have tried relentlessly to reimage women in their fiction. Feminist activist Maeve Kelly is an outstanding example of such writers whose work remains virtually unexplored. Very often Kelly’s protagonists are women in their conventional roles as wives and mothers who struggle for happiness and independence. This essay focuses on her collected stories A Life of Her Own (1976, and particularly on her short story “The vain woman,” in which Kelly presents us with a “new Irish woman” who is no longer the personification of the Virgin Mary, and who actively rebels against her environment.

Implementing evidence-based practices in an emergency department

DEFF Research Database (Denmark)

Kirk, Jeanette W.; Nilsen, Per

2016-01-01

of semi-structured interviews. An activity system analysis, as described in the Cultural Historical Activity Theory, was conducted to identify various contradictions that could exist between different parts of the activity system. RESULTS: The main contradiction identified was that guidelines......BACKGROUND: An emergency department is typically a place of high activity where practitioners care for unanticipated presentations, which yields a flow culture so that actions that secure available beds are prioritised by the practitioners. OBJECTIVES: How does the flow culture in an emergency...... department influence nurses' use of a research-based clinical guideline and a nutrition screening routine. METHODS: Ethnographic fieldwork was carried out over three months. The first author followed nurses, medical secretaries and doctors in the emergency department. Data were also collected by means...

Wait Time for Treatment in Hospital Emergency Departments: 2009

Science.gov (United States)

... Medical Care Survey: 2003 emergency department summary. Advance data from vital and health statistics; no 358. Hyattsville, MD: National Center for Health Statistics. 2005. Burt CW, McCaig LF, Valverde RH. Analysis of ambulance diversions in U.S. emergency departments. Ann ...

Radioactivity monitoring of Irish dairy produce

International Nuclear Information System (INIS)

Kelleher, K.

2010-01-01

Full text: The RPII has been carrying out monitoring of milk and dairy produce since 1986. Milk samples are routinely analysed for radiocaesium and strontium-90 as part of the RPII's environmental monitoring programme to determine the doses received to the Irish population from milk consumption. The method the RPII utilises for determining the Sr-90 activity in milk is by measuring the Cerenkov radiation produced by its daughter 90 Y isolated from interfering nuclides such as uranium, thorium, radium and their decay products as well as isotopes of caesium, potassium and strontium by extraction with 10% di-(2-ethylhexyl)phosphate (HDEHP) in toluene. The chemical yield of 90 Y is determined by the acidmetric titration of yttrium nitrate carrier with titriplex III. The levels of Sr-90 and dose to the Irish population from milk consumption have been negligible when compared to other radioactive sources in the Irish environment. Other dairy products are analysed for radiocaesium on a routine basis for commercial customers to ensure the levels of radioactivity in the dairy products fall within EC regulations governing the export/import of dairy produce. The export of milk and milk produce from Ireland is a very important industry, 80% of dairy products produced in Ireland are exported and these exports are worth Euro 2.2 billion annually to the Irish economy. The dairy products are analysed by gamma spectroscopy and include full and skim milk powders, butter, casein, cheese, cream, whey and lactose. The levels of radiocaesium in these products are typically below 5 Bk/kg and fall well within the limit of 370 Bq/kg laid down by the European Community in Council Regulation 737/90. Although the levels of these radionuclides are relatively low the RPII recognises the importance of analysing these samples for radioactivity to inform the public, ensure consumer confidence and, more importantly, to maintain a level of expertise in the RPII in these analytical techniques so that

Radioactivity monitoring of Irish dairy produce

Energy Technology Data Exchange (ETDEWEB)

Kelleher, K. (Radiological Protection Institute of Ireland. Radiation Monitoring, Dublin (Ireland))

2010-03-15

Full text: The RPII has been carrying out monitoring of milk and dairy produce since 1986. Milk samples are routinely analysed for radiocaesium and strontium-90 as part of the RPII's environmental monitoring programme to determine the doses received to the Irish population from milk consumption. The method the RPII utilises for determining the Sr-90 activity in milk is by measuring the Cerenkov radiation produced by its daughter 90Y isolated from interfering nuclides such as uranium, thorium, radium and their decay products as well as isotopes of caesium, potassium and strontium by extraction with 10% di-(2-ethylhexyl)phosphate (HDEHP) in toluene. The chemical yield of 90Y is determined by the acidmetric titration of yttrium nitrate carrier with titriplex III. The levels of Sr-90 and dose to the Irish population from milk consumption have been negligible when compared to other radioactive sources in the Irish environment. Other dairy products are analysed for radiocaesium on a routine basis for commercial customers to ensure the levels of radioactivity in the dairy products fall within EC regulations governing the export/import of dairy produce. The export of milk and milk produce from Ireland is a very important industry, 80% of dairy products produced in Ireland are exported and these exports are worth Euro 2.2 billion annually to the Irish economy. The dairy products are analysed by gamma spectroscopy and include full and skim milk powders, butter, casein, cheese, cream, whey and lactose. The levels of radiocaesium in these products are typically below 5 Bk/kg and fall well within the limit of 370 Bq/kg laid down by the European Community in Council Regulation 737/90. Although the levels of these radionuclides are relatively low the RPII recognises the importance of analysing these samples for radioactivity to inform the public, ensure consumer confidence and, more importantly, to maintain a level of expertise in the RPII in these analytical techniques so

The Irish Maritime Transport Economist Volume 3

OpenAIRE

Office, Irish Maritime Development

2006-01-01

The Irish Maritime Development Office (IMDO) of the Marine Institute publishes the Irish Maritime Transport Economist each year to provide a descriptive statistical analysis of the Irish ports and shipping services sector, as well as the many factors influencing its performance.

The Irish Maritime Transport Economist Volume 4

OpenAIRE

Office, Irish Maritime Development

2007-01-01

The Irish Maritime Development Office (IMDO) of the Marine Institute publishes the Irish Maritime Transport Economist each year to provide a descriptive statistical analysis of the Irish ports and shipping services sector, as well as the many factors influencing its performance.

Irish treebanking and parsing: a preliminary evaluation

OpenAIRE

Lynn, Teresa; Cetinoglu, Ozlem; Foster, Jennifer; Uí Dhonnchadha, Elaine; Dras, Mark; van Genabith, Josef

2012-01-01

Language resources are essential for linguistic research and the development of NLP applications. Low- density languages, such as Irish, therefore lack significant research in this area. This paper describes the early stages in the development of new language resources for Irish – namely the first Irish dependency treebank and the first Irish statistical dependency parser. We present the methodology behind building our new treebank and the steps we take to leverage upon the few existing resou...

The Changing Identities of History Teachers in an Irish School

Science.gov (United States)

O'Boyle, Ailish

2004-01-01

This article explores how the nature of history as a subject has shaped the subcultural identities of the eight teachers in the History Department of an Irish post-primary school. Using a biographical, cultural and micropolitical framework popular within symbolic interactionism, this case study is based on data gathered over three years from…

A Feminism of Their Own?: Irish Women’s History and Contemporary Irish Women’s Writing

Directory of Open Access Journals (Sweden)

Mary Ryan

2010-03-01

Full Text Available For a long time, Irish women’s lives were strictly confined to the private domain, and women’s issues were largely silenced and hidden from public knowledge. Additionally, both Church and state maintained that women should hold a certain morality, particularly relating to areas of sexuality and reproduction. As a result, until relatively recently, Irish women’s issues remained largely ignored and therefore unremarked upon. This paper will examine two major areas in which Irish women’s lives have traditionally been repressed: women’s sexuality and domestic violence, both issues which were once considered taboo for open discussion. This paper will also discuss how these same issues are being represented in Irish chick lit novels, thus providing a frank and positive voice for these largely female issues and for the everyday experiences of women in Ireland.

Analysis of emergency department waiting lines

Directory of Open Access Journals (Sweden)

Urška Močnik

2014-10-01

Full Text Available Background: Steady increase in the numbers of patients seeking medical assistance has recently been observed at the emergency department of the health center under study. This has led to increases in waiting times for patients. The management of the health center has been considering to implement certain measures to remedy this situation. One proposed solution is to add an additional physician to the emergency department. A computer model was constructed to simulate waiting lines and analyze the economic feasibility of employing an additional physician.Aim: This paper analyzes the waiting lines at the emergency department and performs an economic feasibility study to determine whether adding an additional physician to the department would be economically justified.Methods: Data about waiting times at the emergency department were collected to study the situation. For each patient, the arrival time at the waiting room and the starting and ending times of the examination were registered. The data were collected from 13 June 2011 to 25 September 2011. The sample included data on 65 nightly standbys, nine standbys on Saturdays, and 16 standbys on Sundays. Due to incomplete entries, data for nine weekly standbys and six Saturday standbys were excluded from the sample. Based on the data collected, we calculated the waiting and examination times per patient, average number of patients, average waiting time, average examination time, share of active standby teams in total standby time, and number of patients in different time periods. The study involved 1,039 patients. Using a synthesis method, we designed a computer model of waiting lines and economic feasibility. The model was validated using comparative analysis. A what-if analysis was performed using various computer simulations with various scenarios to consider the outcomes of decision alternatives. We applied economic analysis to select the best possible solution.Results: The research results

Raising the bar of care for older people in Ontario emergency departments.

Science.gov (United States)

Flynn, Doris Splinter; Jennings, Jane; Moghabghab, Rola; Nancekivell, Tracy; Tsang, Clara; Cleland, Michelle; Shipman-Vokner, Karen

2010-09-01

To describe the role of geriatric emergency management nurses as a catalyst for culture change in emergency department processes with the goal to improve care and outcomes of older people. The changing context and literature has called for a culture change within emergency department care to integrate principles of older people care into care delivery. There is a paucity of reports describing how geriatric emergency care models bring about a broader change in culture within the entire emergency department. The Ontario Ministry of Health and Long-term Care in Canada established a programme to place geriatric emergency management nurses into emergency departments with the goal to improve delivery of care through development of unique, site-appropriate solutions. Geriatric emergency management nurses incorporate capacity building into their role to develop and strengthen the skills, instincts, abilities, process and resources of the emergency department. Care processes focus on areas of staffing, mobilization, comfort, medication, hygiene, nutrition/hydration, cognition, environment, equipment and stimulation. Multi-modal educational strategies and advocacy promote appropriate person-centred care. Improved communication among care providers at key patient transition points remains a priority system-level improvement. Geriatric emergency management nurses work collaboratively with the emergency department team to facilitate change in the way that emergency department care is provided to the older person experiencing health emergencies. Known strategies that have been effective in improving outcomes for older people within the hospital and residential care setting can be generalized into emergency department care. Further research into the effectiveness of these strategies in this environment is recommended. © 2010 Blackwell Publishing Ltd.

An Irish Revolution Without A Revolution

Directory of Open Access Journals (Sweden)

Aidan Beatty

2016-03-01

Full Text Available There is a conventional view among Irish historians that a revolution occurred in that country between the passing of the Third Home Rule Bill of 1912 and the end of the Civil War in 1923.  The violence of those years, the collapse in support for the Irish Parliamentary Party (IPP, the meteoric rise to power of Sinn Féin, a new sense of meritocracy, a greater sense of democracy and a widespread radicalism; all are seen as elements of a major change in Irish politics and life, a ‘Revolution.’  Drawing on Gramsci's notion of a “revolution without a revolution”, this paper seeks to understand the events in Ireland of 1912-23, not as a sudden rupture with the past but as the culmination of a much longer period of (often British-backed capitalist development in post-Famine Ireland. This paper argues that Irish nationalist politics in the decades before 1912 is better understood via categories such as class, gender, capitalism and the pervasive power of the British state.  As such, as well as pursuing a reassessment of the project of Irish historical development and state-building, this paper also seeks a reassessment of the project of (an equally statist Irish historiography.

Emergency department management of shoulder dystocia.

Science.gov (United States)

Del Portal, Daniel A; Horn, Amanda E; Vilke, Gary M; Chan, Theodore C; Ufberg, Jacob W

2014-03-01

Precipitous obstetric deliveries can occur outside of the labor and delivery suite, often in the emergency department (ED). Shoulder dystocia is an obstetric emergency with significant risk of adverse outcome. To review multiple techniques for managing a shoulder dystocia in the ED. We review various techniques and approaches for achieving delivery in the setting of shoulder dystocia. These include common maneuvers, controversial interventions, and interventions of last resort. Emergency physicians should be familiar with multiple techniques for managing a shoulder dystocia to reduce the chances of fetal and maternal morbidity and mortality. Copyright © 2014 Elsevier Inc. All rights reserved.

Cost awareness among doctors in an Irish university-affiliated teaching hospital

Directory of Open Access Journals (Sweden)

William H.C. Tiong

2011-11-01

Full Text Available Previous studies in USA and Canada have found that physicians and physicians in training have a limited understanding of medical care costs. In this study, we set out to survey all grades of doctors in the surgical department, emergency department, and anaesthetic department in a university-affiliated, Irish teaching hospital. Open-ended questionnaires on cost of 25 routinely used items in the hospital were sent to each department. The aims of the study were to assess the present knowledge of cost among the various grades of doctors, and to evaluate the level of professional experience on cost awareness and their confidence in their estimates. We had an overall response rate of 56.8% with 68.5% of doctors admitted to have estimated more than 90% of their responses. Ninety three percent of doctors have no confidence in their estimates on cost of listed items. We found that the lack of cost awareness was universal among doctors of all grades (P = 0.236. The doctors in our study population showed a high level of inaccuracy on their estimates of cost of routinely used items with 84% of the items overestimated. Our results were discouraging and demonstrated that considerable educational activity will be necessary if doctors are to be more cost effective in meeting the national health care budget.

Perceptions of Playing-Related Musculoskeletal Disorders (PRMDs) in Irish traditional musicians: a focus group study.

Science.gov (United States)

Wilson, Iseult M; Doherty, Liz; McKeown, Laura

2014-01-01

Playing-related musculoskeletal disorders (PRMDs) are common in musicians and interfere with the ability to play an instrument at the accustomed level. There is limited research into injuries affecting folk musicians. To explore the Irish traditional musicians' experience of PRMDs. Focus group interviews were conducted in 2011 and 2012, in two venues in Ireland. Data were recorded and transcribed verbatim. Data collection ended when no new findings emerged from the analysis of interviews. The inclusion criteria were: males or females aged 18 and above, and who taught or played Irish traditional music on any instrument. The data were analysed using the interpretative phenomenological method. All participants (n=22) believed there was a link between playing music and musculoskeletal problems. The main body areas affected were the back, shoulders, arms and hands. The main theme that emerged was: 'PRMDs are an integral part of being a traditional musician', and that the musical experience was generally prioritised over the health of the musician. There were sub-themes of 'fear' and 'stresses that contributed to PRMDs'. PRMDs are an occupational hazard for Irish musicians. There is an awareness of PRMDs, but changes (technique, environment) may threaten identity.

Horslips in Irish Musical and Literary Culture

Directory of Open Access Journals (Sweden)

John L. Murphy

2008-03-01

Full Text Available This essay examines the literary impact of a musical electric-folk band. Horslips combined psychedelic, and hard rock with Irish traditional motifs and Celtic narrative themes. Spanning the decade from 1970 to 1980, their success and decline followed the trajectory of the countercultural movement, which came late to Ireland. The band’s revival of mythic characters and historical events drawn from the Irish past attracted fans from all over the island, as well as the diaspora; many young people gained an appreciation of their Irish heritage for the first time, as Horslips became the first electric folk-rock band to fuse disparate genres, and to succeed as an Irish-based independent collective who controlled the graphics, marketing, distribution, and promotion of their music. They inspired the likes of U2 and the Irish punk and new-wave rock musicians who followed them, and without the pioneering efforts of Horslips, Irish music and culture today may never have reached its current success, three decades later.

Complexities of emergency communication: clinicians' perceptions of communication challenges in a trilingual emergency department.

Science.gov (United States)

Pun, Jack Kh; Chan, Engle Angela; Murray, Kristen A; Slade, Diana; Matthiessen, Christian Mim

2017-11-01

To understand the challenges that clinicians face in communicating with patients and other clinicians within a Hong Kong trilingual emergency department. Effective communication has long been recognised as fundamental to the delivery of quality health care, especially in high-risk and time-constrained environments such as emergency departments. The issue of effective communication is particularly relevant in Hong Kong emergency departments, due to the high volume of patients and the linguistic complexity of this healthcare context. In Hong Kong, emergency department clinicians are native speakers of Chinese, but have received their medical training in English. The clinicians read and record virtually all of their medical documentation in English, yet they communicate verbally with patients in Cantonese and Mandarin. In addition, communication between clinicians occurs in spoken Cantonese, mixed with medical English. Thus, medical information is translated numerous times within one patient journey. This complex linguistic environment creates the potential for miscommunication. A mixed-methods design consisting of a quantitative survey with a sequential qualitative interview. Data were collected in a survey from a purposive sample of 58 clinicians and analysed through descriptive statistics. Eighteen of the clinicians were then invited to take part in semi-structured interviews, the data from which were then subjected to a manifest content analysis. Nearly half of the clinicians surveyed believed that medical information may be omitted or altered through repeated translation in a trilingual emergency department. Eighty-three per cent of clinicians stated that there are communication problems at triage. Over 40% said that they have difficulties in documenting medical information. Around 50% believed that long work hours reduced their ability to communicate effectively with patients. In addition, 34% admitted that they rarely or never listen to patients during a

Radioactivity Monitoring of the Irish Environment 2006

International Nuclear Information System (INIS)

Smith, V.; Dowdall, A; Fegan, M.; Hayden, E.; Kelleher, K.; Long, S.; McEvoy, I.; Somerville, S.; Wong, J.; Pollard, D.

2007-10-01

This report presents the results of the environmental radioactivity monitoring programme carried out by the Radiological Protection Institute of Ireland (RPII) in 2006. This programme aims to assess the exposure of the Irish population to artificial radioactivity in the environment, to review the temporal and geographical distribution of contaminating radionuclides and to maintain systems and procedures which would allow a rapid assessment of environmental contamination to be made in the event of a radiological emergency. Radioactivity is present in the environment due to natural processes, the testing of nuclear weapons in the atmosphere, past nuclear accidents such as that at Chernobyl in Ukraine and the routine discharge of radionuclides from nuclear installations. Liquid discharges from the British Nuclear Group reprocessing plant at Sellafield in Cumbria in the north-west of England, which are licensed by the UK Environment Agency, continue to be the dominant source of artificial radioactivity in the Irish marine environment. The key elements of the monitoring programme implemented by the RPII in 2006 included; assessment of ambient radioactivity based on measurements of radioactivity in air and of external gamma dose rate at permanent monitoring stations located throughout the country; assessment of levels of radioactivity in drinking water; assessment of levels of radioactivity in foodstuffs based on measurements of total diet, milk and various ingredients; assessment of levels of radioactivity in the Irish marine environment based on sampling and measurement of seawater, sediment, seaweed, fish and shellfish. The RPII monitored airborne radioactivity at ten stations located throughout the country. One of these stations is equipped with a high volume sampler, which allows concentrations of caesium-137 to be measured; another is equipped to detect the presence of the gas krypton-85. This gas is released into the environment primarily as a result of the

The East Irish Sea Basin - from caterpillar to butterfly, a thirty-year metamorphosis

Energy Technology Data Exchange (ETDEWEB)

Colter, V.S.

1997-12-31

In the thirty years since the award of the first licenses, the East Irish Sea Basin has emerged as a significant hydrocarbon province. This paper first lists some of the occasionally almost arbitrary events that led to the first success in the basin, the discovery of the Morecambe Field, in 1974. An attempt is made to review progress over those thirty years in certain topics, namely (1) stratigraphy, (2) structure, (3) sedimentology, (4) diagenesis `The `Platy Illite problem`; and others, (5) uplift and inversion, (6) hydrocarbon sources and types, (7) East Irish Sea Basin analogues. The paper concludes by summarizing the current state of knowledge. (author)

Initiating an online asthma management program in urban emergency departments: the recruitment experience.

Science.gov (United States)

Joseph, Christine L M; Lu, Mei; Stokes-Bruzzelli, Stephanie; Johnson, Dayna A; Duffy, Elizabeth; Demers, Michele; Zhang, Talan; Ownby, Dennis R; Zoratti, Edward; Mahajan, Prashant

2016-01-01

The emergency department could represent a means of identifying patients with asthma who could benefit from asthma interventions. To assess the initiation of a Web-based tailored asthma intervention in the emergency department of 2 urban tertiary care hospitals. In addition to awareness strategies for emergency department staff (eg, attending nursing huddles, division meetings, etc), recruitment experiences are described for 2 strategies: (1) recruitment during an emergency department visit for acute asthma and (2) recruitment from patient listings (mail or telephone). Patient enrollment was defined as baseline completion, randomization, and completion of the first of 4 online sessions. Of 499 eligible patients 13 to 19 years old visiting the emergency department for asthma during the study period, 313 (63%) were contacted in the emergency department (n = 65) or by mail or telephone (n = 350). Of these, 121 (38.6%) were randomized. Mean age of the study sample was 15.4 years and 88.4% were African American. Refusal rates for emergency department recruitment and mail or telephone were 18.5% (12 of 65) and 16.6% (58 of 350), respectively. On average, emergency department enrollment took 44 to 67 minutes, including downtime. When surveyed, emergency department providers were more positive about awareness activities and emergency department recruitment than were research staff. Emergency department recruitment was feasible but labor intensive. Refusal rates were similar for the 2 strategies. Targeting patients with acute asthma in the emergency department is one way of connecting with youth at risk of future acute events. Copyright © 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

The Profile of Neurology Patients Evaluated in the Emergency Department

OpenAIRE

Ufuk Emre; Ayşe Semra Demir; Esra Acıman; Nejla Çabuk; Sibel Kıran; Aysun Ünal

2009-01-01

OBJECTIVE: Early, rapid, and multidisciplinary approaches are very important in the diagnosis of neurological disorders in emergency departments. The present study aimed to investigate the features of patients that presented for neurology consultation in the emergency department. METHODS: The present study included 780 patients. Patient demographic features, reasons for emergent treatment and neurological consultation, neurological diagnosis by the neurologist, and laboratory (total blood...

Emergency Department Care in the Postpartum Period: California Births, 2009-2011.

Science.gov (United States)

Batra, Priya; Fridman, Moshe; Leng, Mei; Gregory, Kimberly D

2017-11-01

To use population data to identify patient characteristics associated with a postpartum maternal emergency department visit within 90 days of discharge after birth. This retrospective cross-sectional study analyzed linked maternal discharge and emergency department data for all live California births from 2009 to 2011. The primary outcome was at least one emergency department visit within 90 days of hospital discharge after birth. Secondary outcomes included three or more visits within 90 days ("high utilization") and inpatient readmission. Independent variables included demographics (age, race or ethnicity, payer, income) and clinical characteristics (length of stay, antepartum complications, mode of delivery, and severe maternal morbidity at delivery). Multilevel logistic regression identified variables associated study outcomes; we validated the predictive model with a split-sample approach and receiver operating characteristic curve analysis. Of 1,071,232 deliveries included, 88,674 women (8.3%) visited the emergency department at least once in the 90 days after delivery discharge. Emergency department use was significantly associated with Medicaid insurance (adjusted odds ratio [OR] 2.15, 95% CI 2.08-2.21), age younger than 20 years (adjusted OR 2.08, 95% CI 1.98-2.19), severe maternal morbidity at delivery (adjusted OR 1.58, 95% CI 1.49-1.71), antepartum complications (adjusted OR 1.46, 95% CI 1.42-1.50), and cesarean delivery (adjusted OR 1.40, 95% CI 1.37-1.44). Approximately one fifth of visits occurred within 4 days of discharge, and more than half were within 3 weeks. High utilizers comprised 0.5% of the entire sample (5,171 women) and only 1.2% of women presenting for emergency department care were readmitted. Receiver operating curve model analysis using the validation sample supported predictive accuracy for postpartum emergency department use (area under the curve=0.95). One in 12 California women visited the emergency department in the first 90 days

[Vertigo in the Emergency Department: new bedside tests].

Science.gov (United States)

Tamás, T László; Garai, Tibor; Tompos, Tamás; Szirmai, Ágnes

2016-03-13

According to international statistics, the first examination of 25% of patients with vertigo is carried out in Emergency Departments. The most important task of the examining physician is to diagnose life threatening pathologic processes. One of the most difficult otoneurological diagnostic challange in Emergency Departments is to differentiate between dangerous posterior scale stroke presenting with isolated vertigo and the benign vestibular neuritis.These two disorders can be safely differentiated using fast, non-invasive, evidence based bedside tests which have been introduced in the past few years. 35% of stroke cases mimicking vestibular neuritis (pseudoneuritis) are misdiagnosed at the Emergency Department, and 40% of these cases develop complications. During the first 48 hours, sensitivity for stroke of the new test that is based on the malfunction of the oculomotor system is better than the diffusion-weighted cranial magnetic resonance imaging. Using special test glasses each component of the new test can be made objective and repeatable.

Emergency Nurses' Perceptions of Providing End-of-Life Care in a Hong Kong Emergency Department: A Qualitative Study.

Science.gov (United States)

Tse, Johnson Wai Keung; Hung, Maria Shuk Yu; Pang, Samantha Mei Che

2016-05-01

Provision of end-of-life (EOL) care in the emergency department has improved globally in recent years and has a different scope of interventions than traditional emergency medicine. In 2010, a regional hospital established the first ED EOL service in Hong Kong. The aim of this study was to understand emergency nurses' perceptions regarding the provision of EOL care in the emergency department. A qualitative approach was used with purposive sampling of 16 nurses who had experience in providing EOL care. Semi-structured, face-to-face interviews were conducted from May to October, 2014. All the interviews were transcribed verbatim for content analysis. Four themes were identified: (1) doing good for the dying patients, (2) facilitating family engagement and involvement, (3) enhancing personal growth and professionalism, and (4) expressing ambiguity toward resource deployment. Provision of EOL care in the emergency department can enhance patients' last moment of life, facilitate the grief and bereavement process of families, and enhance the professional development of staff in emergency department. It is substantiated that EOL service in the emergency department enriches EOL care in the health care system. Findings from this study integrated the perspectives on ED EOL services from emergency nurses. The integration of EOL service in other emergency departments locally and worldwide is encouraged. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

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.

Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments

OpenAIRE

Langabeer, James R.; Gonzalez, Michael; Alqusairi, Diaa; Champagne-Langabeer, Tiffany; Jackson, Adria; Mikhail, Jennifer; Persse, David

2016-01-01

Introduction Emergency medical services (EMS) agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED), affecting the entire emergency care system’s capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. T...

Emergency nurses' perceptions of emergency department preparedness for an ebola outbreak: A qualitative descriptive study.

Science.gov (United States)

Pincha Baduge, Mihirika Sds; Moss, Cheryle; Morphet, Julia

2017-05-01

Ebola Virus Disease is highly contagious and has high mortality. In 2014, when the outbreak in West Africa was declared a public health emergency, emergency departments in Australia commenced preparation and vigilance for people presenting with ebola like symptoms, to limit spread of the disease. To examine Australian emergency nurses' perceptions regarding their own and their emergency departments' preparedness to manage an ebola outbreak. A qualitative descriptive design was used to collect and analyse data in one metropolitan emergency department in Victoria, Australia. Four focus groups were conducted with 13 emergency nurses. Data were thematically analysed. Major themes emerged from the data: organisational, personal and future preparedness. Participants' believed that both the organisation and themselves had achieved desirable and appropriate preparedness for ebola in their emergency setting. Participants trusted their organisation to prepare and protect them for ebola. Appropriate policies, procedures, and equipment infrastructure were reportedly in place. Nurses' decisions to care for a patient with ebola were informed by professional commitment, and personal responsibilities. Participants were concerned about transmitting ebola to their families, and suggested that more regular training in personal protective equipment would increase confidence and skill in self-protection. Copyright © 2017 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

Occupational stress among Thai emergency department nurses : Development and validation of an instrument for measuring stressors in emergency departments

OpenAIRE

Yuwanich, Nuttapol

2017-01-01

Working at an emergency department has some characteristics, which may generate stress. In this thesis, the stressors for emergency nurses were evaluated and an instrument was developed for measuring their impact. In order to gain a deeper understanding regarding the occupational stress among emergency nurses, a descriptive qualitative design with semi-structured interviews were used in two studies (I, II), one at a private and the other at a public hospital in Thailand. Three main categories...

Applicability of the modified Emergency Department Work Index (mEDWIN at a Dutch emergency department.

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Steffie H A Brouns

Full Text Available Emergency department (ED crowding leads to prolonged emergency department length of stay (ED-LOS and adverse patient outcomes. No uniform definition of ED crowding exists. Several scores have been developed to quantify ED crowding; the best known is the Emergency Department Work Index (EDWIN. Research on the EDWIN is often applied to limited settings and conducted over a short period of time.To explore whether the EDWIN as a measure can track occupancy at a Dutch ED over the course of one year and to identify fluctuations in ED occupancy per hour, day, and month. Secondary objective is to investigate the discriminatory value of the EDWIN in detecting crowding, as compared with the occupancy rate and prolonged ED-LOS.A retrospective cohort study of all ED visits during the period from September 2010 to August 2011 was performed in one hospital in the Netherlands. The EDWIN incorporates the number of patients per triage level, physicians, treatment beds and admitted patients to quantify ED crowding. The EDWIN was adjusted to emergency care in the Netherlands: modified EDWIN (mEDWIN. ED crowding was defined as the 75th percentile of mEDWIN per hour, which was ≥0.28.In total, 28,220 ED visits were included in the analysis. The median mEDWIN per hour was 0.15 (Interquartile range (IQR 0.05-0.28; median mEDWIN per patient was 0.25 (IQR 0.15-0.39. The EDWIN was higher on Wednesday (0.16 than on other days (0.14-0.16, p<0.001, and a peak in both mEDWIN (0.30-0.33 and ED crowding (52.9-63.4% was found between 13:00-18:00 h. A comparison of the mEDWIN with the occupancy rate revealed an area under the curve (AUC of 0.86 (95%CI 0.85-0.87. The AUC of mEDWIN compared with a prolonged ED-LOS (≥4 hours was 0.50 (95%CI 0.40-0.60.The mEDWIN was applicable at a Dutch ED. The mEDWIN was able to identify fluctuations in ED occupancy. In addition, the mEDWIN had high discriminatory power for identification of a busy ED, when compared with the occupancy rate.

Clinical Overview and Emergency-Department Whiteboards

DEFF Research Database (Denmark)

Hertzum, Morten; Simonsen, Jesper

2010-01-01

In Denmark emergency departments are newly established and still in a process of devising their procedures and technology support. Electronic whiteboards are a means of supporting clinicians in creating and maintaining the overview necessary to provide quality treatment of patients. The concrete ...

Department of Energy Emergency Management Functional Requirements Study

International Nuclear Information System (INIS)

1987-05-01

This Study, the Emergency Management Functional Requirements Study (EMFRS), identifies the physical environment, information resources, and equipment required in the DOE Headquarters Emergency Operations Center (EOC) to support the DOE staff in managing an emergency. It is the first step toward converting the present Forrestal EOC into a practical facility that will function well in each of the highly diverse types of emergencies in which the Department could be involved. 2 figs

Opportunities to preserve forensic evidence in emergency departments.

Science.gov (United States)

Peel, Matthew

2016-11-10

Victims of violence often seek assistance from emergency departments, so emergency nurses are ideally placed to identify them, and other 'forensic' patients, and protect the evidence that could support any ensuing legal process. Emergency nurses who are trained to identify, collect and preserve forensic evidence can support the identification, elimination and prosecution of suspects. This article gives an overview of forensic evidence, and explains how emergency nurses can preserve and collect samples effectively.

The Effect of Emergency Department Overcrowding on Efficiency of Emergency Medicine Residents’ Education

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Anita Sabzghabaei

2014-09-01

Full Text Available Introduction: Creating a calm and stress-free environment affects education significantly. The effects of the emergency department overcrowding (EDO on the training of emergency medicine residents (EMR is a highly debated subject. Therefore, this study aimed to evaluate the effect of EDO on efficiency of EMR’s education. Methods: In this cross-sectional study, the effects of overcrowding on EMR’s education in the resuscitation room and acute care unit. Data collection was done using a questionnaire, which was filled out by the second year EMRs.  The crowding level was calculated based on the national emergency department overcrowding scale (NEDOCS. The relationship between the two studied variables was evaluated using independent sample t-test and SPSS 21 statistical software. Results: 130 questionnaires were filled out during 61 shifts. 47 (77.05% shifts were overcrowded. The attend’s ability to teach was not affected by overcrowding in the resuscitation room (p=0.008. The similar results were seen regarding the attend’s training ability in the acute care unit. Conclusion: It seems that the emergency department overcrowding has no effect on the quality of education to the EMRs.

Blood pressure documentation in the emergency department

Science.gov (United States)

Daniel, Ana Carolina Queiroz Godoy; Machado, Juliana Pereira; Veiga, Eugenia Velludo

2017-01-01

ABSTRACT Objective To analyze the frequency of blood pressure documentation performed by nursing professionals in an emergency department. Methods This is a cross-sectional, observational, descriptive, and analytical study, which included medical records of adult patients admitted to the observation ward of an emergency department, between March and May 2014. Data were obtained through a collection instrument divided into three parts: patient identification, triage data, and blood pressure documentation. For statistical analysis, Pearson’s correlation coefficient was used, with a significance level of α<0.05. Results One hundred fifty-seven records and 430 blood pressure measurements were analyzed with an average of three measurements per patient. Of these measures, 46.5% were abnormal. The mean time from admission to documentation of the first blood pressure measurement was 2.5 minutes, with 42 minutes between subsequent measures. There is no correlation between the systolic blood pressure values and the mean time interval between blood pressure documentations: 0.173 (p=0.031). Conclusion The present study found no correlation between frequency of blood pressure documentation and blood pressure values. The frequency of blood pressure documentation increased according to the severity of the patient and decreased during the length of stay in the emergency department. PMID:28444085

The Portrayal of Women’s Contribution to Irish Society through a Sample from the Irish Press

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María Martínez Lirola

2014-07-01

Full Text Available The article intends to approach the representation of womanhood in the Irish press from 2006 to 2012. The corpus comprises all the texts dealing with women, from January 1 to 31 December of four years within this time range, taken from one of the main Irish broadsheet newspapers: The Irish Independent. The research database LexisNexis Academic was employed to compile the corpus. For the purposes of this research, I apply Teun van Leeuwen’s (2008 social actor network model. This paper points out that Corpus Linguistics (CL can be a powerful complementary tool to Critical Discourse Analysis (CDA.

Constituency Orientation in Irish Politics

DEFF Research Database (Denmark)

Kusche, Isabel

2017-01-01

The constituency orientation of Irish politicians is a recurring topic in Irish political science. Its analysis has predominantly focused on TDs. This article uses a content analysis of candidate video statements in the general election 2016 in order to assess the strength of constituency...... this pattern, indicated by the weak constituency orientation in Dublin and Cork constituencies. Results also indicate differences between parties and some political statuses, while the gender of the candidates is of no relevance. Although the material does not permit a clear distinction between effects...... of political culture and short-term considerations, taken together the results indicate that localism in Irish politics matters, but in more complicated ways than usually depicted....

Physician Assistants and Nurse Practitioners in Rural Washington Emergency Departments.

Science.gov (United States)

Nelson, Scott C; Hooker, Roderick S

2016-06-01

One role of physician assistants (PAs) and nurse practitioners (NPs) is to meet the growing demand for access to rural health care. Critical Access Hospitals, those with less than 25 beds, are usually located in rural communities, often providing continuity of care that clinics cannot deliver. Because little is known about staffing in these small hospital emergency departments, an exploratory study was undertaken using a mixed-methods approach. In Washington State, 18 of the 39 Critical Access Hospitals staff their emergency departments with PAs and NPs. Utilization data were collected through structured interviews by phone or in person on site. Most PAs and NPs lived within the community and staffing tended to be either 24 hours in-house or short notice if they lived or worked nearby. Emergency department visits ranged from 200 to 25,000 per year. All sites were designated level V or IV trauma centers and often managed cardiac events, significant injuries and, in some larger settings, obstetrics. In most instances, PAs were the sole providers in the emergency departments, albeit with physician backup and emergency medical technician support if a surge of emergency cases arose. Two-thirds of the PAs had graduated within the last 5 years. Most preferred the autonomy of the emergency department role and all expressed job satisfaction. Geographically, the more remote a Washington State Critical Access Hospital is, the more likely it will be staffed by PAs/NPs. The diverse utilization of semiautonomous PAs and NPs and their rise in rural hospital employment is a new workforce observation that requires broader investigation.

Genome Analyses of an Aggressive and Invasive Lineage of the Irish Potato Famine Pathogen

NARCIS (Netherlands)

Cooke, D.E.L.; Cano, L.M.; Raffaele, S.; Bain, R.A.; Cooke, L.R.; Etherington, G.J.; Deahl, K.L.; Farrer, R.A.; Gilroy, E.M.; Goss, E.M.; Grünwald, N.J.; Hein, I.; Maclean, D.; McNicol, J.W.; Randall, E.; Oliva, R.F.; Pel, M.; Shaw, D.S.; Squires, J.N.; Taylor, M.C.; Vleeshouwers, V.G.A.A.; Birch, P.R.J.; Lees, A.K.; Kamoun, S.

2012-01-01

Pest and pathogen losses jeopardise global food security and ever since the 19th century Irish famine, potato late blight has exemplified this threat. The causal oomycete pathogen, Phytophthora infestans, undergoes major population shifts in agricultural systems via the successive emergence and

[Hospitality for elderly patients in the emergency department].

Science.gov (United States)

Boulet, Marie-Claude; Dami, Fabrice; Hugli, Olivier; Renard, Delphine; Foucault, Eliane; Carron, Pierre-Nicolas

2015-12-09

Demographic evolution results in a growing use of emergency department by elderly patients. They require special care to avoid any further degradation of cognitive and functional abilities already compromised by the disease or injury that led them to hospital in the first place. Through a clinical case, we list the risks related to the care of these particular patients in the emergency department. Early recognition of those risks and careful management of these patients' specific needs can significantly contribute to reduce lengths of stay, an important outcome from both the individual patient's and society's perspective.

Advertising Emergency Department Wait Times

Directory of Open Access Journals (Sweden)

Scott G. Weiner

2013-03-01

Full Text Available Advertising emergency department (ED wait times has become a common practice in the UnitedStates. Proponents of this practice state that it is a powerful marketing strategy that can help steerpatients to the ED. Opponents worry about the risk to the public health that arises from a patient withan emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standarddefinition of the reported time, and directing lower acuity patients to the higher cost ED setting insteadto primary care. Three sample cases demonstrating the pitfalls of advertising ED wait times arediscussed. Given the lack of rigorous evidence supporting the practice and potential adverse effects tothe public health, caution about its use is advised

Irish Intercultural Cinema: Memory, Identity and Subjectivity

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Murray, Enda Vincent

2015-12-01

Full Text Available Irish intercultural cinema looks at the development of a cinematic genre which focuses on issues of Irish migrancy but is produced outside of Ireland. This paper has as its focus the cultural landscape of Irish-Australia. The essay uses methodologies of ethnographic and documentary theory plus textual analysis of film and written texts to establish a throughline of Irish intercultural film. The essay begins by contextualising the place of the Irish diaspora within the creation of Irish identity globally. The discussion around migrancy is widened to consider the place of memory and intergenerational tensions within not just the Irish migrant population, but also within the diverse cultures which comprise the contemporary Australian landscape. The historical development of intercultural cinema is then explored internationally within a context of colonial, gender and class struggles in the 1970s and1980s. The term intercultural cinema has its origins in the Third Cinema of Argentinians Solanas and Getino in the 1970s and covers those films which deal with issues involving two countries or cultures. The term was refined by Laura Marks in 2000 and further developed by Hamid Naficy in 2001 in his discussion of accented cinema which narrows its definition to include the politics of production. The paper then traces the development of Irish intercultural cinema from its beginnings in England in the 1970s with Thaddeus O'Sullivan through to Nicola Bruce and others including Enda Murray in the present day. The essay concludes by bringing these various strands together to see where intercultural film might have a place in today's globalised cultural landscape. Common traits within intercultural film such as the notion of place, autobiographical film and personal identity are explored using examples of intercultural filmmaking from around the globe. These commonalities point to a way forward for the future of a sustainable multicultural film culture.

Evaluation of Head Trauma Cases in the Emergency Department

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Alim Cokuk

2013-02-01

Full Text Available Aim: In this study, we aimed to determine the epidemiological characteristics, morbidity and mortality rates of patients admitted to the emergency department with head trauma. Material and Methods: In this study, ambulatory and hospitalized patients over the age of 18 brought to the Emergency Department because of head trauma between 01.12.2009 - 31.12.2010 were analyzed retrospectively. Patient data were recorded to standard data entry form. SPSS 17.0 package program was used for statistical analysis of data. The statistical significance level of all tests was p <0.05. Results: 5200 patients were included in this study. The average age of the patients was 39.97 ± 16.66 years. 4682'si patients (90 % were discharged from the emergency department. The most common reason for admission to the emergency department was falls (41.81 % in the discharged patients. 518 (10 % patients were hospitalized. Gender of these patients was 110 female (21:24% and 408 male (78.76%. 256 patients (48.35% were injured as a result of a traffic accident. 201(38.8% of the cerebral CT were reported as normal and 89 (17.2% of the cerebral CT were reported as traumatic subarachnoid hemorrhage (SAH in hospitalized patients. The fracture of lumbar spine (12 % was detected as an additional pathological disease in patients. 75 patients hospitalized because of head trauma (14.5% had died (1.44 % of all patients. Cervical spine fracture was the most common (14 patients, 18.68 % additional pathology in patients who died. Thoracic trauma was detected as the second most common (13 patients, 17.33 % additional pathology. Conclusion: Most of the patients admitted to the emergency department with head injury had a minor trauma. Patients can be discharged from the emergency department after a thorough physical examination and simple medical intervention. Most of the head injury patients admitted to hospital were male. The most common reason of the patients with head injury admitted to

Clinical audit of emergency unit before and after establishment of the emergency medicine department.

Science.gov (United States)

Amini, Afshin; Dindoost, Payam; Moghimi, Mehrdad; Kariman, Hamid; Shahrami, Ali; Dolatabadi, Ali Arhami; Ali-Mohammadi, Hossein; Alavai-Moghaddam, Mostafa; Derakhshanfar, Hojjat; Hatamabadi, HamidReza; Heidari, Kamran; Alamdari, Shahram; Meibodi, Mohammad Kalantar; Shojaee, Majid; Foroozanfar, Mohammad Mehdi; Hashemi, Behrooz; Sabzeghaba, Anita; Kabir, Ali

2012-02-01

To assess the deficiencies and potential areas through a medical audit of the emergency departments, in six general hospitals affiliated to Shahid Beheshti University of Medical Sciences at Tehran, Iran, after preparing specific wards-based international standards. A checklist was completed for all hospitals which met our eligibility criteria mainly observation and interviews with head nurses and managers of the emergency medicine unit of the hospitals before (2003) and after (2008) the establishment of emergency departments there. Domains studied included staffing, education and continuing professional development (CPD), facility (design), equipment, ancillary services, medical records, manuals and references, research, administration, pre-hospital care, information systems, disaster planning, bench-marking and hospital accreditation. Education and CPD (p = 0.042), design and facility (p = 0.027), equipment (p = 0.028), and disaster (p = 0.026) had significantly improved after the establishment of emergency departments. Nearly all domains showed a positive change though it was non-significant in a few. In terms of observation, better improvement was seen in disaster, security, design, and research. According to the score for each domain compared to what it was in the earlier phase, better improvement was observed in hospital accreditation, information systems, security, disaster planning, and research. Security, disaster planning, research, design and facility had improved in hospitals that wave studied, while equipment, records, ancillary services, administration and bench-marking had the lowest improvement even after the establishment of emergency department, and, hence, needed specific attention.

Managing patients with oncologic complications in the emergency department [digest].

Science.gov (United States)

Wacker, David; McCurdy, Michael T; Nusbaum, Jeffrey; Gupta, Nachi

2018-01-22

As the prevalence of cancer continues to increase in the general population and improvements in cancer treatment prolong survival, the incidence of patients presenting to the emergency department with oncologic complications will, similarly, continue to rise. This issue reviews 3 of the more common presentations of oncology patients to the emergency department: metastatic spinal cord compression, tumor lysis syndrome, and febrile neutropenia. Signs and symptoms of these conditions can be varied and nonspecific, and may be related to the malignancy itself or to an adverse effect of the cancer treatment. Timely evidence-based decisions in the emergency department regarding diagnostic testing, medications, and arrangement of disposition and oncology follow-up can significantly improve a cancer patient's quality of life. [Points & Pearls is a digest of Emergency Medicine Practice.].

Radioactivity monitoring of the Irish marine environment 1998 and 1999

International Nuclear Information System (INIS)

Ryan, T.P.; Long, S.; Dowdall, A.; Hayden, E.; Smith, V.; Fegan, M.; Sequeira, S.; Pollard, D.; Cunningham, J.D.

2000-09-01

The safety of the food chain and the protection of the environment are prime concerns of the Irish public. This report presents the results of the marine radioactivity monitoring programme carried out by the Radiological Protection Institute of Ireland (RPII) during 1998 and 1999. The primary objective of the programme is to assess the exposure of the Irish population resulting from radioactive contamination of the Irish marine environment and to estimate the risks to health from this exposure. Discharged radioactive waste from the British Nuclear Fuels plc (BNFL) reprocessing plant at Sellafield continues to be the dominant source of this contamination. In particular, the remobilisation from sediments of historic discharges makes an important contribution to the levels of radioactivity in the seawater of the western Irish Sea. Approximately 300 samples of fish, shellfish, seaweed, seawater and sediment were collected in 1998 and again in 1999. Both the Marine Institute and the Department of the Marine and Natural Resources assisted the Institute with this sampling. The samples were analysed for a range of contaminating radionuclides at the Institute's radio-analytical laboratory. The results show that the radionuclide of greatest dosimetric significance continues to be caesium-137. The activity concentration of this radionuclide in the Irish marine environment has remained relatively stable since the mid 1990s but at a lower level than that observed during the previous two decades. Along the Irish coastline the highest activity concentrations observed are in the north-east. Since 1994 the commissioning and operation of new facilities at Sellafield have resulted in an increase in the discharges of technetium-99 to the Irish Sea. This has been reflected in an increase in the activity concentrations of this radionuclide at all east coast sampling sites between 1994 and 1999. However, the low radiotoxicity of technetium-99 means that it is generally of lesser

Radioactivity monitoring of the Irish marine environment 1998 and 1999

International Nuclear Information System (INIS)

Ryan, T.; Long, S.; Dowdall, A.

2000-09-01

The safety of the food chain and the protection of the environment are prime concerns of the Irish public. This report presents the results of the marine radioactivity monitoring programme carried out by the Radiological Protection Institute of Ireland (RPII) during 1998 and 1999. The primary objective of the programme is to assess the exposure of the Irish population resulting from radioactive contamination of the Irish marine environment and to estimate the risks to health from this exposure. Discharged radioactive waste from the British Nuclear Fuels plc (BNFL) reprocessing plant at Sellafield continues to be the dominant source of this contamination. In particular, the remobilization from sediments of historic discharges makes an important contribution to the levels of radioactivity in the seawater of the western Irish Sea. Approximately 300 samples of fish, shellfish, seaweed, seawater and sediment were collected in 1998 and again in 1999. Both the Marine Institute and the Department of the Marine and Natural Resources assisted the Institute with this sampling. The samples were analysed for a range of contaminating radionuclides at the Institute's radio-analytical laboratory. The results show that the radionuclide of greatest dosimetric significance continues to be caesium-137. The activity concentration of this radionuclide in the Irish marine environment has remained relatively stable since the mid 1990s but at a lower level than that observed during the previous two decades. Along the Irish coastline the highest activity concentrations observed are in the north-east. Since 1994 the commissioning and operation of new facilities at Sellafield have resulted in an increase in the discharges of technetium-99 to the Irish Sea. This has been reflected in an increase in the activity concentrations of this radionuclide at all east coast sampling sites between 1994 and 1999. However, the low radiotoxicity of technetium-99 means that it is generally of lesser

Demographic, Seasonal, and Geographic Differences in Emergency Department Visits for Epistaxis.

Science.gov (United States)

Chaaban, Mohamad R; Zhang, Dong; Resto, Vicente; Goodwin, James S

2017-01-01

Objective To determine the demographics and seasonal and geographic variation of epistaxis in the United States. Study Design Retrospective cohort analysis based on data from Medicare claims. Setting Emergency department visits. Subjects and Methods We used a 5% sample of Medicare data from January 2012 to December 2012. Our cohort included patients with an incident diagnosis of epistaxis during a visit to the emergency department, excluding those with a diagnosis in the prior 12 months. Demographics included age, sex, race, and ethnicity. We compared the rate of emergency department visits for epistaxis by geographic division and individual states. Results In the 5% sample of Medicare data, 4120 emergency department visits for incident epistaxis were identified in 2012. Our results showed an increase in the emergency department visits for epistaxis with age. Compared with patients 85 years old were 1.36 (95% confidence interval [95% CI], 1.23-1.50), 2.37 (95% CI, 2.14-2.62), and 3.24 (95% CI, 2.91-3.62) more likely to present with epistaxis, respectively. Men were 1.24 (95% CI, 1.17-1.32) times more likely to present with epistaxis than women. Blacks were 1.23 (95% CI, 1.10-1.36) times more likely to present with epistaxis when compared with non-Hispanic whites. Epistaxis emergency department visits were 40% lower in the summer months versus winter. The seasonal variation was more pronounced in the northern versus southern United States. Conclusion Emergency department visits for epistaxis increase with age and appear to be seasonal, with a more pronounced variation in the northern versus southern United States.

Clinical Aspects and Emergent Management of Snake Bites Presented to Emergency Department

Directory of Open Access Journals (Sweden)

Bedriye Sonmez

2014-03-01

Full Text Available Aim: Evaluating the epidemiologic characteristics and management of snake bites presenting to emergency departments. Material and Method: In this retrospective study 74 cases of snakebites admitted to Emergency Department of Diyarbakir Training and Research Hospital between 2008 and 2009 were retrospectively evaluated. Results: Fourty-six (62.2% of patients were male and 28 (37.8% were female. Mean age of the study population was 34.85±19.17 (min 7- max 80 years. Most of the snakebites occurred between 18.00 to 06.00 hours and at home (73%. 79.7% of snake bites occurred to upper extremities. %93 of cases had intravenous administration of antivenin (one dose. Neither none of the patients needed recurrent administration. Discussion: Snake bites are still a major public health problem especially in rural areas. Particularly emergency care physicians should be adequately capable and sophisticated in multidisciplinary management of snake bites.

Identifying Patients at Risk of Deterioration in the Joint Emergency Department

DEFF Research Database (Denmark)

Schmidt, Thomas; Wiil, Uffe Kock

2015-01-01

at the case through the lenses of common information spaces. In particular, we apply Bossen’s seven-parameter framework to discover new dimensions of how Emergency Departments and individual clinicians identify and respond to unforeseen events, and how they handle the associated cognitive challenges. We......In recent years, Danish hospitals have merged their emergency facilities into Joint Emergency Departments. This poses new collaborative challenges across traditionally separated specialized departments, which now have to collaborate in a shared environment. Despite established protocols and patient...

The Ulster Cycle: Cultural Significance for Irish Composers

Directory of Open Access Journals (Sweden)

Angela Goff

2017-10-01

Full Text Available For more than three hundred years, Irish composers have engaged with tales from early Irish saga-literature which comprises four main series: Mythological, Ulster and Fenian cycles as well as the Cycle of Kings. This literary corpus dates from 600–1200 CE and is amongst the oldest in Europe. The fragmented history of the literature reveals a continuity of tradition in that the ancient sagas evolved from the oral Irish tradition, were gradually recorded in Irish, and kept alive in modern times through translation into the English language. The timelessness and social impact of these sagas, centuries after they were documented, resonate with Irish composers through the identification of local features and/or universal themes of redemption, triumph or tragedy depicted in the literature. The focus here is on sagas from the Ulster Cycle as they have been most celebrated by Irish composers; the majority of which have been composed since Thomas Kinsella’s successful translation of the Táin Bó Cuailnge in 1969. How the composers chose to embrace the Irish past lies in each composer’s execution of the peculiar local and universal themes exhibited in the sagas. The aim of this article is to initiate an interdisciplinary discussion of the cultural significance of this literary corpus for Irish composers by exploring an area of Irish musicological discourse that has not been hitherto documented. A brief literary background to the Ulster Cycle leads to a discussion of what prompted the composers to engage with Ulster Cycle themes at a particular time in their respective careers. An exploration of the various stylistic features employed in selected works sheds light on the cultural ideologies that prevailed in Ireland at the time of their respective composition.

Advertising emergency department wait times.

Science.gov (United States)

Weiner, Scott G

2013-03-01

Advertising emergency department (ED) wait times has become a common practice in the United States. Proponents of this practice state that it is a powerful marketing strategy that can help steer patients to the ED. Opponents worry about the risk to the public health that arises from a patient with an emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standard definition of the reported time, and directing lower acuity patients to the higher cost ED setting instead to primary care. Three sample cases demonstrating the pitfalls of advertising ED wait times are discussed. Given the lack of rigorous evidence supporting the practice and potential adverse effects to the public health, caution about its use is advised.

Advertising Emergency Department Wait Times

Science.gov (United States)

Weiner, Scott G.

2013-01-01

Advertising emergency department (ED) wait times has become a common practice in the United States. Proponents of this practice state that it is a powerful marketing strategy that can help steer patients to the ED. Opponents worry about the risk to the public health that arises from a patient with an emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standard definition of the reported time, and directing lower acuity patients to the higher cost ED setting instead to primary care. Three sample cases demonstrating the pitfalls of advertising ED wait times are discussed. Given the lack of rigorous evidence supporting the practice and potential adverse effects to the public health, caution about its use is advised. PMID:23599836

Management of information within emergencies departments in developing countries: analysis at the National Emergency Department in Benin.

Science.gov (United States)

Ahanhanzo, Yolaine Glèlè; Kpozehouen, Alphonse; Sopoh, Ghislain; Sossa-Jérôme, Charles; Ouedraogo, Laurent; Wilmet-Dramaix, Michèle

2016-01-01

The management of health information is a key pillar in both emergencies reception and handling facilities, given the strategic position and the potential of these facilities within hospitals, and in the monitoring of public health and epidemiology. With the technological revolution, computerization made the information systems evolve in emergency departments, especially in developed countries, with improved performance in terms of care quality, productivity and patient satisfaction. This study analyses the situation of Benin in this field, through the case of the Academic Clinic of Emergency Department of the National University Teaching Hospital of Cotonou, the national reference hospital. The study is cross-sectional and evaluative. Collection techniques are literature review and structured interviews. The components rated are resources, indicators, data sources, data management and the use-dissemination of the information through a model adapted from Health Metrics Network framework. We used quantitative and qualitative analysis. The absence of a regulatory framework restricts the operation of the system in all components and accounts for the lack and inadequacy of the dedicated resources. Dedication of more resources for this system for crucial needs such as computerization requires sensitization and greater awareness of the administrative authorities about the fact that an effective health information management system is of prime importance in this type of facility.

Classificatory multiplicity: intimate partner violence diagnosis in emergency department consultations.

Science.gov (United States)

Olive, Philippa

2017-08-01

To explore the naming, or classification, of physical assaults by a partner as 'intimate partner violence' during emergency department consultations. Research continues to evidence instances when intimate partner physical violence is 'missed' or unacknowledged during emergency department consultations. Theoretically, this research was approached through complexity theory and the sociology of diagnosis. Research design was an applied, descriptive and explanatory, multiple-method approach that combined qualitative semistructured interviews with service-users (n = 8) and emergency department practitioners (n = 9), and qualitative and quantitative document analysis of emergency department health records (n = 28). This study found that multiple classifications of intimate partner violence were mobilised during emergency department consultations and that these different versions of intimate partner violence held different diagnostic categories, processes and consequences. The construction of different versions of intimate partner violence in emergency department consultations could explain variance in people's experiences and outcomes of consultations. The research found that the classificatory threshold for 'intimate partner violence' was too high. Strengthening systems of diagnosis (identification and intervention) so that all incidents of partner violence are named as 'intimate partner violence' would reduce the incidence of missed cases and afford earlier specialist intervention to reduce violence and limit its harms. This research found that identification of and response to intimate partner violence, even in contexts of severe physical violence, was contingent. By lowering the classificatory threshold so that all incidents of partner violence are named as 'intimate partner violence', practitioners could make a significant contribution to reducing missed intimate partner violence during consultations and improving health outcomes for this population. This

Sport and active recreation injuries in Australia: evidence from emergency department presentations

OpenAIRE

Finch, C.; Valuri, G.; Ozanne-Smith, J.

1998-01-01

OBJECTIVE: Despite the rise in specialist clinical services for the management of sports and active recreation injury, many patients attend hospital emergency departments for treatment. The purpose of this study was to describe sports injury cases presented to selected hospital emergency departments around Australia for the period 1989-1993. METHODS: Routinely collected emergency department injury presentation data from the Australian National Injury Surveillance Unit were examined. Dat...

Emergency department management of priapism [digest].

Science.gov (United States)

Podolej, Gregory S; Babcock, Christine; Kim, Jeremy

2017-01-22

Priapism is a genitourinary emergency that demands a thorough, time-sensitive evaluation. There are 3 types of priapism: ischemic, nonischemic, and recurrent ischemic priapism; ischemic priapism accounts for 95% of cases. Ischemic priapism must be treated within 4 to 6 hours to minimize morbidity, including impotence. The diagnosis of ischemic priapism relies heavily on the history and physical examination and may be facilitated by penile blood gas analysis and penile ultrasound. This issue reviews current evidence regarding emergency department treatment of ischemic priapism using a stepwise approach that begins with aspiration of cavernosal blood, cold saline irrigation, and penile injection with sympathomimetic agents. Evidence-based management and appropriate urologic follow-up of nonischemic and recurrent ischemic priapism maximizes patient outcomes and resource utilization. [Points & Pearls is a digest of Emergency Medicine Practice].

Radioactivity Monitoring of the Irish Environment 2007

International Nuclear Information System (INIS)

Fegan, M.; Dowdall, A.; Hanley, O.; Hayden, E.; Kelleher, K.; Long, S.; Smith, V.; Somerville, S.; Wong, J.; Pollard, D.

2008-10-01

This report presents the results of the environmental radioactivity monitoring programme carried out by the Radiological Protection Institute of Ireland (RPII) in 2007. This programme aims to assess the exposure of the Irish population to artificial radioactivity in the envorinment, to review the temporal and geographical distribution of contaminating radionuclides and to maintain systems and procedures which would allow a rapid assessment of environmental contamination to be made in the event of a radiological emergency. In additiopn, some natural radioactivity exposure pathways are included in the programme including radioactivity in surface and ground drinking water. Radioactivity is present in the environment due to natural oprocesses, the testing of nuclear weapons in the atmosphere, past nuclear accidents such as that at Chernobyl in the Ukraine and the routine discharge of radionuclides from nuclear installations. Liquid discharges from the British Nuclear Group reprocessing plant at Sellafield in Cumbria in the north-west of England continue to be the dominant source of artificial radioactivity in the Irish marine environment. The key elements of the monitoring programme implemented by the RPII in 2007 included; assessment of ambient radioactivity based on measurements of radioactivity in air and of external gamma dose rate at permanent monitoring stations located throughout the country; assessment of levels of radioactivity in drinking water; assessment of levels of radioactivity in foodstuffs based on measurements of total diet, milk and various ingredients; assessment of levels of radioactivity in the Irish marine environment based on sampling and measurement of seawater, sediment, seaweed, fish and shellfish. The RPII monitored airborne radioactivity at twelve stations located throughout the country. One of these stations is equipped with a high volume sampler, which allows background concentrations of caesium-137 to be measured; another is equipped to

Emergency Department and Older Adult Motor Vehicle Collisions

Directory of Open Access Journals (Sweden)

Lotfipour, Shahram

2013-11-01

Full Text Available In 2009, the Center for Disease Control and Prevention reported there were 33 million licensed drivers 65 years and older in the U.S. This represents a 23 percent increase from 1999, number that is predicted to double by 2030. Although, motor vehicle collisions (MVC-related to emergency department (ED visits for older adults are lower per capita than for younger adults, the older-adults MVCs require more resources, such as additional diagnostic imaging and increased odds of admission. Addressing the specific needs of older-adults could lead to better outcomes yet not enough research currently exists. It is important to continue training emergency physicians to treat the increasing older-patient population, but its also imperative we increase our injury prevention and screening methodology. We review research findings from the article: Emergency Department Visits by Older Adults for Motor Vehicle Collisions: A Five-year national study, with commentary on current recommendation and policies for the growing older-adult driving population. [West J Emerg Med.2013;14(6:582–584.

Treating pain in the emergency department.

LENUS (Irish Health Repository)

Kuan, Samuel C

2012-02-01

The objective of this audit was to evaluate the impact of brief educational intervention on prompt recognition and treatment of pain in the emergency department. The audit was performed on all patients in the emergency department with pain presenting over a 24-h period on three occasions: preintervention, 1-week postintervention and at 4 months. In 151 patients, pain severity scores were mild (24%), moderate (42%), severe (16%) and unknown (18%). Pain score documentation at triage improved from 72 to 94% during the audit (P = 0.01). There was no significant difference in the number of patients treated within 20 min for severe pain (P = 0.076) and within 60 min for moderate pain (P = 0.796) between audits. The likelihood of receiving analgesia within 20 min increased with the patients\\' pain category (relative risk: 1.8 95% confidence interval: 1.4-2.3). Documentation of pain assessment and the use of pain scores at triage improved after a brief educational intervention but there was no measurable impact on treatment times.

Emergency Department Management of Delirium in the Elderly

OpenAIRE

Lynn E.J. Gower, DO; Medley O’Keefe Gatewood, MD; Christopher S. Kang, MD

2012-01-01

An increasing number of elderly patients are presenting to the emergency department. Numerous studies have observed that emergency physicians often fail to identify and diagnose delirium in the elderly. These studies also suggest that even when emergency physicians recognized delirium, they still may not have fully appreciated the import of the diagnosis. Delirium is not a normal manifestation of aging and, often, is the only sign of a serious underlying medical condition. This article will r...

Engineering Research in Irish Economic Development

Science.gov (United States)

Kelly, John

2011-01-01

This article summarizes the main findings and recommendations of a report published in December 2010 by the Irish Academy of Engineering (IAE). The report, representing the views of a committee of distinguished Irish engineers from a wide range of disciplines, addresses the role of engineering research in Ireland's economic development and the…

Foreign Adoption in Ireland: A Case Study of the Irish-American Adoptions, 1947–1952

Directory of Open Access Journals (Sweden)

O'Keeffe, Brian

2016-12-01

Full Text Available The Irish-American adoptions were a revolutionary way of dealing with Ireland’s ‘problem of the illegitimate child’. Ireland had long been promoted as a Catholic, and thus, a morally pure country. Having a child out of wedlock often resulted in the mother and child being shunned by their family and community and having little choice but to seek the help of church-run institutions. These institutions began facilitating illegal extraterritorial adoptions in 1947 to relieve the mounting pressures as those seeking their help continued to grow annually. These adoptions were heavily concerned with protecting the religious faith of the child, and this often took prominence over the quality of home. The adoptions were facilitated exclusively by these church-run institutions, allowing for complete control over the selection of prospective parents. The standards of these adoptions fell well below what was expected on the U.S. domestic scale, with no visits to the homes of prospective parents occurring, and crucially, there was no way to facilitate the reversal of an adoption. During the early life of the Irish-American adoptions, the Department of External Affairs had little involvement, only issuing passports for children that had been adopted. This changed however in 1951, as the ‘Jane Russell Case’ attracted front page media attention. The Russell case highlighted the lackadaisical approach of many of those within the Department to the exporting of some of Ireland’s youngest citizens. Undue publicity continued in the early 1950s, notably with the German newspaper, 8 Uhr Blatt. It is this media attention that forced the Department to finally address the glaring issues that severely hindered the success of the Irish-American adoptions. The Department was powerless to do anything once the child had been passed into the care of the adoptive parents. The Adoption Act 1952, marked a major turning point in the care of illegitimate children in

The culture of an emergency department: an ethnographic study.

Science.gov (United States)

Person, John; Spiva, Leeanna; Hart, Patricia

2013-10-01

In an environment of change and social interaction, hospital emergency departments create a unique sub-culture within healthcare. Patient-centered care, stressful situations, social gaps within the department, pressure to perform, teamwork, and maintaining a work-life balance were examined as influences that have developed this culture into its current state. The study aim was to examine the culture in an emergency department. The sample consisted of 34 employees working in an emergency department, level II trauma center, located in the Southeastern United States. An ethnographic approach was used to gather data from the perspective of the cultural insider. Data revealed identification of four categories that included cognitive, environmental, linguistic, and social attributes that described the culture. Promoting a culture that values the staff is essential in building an environment that fosters the satisfaction and retention of staff. Findings suggest that efforts be directed at improving workflow and processes. Development and training opportunities are needed to improve relationships to promote safer, more efficient patient care. Removing barriers and improving processes will impact patient safety, efficiency, and cost-effectiveness. Findings show that culture is influenced and created by multiple elements. Copyright © 2012 Elsevier Ltd. All rights reserved.

Emergency department discharge prescription interventions by emergency medicine pharmacists.

Science.gov (United States)

Cesarz, Joseph L; Steffenhagen, Aaron L; Svenson, James; Hamedani, Azita G

2013-02-01

We determine the rate and details of interventions associated with emergency medicine pharmacist review of discharge prescriptions for patients discharged from the emergency department (ED). Additionally, we evaluate care providers' satisfaction with such services provided by emergency medicine pharmacists. This was a prospective observational study in the ED of an academic medical center that serves both adult and pediatric patients. Details of emergency medicine pharmacist interventions on discharge prescriptions were compiled with a standardized form. Interventions were categorized as error prevention or optimization of therapy. The staff of the ED was surveyed related to the influence and satisfaction of this new emergency medicine pharmacist-provided service. The 674 discharge prescriptions reviewed by emergency medicine pharmacists during the study period included 602 (89.3%) for adult patients and 72 (10.7%) for pediatric patients. Emergency medicine pharmacists intervened on 68 prescriptions, resulting in an intervention rate of 10.1% (95% confidence interval [CI] 8.0% to 12.7%). The intervention rate was 8.5% (95% CI 6.4% to 11.1%) for adult prescriptions and 23.6% for pediatric prescriptions (95% CI 14.7% to 35.3%) (difference 15.1%; 95% CI 5.1% to 25.2%). There were a similar number of interventions categorized as error prevention and optimization of medication therapy, 37 (54%) and 31 (46%), respectively. More than 95% of survey respondents believed that the new pharmacist services improved patient safety, optimized medication regimens, and improved patient satisfaction. Emergency medicine pharmacist review of discharge prescriptions for discharged ED patients has the potential to significantly improve patient care associated with suboptimal prescriptions and is highly valued by ED care providers. Copyright © 2012. Published by Mosby, Inc.

Evaluation of emergency department nursing services and patient satisfaction of services.

Science.gov (United States)

Mollaoğlu, Mukadder; Çelik, Pelin

2016-10-01

To identify nursing services and assess patient satisfaction in patients who present to the emergency department. Emergency nursing care is a significant determinant of patient satisfaction. Patient satisfaction is often regarded as a reliable indicator of the quality of services provided in the emergency department. This is a descriptive study. Eighty-four patients who presented to the university emergency department were included in the study. The study data were collected by the Patient Information Form and the Satisfaction Level Form. Emergency nursing services, including history taking, assessing vital signs, preparing the patient for an emergency intervention, oxygen therapy, drug delivery and blood-serum infusion were shown to be more commonly provided compared with other services such as counselling the patients and the relatives about their care or delivering educational and psychosocial services. However, 78·6% of the patients were satisfied with their nursing services. The highest satisfaction rates were observed in the following sub-dimensions of the Satisfaction Level Form: availability of the nurse (82·1%), behaviour of the nurse towards the patient (78·6%) and the frequency of nursing rounds (77·4%). The most common practices performed by nurses in the emergency department were physical nursing services. Patient satisfaction was mostly associated with the availability of nurses when they were needed. Our results suggest that in addition to the physical care, patients should also receive education and psychosocial care in the emergency department. We believe that this study will contribute to the awareness and understanding of principles and concepts of emergency nursing, extend the limits of nursing knowledge and abilities, and improve and maintain the quality of clinical nursing education and practice to train specialist nurses with high levels of understanding in ethical, intellectual, administrative, investigative and professional issues. �

ABC estimation of unit costs for emergency department services.

Science.gov (United States)

Holmes, R L; Schroeder, R E

1996-04-01

Rapid evolution of the health care industry forces managers to make cost-effective decisions. Typical hospital cost accounting systems do not provide emergency department managers with the information needed, but emergency department settings are so complex and dynamic as to make the more accurate activity-based costing (ABC) system prohibitively expensive. Through judicious use of the available traditional cost accounting information and simple computer spreadsheets. managers may approximate the decision-guiding information that would result from the much more costly and time-consuming implementation of ABC.

Secondary traumatic stress among emergency nurses: a cross-sectional study.

Science.gov (United States)

Duffy, Emer; Avalos, Gloria; Dowling, Maura

2015-04-01

Emergency department nurses are required to deal with emotional trauma issues on a daily basis, which may result in them experiencing symptoms of secondary traumatic stress, a consequence of stress experienced when helping or wanting to help a person traumatised or suffering. This study measured emergency department nurses' self-reported levels of secondary traumatic stress. Registered nurses (n = 117) working at three emergency departments in the Western geographical region of Ireland were invited to complete the secondary traumatic stress scale (STSS). A response rate of 90% (n = 105) was achieved. Most participants (n = 67/64%) met the criteria for secondary traumatic stress. A statistically significant finding was that the highest proportion (82%) of secondary traumatic stress existed in the staff nurse group (p = 0.042). Moreover, for those nurses reporting secondary traumatic stress, statistical significance was found for the variables 'change of career considered' (p = 0.017) and 'finds alcohol helpful in alleviating work-related stress' (p = 0.004), when compared with nurses not reporting secondary traumatic stress. The findings suggest the need to examine current crisis management interventions and to introduce new systems to support nurses in Irish emergency departments. Moreover, because different types of traumatic events in the ED require different types of interventions, the prevention and management of STS among emergency department nurses must be tackled using a variety of approaches. Copyright © 2014 Elsevier Ltd. All rights reserved.

Radioactivity monitoring of the Irish marine environment 1987

International Nuclear Information System (INIS)

O'Grady, J.; Currivan, L.

1990-06-01

This report represents the results of the Board's monitoring of radioactivity levels in the Irish marine environment during 1987. The principal objective of the monitoring programme is to obtain estimates of radiation doses to the Irish public arising from caesium-137 and caesium 134, the main contaminating radionuclides. Estimates are presented of the radiation doses to the Irish public arising from the consumption of fish and shellfish contaminated with radiocaesium

The Profile of Neurology Patients Evaluated in the Emergency Department

Directory of Open Access Journals (Sweden)

Ufuk Emre

2009-09-01

Full Text Available OBJECTIVE: Early, rapid, and multidisciplinary approaches are very important in the diagnosis of neurological disorders in emergency departments. The present study aimed to investigate the features of patients that presented for neurology consultation in the emergency department. METHODS: The present study included 780 patients. Patient demographic features, reasons for emergent treatment and neurological consultation, neurological diagnosis by the neurologist, and laboratory (total blood count, serum glucose level, urea, creatine, erythrocyte sedimentation rate, and D-dimer levels and imaging findings were retrospectively evaluated based on patient charts. RESULTS: Impaired consciousness was the most frequent reason for neurological consultation (19.7%. Among these patients, ischemic stroke was diagnosed in 27.9%, hypoxic encephalopathy in 18.2%, cerebral hemorrhage in 9.1%, and 11% had no neurological diagnosis. Other common reasons for neurological consultation were vertigo, headache, seizure, and stroke. Clinical findings were related to other systemic causes in 43.7% of the study group. Focal neurological findings were present, especially in patients that presented with ischemic and hemorrhagic stroke, epilepsy, and hypoxic encephalopathy. CONCLUSION: In emergency departments, metabolic causes should be ruled out in patients with impaired consciousness and the absence of focal neurological signs. Intracranial structural disorders must be evaluated when focal neurological signs are present. Cautiously prepared algorithms and neurological examination training will help improve the accuracy of emergency department diagnoses

Emergency Department Management of Delirium in the Elderly

Directory of Open Access Journals (Sweden)

Lynn E.J. Gower, DO

2012-05-01

Full Text Available An increasing number of elderly patients are presenting to the emergency department. Numerousstudies have observed that emergency physicians often fail to identify and diagnose delirium in theelderly. These studies also suggest that even when emergency physicians recognized delirium, theystill may not have fully appreciated the import of the diagnosis. Delirium is not a normal manifestation ofaging and, often, is the only sign of a serious underlying medical condition. This article will review thesignificance, definition, and principal features of delirium so that emergency physicians may betterappreciate, recognize, evaluate, and manage delirium in the elderly.

A major sporting event does not necessarily mean an increased workload for accident and emergency departments. Euro96 Group of Accident and Emergency Departments

OpenAIRE

Cooke, M. W.; Allan, T. F.; Wilson, S.

1999-01-01

AIM: To determine whether there were any changes in attendance at accident and emergency departments that could be related to international football matches (Euro96 tournament). METHOD: Fourteen accident and emergency departments (seven adjacent to and seven distant from a Euro96 venue) provided their daily attendance figures for a nine week period: three weeks before, during, and after the tournament. The relation between daily attendance rates and Euro96 football matches was assessed ...

Molar Pregnancy in the Emergency Department

Directory of Open Access Journals (Sweden)

Masterson, Lori

2009-11-01

Full Text Available A 15-year-old female presented to the emergency department with complaints of vaginal bleeding. She was pale, anxious, cool and clammy with tachycardic, thready peripheral pulses and hemoglobin of 2.4g/dL. Her abdomen was gravid appearing, approximately early to mid-second trimester in size. Pelvic examination revealed 2 cm open cervical os with spontaneous discharge of blood, clots and a copious amount of champagne-colored grapelike spongy material. After 2L boluses of normal saline and two units of crossmatched blood, patient was transported to the operating room. Surgical pathology confirmed a complete hydatidiform mole.[West J Emerg Med. 2009;10(4:295-296.

[Prevention of cardiovascular complications associated with diabetes mellitus: hospital emergency department involvement].

Science.gov (United States)

Agudo Villa, Teresa; Álvarez-Rodríguez, Esther; Caurel Sastre, Zaida; Martín Martínez, Alfonso; Merinero Palomares, Raúl; Alvarez Rodríguez, Virginia; Portero Sánchez, Isabel

2015-06-01

To analyze the risk profile of patients with diabetes who seek care from hospital emergency departments and emergency department involvement in preventing cardiovascular complications in these patients. Cross-sectional analysis of case series from 2 Spanish hospital emergency departments. We included all patients with a history or final diagnosis of diabetes mellitus who were treated in the emergency department between November 1, 2010, and June 30, 2011. Each patient's cardiovascular risk profile was analyzed. The main outcome was the appropriate of prescribed treatment to prevent cardiovascular complications according to the 2012 guidelines of the American Diabetes Association on the patient's discharge from emergency care. A total of 298 patients were included; 275 (92%) had type II diabetes. Ninety percent of the series (269 patients) had at least 1 cardiovascular risk factor and 147 (49%) had prior target organ damage; target organ damage was newly diagnosed in 41 (14%). Fifty-eight percent (172 patients) were discharged home from the emergency department. Although 215 patients (72%) were not adhering to at least 1 previously prescribed preventive treatment and 30 (10%) were not adhering to any prescribed treatment, drug prescriptions were modified only in 1.1% to 3.3% of patients and no follow-up was recommended in 42 cases (24%). Although diabetic patients treated in emergency departments are at high risk for cardiovascular complications, their visit is not used to optimize preventive treatment for these complications or ensure appropriate follow-up.

Models of emergency departments for reducing patient waiting times.

Directory of Open Access Journals (Sweden)

Marek Laskowski

Full Text Available In this paper, we apply both agent-based models and queuing models to investigate patient access and patient flow through emergency departments. The objective of this work is to gain insights into the comparative contributions and limitations of these complementary techniques, in their ability to contribute empirical input into healthcare policy and practice guidelines. The models were developed independently, with a view to compare their suitability to emergency department simulation. The current models implement relatively simple general scenarios, and rely on a combination of simulated and real data to simulate patient flow in a single emergency department or in multiple interacting emergency departments. In addition, several concepts from telecommunications engineering are translated into this modeling context. The framework of multiple-priority queue systems and the genetic programming paradigm of evolutionary machine learning are applied as a means of forecasting patient wait times and as a means of evolving healthcare policy, respectively. The models' utility lies in their ability to provide qualitative insights into the relative sensitivities and impacts of model input parameters, to illuminate scenarios worthy of more complex investigation, and to iteratively validate the models as they continue to be refined and extended. The paper discusses future efforts to refine, extend, and validate the models with more data and real data relative to physical (spatial-topographical and social inputs (staffing, patient care models, etc.. Real data obtained through proximity location and tracking system technologies is one example discussed.

76 FR 65360 - Irish Potatoes Grown in Southeastern States; Suspension of Marketing Order Provisions

Science.gov (United States)

2011-10-21

... operate without marketing order requirements in order to review the effectiveness of the order. During the... DEPARTMENT OF AGRICULTURE Agricultural Marketing Service 7 CFR Part 953 [Doc. No. AMS-FV-11-0027; FV11-953-1 FR] Irish Potatoes Grown in Southeastern States; Suspension of Marketing Order Provisions...

The Integration of Palliative Care into the Emergency Department

Directory of Open Access Journals (Sweden)

Nursah BASOL

2015-06-01

Full Text Available SUMMARY: Palliative care (PC is a new and developing area. It aims to provide the best possible quality of life for patients with life-limiting diseases. It does not primarily include life-extending therapies, but rather tries to help patients spend the rest of their lives in the best way. PC patients often are admitted to emergency departments during the course of a disease. The approach and management of PC include differences with emergency medicine. Thus, there are some problems while providing PC in the ED. With this article, the definition, main features, benefits, and problems of providing PC are presented, with the primary aim of emphasizing the importance of PC integration into the ED. Key words: Emergency department, integration, palliative care, training

Defining dignity in end-of-life care in the emergency department.

Science.gov (United States)

Fernández-Sola, Cayetano; Cortés, María Mar Díaz; Hernández-Padilla, José Manuel; Torres, Cayetano José Aranda; Terrón, José María Muñoz; Granero-Molina, José

2017-02-01

Respecting dignity is having a profound effect on the clinical relationship and the care framework for terminally ill patients in palliative care units, hospices and their own homes, with particular consequences for the emergency department. However, dignity is a vague and multifaceted concept that is difficult to measure. The aim of this study is to define the attributes of dignity in end-of-life care in the emergency department, based on the opinions of physicians and nurses. A hermeneutic phenomenological approach utilising Gadamer's philosophical underpinnings guided the study. Participants and research context: This research was conducted in Spain in 2013-2014. Participants included 10 physicians and 16 nurses with experience working in the emergency department. Two focus groups and 12 in-depth interviews were carried out. Ethical considerations: The study was approved by the Research Centre Ethical Committee (Andalusian Health Service, Spain). The results point to the person's inherent value, socio-environmental conditions and conscious actions/attitudes as attributes of dignity when caring for a dying patient in the emergency department. Dying with dignity is a basic objective in end-of-life care and is an ambiguous but relevant concept for physicians and nurses. In line with our theoretical framework, our results highlight care environment, professional actions and socio-family context as attributes of dignity. Quality care in the emergency department includes paying attention to the dignity of people in the process of death. The dignity in the care of a dying person in the emergency department is defined by acknowledging the inherent value in each person, socio-environmental conditions and social and individual acceptance of death. Addressing these questions has significant repercussions for health professionals, especially nurses.

Violence toward health care workers in emergency departments in Denizli, Turkey.

Science.gov (United States)

Boz, Bora; Acar, Kemalettin; Ergin, Ahmet; Erdur, Bulent; Kurtulus, Ayse; Turkcuer, Ibrahim; Ergin, Nesrin

2006-01-01

This study sought to determine the frequency and types of violence that occurred during the previous year against health care workers in emergency departments in Denizli, Turkey, and to discern the views of workers on the prevention of such aggressive behavior. This study was conducted from March 1 to April 15, 2003, and included a group of 79 health care workers from the emergency departments of 3 hospitals in Denizli, namely, the Hospital of Pamukkale University Medical Faculty, the City Hospital of Denizli, and the Hospital of the Social Insurance Foundation. Data were collected from a self-administered questionnaire. In all, 88.6% of participants had been subjected to or had witnessed verbal violence, and 49.4% of them had been subjected to or had witnessed physical violence during the previous year. The most frequent reason (31.4%) for violence was abuse of alcohol and drugs by perpetrators. The second most frequent reason (24.7%) was the long waiting times typical of emergency departments. The most common type of violence was loud shouting; swearing, threatening, and hitting were the next most frequent violent behaviors. In all, 36.1% of subjects who had experienced violence reported that they developed psychological problems after the incident. Most participants commented on the insufficiency of currently available security systems within emergency departments and on the need for further training about violence. All health care personnel within emergency departments should be aware of the risk of violence and should be prepared for unpredictable conditions and events; in addition, security systems should be updated so that violence within emergency departments can be prevented.

Advanced nursing interventions and length of stay in the emergency department.

Science.gov (United States)

Stauber, Mary A

2013-05-01

Over the past 15 years, emergency departments have become overcrowded, with prolonged wait times and an extended length of stay (LOS). These factors cause delay in treatment, which reduces quality of care and increases the potential for adverse events. One suggestion to decrease LOS in the emergency department is to implement advanced nursing interventions (ANIs) at triage. The study purpose was to determine whether there was a difference in ED LOS between patients presenting with a chief complaint of abdominal pain who received ANIs at triage and patients who did not receive ANIs at triage. A retrospective chart review was performed to determine the ED LOS (mean time in department and mean time in room [TIR]). The convenience sample included ED patients who presented to a large Midwestern academic medical center's emergency department with a chief complaint of abdominal pain and Emergency Severity Index level 3. Independent-samples t tests were used to determine whether there was any statistical difference in LOS between the two groups. Cohen's d statistic was used to determine effect size. Implementation of ANIs at triage for patients with low-acuity abdominal pain resulted in an increased time in department and a decreased TIR with a medium effect size. A reduction in TIR optimizes bed availability in the emergency department. Low-acuity patients spend less time occupying an ED bed, which preserves limited bed space for the sickest patients. Results of diagnostic tests are often available by the time the patient is placed in a room, facilitating early medical decision making and decreasing treatment time. Copyright © 2013 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

'HAs fail to consult Irish people in UK'.

Science.gov (United States)

1992-11-10

Health authorities are failing to consult local people on their health needs, a conference on the mental health of Irish people living in the UK heard last week. Consulting Irish people was often only 'symbolic', despite the requirements of the NHS and Community Care Act, conference Chair Padraic Kenna, Director of Innisfree Housing Association, told delegates. 'The Irish caught the boat in the 1950s only to miss the boat ever since,' he said.

Current use of intraosseous infusion in Danish emergency departments

DEFF Research Database (Denmark)

Molin, Rune; Hallas, Peter; Brabrand, Mikkel

2010-01-01

BACKGROUND: Intraosseous infusion (IOI) is recommended when intravenous access cannot be readily established in both pediatric and adult resuscitation. We evaluated the current use of IOI in Danish emergency departments (EDs). METHODS: An online questionnaire was e-mailed to the Heads of Department...

Radioactivity monitoring of the Irish marine environment 2000 and 2001

International Nuclear Information System (INIS)

Ryan, T.P.; McMahon, C.A.; Dowdall, A.

2003-04-01

This report presents the results of the marine radioactivity monitoring programme carried out by the Radiological Protection Institute of Ireland (RPII) during 2000 and 2001. The primary objective of the programme is to assess the exposure of the Irish population resulting from radioactive contamination of the Irish marine environment and to estimate the risks to health from this exposure. Discharged radioactive waste from the British Nuclear Fuels plc (BNFL) reprocessing plant at Sellafield in Cumbria in the North West of England continues to be the dominant source of this contamination. In particular, the remobilisation from sediments of historic discharges makes an important contribution to the levels of radioactivity in the seawater of the western Irish Sea. Approximately 300 samples of fish, shellfish, seaweed, seawater and sediment were collected in 2000 and again in 2001. Both the Marine Institute and the Department of Communications, Marine and Natural Resources assisted the Institute with this sampling. The samples were analysed for a range of radionuclides at the Institute's radio-analytical laboratory. The results show that the artificial radionuclide of greatest dosimetric significance continues to be caesium-137. The activity concentration of this radionuclide in the Irish marine environment has remained relatively stable since the mid 1990s but at a lower level than that observed during the previous two decades. Along the Irish coastline the highest activity concentrations observed are in the north-east. Since 1994 the commissioning and operation of new facilities at Sellafield have resulted in an increase in the discharges of technetium-99 to the Irish Sea. This has been reflected in an increase in the activity concentrations of this radionuclide at all east coast sampling sites. However, the low radiotoxicity of technetium-99 means that it is generally of lesser radiological significance than caesium-137. The main pathway contributing to the

Enhanced monitoring of abnormal emergency department demands

KAUST Repository

Harrou, Fouzi

2016-06-13

This paper presents a statistical technique for detecting signs of abnormal situation generated by the influx of patients at emergency department (ED). The monitoring strategy developed was able to provide early alert mechanisms in the event of abnormal situations caused by abnormal patient arrivals to the ED. More specifically, This work proposed the application of autoregressive moving average (ARMA) models combined with the generalized likelihood ratio (GLR) test for anomaly-detection. ARMA was used as the modelling framework of the ARMA-based GLR anomaly-detection methodology. The GLR test was applied to the uncorrelated residuals obtained from the ARMA model to detect anomalies when the data did not fit the reference ARMA model. The ARMA-based GLR hypothesis testing scheme was successfully applied to the practical data collected from the database of the pediatric emergency department (PED) at Lille regional hospital center, France. © 2015 IEEE.

Nature tourism and Irish film

OpenAIRE

Brereton, Pat

2006-01-01

This article provides a historical overview and reading of seminal Irish film from the perspective of nature tourism. Within Irish cultural studies, tourism is frequently equated with an overly romantic image of the island, which has been used to sell the country abroad. However, using notions like the tourist gaze and taking on board influential debates around space/place, one can posit a more progressive environmental vision of nature and landscape in our readings of film.

Designing a clinical dashboard to fill information gaps in the emergency department.

Science.gov (United States)

Swartz, Jordan L; Cimino, James J; Fred, Matthew R; Green, Robert A; Vawdrey, David K

2014-01-01

Data fragmentation within electronic health records causes gaps in the information readily available to clinicians. We investigated the information needs of emergency medicine clinicians in order to design an electronic dashboard to fill information gaps in the emergency department. An online survey was distributed to all emergency medicine physicians at a large, urban academic medical center. The survey response rate was 48% (52/109). The clinical information items reported to be most helpful while caring for patients in the emergency department were vital signs, electrocardiogram (ECG) reports, previous discharge summaries, and previous lab results. Brief structured interviews were also conducted with 18 clinicians during their shifts in the emergency department. From the interviews, three themes emerged: 1) difficulty accessing vital signs, 2) difficulty accessing point-of-care tests, and 3) difficulty comparing the current ECG with the previous ECG. An emergency medicine clinical dashboard was developed to address these difficulties.

Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments.

Science.gov (United States)

Langabeer, James R; Gonzalez, Michael; Alqusairi, Diaa; Champagne-Langabeer, Tiffany; Jackson, Adria; Mikhail, Jennifer; Persse, David

2016-11-01

Emergency medical services (EMS) agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED), affecting the entire emergency care system's capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program. The Houston Fire Department initiated the Emergency Telehealth and Navigation (ETHAN) program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care-related patients away from the ED where possible. Using a case-control study design, we describe the program and compare differences in effectiveness measures relative to the control group. During the first 12 months, 5,570 patients participated in the telehealth-enabled program, which were compared against the same size control group. We found a 56% absolute reduction in ambulance transports to the ED with the intervention compared to the control group (18% vs. 74%, P models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions.

National Differences in Regional Emergency Department Boarding Times: Are US Emergency Departments Prepared for a Public Health Emergency?

Science.gov (United States)

Love, Jennifer S; Karp, David; Delgado, M Kit; Margolis, Gregg; Wiebe, Douglas J; Carr, Brendan G

2016-08-01

Boarding admitted patients decreases emergency department (ED) capacity to accommodate daily patient surge. Boarding in regional hospitals may decrease the ability to meet community needs during a public health emergency. This study examined differences in regional patient boarding times across the United States and in regions at risk for public health emergencies. A retrospective cross-sectional analysis was performed by using 2012 ED visit data from the American Hospital Association (AHA) database and 2012 hospital ED boarding data from the Centers for Medicare and Medicaid Services Hospital Compare database. Hospitals were grouped into hospital referral regions (HRRs). The primary outcome was mean ED boarding time per HRR. Spatial hot spot analysis examined boarding time spatial clustering. A total of 3317 of 4671 (71%) hospitals were included in the study cohort. A total of 45 high-boarding-time HRRs clustered along the East/West coasts and 67 low-boarding-time HRRs clustered in the Midwest/Northern Plains regions. A total of 86% of HRRs at risk for a terrorist event had high boarding times and 36% of HRRs with frequent natural disasters had high boarding times. Urban, coastal areas have the longest boarding times and are clustered with other high-boarding-time HRRs. Longer boarding times suggest a heightened level of vulnerability and a need to enhance surge capacity because these regions have difficulty meeting daily emergency care demands and are at increased risk for disasters. (Disaster Med Public Health Preparedness. 2016;10:576-582).

The contribution of radioactivity in the Irish Sea to the radiation exposure of the Irish population during 1982-'83

International Nuclear Information System (INIS)

Cunningham, J.D.; O'Grady, J.

1984-03-01

This report presents an estimate of the exposure of members of the Irish public during the period of May 1982 to June 1983 due to the consumption of fish and shellfish, the most important route by which exposure of the Irish public can occur from radioactivity, in particular radiocaesium, in the Irish Sea. Radiation exposure from other pathways, such as external radiation, is neglegible. The results are examined in terms of the dose limits recommended by the International Commission on Radiological Protection and the basic radiation safety standards of the European Community. The results show a small decrease on the levels of recent years and indicate a decreasing trend probably reflecting the reduction in the quantity of radiocaesium being discharged annually from Sellafield. The monitoring programme enables the radioactivity levels of the Irish Sea to be kept under review and will be continued to enable trends to be identified. (author)

A Survey of Tritium in Irish Seawater

International Nuclear Information System (INIS)

Currivan, L.; Kelleher, K.; McGinnity, P.; Wong, J.; McMahon, C.

2013-07-01

This report provides a comprehensive record of the study and measurements of tritium in Irish seawater undertaken by the Radiological Protection Institute of Ireland RPII. The majority of the samples analysed were found to have tritium concentrations below the limit of detection and a conservative assessment of radiation dose arising showed a negligible impact to the public. Tritium is discharged in large quantities from various nuclear facilities, and mostly in liquid form. For this reason it is included in the list of radioactive substances of interest to the OSPAR (Oslo-Paris) Convention to protect the marine environment of the North-East Atlantic. To fulfil its role within OSPAR, to provide technical support to the Irish Government, RPII carried out a project to determine the levels of tritium in seawater from around the Irish coast to supplement its routine marine monitoring programme. A total of 85 seawater samples were collected over a three year period and analysed at the RPII's laboratory. Given that the operational discharges for tritium from the nuclear fuel reprocessing plant at Sellafield, UK, are expected to increase due to current and planned decommissioning activities RPII will continue to monitor tritium levels in seawater around the Irish coast, including the Irish Sea, as part of its routine marine monitoring programme

The Impact of Oil Prices on Irish Inflation

OpenAIRE

O'Brien, Derry; Weymes, Laura

2010-01-01

Oil prices have been characterised by large fluctuations in recent years. Strong volatility in oil prices has important implications for the Irish economy as Ireland has a relatively poor fuel endowment and relies heavily on imported oil. Energy price increases have been one of the principal drivers behind HICP inflation rates in Ireland in recent years. This article highlights the distinctive features of the Irish energy market which render the impact of oil price changes on Irish inflation ...

Recent Suicidal Ideation among Patients in an Inner City Emergency Department

Science.gov (United States)

Ilgen, Mark A.; Walton, Maureen A.; Cunningham, Rebecca M.; Barry, Kristen L.; Chermack, Steve T.; De Chavez, Peter; Blow, Frederic C.

2009-01-01

The rates and associated features of suicidal ideation among 5,641 patients seeking routine, nonsuicide related care in an inner-city emergency department were examined. Approximately 8% of patients seeking routine care in the emergency department reported some form of suicidal ideation within the past 2 weeks. Suicidal ideation was common in…

Reawakening the Irish language through the ırish education system: Challenges and priorities

Directory of Open Access Journals (Sweden)

T.J. Ó Ceallaigh

2015-12-01

Full Text Available As a language, Irish is unique to Ireland and is, therefore, of crucial importance to the identity of the Irish people, to Irish culture and to world heritage. The Irish language however has had a turbulent and traumatic history and has endured a complex and varied relationship with the Irish people. Since the foundation of the Irish Free State, the education system has been targeted as an agency and model for Irish language planning, education and language revitalisation and has had a critical role in generating linguistic ability in the Irish language. This paper reviews the complex and controversial relationship between the Irish language, the State and the education system from an historical perspective. Some key acts of recent legislation and government initiatives, which impact on the status of the Irish language are considered and barriers and challenges to progress in the education system are outlined. The paper concludes with a discussion on significant positive factors which may revolutionise and reawaken the Irish language through our education syste

The legal and ethical implications of social media in the emergency department.

Science.gov (United States)

Lyons, Rachel; Reinisch, Courtney

2013-01-01

Social media is a growing and popular means of communication. It is understandable that health care providers may not share identifying information on patients through these sources. Challenges arise when patients and family members wish to record the care provided in the emergency department. The health care provider may be faced with an ethical and possibly legal dilemma when social media is present in the emergency department. This article seeks to discuss the legal and ethical principles surrounding social media in the emergency department.

Irish-Israelism

DEFF Research Database (Denmark)

Yazell, Bryan

2018-01-01

This article re-considers the language of racial stereotype that is at the forefront of the “Cyclops” episode in Ulysses. Critics have long characterized the conflict between Leopold Bloom and the Citizen in terms of how each character defines the Irish nation. According to these readings, Bloom’...

Emergency department radiology: reality or luxury? An international comparison.

NARCIS (Netherlands)

Kool, D.R.; Blickman, J.G.

2010-01-01

Changes in society and developments within emergency care affect imaging in the emergency department. It is clear that radiologists have to be pro-active to even survive. High quality service is the goal, and if we are to add value to the diagnostic (and therapeutic) chain of healthcare,

Situational Factors Associated With Burnout Among Emergency Department Nurses.

Science.gov (United States)

Rozo, Jose Andres; Olson, DaiWai M; Thu, Hlaing Sue; Stutzman, Sonja E

2017-06-01

Emergency departments are high-stress environments for patients and clinicians. As part of the clinical team, nurses experience this stress daily and are subject to high levels of burnout, which has been shown to lead to hypertension, depression, and anxiety. Presence of these diseases may also contribute to burnout, creating a cycle of stress and illness. This prospective qualitative study used a phenomenological approach to better understand factors associated with burnout among emergency department nurses. Burnout manifests itself in multiple modes, can affect nurses' decisions to leave the profession, and must be addressed to mitigate the phenomenon.

Injuries in Irish dance.

Science.gov (United States)

Stein, Cynthia J; Tyson, Kesley D; Johnson, Victor M; Popoli, David M; d'Hemecourt, Pierre A; Micheli, Lyle J

2013-12-01

Irish dance is growing in popularity and competitiveness; however, very little research has focused specifically on this genre of dance. The purpose of this study was to analyze the types of dance injuries incurred by Irish dancers. A chart review was performed to identify all injuries associated with Irish dance seen in the sports medicine or orthopaedic clinics at the investigators' hospital over an 11-year period. "Injury" was defined as any dance-related pain or disorder that led to evaluation in the clinics. Survey data were also collected from study participants. Ultimately, 255 patients from over 30 different schools of dance were seen with injuries directly related (726 clinic visits) or partially related (199 visits) to Irish dance. Participants ranged in age from 4 to 47, with 95% (243/255) under the age of 19. These 255 patients received 437 diagnoses. Almost 80% of the injuries (348/437) were attributable to overuse, and 20.4% were acute and traumatic injuries (89/437). Ninety-five percent (95.9%) of injuries involved the hip or lower extremity. The most common sites were the foot (33.2%), ankle (22.7%), knee (19.7%), and hip (14.4%). Typical diagnoses were tendon injury (13.3%), apophysitis (11.4%), patellofemoral pain and instability (10.8%), stress injury (10.1%), and muscle injury (7.8%). The majority of traumatic injuries were seen in clinic within 3 weeks, but less than a quarter of overuse injuries were seen that quickly. The most common treatment, prescribed to 84.3% of patients, was physical therapy and home exercises, and the majority of dancers (64.3%) were able to return to full dance activity after injury.

Effects of Systematic Screening and Detection of Child Abuse in Emergency Departments

NARCIS (Netherlands)

Louwers, Eveline C. F. M.; Korfage, Ida J.; Affourtit, Marjo J.; Scheewe, Dop J. H.; van de Merwe, Marjolijn H.; Vooijs-Moulaert, Anne-Françoise S. R.; van den Elzen, Annette P. M.; Jongejan, Mieke H. T. M.; Ruige, Madelon; Manaï, Badies H. A. N.; Looman, Caspar W. N.; Bosschaart, Adriaan N.; Teeuw, Arianne H.; Moll, Henriëtte A.; de Koning, Harry J.

2012-01-01

OBJECTIVE: Although systematic screening for child abuse of children presenting at emergency departments might increase the detection rate, studies to support this are scarce. This study investigates whether introducing screening, and training of emergency department nurses, increases the detection

Dietary habits of the Irish population: results from SLÃÅN Annual Report 2003

OpenAIRE

Department of Health (Ireland)

2003-01-01

Dietary habits of the Irish population: results from SLÃÂÅN Annual Report 2003 The National Nutritional Surveillance Centre was established in 1992, in the Department of Health Promotion, National University of Ireland,Galway. In 2003 the Centre moved to the Department of Public Health Medicine and Epidemiology, University College Dublin. Its main functions are to provide nutrition-related information to relevant organizations in an accessible form and to monitor trends in health status i...

Radioactivity Monitoring of the Irish Environment 2003-2005

International Nuclear Information System (INIS)

Ryan, R.W.; Dowdall, A; Fegan, M.F.; Hayden, E.; Kelleher, K.; Long, S.; McEvoy, I.; McKittrick, L.; McMahon, C.A.; Murray, M.; Smith, K.; Sequeira, S.; Wong, J.; Pollard, D.

2007-05-01

This report presents the results of the environmental radioactivity monitoring programme carried out by the Radiological Protection Institute of Ireland (RPII) between 2003 and 2005. This programme aims to assess the exposure of the Irish population to anthropogenic radioactivity in the environment, to review the temporal and geographical distribution of contaminating radionuclides and to maintain systems and procedures which would allow a rapid assessment of environmental contamination to be made in the event of a radiological emergency. Radioactivity is present in the environment due to natural processes, the testing of nuclear weapons in the atmosphere, past nuclear accidents such as that at Chernobyl and the routine licensed discharge of radionuclides from nuclear installations. Liquid discharges from the British Nuclear Group reprocessing plant at Sellafield in Cumbria in the North-West of England continue to be the dominant source of anthropogenic radioactivity in the Irish marine environment. The key elements of the monitoring programme implemented by the RPII during the reporting period include; assessment of ambient radioactivity based on measurements of radioactivity in air and external gamma dose rate at permanent monitoring stations located throughout the country; assessment of levels of radioactivity in drinking water; assessment of levels of radioactivity in foodstuffs based on measurements of total diet, milk and miscellaneous ingredients; assessment of levels of radioactivity in the marine environment based on sampling and measurements of seawater, sediment, seaweed, fish and shellfish. The RPII monitored airborne radioactivity at eleven stations located throughout the country. One station is equipped with a high volume sampler, which allows global fallout concentrations to be measured, and one is equipped to detect the presence of the gas krypton-85. Krypton-85 is released into the environment primarily as a result of the reprocessing of nuclear

[Causes of 72-hour return visits to hospital emergency departments].

Science.gov (United States)

Jiménez-Puente, Alberto; Del Río-Mata, José; Arjona-Huertas, José Luis; Mora-Ordóñez, Begoña; Nieto-de Haro, Lourdes; Lara-Blanquer, Antonio; Martínez-Reina, Alfonso; Martínez Del Campo, Miguel

2015-10-01

The return-visit rate has been suggested as a measure of emergency department quality of care. We aimed to identify the reasons for emergency revisits and the percentage of returns related to problems with quality of care in the previous visit. Cross-sectional observational study of clinical records for a random sample of unscheduled returns within 72 hours of discharge from the emergency departments of 3 hospitals attending a population of nearly 3 million in the Spanish province of Malaga. The records were reviewed by 2 data collectors, who assigned a reason for revisits according to a standardized classification. A sample of 1075 emergency revisits were reviewed; 895 met the inclusion criteria. The most common reasons for revisits were the persistence or progression of disease (48.8%), an unrelated new problem (9.3%), and referral from a hospital that did not have the required specialized service (8.6%). Reasons attributable to the patient accounted for 14.5% of the revisits; 15.2% were attributable to health care staff errors, 9.2% to system organization, and 61.1% to the disease process. Most emergency department revisits are related to the progression of the disease that led to the first visit. Only a small percentage can be linked to diagnostic or treatment errors in the previous visit.

Surveillance of construction worker injuries through an urban emergency department.

Science.gov (United States)

Hunting, K L; Nessel-Stephens, L; Sanford, S M; Shesser, R; Welch, L S

1994-03-01

To learn more about the causes of nonfatal construction worker injuries, and to identify injury cases for further work-site investigations or prevention programs, an emergency department-based surveillance program was established. Construction workers with work-related injuries or illnesses were identified by reviewing the medical records of all patients treated at the George Washington University Emergency Department between November 1, 1990 and November 31, 1992. Information regarding the worker, the injury, and the injury circumstances were abstracted from medical records. Information was obtained on 592 injured construction workers from numerous trades. Lacerations were the most commonly treated injuries among these workers, followed by strains and sprains, contusions, and eye injuries. Injuries were most commonly caused by sharp objects (n = 155, 26%), falls (n = 106, 18%), and falling objects (n = 70, 12%). Thirty-five percent of injuries were to the hands, wrists, or fingers. Among the twenty-eight injuries severe enough to require hospital admission, eighteen (64%) were caused by falls. Laborers and Hispanic workers were overrepresented among these severe cases. Emergency Department records were a useful surveillance tool for the initial identification and description of work-related injuries. Although E codes were not that useful for formulating prevention strategies, detailed review of injury circumstances from Emergency Department records was valuable and has helped to establish priorities for prevention activities.

Human Trafficking in the Emergency Department

OpenAIRE

Patel, Ronak B; Ahn, Roy; Burke, Thomas F

2010-01-01

Human trafficking continues to persist, affecting up to 200 million people worldwide. As clinicians in emergency departments commonly encounter victims of intimate partner violence, some of these encounters will be with trafficking victims. These encounters provide a rare opportunity for healthcare providers to intervene and help. This case report of a human trafficking patient from a teaching hospital illustrates the complexity in identifying these victims. Clinicians can better identify pot...

Improving communication between emergency department staff.

Science.gov (United States)

Moore, Kate

2014-05-01

During redevelopment of the emergency department at the Royal Sussex County Hospital, Brighton, it was deemed vital that its internal communication system should be as effective as possible. An audit of staff perceptions of the existing communication system and a relevant literature review were undertaken, therefore, to inform a proposal for the development of a new online system. This article describes the development and implementation of the system.

The Quebec emergency department guide: A cross-sectional study to evaluate its use, perceived usefulness, and implementation in rural emergency departments.

Science.gov (United States)

Fleet, Richard; Hegg-Deloye, Sandrine; Maltais-Giguère, Julie; Légaré, France; Ouimet, Mathieu; Poitras, Julien; Tanguay, Alain; Archambault, Patrick; Levesque, Jean-Frédéric; Simard-Racine, Geneviève; Dupuis, Gilles

2017-12-07

The Quebec Emergency Department Management Guide (QEDMG) is a unique document with 78 recommendations designed to improve the organization of emergency departments (EDs) in the province of Quebec. However, no study has examined how this guide is perceived or used by rural health care management. We invited all directors of professional services (DPS), directors of nursing services (DNS), head nurses (HN), and emergency department directors (EDD) working in Quebec's rural hospitals to complete an online survey (144 questions). Simple frequency analyses (percentage [%] and 95% confidence interval) were conducted to establish general familiarity and use of the QEDMG, as well as perceived usefulness and implementation of its recommendations. Seventy-three percent (19/26) of Quebec's rural EDs participated in the study. A total of 82% (62/76) of the targeted stakeholders participated. Sixty-one percent of respondents reported being "moderately or a lot" familiar with the QEDMG, whereas 77% reported "almost never or sometimes" refer to this guide. Physician management (DPS, EDD) were more likely than nursing management (DNS and especially HN) to report "not at all" or "little" familiarity on use of the guide. Finally, 98% of the QEDMG recommendations were considered useful. Although the QEDMG is considered a useful guide for rural EDs, it is not optimally known or used in rural EDs, especially by physician management. Stakeholders should consider these findings before implementing the revised versions of the QEDMG.

[The department of interdisciplinary emergency medicine: organization, structure and process optimization].

Science.gov (United States)

Bernhard, Michael; Pietsch, Christian; Gries, André

2009-06-01

The essential tasks of a department of interdisciplinary emergency medicine are the initial triage and assessment of vital function as well as the subsequent organization und initiation of emergency treatment. A previously defined set of diagnostic and therapeutic measures is carried out before the patient is allocated to an in-hospital clinical service and is admitted to a ward. Moreover, diagnosis and treatment for outpatients are performed. "Time" is a critical factor to be considered for all organizational and structural aspects of a department of interdisciplinary emergency medicine.

The sword and the prayerbook: ideals of authentic Irish manliness.

Science.gov (United States)

Nugent, Joseph

2008-01-01

As the Catholic Church responded to secular models of the nineteenth-century hero by refurbishing its saints, the Irish Church promoted its native saint, Colmcill, as the sole authentic positive stereotype deserving of the Irishman's emulation. At a time when the concepts of Irishness and manliness were being contested, the League of St. Columba proposed that the physical, psychological, and spiritual characteristics of Colmcill be materialized in the new Irish youth. By folding the mystical rhetoric of Catholicism into the search for national identity, the League altered the course of Irish nationalism and inflected the trajectory of Irish masculine development. While Colmcill's ascendance as an emulatory type was brief, the qualities he was shaped to embody were reinscribed in the Catholic priest, who became installed as the aspirational model for the youth of Ireland.

Use of mobile devices in the emergency department: A scoping review.

Science.gov (United States)

Dexheimer, Judith W; Borycki, Elizabeth M

2015-12-01

Electronic health records are increasingly used in regional health authorities, healthcare systems, hospitals, and clinics throughout North America. The emergency department provides care for urgent and critically ill patients. Over the past several years, emergency departments have become more computerized. Tablet computers and Smartphones are increasingly common in daily use. As part of the computerization trend, we have seen the introduction of handheld computers, tablets, and Smartphones into practice as a way of providing health professionals (e.g. physicians, nurses) with access to patient information and decision support in the emergency department. In this article, we present a scoping review and outline the current state of the research using mobile devices in the emergency departments. Our findings suggest that there is very little research evidence that supports the use of these mobile devices, and more research is needed to better understand and optimize the use of mobile devices. Given the prevalence of handheld devices, it is inevitable that more decision support, charting, and other activities will be performed on these devices. These developments have the potential to improve the quality and timeliness of care but should be thoroughly evaluated. © The Author(s) 2014.

Violence against emergency department employees and the attitude of employees towards violence.

Science.gov (United States)

Çıkrıklar, H Í; Yürümez, Y; Güngör, B; Aşkın, R; Yücel, M; Baydemir, C

2016-10-01

This study was conducted to evaluate the occurrence of violent incidents in the workplace among the various professional groups working in the emergency department. We characterised the types of violence encountered by different occupation groups and the attitude of individuals working in different capacities. This cross-sectional study included 323 people representing various professional groups working in two distinct emergency departments in Turkey. The participants were asked to complete questionnaires prepared in advance by the researchers. The data were analysed using the Statistical Package for the Social Sciences (Windows version 15.0). A total of 323 subjects including 189 (58.5%) men and 134 (41.5%) women participated in the study. Their mean (± standard deviation) age was 31.5 ± 6.5 years and 32.0 ± 6.9 years, respectively. In all, 74.0% of participants had been subjected to verbal or physical violence at any point since starting employment in a medical profession. Moreover, 50.2% of participants stated that they had been subjected to violence for more than 5 times. Among those who reported being subjected to violence, 42.7% had formally reported the incident(s). Besides, 74.3% of participants did not enjoy their profession, did not want to work in the emergency department, or would prefer employment in a non-health care field after being subjected to violence. According to the study participants, the most common cause of violence was the attitude of patients or their family members (28.7%). In addition, 79.6% (n=257) of participants stated that they did not have adequate safety protection in their working area. According to the study participants, there is a need for legal regulations to effectively deter violence and increased safety measures designed to reduce the incidence of violence in the emergency department. Violence against employees in the emergency department is a widespread problem. This situation has a strong negative effect on employee

Assessment of Pain Management in Pediatric Emergency Department in Mashhad -Iran

Directory of Open Access Journals (Sweden)

Ahmadshah Farhat

2013-12-01

Full Text Available Introduction: Pain may be described as a sensation of hurt or strong discomfort and is the body's way of sending message to the brain that an injury has occurred. Pain medicines block these messages or reduce their effect on the brain. Accurate administration of analgesia have a long –lasting effect on children whole experience of medical care and affects parents' and children's future reaction to pediatrics emergency departments. The purpose of this study was to evaluate pain management on children in our emergency department. Materials and Methods: In this study we evaluated the relief of pain and anxiety on 100 children who referred to our pediatric Emergency Department (ED in Imam Reza Hospital- Mashhad .The patients were assessed based on the American Academy of Pediatrics (AAP recommendations about pain.  Results: Patients were gone under IV Line 97%, Intubation 5% and Lumbar Puncture 28%. Training had been provided to 70% participants in the Emergency Department. Nonpharmacologic stress reduction was used in 35% of cases. Family presence was allowed only in 5%. Prehospital pain controlling was began on 20% of patients and continued in ED on 40%. At the time of discharge 40% prescribed analgesics. Sedation and pain prophylaxis was provided for 10% of patients undergoing painful procedures in ED.  Conclusion: According to results, pain management in our Pediatric Emergency Department was inadequate. Physicians and prehospital EMS providers should be justified about the importance of pain relieving and trained how to use all available analgesic and sedative options.

Therapeutic hypothermia following out-of-hospital cardiac arrest; does it start in the emergency department?

Science.gov (United States)

Galloway, R; Sherren, P B

2010-12-01

The use of therapeutic hypothermia after cardiac arrest is a well-practised treatment modality in the intensive care unit (ICU). However, recent evidence points to advantages in starting the cooling process as soon as possible after the return of spontaneous circulation (ROSC). There are no data on implementation of this treatment in the emergency department. A telephone survey was conducted of the 233 emergency departments in the UK. The most senior available clinician was asked if, in cases where they have a patient with a ROSC after an out-of-hospital cardiac arrest, would therapeutic hypothermia be started in the emergency department. Of the 233 hospitals called, 230 responded, of which 35% would start cooling in the emergency department. Of this 35%, over half (56%) said the decision to start cooling was made by the emergency physician before consultation with the ICU. Also, of the 35% who would begin cooling in the emergency department, 55% would cool only for ventricular fibrillation/ventricular tachycardia, 66% would monitor temperature centrally, and 14% would use specialised cooling equipment. There is often a delay in getting patients to ICU from the emergency department, and thus the decision not to start cooling in the emergency department may impact significantly on patient outcome. The dissemination of these data may persuade emergency physicians that starting treatment in the emergency department is an appropriate and justifiable decision that is becoming a more accepted practice throughout the UK.

Prospective pilot study of a tablet computer in an Emergency Department.

Science.gov (United States)

Horng, Steven; Goss, Foster R; Chen, Richard S; Nathanson, Larry A

2012-05-01

The recent availability of low-cost tablet computers can facilitate bedside information retrieval by clinicians. To evaluate the effect of physician tablet use in the Emergency Department. Prospective cohort study comparing physician workstation usage with and without a tablet. 55,000 visits/year Level 1 Emergency Department at a tertiary academic teaching hospital. 13 emergency physicians (7 Attendings, 4 EM3s, and 2 EM1s) worked a total of 168 scheduled shifts (130 without and 38 with tablets) during the study period. Physician use of a tablet computer while delivering direct patient care in the Emergency Department. The primary outcome measure was the time spent using the Emergency Department Information System (EDIS) at a computer workstation per shift. The secondary outcome measure was the number of EDIS logins at a computer workstation per shift. Clinician use of a tablet was associated with a 38min (17-59) decrease in time spent per shift using the EDIS at a computer workstation (pcomputer was associated with a reduction in the number of times physicians logged into a computer workstation and a reduction in the amount of time they spent there using the EDIS. The presumed benefit is that decreasing time at a computer workstation increases physician availability at the bedside. However, this association will require further investigation. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

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

Shock in the emergency department

DEFF Research Database (Denmark)

Holler, Jon Gitz; Henriksen, Daniel Pilsgaard; Mikkelsen, Søren

2016-01-01

BACKGROUND: The knowledge of the frequency and associated mortality of shock in the emergency department (ED) is limited. The aim of this study was to describe the incidence, all-cause mortality and factors associated with death among patients suffering shock in the ED. METHODS: Population...... failures. Outcomes were annual incidence per 100,000 person-years at risk (pyar), all-cause mortality at 0-7, and 8-90 days and risk factors associated with death. RESULTS: We identified 1646 of 438,191 (0.4 %) ED patients with shock at arrival. Incidence of shock increased from 53.8 to 80.6 cases per 100...

Collaboration and patient safety at an emergency department - a qualitative case study.

Science.gov (United States)

Pedersen, Anna Helene Meldgaard; Rasmussen, Kurt; Grytnes, Regine; Nielsen, Kent Jacob

2018-03-19

Purpose The purpose of this paper is to examine how conflicts about collaboration between staff at different departments arose during the establishment of a new emergency department and how these conflicts affected the daily work and ultimately patient safety at the emergency department. Design/methodology/approach This qualitative single case study draws on qualitative semi-structured interviews and participant observation. The theoretical concepts "availability" and "receptiveness" as antecedents for collaboration will be applied in the analysis. Findings Close collaboration between departments was an essential precondition for the functioning of the new emergency department. The study shows how a lack of antecedents for collaboration affected the working relation and communication between employees and departments, which spurred negative feelings and reproduced conflicts. This situation was seen as a potential threat for the safety of the emergency patients. Research limitations/implications This study presents a single case study, at a specific point in time, and should be used as an illustrative example of how contextual and situational factors affect the working environment and through that patient safety. Originality/value Few studies provide an in-depth investigation of what actually takes place when collaboration between professional groups goes wrong and escalates, and how problems in collaboration may affect patient safety.

Thallium myocardial scanning in the emergency department evaluation of chest pain

International Nuclear Information System (INIS)

Mace, S.E.

1989-01-01

Chest pain is a common complaint of patients seen in the emergency department. The causes are legion, and range from the non-life threatening to the potentially catastrophic. Thallium heart scanning was done prospectively in 20 patients with a ''classic'' history for myocardial infarction (eight patients) or atypical chest pain and/or associated symptoms plus an abnormal ECG (12 patients) to discern a subset of patients from whom thallium scintography may be indicated in the emergency department. Although further investigation is needed, our preliminary study suggests that myocardial scanning with thallium can be a safe, fairly rapid, and useful objective parameter in the emergency department detection of suspected myocardial infarction, and in differential diagnosis of chest pain when other data such as the history, physical examination, ECG, or enzymes are inconclusive

Primary medical care in Irish prisons.

Science.gov (United States)

Barry, Joe M; Darker, Catherine D; Thomas, David E; Allwright, Shane P A; O'Dowd, Tom

2010-03-22

An industrial dispute between prison doctors and the Irish Prison Service (IPS) took place in 2004. Part of the resolution of that dispute was that an independent review of prison medical and support services be carried out by a University Department of Primary Care. The review took place in 2008 and we report here on the principal findings of that review. This study utilised a mixed methods approach. An independent expert medical evaluator (one of the authors, DT) inspected the medical facilities, equipment and relevant custodial areas in eleven of the fourteen prisons within the IPS. Semistructured interviews took place with personnel who had operational responsibility for delivery of prison medical care. Prison doctors completed a questionnaire to elicit issues such as allocation of clinician's time, nurse and administrative support and resources available. There was wide variation in the standard of medical facilities and infrastructure provided across the IPS. The range of medical equipment available was generally below that of the equivalent general practice scheme in the community. There is inequality within the system with regard to the ratio of doctor-contracted time relative to the size of the prison population. There is limited administrative support, with the majority of prisons not having a medical secretary. There are few psychiatric or counselling sessions available. People in prison have a wide range of medical care needs and there is evidence to suggest that these needs are being met inconsistently in Irish prisons.

Evaluation of response capacity to patient attention demand in an Emergency Department

OpenAIRE

Bruballa Vilas, Eva

2017-01-01

The progressive growth of aging, increased life expectancy and a greater number of chronic diseases contribute significantly to the growing demand of emergency medical care, and thus, on saturation of Emergency Departments. This is one of the most important current problems in healthcare systems worldwide. This work proposes an analytical model to calculate the theoretical throughput of a particular sanitary staff configuration in a Hospital Emergency Department, which is, the number of patie...

The Emergency Department: Challenges and Opportunities for Suicide Prevention.

Science.gov (United States)

Asarnow, Joan Rosenbaum; Babeva, Kalina; Horstmann, Elizabeth

2017-10-01

Emergency departments (EDs) can offer life-saving suicide prevention care. This article focuses on the ED and emergency services as service delivery sites for suicide prevention. Characteristics of EDs, models of emergency care, ED screening and brief intervention models, and practice guidelines and parameters are reviewed. A care process model for youths at risk for suicide and self-harm is presented, with guidance for clinicians based on the scientific evidence. Strengthening emergency infrastructure and integrating effective suicide prevention strategies derived from scientific research are critical for advancing suicide prevention objectives. Copyright © 2017 Elsevier Inc. All rights reserved.

Emergency department radiology: Reality or luxury? An international comparison

International Nuclear Information System (INIS)

Kool, D.R.; Blickman, J.G.

2010-01-01

Changes in society and developments within emergency care affect imaging in the emergency department. It is clear that radiologists have to be pro-active to even survive. High quality service is the goal, and if we are to add value to the diagnostic (and therapeutic) chain of healthcare, sub-specialization is the key, and, although specifically patient-oriented and not organ-based, emergency and trauma imaging is well suited for that. The development of emergency radiology in Europe and the United States is compared with emphasis on how different healthcare systems and medical cultures affect the utilization of Acute Care imaging.

Evaluating Emergency Department Asthma Management Practices in Florida Hospitals.

Science.gov (United States)

Nowakowski, Alexandra C H; Carretta, Henry J; Dudley, Julie K; Forrest, Jamie R; Folsom, Abbey N

2016-01-01

To assess gaps in emergency department (ED) asthma management at Florida hospitals. Survey instrument with open- and closed-ended questions. Topics included availability of specific asthma management modalities, compliance with national guidelines, employment of specialized asthma care personnel, and efforts toward performance improvement. Emergency departments at 10 large hospitals in the state of Florida. Clinical care providers and health administrators from participating hospitals. Compliance with national asthma care guideline standards, provision of specific recommended treatment modalities and resources, employment of specialized asthma care personnel, and engagement in performance improvement efforts. Our results suggest inconsistency among sampled Florida hospitals' adherence to national standards for treatment of asthma in EDs. Several hospitals were refining their emergency care protocols to incorporate guideline recommendations. Despite a lack of formal ED protocols in some hospitals, adherence to national guidelines for emergency care nonetheless remained robust for patient education and medication prescribing, but it was weaker for formal care planning and medical follow-up. Identified deficiencies in emergency asthma care present a number of opportunities for strategic mitigation of identified gaps. We conclude with suggestions to help Florida hospitals achieve success with ED asthma care reform. Team-based learning activities may offer an optimal strategy for sharing and implementing best practices.

Database in Theory and Practice: The Bibliography of Irish Literary Criticism

Science.gov (United States)

Howell, Sonia

2013-01-01

Focusing on "The Bibliography of Irish Literary Criticism" (BILC, 2010), a bibliographical database of Irish literary criticism developed by humanities and information and communications technology (ICT) researchers in NUI Maynooth, this chapter investigates the opportunities and implications afforded the field of Irish literary studies…

Improving handoffs in the emergency department.

Science.gov (United States)

Cheung, Dickson S; Kelly, John J; Beach, Christopher; Berkeley, Ross P; Bitterman, Robert A; Broida, Robert I; Dalsey, William C; Farley, Heather L; Fuller, Drew C; Garvey, David J; Klauer, Kevin M; McCullough, Lynne B; Patterson, Emily S; Pham, Julius C; Phelan, Michael P; Pines, Jesse M; Schenkel, Stephen M; Tomolo, Anne; Turbiak, Thomas W; Vozenilek, John A; Wears, Robert L; White, Marjorie L

2010-02-01

Patient handoffs at shift change are a ubiquitous and potentially hazardous process in emergency care. As crowding and lengthy evaluations become the standard for an increasing proportion of emergency departments (EDs), the number of patients handed off will likely increase. It is critical now more than ever before to ensure that handoffs supply valid and useful shared understandings between providers at transitions of care. The purpose of this article is to provide the most up-to-date evidence and collective thinking about the process and safety of handoffs between physicians in the ED. It offers perspectives from other disciplines, provides a conceptual framework for handoffs, and categorizes models of existing practices. Legal and risk management issues are also addressed. A proposal for the development of handoff quality measures is outlined. Practical strategies are suggested to improve ED handoffs. Finally, a research agenda is proposed to provide a roadmap to future work that may increase knowledge in this area. Copyright (c) 2009 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Physicians' and nurses' perceptions of patient safety risks in the emergency department.

Science.gov (United States)

Källberg, Ann-Sofie; Ehrenberg, Anna; Florin, Jan; Östergren, Jan; Göransson, Katarina E

2017-07-01

The emergency department has been described as a high-risk area for errors. It is also known that working conditions such as a high workload and shortage off staff in the healthcare field are common factors that negatively affect patient safety. A limited amount of research has been conducted with regard to patient safety in Swedish emergency departments. Additionally, there is a lack of knowledge about clinicians' perceptions of patient safety risks. Therefore, the purpose of this study was to describe emergency department clinicians' experiences with regard to patient safety risks. Semi-structured interviews were conducted with 10 physicians and 10 registered nurses from two emergency departments. Interviews were analysed by inductive content analysis. The experiences reflect the complexities involved in the daily operation of a professional practice, and the perception of risks due to a high workload, lack of control, communication and organizational failures. The results reflect a complex system in which high workload was perceived as a risk for patient safety and that, in a combination with other risks, was thought to further jeopardize patient safety. Emergency department staff should be involved in the development of patient safety procedures in order to increase knowledge regarding risk factors as well as identify strategies which can facilitate the maintenance of patient safety during periods in which the workload is high. Copyright © 2017 Elsevier Ltd. All rights reserved.

The impact of thunderstorm asthma on emergency department attendances across London during July 2013.

Science.gov (United States)

Elliot, A J; Hughes, H E; Hughes, T C; Locker, T E; Brown, R; Sarran, C; Clewlow, Y; Murray, V; Bone, A; Catchpole, M; McCloskey, B; Smith, G E

2014-08-01

This study illustrates the potential of using emergency department attendance data, routinely accessed as part of a national syndromic surveillance system, to monitor the impact of thunderstorm asthma. The Emergency Department Syndromic Surveillance System (EDSSS) routinely monitors anonymised attendance data on a daily basis across a sentinel network of 35 emergency departments. Attendance data for asthma, wheeze and difficulty breathing are analysed on a daily basis. A statistically significant spike in asthma attendances in two EDSSS emergency departments in London was detected on 23 July 2013, coinciding with a series of large violent thunderstorms across southern England. There was also an increase in the reported severity of these attendances. This preliminary report illustrates the potential of the EDSSS to monitor the impact of thunderstorms on emergency department asthma attendances. Further work will focus on how this system can be used to quantify the impact on emergency departments, thus potentially improving resource planning and also adding to the thunderstorm asthma evidence-base. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

United States Department of Energy radiological emergency response programme - a national capability

International Nuclear Information System (INIS)

Gordon-Hagerty, L.E.

1993-01-01

In order to respond to a radiological emergency, the United States Department of Energy (USDOE) maintains seven emergency response assets and capabilities in support of a radiological emergency of any proportion within the continental United States and abroad. The seven emergency response assets and capabilities include: Accident Response Group; Aerial Measuring Systems; Atmospheric Release Advisory Capability; Federal Radiological Monitoring and Assessment Center; Nuclear Emergency Search Team; Radiation Emergency Assistance Center/Training Site; and Radiological Assistance Program. Presently, USDOE maintains the most comprehensive national radiological emergency response assets in the United States, capable of dealing with any type of emergency involving nuclear materials. In all, the Department's assets are available to support any type of accident/incident involving radioactive materials in coordination with other United States Federal agencies, as well as state and local governments, as required. (author)

Global trends in milk quality: implications for the irish dairy industry

Directory of Open Access Journals (Sweden)

More SJ

2009-04-01

Full Text Available Abstract The quality of Irish agricultural product will become increasingly important with the ongoing liberalisation of international trade. This paper presents a review of the global and Irish dairy industries; considers the impact of milk quality on farm profitability, food processing and human health, examines global trends in quality; and explores several models that are successfully being used to tackle milk quality concerns. There is a growing global demand for dairy products, fuelled in part by growing consumer wealth in developing countries. Global dairy trade represents only 6.2% of global production and demand currently outstrips supply. Although the Irish dairy industry is small by global standards, approximately 85% of annual production is exported annually. It is also the world's largest producer of powdered infant formula. Milk quality has an impact on human health, milk processing and on-farm profitability. Somatic cell count (SCC is a key measure of milk quality, with a SCC not exceeding 400,000 cells/ml (the EU milk quality standard generally accepted as the international export standard. There have been ongoing improvements in milk quality among both established and emerging international suppliers. A number of countries have developed successful industry-led models to tackle milk quality concerns. Based on international experiences, it is likely that problems with effective translation of knowledge to practice, rather than incomplete knowledge per se, are the more important constraints to national progress towards improved milk quality.

Discharge from an emergency department observation unit and a surgical assessment unit

DEFF Research Database (Denmark)

Schultz, Helen; Qvist, Niels; Backer Mogensen, Christian

2014-01-01

To investigate the experiences of patients with acute abdominal pain at discharge from an emergency department observation unit compared with discharge from a surgical assessment unit.......To investigate the experiences of patients with acute abdominal pain at discharge from an emergency department observation unit compared with discharge from a surgical assessment unit....

A retrospective study of the demographics of sport and exercise injuries in 1143 children presenting to an Irish emergency department over a 6-month period.

LENUS (Irish Health Repository)

O'Rourke, Killian Patrick

2012-02-03

The purpose of this study was to provide up-to-date data on the nature of sport related injury (SRI) presenting to a large emergency department in Ireland. Data were collected retrospectively on all children under 17 years of age with a SRI, presenting to the emergency department of a major teaching hospital, over a 6-month period, and entered into a Microsoft Access database. A total of 1143 SRIs were identified which had occurred over a 6-month period, from 53 different sports. There was a high proportion of humerus and back SRIs in females, and a higher proportion of falls in females. Males were more frequently involved in collisions. Children with SRI were not using protective equipment in 94% of cases. Advice regarding rest, ice, compression and elevation (RICE)\\/general injury advice was given to 25% of patients and regarding injury preventive measures in less than 0.1% of cases. Of children, 28% had previously attended with a SRI. We also observed a lower rate of analgesia prescription to children under age 4, compared to children of an older age, and rarity of topical analgesic prescription. Overall, 10% of SRIs required admission, with 65% of these cases needing orthopaedic intervention. CONCLUSION: The data provided from this study should raise awareness of the different aspects of sport related injuries affecting children, and may help to provide the impetus for suggesting direction and guidance for reducing such events.

Universal precautions--do Irish anaesthetists comply?

LENUS (Irish Health Repository)

O'Rourke, N

2012-02-03

BACKGROUND: Anaesthetists are at high risk from blood-borne pathogens. Universal Precautions (UP) include the routine use of appropriate barrier precautions and techniques to reduce the likelihood of exposure to blood, body fluids and tissues that may contain pathogens. The compliance of Irish anaesthetists with these precautions has not been studied. AIM: To study the attitudes of Irish anaesthetists to Universal Precautions. METHOD: A postal questionnaire was sent to 210 anaesthetists currently practising in Ireland. The questionnaire was based on a model used in Australia and New Zealand. RESULTS: There was a 50% response rate to the survey. Only 15% of respondents had taken a risk history from a patient in the preceding four weeks. Resheathing of needles was commonplace. The effectiveness of hepatitis B immunisation was rarely checked and only 66% of respondents believe implementation of Universal Precautions to be practical. CONCLUSION: Irish anaesthetists comply poorly with Universal Precautions.

The Irish Theme in the Writings of Bill Naughton

Directory of Open Access Journals (Sweden)

David Pierce

2005-03-01

Full Text Available The student interested in cultural assimilation, hybridity, and naturalization, in masculinity, authorship, and identity, in what happened to the Irish in Britain in the twentieth century, will turn at some point to the Mayo-born, Lancashire writer Bill Naughton (1910-1992, author of a classic children’s story collection The Goalkeeper’s Revenge and Other Stories (1961, ofAlfie (1965, the film which helped define 1960s London, and of a series of autobiographies largely centering on his Irish childhood and upbringing in Bolton. It has been the historic role of Irish writers from Richard Brinsley Sheridan to Oscar Wilde, from Elizabeth Bowen to William Trevor, to give the English back to themselves in a gallery of portraits. Naughton is part of this tradition, but, unlike these other writers, his subject is the English working class, which he writes about from within, with both sympathy and knowledge. It can be readily conceded that his work is not at the forefront of modern English or Irish writing, but it does deserve to be better known and appreciated. Here in this discursive essay, with an eye on his Irish background, I move back and forth across his writing to reflect on his contribution not so to much the cultural greening of Britain as to the mass observation of the English and of the Irish in Britain.

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.

Organizational factors affecting length of stay in the emergency department: initial observational study.

Science.gov (United States)

Bashkin, Osnat; Caspi, Sigalit; Haligoa, Rachel; Mizrahi, Sari; Stalnikowicz, Ruth

2015-01-01

Length of stay (LOS) is considered a key measure of emergency department throughput, and from the perspective of the patient, it is perceived as a measure of healthcare service quality. Prolonged LOS can be caused by various internal and external factors. This study examined LOS in the emergency department and explored the main factors that influence LOS and cause delay in patient care. Observations of 105 patients were performed over a 3-month period at the emergency room of a community urban hospital. Observers monitored patients from the moment of entrance to the department until discharge or admission to another hospital ward. Analysis revealed a general average total emergency department LOS of 438 min. Significant differences in average LOS were found between admitted patients (Mean = 544 min, SD = 323 min) and discharged patients (Mean = 291 min, SD = 286 min). In addition, nurse and physician change of shifts and admissions to hospital wards were found to be significant factors associated with LOS. Using an Ishikawa causal diagram, we explored various latent organizational factors that may prolong this time. The study identified several factors that are associated with high average emergency department LOS. High LOS may lead to increases in expenditures and may have implications for patient safety, whereas certain organizational changes, communication improvement, and time management may have a positive effect on it. Interdisciplinary methods can be used to explore factors causing prolonged emergency department LOS and contribute to a better understanding of them.

Managing hypopituitarism in emergency departments.

Science.gov (United States)

Welsh, Jeanette

2015-10-01

Healthcare professionals manage patients with a vast range of conditions, but often specialise and acquire expertise in specific disease processes. Emergency and pre-hospital clinicians care for patients with various conditions for short periods of time, so have less opportunity to become familiar with more unusual conditions, yet it is vital that they have some knowledge and understanding of these. Patients with rare conditions can present at emergency departments with common complaints, but the effect of their original diagnosis on the presenting complaint may be overlooked or underestimated. This article uses a case study to describe the experience of one patient who presented with vomiting, but who also had hypopituitarism and therefore required specific management she did not at first receive. The article describes hypopituitarism and the initial management of patients with this condition who become unwell, and discusses how the trust responded to the patient's complaint to improve patient safety and care. It has been written with the full participation and consent of the patient and her husband.

Worker, workplace, and community/environmental risk factors for workplace violence in emergency departments.

Science.gov (United States)

Gillespie, Gordon Lee; Pekar, Bunnany; Byczkowski, Terri L; Fisher, Bonnie S

2017-03-04

Workplace violence committed by patients and visitors has high propensity to occur against emergency department employees. This article reports the association of worker, workplace, and community/environmental factors with violence risks. A cross-sectional research design was used with 280 employees from six emergency departments in the Midwest United States. Respondents completed the Survey of Violence Experienced by Staff and a 10-item demographic questionnaire. Data were analyzed using frequencies, percentages, Chi-square tests, and adjusted relative risks with 95% confidence intervals. Over 80% of respondents experienced at least one type of workplace violence with their current employer and approximately 40% experienced all three types. Risks for workplace violence were significantly higher for registered nurses and hospital-based emergency departments. Workplace violence can impact all employees in the emergency department regardless of worker, workplace, and community/environmental factors.

Reliability and validity of emergency department triage systems

NARCIS (Netherlands)

van der Wulp, I.

2010-01-01

Reliability and validity of triage systems is important because this can affect patient safety. In this thesis, these aspects of two emergency department (ED) triage systems were studied as well as methodological aspects in these types of studies. The consistency, reproducibility, and criterion

LQAS usefulness in an emergency department.

Science.gov (United States)

de la Orden, Susana Granado; Rodríguez-Rieiro, Cristina; Sánchez-Gómez, Amaya; García, Ana Chacón; Hernández-Fernández, Tomás; Revilla, Angel Abad; Escribano, Dolores Vigil; Pérez, Paz Rodríguez

2008-01-01

This paper aims to explore lot quality assurance sampling (LQAS) applicability and usefulness in the evaluation of quality indicators in a hospital emergency department (ED) and to determine the degree of compliance with quality standards according to this sampling method. Descriptive observational research in the Hospital General Universitario Gregorio Marañón (HGUGM) emergency department (ED). Patients older than 15 years, diagnosed with dyspnoea, chest pain, urinary tract colic or bronchial asthma attending the HGUGM ED from December 2005 to May 2006, and patients admitted during 2005 with exacerbation of chronic obstructive pulmonary disease or acute meningitis were included in the study. Sample sizes were calculated using LQAS. Different quality indicators, one for each process, were selected. The upper (acceptable quality level (AQL)) and lower thresholds (rejectable quality level (RQL)) were established considering risk alpha = 5 per cent and beta = 20 per cent, and the minimum number of observations required was calculated. It was impossible to reach the necessary sample size for bronchial asthma and urinary tract colic patients. For chest pain, acute exacerbation of chronic obstructive pulmonary disease, and acute meningitis, quality problems were detected. The lot was accepted only for the dyspnoea indicator. The usefulness of LQAS to detect quality problems in the management of health processes in one hospital's ED. The LQAS could complement traditional sampling methods.

Ecocriticism and Irish Poetry A Preliminary Outline

Directory of Open Access Journals (Sweden)

James Mc Elroy

2011-03-01

Full Text Available This article offers a brief thumbnail sketch of how Irish poetry has situated “nature” inside its competing narrative forms. Beginning with Irish poetry’s earliest lyrics and concluding with some of Ireland’s most recent, and most experimental, writers, the goal of the piece is to introduce some rudimentary eco-critical theory as a means of better understanding how nature acts as a complex cultural and political semiotic, so often overlooked, in Irish literature. En route, the article examines and in part deconstructs those critical categories that have often divided Irish literature into two distinct ecological camps: the picturesque (read colonialist/tourist and the oral (read native/indigenous. The article also considers the importance of ecofeminist theory and asks how critics might better read Ireland’s women poets as nature poets in their own right. In closing, the piece turns its attention to a number of recent poets, both men and women, who have exceeded the picturesque/oral divide and now require eco-alternative readings of nature as we enter the second decade of the 21st Century.

75 FR 10159 - Irish-American Heritage Month, 2010

Science.gov (United States)

2010-03-05

... America A Proclamation From long before American independence to today, countless individuals have reached... the Emerald Isle. Irish Americans fought for our independence, and their signatures adorn our founding documents. When famine ravaged Ireland in the 1840s and 1850s, many Irish men and women sought a new...

Nurses' attitudes towards the reporting of violence in the emergency department.

Science.gov (United States)

Hogarth, Kathryn M; Beattie, Jill; Morphet, Julia

2016-05-01

The incidence of workplace violence against nurses in emergency departments is underreported. Thus, the true nature and frequency of violent incidents remains unknown. It is therefore difficult to address the problem. To identify the attitudes, barriers and enablers of emergency nurses to the reporting of workplace violence. Using a phenomenological approach, two focus groups were conducted at a tertiary emergency department. The data were audio-recorded, transcribed verbatim and analysed using thematic analysis. Violent incidents in this emergency department were underreported. Nurses accepted violence as part of their normal working day, and therefore were less likely to report it. Violent incidents were not defined as 'violence' if no physical injury was sustained, therefore it was not reported. Nurses were also motivated to report formally in order to protect themselves from any possible future complaints made by perpetrators. The current formal reporting system was a major barrier to reporting because it was difficult and time consuming to use. Nurses reported violence using methods other than the designated reporting system. While emergency nurses do report violence, they do not use the formal reporting system. When they did use the formal reporting system they were motivated to do so in order to protect themselves. As a consequence of underreporting, the nature and extent of workplace violence remains unknown. Copyright © 2015 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

Corned Beef: an Enigmatic Irish Dish

OpenAIRE

Mac Con Iomaire, Máirtín; Gallagher, Pádraic Óg

2011-01-01

Corned beef and cabbage, which is consumed in America in large quantities each Saint Patrick’s Day (17th March), is considered by most Americans to be the ultimate Irish dish. However, corned beef and cabbage is seldom eaten in modern day Ireland. It is widely reported that Irish immigrants replaced their beloved bacon and cabbage with corned beef and cabbage when they arrived in America, drawing on the corned beef supplied by their neighbouring Jewish butchers, but not all commentators beli...

Irish Corned Beef: A Culinary History

OpenAIRE

Mac Con Iomaire, Máirtín; Gallagher, Pádraic Óg

2011-01-01

This article proposes that a better knowledge of culinary history enriches all culinary stakeholders. The article will discuss the origins and history of corned beef in Irish cuisine and culture. It outlines how cattle have been central to the ancient Irish way of life for centuries, but were cherished more for their milk than their meat. In the early modern period, with the decline in the power of the Gaelic lords, cattle became and economic commodity that was exported to England. The Cattle...

Violence in the Emergency Department.

Science.gov (United States)

Stowell, Keith R; Hughes, Nolan P; Rozel, John S

2016-12-01

Violence is common in the emergency department (ED). The ED setting has numerous environmental risk factors for violence, including poor staffing, lack of privacy, overcrowding, and ready availability of nonsecured equipment that can be used as weapons. Strategies can be taken to mitigate the risk of violence toward health care workers, including staff training, changes to the ED layout, appropriate use of security, and policy-level changes. Health care providers in the ED should be familiar with local case law and standards related to the duty to warn third parties when a violent threat is made by a patient. Copyright © 2016 Elsevier Inc. All rights reserved.

Psychiatric service users' experiences of emergency departments

DEFF Research Database (Denmark)

Carstensen, Kathrine; Lou, Stina; Jensen, Lotte Groth

2017-01-01

Background: There is increased clinical and political attention towards integrating general and psychiatric emergency departments (ED). However, research into psychiatric service users’ experiences regarding general EDs is limited. Aim: To identify and summarize current, qualitative evidence rega...... the discomfort. Overall, the results of this review speak in favour of integrated EDs where service users’ needs are more likely to be recognized and accommodated....

Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments

Directory of Open Access Journals (Sweden)

James Robert Langabeer

2016-11-01

Full Text Available Introduction Emergency medical services (EMS agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED, affecting the entire emergency care system’s capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program. Methods The Houston Fire Department initiated the Emergency Telehealth and Navigation (ETHAN program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care-related patients away from the ED where possible. Using a case-control study design, we describe the program and compare differences in effectiveness measures relative to the control group. Results During the first 12 months, 5,570 patients participated in the telehealth-enabled program, which were compared against the same size control group. We found a 56% absolute reduction in ambulance transports to the ED with the intervention compared to the control group (18% vs. 74%, P<.001. EMS productivity (median time from EMS notification to unit back in service was 44 minutes faster for the ETHAN group (39 vs. 83 minutes, median. There were no statistically significant differences in mortality or patient satisfaction. Conclusion We found that mobile technology-driven delivery models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions.

Emergency Department Crowding: Factors Influencing Flow

OpenAIRE

Arkun, Alp; Briggs, William M; Patel, Sweha; Datillo, Paris A; Bove, Joseph; Birkhahn, Robert H

2010-01-01

Background: The objective of this study was to evaluate those factors, both intrinsic and extrinsic to the emergency department (ED) that influence two specific components of throughput: “door-to-doctor” time and dwell time. Methods: We used a prospective observational study design to determine the variables that played a significant role in determining ED flow. All adult patients seen or waiting to be seen in the ED were observed at 8pm (Monday-Friday) during a three-month period. V...

Sport and active recreation injuries in Australia: evidence from emergency department presentations.

Science.gov (United States)

Finch, C; Valuri, G; Ozanne-Smith, J

1998-09-01

Despite the rise in specialist clinical services for the management of sports and active recreation injury, many patients attend hospital emergency departments for treatment. The purpose of this study was to describe sports injury cases presented to selected hospital emergency departments around Australia for the period 1989-1993. Routinely collected emergency department injury presentation data from the Australian National Injury Surveillance Unit were examined. Data on 98,040 sports and active recreation emergency department presentations were analysed. Sports and active recreation activities were ranked according to frequency of presentation. Relative proportions of injury type and body region injured were determined. Data are presented separately for children (15 years of age). Among the 10 activities that most commonly led to a sports or active recreation injury presentation for all ages were cycling, Australian football, basketball, soccer, cricket, netball, and rugby. For children, injuries were also commonly associated with roller skating/blading, skateboarding, and trampolining. Hockey, martial arts, and dancing injuries were frequent in adults. Most sporting injuries occurred during organised competition or practice whereas the active recreation injuries occurred in a variety of settings. Fractures, strains, and sprains, particularly to the lower and upper extremities, were common types of injury. The rich, but nevertheless limited, information available about sports and active recreation injuries from data collected in emergency departments indicates that these activities are a common context for injury at the community level in Australia.

Sport and active recreation injuries in Australia: evidence from emergency department presentations

Science.gov (United States)

Finch, C.; Valuri, G.; Ozanne-Smith, J.

1998-01-01

OBJECTIVE: Despite the rise in specialist clinical services for the management of sports and active recreation injury, many patients attend hospital emergency departments for treatment. The purpose of this study was to describe sports injury cases presented to selected hospital emergency departments around Australia for the period 1989-1993. METHODS: Routinely collected emergency department injury presentation data from the Australian National Injury Surveillance Unit were examined. Data on 98,040 sports and active recreation emergency department presentations were analysed. Sports and active recreation activities were ranked according to frequency of presentation. Relative proportions of injury type and body region injured were determined. Data are presented separately for children (15 years of age). RESULTS: Among the 10 activities that most commonly led to a sports or active recreation injury presentation for all ages were cycling, Australian football, basketball, soccer, cricket, netball, and rugby. For children, injuries were also commonly associated with roller skating/blading, skateboarding, and trampolining. Hockey, martial arts, and dancing injuries were frequent in adults. Most sporting injuries occurred during organised competition or practice whereas the active recreation injuries occurred in a variety of settings. Fractures, strains, and sprains, particularly to the lower and upper extremities, were common types of injury. CONCLUSION: The rich, but nevertheless limited, information available about sports and active recreation injuries from data collected in emergency departments indicates that these activities are a common context for injury at the community level in Australia. 


 PMID:9773170

Modelling travel and residence times in the eastern Irish Sea

International Nuclear Information System (INIS)

Dabrowski, T.; Hartnett, M.

2008-01-01

The Irish Sea, which lies between 51 deg. N-56 deg. N and 2 deg. 50'W-7 deg. W, provides a sheltered environment to exploit valuable fisheries resource. Anthropogenic activity is a real threat to its water quality. The majority of freshwater input down rivers flows into the eastern Irish Sea. The structure of the water circulation was not well understood during the planning of Sellafield nuclear plant outfall site in the eastern Irish Sea. A three-dimensional primitive equation numerical model was applied to the Irish Sea to simulate both barotropic and baroclinic circulation within the region. High accuracy was achieved with regard to the prediction of both tidal circulation and surface and nearbed water temperatures across the region. The model properly represented the Western Irish Sea Gyre, induced by thermal stratification and not known during planning Sellafield. Passive tracer simulations based on the developed hydrodynamic model were used to deliver residence times of the eastern Irish Sea region for various times of the year as well as travel times from the Sellafield outfall site to various locations within the Irish Sea. The results indicate a strong seasonal variability of travel times from Sellafield to the examined locations. Travel time to the Clyde Sea is the shortest for the autumnal tracer release (90 days); it takes almost a year for the tracer to arrive at the same location if it is released in January. Travel times from Sellafield to Dublin Bay fall within the range of 180-360 days. The average residence time of the entire eastern Irish Sea is around 7 months. The areas surrounding the Isle of Man are initially flushed due to a predominant northward flow; a backwater is formed in Liverpool Bay. Thus, elevated tracer concentrations are predicted in Liverpool Bay in the case of accidental spills at the Sellafield outfall site

On a Work Expected to the Department of Emergency and Critical Care Medicine and the Emergency Unit of the Niigata University Hospital

OpenAIRE

小山, 真; Koyama, Shin

2001-01-01

The author would like to celebrate the start of the Department of emergency and critical care medicine and the Emergency unit of the Niigata University Hospital. The author also wishes to express his opinion, which is mentioned below, on preparing the Department and the Emergency unit for their future activity. 1 . The stuff members of the Department are expected to instruct undergraduate students in the knowledge and technique of Triage and the first aid in emergency exactly. 2 . The Emergen...

Syndromic surveillance: hospital emergency department participation during the Kentucky Derby Festival.

Science.gov (United States)

Carrico, Ruth; Goss, Linda

2005-01-01

Electronic syndromic surveillance may have value in detecting emerging pathogens or a biological weapons release. Hospitals that have an agile process to evaluate chief complaints of patients seeking emergency care may be able to more quickly identify subtle changes in the community's health. An easily adaptable prototype system was developed to monitor emergency department patient visits during the Kentucky Derby Festival in Louisville, Kentucky, from April 16-May 14, 2002. Use of the system was continued during the same festival periods in 2003 and 2004. Twelve area hospitals in Louisville, Kentucky, participated in a prospective analysis of the chief symptoms of patients who sought care in the emergency department during the Kentucky Derby Festival during 2002. Six hospitals were classified as computer record groups (CRG) and used their existing computerized record capabilities. The other 6 hospitals used a personal digital assistant (PDA) with customized software (PDA group). Data were evaluated by the health department epidemiologist using SaTScan, a modified version of a cancer cluster detection program, to look for clusters of cases above baseline over time and by Zip code. All 12 hospitals were able to collect and provide data elements during the study period. The 6 CRG hospitals were able to perform daily data transmission; however, 3 CRG hospitals were unable to interpret their data because it was transmitted in pure text format. In contrast, data from all 6 PDA group hospitals were interpretable. Real-time data analysis was compared with post-event data, and it was found that the real-time evaluation correctly identified no unusual disease activity during the study period. The 12 hospitals participating in this study demonstrated that community-wide surveillance using computerized data was possible and that the 6 study hospitals using a PDA could quickly interpret emergency department patients' chief complaints. The emergency department chief complaints

Mental Health and Drivers of Need in Emergent and Non-Emergent Emergency Department (ED) Use: Do Living Location and Non-Emergent Care Sources Matter?

Science.gov (United States)

McManus, Moira C; Cramer, Robert J; Boshier, Maureen; Akpinar-Elci, Muge; Van Lunen, Bonnie

2018-01-13

Emergency department (ED) utilization has increased due to factors such as admissions for mental health conditions, including suicide and self-harm. We investigate direct and moderating influences on non-emergent ED utilization through the Behavioral Model of Health Services Use. Through logistic regression, we examined correlates of ED use via 2014 New York State Department of Health Statewide Planning and Research Cooperative System outpatient data. Consistent with the primary hypothesis, mental health admissions were associated with emergent use across models, with only a slight decrease in effect size in rural living locations. Concerning moderating effects, Spanish/Hispanic origin was associated with increased likelihood for emergent ED use in the rural living location model, and non-emergent ED use for the no non-emergent source model. 'Other' ethnic origin increased the likelihood of emergent ED use for rural living location and no non-emergent source models. The findings reveal 'need', including mental health admissions, as the largest driver for ED use. This may be due to mental healthcare access, or patients with mental health emergencies being transported via first responders to the ED, as in the case of suicide, self-harm, manic episodes or psychotic episodes. Further educating ED staff on this patient population through gatekeeper training may ensure patients receive the best treatment and aid in driving access to mental healthcare delivery changes.

Balancing Tradition and Transcendence in the Implementation of Emergency-Department Electronic Whiteboads

DEFF Research Database (Denmark)

Rasmussen, Rasmus; Fleron, Benedicte; Hertzum, Morten

2010-01-01

We report from a case study of the implementation of an electronic whiteboard system at two emergency departments at Danish hospitals. The purpose of the whiteboards is to support the clinicians in maintaining an overview of the patients at the departments. The electronic whiteboard system...... in the implementation of the whiteboards at the two emergency departments. The electronic whiteboards were initially configured to resemble the dry-erase whiteboards and then gradually reconfigured and extended through an improvisational process, along with changes in the clinicians’ work practices....

Gaeilge Gaming: Assessing How Games Can Help Children to Learn Irish

Science.gov (United States)

Dalton, Gene; Devitt, Ann

2016-01-01

In the 2011 census almost one in three Irish teenagers claimed to be unable to speak Irish (Central Statistics Office, Ireland, 2012), despite the language being taught daily in school. The challenges facing the Irish language in schools are complex and multifaceted. The research reported here attempts to address some of these challenges by…

Glacigenic landforms and sediments of the Western Irish Shelf

Science.gov (United States)

McCarron, Stephen; Monteys, Xavier; Toms, Lee

2013-04-01

Vibrocoring of possible glacigenic landforms identified from high resolution bathymetric coverage of the Irish Shelf by the Irish National Seabed Survey (INSS) has provided several clusters of short (<3m) cores that, due to a regional post-glacial erosional event, comprise last glacial age stratigraphies. In addition, new shallow seismic data and sedimentological information from across the Western Irish Shelf provide new insights into aspects of the nature, timing and pattern of shelf occupation by grounded lobate extensions of the last Irish Ice Sheet. Restricted chronological control of deglacial sequences in several cores indicates that northern parts of the western mid-shelf (south of a prominent outer Donegal Bay ridge) were ice free by ~24 ka B.P., and that ice had also probably retreated from outer shelf positions (as far west as the Porcupine Bank) at or before this time.

Aftercare, Emergency Department Visits, and Readmission in Adolescents

Science.gov (United States)

Carlisle, Corine E.; Mamdani, Muhammad; Schachar, Russell; To, Teresa

2012-01-01

Objective: U.S. and Canadian data demonstrate decreasing inpatient days, increasing nonurgent emergency department (ED) visits, and short supply of child psychiatrists. Our study aims to determine whether aftercare reduces ED visits and/or readmission in adolescents with first psychiatric hospitalization. Method: We conducted a population-based…

Demand and capacity planning in the emergency department: how to do it.

Science.gov (United States)

Higginson, I; Whyatt, J; Silvester, K

2011-02-01

Unless emergency departments have adequate capacity to meet demand, they will fail to meet clinical and performance standards and will be operating in the 'coping zone'. This carries risks both for staff and patients. As part of a quality improvement programme, the authors undertook an in-depth analysis of demand and capacity for an emergency department in the UK. The paper describes this rigorous approach to capacity planning, which draws on techniques from other industries. Proper capacity planning is vital, but is often poorly done. Planning using aggregated data will lead to inadequate capacity. Understanding demand, and particularly the variation in that demand, is critical to success. Analysis of emergency department demand and capacity is the first step towards effective workforce planning and process redesign.

Patients in prehospital transport to the emergency department

DEFF Research Database (Denmark)

Bech, Camilla Louise Nørgaard; Brabrand, Mikkel; Mikkelsen, Søren

2018-01-01

BACKGROUND: Ambulance transfer is the first contact with the healthcare system for many patients in emergency conditions.We aimed to identify prognostic risk factors accessible in the prehospital phase that indicate an increased risk of 7-day mortality. PATIENTS AND METHODS: We included patients ...... aged 18 years or older, transferred by ambulance to the emergency department at Odense University Hospital, from 1 April 2012 to 30 September 2014. We carried out multivariate logistic regressions, adjusted for age and sex, to describe the relationship between vital sign values recorded...

76 FR 60067 - Privacy Act of 1974; Department of Homeland Security Federal Emergency Management Agency-012...

Science.gov (United States)

2011-09-28

... 1974; Department of Homeland Security Federal Emergency Management Agency--012 Suspicious Activity... establish a new system of records titled, ``Department of Homeland Security/Federal Emergency Management... Department of Homeland Security/Federal Emergency Management Agency to collect, maintain, and retrieve...

Profiling vocabulary acquisition in Irish.

Science.gov (United States)

O'Toole, Ciara; Fletcher, Paul

2012-01-01

Investigations into early vocabulary development, including the timing of the acquisition of nouns, verbs and closed-class words, have produced conflicting results, both within and across languages. Studying vocabulary development in Irish can contribute to this area, as it has potentially informative features such as a VSO word order, and semantically rich prepositions. This study used a parent report adapted for Irish, to measure vocabulary development longitudinally for children aged between 1,04 and 3,04. The findings indicated that the children learned closed-class words at relatively smaller vocabulary sizes compared to children acquiring other languages, and had a strong preference for nouns.

Effects of emergency department expansion on emergency department patient flow.

Science.gov (United States)

Mumma, Bryn E; McCue, James Y; Li, Chin-Shang; Holmes, James F

2014-05-01

Emergency department (ED) crowding is an increasing problem associated with adverse patient outcomes. ED expansion is one method advocated to reduce ED crowding. The objective of this analysis was to determine the effect of ED expansion on measures of ED crowding. This was a retrospective study using administrative data from two 11-month periods before and after the expansion of an ED from 33 to 53 adult beds in an academic medical center. ED volume, staffing, and hospital admission and occupancy data were obtained either from the electronic health record (EHR) or from administrative records. The primary outcome was the rate of patients who left without being treated (LWBT), and the secondary outcome was total ED boarding time for admitted patients. A multivariable robust linear regression model was used to determine whether ED expansion was associated with the outcome measures. The mean (±SD) daily adult volume was 128 (±14) patients before expansion and 145 (±17) patients after. The percentage of patients who LWBT was unchanged: 9.0% before expansion versus 8.3% after expansion (difference = 0.6%, 95% confidence interval [CI] = -0.16% to 1.4%). Total ED boarding time increased from 160 to 180 hours/day (difference = 20 hours, 95% CI = 8 to 32 hours). After daily ED volume, low-acuity area volume, daily wait time, daily boarding hours, and nurse staffing were adjusted for, the percentage of patients who LWBT was not independently associated with ED expansion (p = 0.053). After ED admissions, ED intensive care unit (ICU) admissions, elective surgical admissions, hospital occupancy rate, ICU occupancy rate, and number of operational ICU beds were adjusted for, the increase in ED boarding hours was independently associated with the ED expansion (p = 0.005). An increase in ED bed capacity was associated with no significant change in the percentage of patients who LWBT, but had an unintended consequence of an increase in ED boarding hours. ED expansion alone does

Chloramphenicol and acute esophagitis in the emergency department

Directory of Open Access Journals (Sweden)

Chad T Andicochea

2015-01-01

Full Text Available Even with its broad spectrum and low cost, concern over chloramphenicol′s adverse effects limited its use in the United States during the 1980s. Reports from United Kingdom and China in the 1990s demonstrated a low incidence of blood dyscrasias with the topical preparation of chloramphenicol, and showed continued good efficacy and low cost. Today, topical chloramphenicol is being used by some groups within otolaryngology and ophthalmology in the United States. As a result, emergency physicians are once again considering chloramphenicol-induced side effects in patients presenting to the emergency department. To date, there have been no published reports associating chest pain, dyspnea with chloramphenicol use, and there has only been one report of fungal esophagitis associated with topical chloramphenicol. We present a 31-year-old woman, 4 months status post tympanoplasty with a modified radical canal wall down mastoidectomy due to a cholesteatoma involving the epitympanum who had a residual tympanic membrane defect. She presented to the emergency department with chest "burning", with no other symptoms shortly after starting treatment with an insufflated combination antibiotic containing chloramphenicol. After ruling out cardiopulmonary or vascular etiology, she was treated successfully with a gastrointestinal cocktail cocktail for presumed esophagitis secondary to newly prescribed chloramphenicol.

Forecasting Irish Inflation: A Composite Leading Indicator

OpenAIRE

Quinn, Terry; Mawdsley, Andrew

1996-01-01

This paper presents the results of research into the construction of a composite leading indicator of the Irish rate of inflation, as measured by the annual percentage change in the Consumer Price Index (CPI). It follows the work of Fagan and Fell (1994) who applied the business cycle leading indicator methodology, initially established by Mitchell and Burns (1938,1946), to construct a composite leading indicator of the Irish business cycle.

Differential diagnosis of vertigo and dizziness in the emergency department.

Science.gov (United States)

Ozono, Yoshiyuki; Kitahara, Tadashi; Fukushima, Munehisa; Michiba, Takahiro; Imai, Ryusuke; Tomiyama, Youichirou; Nishiike, Suetaka; Inohara, Hidenori; Morita, Hisaki

2014-02-01

To establish a system of differential diagnosis for vertigo/dizziness at the Emergency Department (ED), careful history-taking of complications and examinations of nystagmus should be helpful and therefore prepared by ED staff. Vertigo/dizziness could come from various kinds of organs for equilibrium, sometimes resulting in an emergency due to the central origin. In the present study, we checked patients' background data at the ED in advance of a definitive diagnosis at the Department of Otolaryngology and examined the significance of the correlation between the data and the diagnosis. We studied a series of 120 patients with vertigo/dizziness, who visited the Departments of Emergency and Otolaryngology between April 2011 and March 2012. At the ED, we first checked patients' backgrounds and carried out neurologic and neuro-otologic examinations. At the Department of Otolaryngology, we finally diagnosed all the patients according to the criteria and classified the origins of vertigo/dizziness into central and non-central diseases. The ratio of patients with disease of central origin was 12.5% and that for non-central origin was 87.5%. The risk factors for cerebrovascular disease such as hypertension, heart disease, and diabetes were also the risk factors for central vertigo/dizziness by the chi-squared test. To predict a central origin for vertigo/dizziness, only gaze nystagmus was the significant factor by multivariate regression analysis.

Adult Status Epilepticus: A Review of the Prehospital and Emergency Department Management

Science.gov (United States)

Billington, Michael; Kandalaft, Osama R.; Aisiku, Imoigele P.

2016-01-01

Seizures are a common presentation in the prehospital and emergency department setting and status epilepticus represents an emergency neurologic condition. The classification and various types of seizures are numerous. The objectives of this narrative literature review focuses on adult patients with a presentation of status epilepticus in the prehospital and emergency department setting. In summary, benzodiazepines remain the primary first line therapeutic agent in the management of status epilepticus, however, there are new agents that may be appropriate for the management of status epilepticus as second- and third-line pharmacological agents. PMID:27563928

Primary medical care in Irish prisons

Directory of Open Access Journals (Sweden)

Allwright Shane PA

2010-03-01

Full Text Available Abstract Background An industrial dispute between prison doctors and the Irish Prison Service (IPS took place in 2004. Part of the resolution of that dispute was that an independent review of prison medical and support services be carried out by a University Department of Primary Care. The review took place in 2008 and we report here on the principal findings of that review. Methods This study utilised a mixed methods approach. An independent expert medical evaluator (one of the authors, DT inspected the medical facilities, equipment and relevant custodial areas in eleven of the fourteen prisons within the IPS. Semistructured interviews took place with personnel who had operational responsibility for delivery of prison medical care. Prison doctors completed a questionnaire to elicit issues such as allocation of clinician's time, nurse and administrative support and resources available. Results There was wide variation in the standard of medical facilities and infrastructure provided across the IPS. The range of medical equipment available was generally below that of the equivalent general practice scheme in the community. There is inequality within the system with regard to the ratio of doctor-contracted time relative to the size of the prison population. There is limited administrative support, with the majority of prisons not having a medical secretary. There are few psychiatric or counselling sessions available. Conclusions People in prison have a wide range of medical care needs and there is evidence to suggest that these needs are being met inconsistently in Irish prisons.

Travellers and Cowboys: Myths of the Irish West.

Science.gov (United States)

Bisplinghoff, Gretchen

The recent Irish film "Into the West" (1992) explores the myth of the West on two continents. Images from television and movies appear as a visual reference point within "Into the West"; the main characters, two young Irish boys, are fascinated with the American West of cowboys and Indians as depicted in countless Hollywood…

Clinical features of emergency department patients with depression ...

African Journals Online (AJOL)

Clinical features of emergency department patients with depression who had attempted to commit suicide by poisoning. ... MDD patients. Conclusion: In poisoning patients with MDD, physicians in the ED must consider that they have a higher tendency to show suicidal behavior and to have ingested multiple types of drugs.

Assessing the physical service setting: a look at emergency departments.

Science.gov (United States)

Steinke, Claudia

2015-01-01

To determine the attributes of the physical setting that are important for developing a positive service climate within emergency departments and to validate a measure for assessing physical service design. The design of the physical setting is an important and contributing factor for creating a service climate in organizations. Service climate is defined as employee perceptions of the practices, procedures, and behaviors that get rewarded, supported, and expected with regard to customer service and customer service quality. There has been research conducted which identifies antecedents within organization that promotes a positive service climate which in turn creates service-oriented behaviors by employees toward clients. The antecedent of the physical setting and its impact on perceptions of service climate has been less commonly explored. Using the concept of the physical service setting (which may be defined as aspects of the physical, built environment that facilitate the delivery of quality service), attributes of the physical setting and their relationship with service climate were explored by means of a quantitative paper survey distributed to emergency nurses (n = 180) throughout a province in Canada. The results highlight the validity and reliability of six scales measuring the physical setting and its relation to service. Respondents gave low ratings to the physical setting of their departments, in addition to low ratings of service climate. Respondents feel that the design of the physical setting in the emergency departments where they work is not conducive to providing quality service to clients. Certain attributes of the physical setting were found to be significant in influencing perceptions of service climate, hence service quality, within the emergency department setting. © The Author(s) 2015.

Evaluation and management of acute abdominal pain in the emergency department

Directory of Open Access Journals (Sweden)

Macaluso CR

2012-09-01

Full Text Available Christopher R Macaluso, Robert M McNamaraDepartment of Emergency Medicine, Temple University School of Medicine, Philadelphia, PA, USAAbstract: Evaluation of the emergency department patient with acute abdominal pain is sometimes difficult. Various factors can obscure the presentation, delaying or preventing the correct diagnosis, with subsequent adverse patient outcomes. Clinicians must consider multiple diagnoses, especially those life-threatening conditions that require timely intervention to limit morbidity and mortality. This article will review general information on abdominal pain and discuss the clinical approach by review of the history and the physical examination. Additionally, this article will discuss the approach to unstable patients with abdominal pain.Keywords: acute abdomen, emergency medicine, peritonitis

The association between home care visits and same-day emergency department use: a case-crossover study.

Science.gov (United States)

Jones, Aaron; Schumacher, Connie; Bronskill, Susan E; Campitelli, Michael A; Poss, Jeffrey W; Seow, Hsien; Costa, Andrew P

2018-04-30

The extent to which home care visits contribute to the delay or avoidance of emergency department use is poorly characterized. We examined the association between home care visits and same-day emergency department use among patients receiving publicly funded home care. We conducted a population-based case-crossover study among patients receiving publicly funded home care in the Hamilton-Niagara-Haldimand-Brant region of Ontario between January and December 2015. Within individuals, all days with emergency department visits after 5 pm were selected as cases and matched with control days from the previous week. The cohort was stratified according to whether patients had ongoing home care needs ("long stay") or short-term home care needs ("short stay"). We used conditional logistical regression to estimate the association between receiving a home care visit during the day and visiting the emergency department after 5 pm on the same day. A total of 4429 long-stay patients contributed 5893 emergency department visits, and 2836 short-stay patients contributed 3476 visits. Receiving a home care nursing visit was associated with an increased likelihood of visiting the emergency department after 5 pm on the same day in both long-stay (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.17-1.48) and short-stay patients (OR 1.22, 95% CI 1.07-1.39). Stronger associations were observed for less acute visits to the emergency department. No associations were observed for other types of home care visits. Patients receiving home care were more likely to visit the emergency department during the evening on days they received a nursing visit. The mechanism of the association between home care visits and same-day emergency department use and the extent to which same-day emergency department visits could be prevented or diverted require additional investigation. © 2018 Joule Inc. or its licensors.

[Managing the discharge of diabetic patients from the emergency department: a consensus paper].

Science.gov (United States)

Cuervo Pinto, Rafael; Álvarez-Rodríguez, Esther; González Pérez de Villar, Noemí; Artola-Menéndez, Sara; Girbés Borrás, Juan; Mata-Cases, Manel; Galindo Rubio, Mercedes; Puig Larrosa, Juan; Muñoz Albert, Ricardo; Díaz Pérez, José Ángel

2017-10-01

Eighty to 90% of patients attended in emergency departments are discharged to home. Emergency department physicians are therefore responsible for specifying how these patients are treated afterwards. An estimated 30% to 40% of emergency patients have diabetes mellitus that was often decompensated or poorly controlled prior to the emergency. It is therefore necessary to establish antidiabetic treatment protocols that contribute to adequate metabolic control for these patients in the interest of improving the short-term prognosis after discharge. The protocols should also maintain continuity of outpatient care from other specialists and contribute to improving the long-term prognosis. This consensus paper presents the consensus of experts from 3 medical associations whose members are directly involved with treating patients with diabetes. The aim of the paper is to facilitate the assessment of antidiabetic treatment when the patient is discharged from the emergency department and referred to outpatient care teams.

Future enhanced clinical role of pharmacists in emergency departments in England:multi-site observational evaluation

OpenAIRE

Hughes, Elizabeth; Terry, David; Huynh, Chi; Petridis, Konstantinos; Aiello, Matthew; Mazard, Louis; Ubhi, Hirminder; Terry, Alex; Wilson, Keith; Sinclair, Anthony

2017-01-01

Background There are concerns about maintaining appropriate clinical staffing levels in Emergency Departments. Pharmacists may be one possible solution. Objective To determine if Emergency Department attendees could be clinically managed by pharmacists with or without advanced clinical practice training. Setting Prospective 49 site cross-sectional observational study of patients attending Emergency Departments in England. Method Pharmacist data collectors identified patient attendance at thei...

Attitudes of Irish dental graduates to vocational training.

LENUS (Irish Health Repository)

McKenna, G

2010-05-01

Vocational training (VT) is a mandatory 12 month period for UK dental graduates after graduation. Graduates of Irish Dental Schools are eligible to enter the general dental service in Ireland or obtain an NHS performers list number in the UK immediately after qualification. Reports would suggest that some graduates of Irish Dental Schools are choosing to take part in VT in the UK and find the experience beneficial. This study aimed to record the uptake of VT amongst recent graduates from University College Cork and to document their experiences. It was designed to compare the attitudes and experiences of graduates of Irish Dental Schools who undertook VT compared with those who entered the general dental service.

Technetium-99 in the Irish marine environment

Energy Technology Data Exchange (ETDEWEB)

Smith, V.; Fegan, M.; Pollard, D.; Long, S.; Hayden, E.; Ryan, T.P

2001-07-01

Technetium-99 activity concentrations in seawater and biota from Irish coastal waters are presented. Time series measurements of {sup 99}Tc in seawater and Fucus vesiculosus from the western Irish Sea show that activity concentrations have increased in line with the increase in discharges of {sup 99}Tc from Sellafield. The peak in activity concentrations in both seawater and Fucus vesiculosus occurred in 1997 approximately two years after the peak in {sup 99}Tc discharges. The highest activity concentration recorded in Fucus vesiculosus showed a 29-fold increase over the mean concentration for the period 1988-1993. Technetium-99 activity concentrations were measured in fish, lobsters, prawns, mussels and oysters landed at major fishing ports on the east and northeast coasts of Ireland between 1996 and 1998. Concentration factors for {sup 99}Tc in the brown seaweed Fucus vesiculosus and certain species of fish, crustaceans and molluscs from the Irish Sea were estimated. In general, these concentration factors were higher than those in the literature which were derived from laboratory studies, but agreed well with values which were based on field studies. The mean committed effective doses to Irish typical and heavy seafood consumers due to {sup 99}Tc in the period 1996-1998 were 0.061 and 0.24 {mu}Sv, respectively.

Modeling factors influencing the demand for emergency department services in ontario: a comparison of methods

Directory of Open Access Journals (Sweden)

Meaney Christopher

2011-08-01

Full Text Available Abstract Background Emergency departments are medical treatment facilities, designed to provide episodic care to patients suffering from acute injuries and illnesses as well as patients who are experiencing sporadic flare-ups of underlying chronic medical conditions which require immediate attention. Supply and demand for emergency department services varies across geographic regions and time. Some persons do not rely on the service at all whereas; others use the service on repeated occasions. Issues regarding increased wait times for services and crowding illustrate the need to investigate which factors are associated with increased frequency of emergency department utilization. The evidence from this study can help inform policy makers on the appropriate mix of supply and demand targeted health care policies necessary to ensure that patients receive appropriate health care delivery in an efficient and cost-effective manner. The purpose of this report is to assess those factors resulting in increased demand for emergency department services in Ontario. We assess how utilization rates vary according to the severity of patient presentation in the emergency department. We are specifically interested in the impact that access to primary care physicians has on the demand for emergency department services. Additionally, we wish to investigate these trends using a series of novel regression models for count outcomes which have yet to be employed in the domain of emergency medical research. Methods Data regarding the frequency of emergency department visits for the respondents of Canadian Community Health Survey (CCHS during our study interval (2003-2005 are obtained from the National Ambulatory Care Reporting System (NACRS. Patients' emergency department utilizations were linked with information from the Canadian Community Health Survey (CCHS which provides individual level medical, socio-demographic, psychological and behavioral information for

Modeling factors influencing the demand for emergency department services in Ontario: a comparison of methods.

Science.gov (United States)

Moineddin, Rahim; Meaney, Christopher; Agha, Mohammad; Zagorski, Brandon; Glazier, Richard Henry

2011-08-19

Emergency departments are medical treatment facilities, designed to provide episodic care to patients suffering from acute injuries and illnesses as well as patients who are experiencing sporadic flare-ups of underlying chronic medical conditions which require immediate attention. Supply and demand for emergency department services varies across geographic regions and time. Some persons do not rely on the service at all whereas; others use the service on repeated occasions. Issues regarding increased wait times for services and crowding illustrate the need to investigate which factors are associated with increased frequency of emergency department utilization. The evidence from this study can help inform policy makers on the appropriate mix of supply and demand targeted health care policies necessary to ensure that patients receive appropriate health care delivery in an efficient and cost-effective manner. The purpose of this report is to assess those factors resulting in increased demand for emergency department services in Ontario. We assess how utilization rates vary according to the severity of patient presentation in the emergency department. We are specifically interested in the impact that access to primary care physicians has on the demand for emergency department services. Additionally, we wish to investigate these trends using a series of novel regression models for count outcomes which have yet to be employed in the domain of emergency medical research. Data regarding the frequency of emergency department visits for the respondents of Canadian Community Health Survey (CCHS) during our study interval (2003-2005) are obtained from the National Ambulatory Care Reporting System (NACRS). Patients' emergency department utilizations were linked with information from the Canadian Community Health Survey (CCHS) which provides individual level medical, socio-demographic, psychological and behavioral information for investigating predictors of increased emergency

Effective communication of public health guidance to emergency department clinicians in the setting of emerging incidents: a qualitative study and framework.

Science.gov (United States)

Khan, Yasmin; Sanford, Sarah; Sider, Doug; Moore, Kieran; Garber, Gary; de Villa, Eileen; Schwartz, Brian

2017-04-28

Evidence to inform communication between emergency department clinicians and public health agencies is limited. In the context of diverse, emerging public health incidents, communication is urgent, as emergency department clinicians must implement recommendations to protect themselves and the public. The objectives of this study were to: explore current practices, barriers and facilitators at the local level for communicating public health guidance to emergency department clinicians in emerging public health incidents; and develop a framework that promotes effective communication of public health guidance to clinicians during emerging incidents. A qualitative study was conducted using semi-structured interviews with 26 key informants from emergency departments and public health agencies in Ontario, Canada. Data were analyzed inductively and the analytic approach was guided by concepts of complexity theory. Emergent themes corresponded to challenges and strategies for effective communication of public health guidance. Important challenges related to the coordination of communication across institutions and jurisdictions, and differences in work environments across sectors. Strategies for effective communication were identified as the development of partnerships and collaboration, attention to specific methods of communication used, and the importance of roles and relationship-building prior to an emerging public health incident. Following descriptive analysis, a framework was developed that consists of the following elements: 1) Anticipate; 2) Invest in building relationships and networks; 3) Establish liaison roles and redundancy; 4) Active communication; 5) Consider and respond to the target audience; 6) Leverage networks for coordination; and 7) Acknowledge and address uncertainty. The qualities inherent in local relationships cut across framework elements. This research indicates that relationships are central to effective communication between public health

Retrospective Evaluation of Patients Admitted to the Pediatric Emergency Department with Intoxication

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Alaaddin Yorulmaz

2017-12-01

Full Text Available Introduction: In this study, we aimed to retrospectively analyze the demographic and epidemiologic features, clinical course, laboratory results and prognoses of the patients admitted to the department of pediatric emergency due to poisoning. Methods: This trial enrolled a total of 430 patients aged 1 month to 18 years. The medical data of the patients were reviewed retrospectively according to patient's medical record. Demographic data such as age, sex, time of occurrence, time of patient presentation to the emergency department, time to first medical intervention after taking the drug, cause of poisoning, received active substances, ways of taking, number of active substances received, and symptoms at admission to the hospital were analyzed. Results: The study population consisted of 0.74% of all patients who were admitted to the department of pediatric emergency. 243 (56.5% patients were female and 187 (43.5% were male. The age of the patients ranged from 4 months to 220 months (72.89±66.38. One hundred-thirteen (26.3% of our patients were referred to our hospital in the summer, 111 (25.8% in the spring, 110 (25.6% in the autumn and 96 (22.3% in the winter. Eighteen patients were admitted to our emergency department with poisoning in 2014, 193 in 2015, 178 in 2016 and 41 in 2017. 12.3% of our patients were referred to our emergency department between hours 00:00 and 08:00, 35.1% between 08:00 and 16:00 and 52.6% between 16:00 and 24:00. Ninety-six of the patients were admitted to our emergency department due to suicidal poisoning and 334 due to accidental poisoning. Nausea was present at the time of presentation in 142 (33.02% of our patients, vomiting in 122 (28.37% and dizziness in 102 (23.72%. Conclusion: We believe that determination of the epidemiological features of the poisonings in our country by large scale studies and public consciousness will contribute significantly to the prevention of childhood poisoning.

Angels and IPOs: Policies for Sustainable Equity Financing of Irish Small Businesses

OpenAIRE

Mulcahy, Diane

2005-01-01

Angels and IPOs: Policies for Sustainable Equity Financing of Irish Small Businesses explores the rationale for the Irish government?s investments of more than 300 million Euro in Irish companies and the domestic venture capital industry. It challenges the conventional wisdom that there is an `equity gap? of early stage risk capital in Ireland. In the context of the equity financing cycle, it discusses the limited supply of angel capital available to Irish firms as well as the `exit gap? resu...

How Can an Emergency Department Assist Patients and Caregivers at the End of Life?

Science.gov (United States)

... And Caregivers At The End Of Life? How Can An Emergency Department Assist Patients And Caregivers At ... your family. Five ways that the Emergency Department can help 1. Assist in the recognition and understanding ...

Assessment and Management of Bullied Children in the Emergency Department

Science.gov (United States)

Waseem, Muhammad; Ryan, Mary; Foster, Carla Boutin; Peterson, Janey

2015-01-01

Bullying is an important public health issue in the United States. Up to 30% of children report exposure to such victimization. Not only does it hurt bully victim, but it also negatively impacts the bully, other children, parents, school staff, and health care providers. Because bullying often presents with accompanying serious emotional and behavioral symptoms, there has been an increase in psychiatric referrals to emergency departments. Emergency physicians may be the first responders in the health care system for bullying episodes. Victims of bullying may present with nonspecific symptoms and be reluctant to disclose being victimized, contributing to the underdiagnosis and underreporting of bully victimization. Emergency physicians therefore need to have heightened awareness of physical and psychosocial symptoms related to bullying. They should rapidly screen for bullying, assess for injuries and acute psychiatric issues that require immediate attention, and provide appropriate referrals such as psychiatry and social services. This review defines bullying, examines its presentations and epidemiology, and provides recommendations for the assessment and evaluation of victims of bullying in the emergency department. PMID:23462401

Complaints from emergency department patients largely result from treatment and communication problems.

Science.gov (United States)

Taylor, David McD; Wolfe, Rory; Cameron, Peter A

2002-03-01

Emergency department patient complaints are often justified and may lead to apology, remedial action or compensation. The aim of the present study was to analyse emergency department patient complaints in order to identify procedures or practices that require change and to make recommendations for intervention strategies aimed at decreasing complaint rates. We undertook a retrospective analysis of patient complaints from 36 Victorian emergency departments during a 61 month period. Data were obtained from the Health Complaint Information Program (Health Services Commissioner). In all, 2,419 emergency department patients complained about a total of 3,418 separate issues (15.4% of all issues from all hospital departments). Of these, 1,157 complaints (47.80%) were received by telephone and 829 (34.3%) were received by letter; 1,526 (63.1 %) complaints were made by a person other than the patient. Highest complaint rates were received from patients who were female, born in non-English-speaking countries and very young or very old. One thousand one hundred and forty-one issues (33.4%) related to patient treatment, including inadequate treatment (329 issues) and inadequate diagnosis (249 issues); 1079 (31.6%) issues related to communication, including poor staff attitude, discourtesy and rudeness (444 issues); 407 (11.9%) issues related to delay in treatment. Overall, 2516 issues (73.6%) were resolved satisfactorily, usually by explanation or apology. Only 59 issues (1.7%) resulted in a procedure or policy change. Remedial action was taken in 109 issues (3.2%) and compensation was paid to eight patients. Communication remains a significant factor in emergency department patient dissatisfaction. While patient complaints have resulted in major changes to policy and procedure, research and intervention strategies into communication problems are indicated. In the short term, focused staff training is recommended.

EJBEVol.1 No.1/2010 Page 134 The Conditionality of Irish aid ...

African Journals Online (AJOL)

User

focus will be on the impact of Irish development assistance in Sudan. Irish aid administered by .... 'priority' countries and the relationships between Irish Aid and trade. ..... of excessive government spending, budget deficits and inflation, and overvalued ..... indemnified against any credit risk from overseas customers by the.

Prospective Analysis of Geriatric Patients Admitted to Emergency Department With Trauma

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Abdulkadir Akturk

2013-08-01

Full Text Available Objective: The aim of this study is to reveal the demographic characteristics, causes of trauma, physical examination findings, the presence of fractures and the status of the outcome of the geriatric trauma patients admitted to the emergency department of an educational research hospital. Material and Methods: This study covers all the cases over 65 years who were admitted to emergency department with trauma between September 1 2011-31 August 2012. The demographic characteristics of the patients such as, age, gender, date of application and as well as the causes of trauma, physical examination findings and outcome situation in the emergency department were evaluated. The study was performed prospectively. SPSS V.20 was used for statistical analysis of the data obtained. Results: Total 175 patients were included to the study, 74 were male (42.28% and 101 were female (57.72%. The mean age of male patients were 75.01 ± 6.557 while the mean age of female patients were 76.10 ± 7.353. The most common cause of trauma in both gender was falls. This rate was 91.1% in female and 8.9% in male patients. 40.6% of the female patients and 27% of the male patients were admitted to the hospital before because of any trauma. The most common form of trauma according to exposed body localization in both gender was extremity traumas. It was seen in 51.5% of the females and 56.8% of the males. 30 female patients (29.7% and 13 male patients (17.6% had fracture in limbs. 78.3% of all patients were discharged from the emergency department and 21.7% of the patients were hospitalised. None of the patients were died in emergency department and none of the patients were referred to another institution from the emergency department. Total 38 patients were hospitalised, 32 of them were discharged, 2 of them were referred to another institution, and 4 of them were died. 26 of 38 hospitalised patients had undergone surgery while 20 of them were orthopedic surgeries

Forensic Emergency Medicine - Six-Year Experience of 13823 Cases in a University Emergency Department

OpenAIRE

DEMİRCAN, Ahmet; KELEŞ, Ayfer; GÜRBÜZ, Neslihan; BİLDİK, Fikret

2008-01-01

Aims: Clinical forensic medicine deals with cases involving both the legal and medical aspects of patient care, such as motor vehicle trauma or poisoning. In this study, we aimed to draw attention to the forensic issues by retrospective investigation of 13823 emergency cases and to share our experiences on this topic. Materials and Methods: This retrospective study was conducted in a university Emergency Department (ED) in Ankara, Turkey. The data were collected from official hospital polic...

Bowery to Broadway. The American Irish in Classic Hollywood Cinema (Christopher Shannon & New Irish Storytellers. Narrative Strategies in Film (Díóg O’Connell

Directory of Open Access Journals (Sweden)

Carlos Menéndez-Otero

2011-03-01

Full Text Available Reseñas de los libros de cine Bowery to Broadway. The American Irish in Classic Hollywood Cinema (Christopher Shannon 2010 & New Irish Storytellers. Narrative Strategies in Film (Díóg O’Connell 2010

Emergency department performance measures updates: proceedings of the 2014 emergency department benchmarking alliance consensus summit.

Science.gov (United States)

Wiler, Jennifer L; Welch, Shari; Pines, Jesse; Schuur, Jeremiah; Jouriles, Nick; Stone-Griffith, Suzanne

2015-05-01

The objective was to review and update key definitions and metrics for emergency department (ED) performance and operations. Forty-five emergency medicine leaders convened for the Third Performance Measures and Benchmarking Summit held in Las Vegas, February 21-22, 2014. Prior to arrival, attendees were assigned to workgroups to review, revise, and update the definitions and vocabulary being used to communicate about ED performance and operations. They were provided with the prior definitions of those consensus summits that were published in 2006 and 2010. Other published definitions from key stakeholders in emergency medicine and health care were also reviewed and circulated. At the summit, key terminology and metrics were discussed and debated. Workgroups communicated online, via teleconference, and finally in a face-to-face meeting to reach consensus regarding their recommendations. Recommendations were then posted and open to a 30-day comment period. Participants then reanalyzed the recommendations, and modifications were made based on consensus. A comprehensive dictionary of ED terminology related to ED performance and operation was developed. This article includes definitions of operating characteristics and internal and external factors relevant to the stratification and categorization of EDs. Time stamps, time intervals, and measures of utilization were defined. Definitions of processes and staffing measures are also presented. Definitions were harmonized with performance measures put forth by the Centers for Medicare and Medicaid Services (CMS) for consistency. Standardized definitions are necessary to improve the comparability of EDs nationally for operations research and practice. More importantly, clear precise definitions describing ED operations are needed for incentive-based pay-for-performance models like those developed by CMS. This document provides a common language for front-line practitioners, managers, health policymakers, and researchers. �

The National Trauma Data Bank story for emergency department thoracotomy: How old is too old?

Science.gov (United States)

Gil, Lindsay A; Anstadt, Michael J; Kothari, Anai N; Javorski, Michael J; Gonzalez, Richard P; Luchette, Fred A

2018-03-01

The fastest growing segment of the American population is the elderly (>65 years). This change in demographics also is being seen in trauma centers. Emergency department thoracotomy is utilized in an attempt to restore circulation for patients arriving in extremis. The purpose of this study was to investigate the relationship between clinical variables, particularly age, and outcomes for injured patients receiving an emergency department thoracotomy. Using the National Trauma Data Bank for years 2008-2012, observations with International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes for exploratory thoracotomy were identified. Emergency department thoracotomy was defined as any observation that occurred at a time to thoracotomy less than the total time spent in the emergency department thoracotomy, and within 15 minutes of arrival. Mechanisms of injury, demographic data, and injuries were analyzed for predictors of survival and mortality rates. Mortality rates were determined for each decade and year of life. There were 11,380 observations for thoracotomy identified. Of these, 2,519 were emergency department thoracotomy, with the majority (n= 2,026, 80% observations) performed for penetrating wounds. Mortality rates ranged from 80% to 100% for each decade of life. Mortality was 100% for patients >57 years old with either penetrating or blunt mechanisms of injury. Emergency department thoracotomy offered no survival benefit for patients older than 57 years of age. These data suggest that emergency department thoracotomy performed in elderly patients may be futile. Copyright © 2017 Elsevier Inc. All rights reserved.

Prognostic value of infrared thermography in an emergency department

DEFF Research Database (Denmark)

Holm, Jesper K; Kellett, John G; Jensen, Nadia H

2018-01-01

OBJECTIVE: In this study, we aimed to investigate the prognostic potential of infrared thermography in a population of medical patients admitted to the emergency department. Central-to-peripheral temperature gradients were analyzed for association with 30-day mortality. METHODS: This prospective...... as a marker for central temperature and the three others as markers for peripheral temperatures, resulting in three gradients per patient. Thirty-day follow-up was performed and 30-day mortality was reported. RESULTS: One hundred and ninety-eight patients were included and the number of events was nine...... observational study included 198 medical patients admitted to the Emergency Department, at Odense University Hospital. A standardized thermal picture was taken and temperatures of the inner canthus, the earlobe, the nose tip, and the tip of the third finger were reported. The inner canthus was chosen...

Wait times in the emergency department for patients with mental illness

Science.gov (United States)

Atzema, Clare L.; Schull, Michael J.; Kurdyak, Paul; Menezes, Natasja M.; Wilton, Andrew S.; Vermuelen, Marian J.; Austin, Peter C.

2012-01-01

Background: It has been suggested that patients with mental illness wait longer for care than other patients in the emergency department. We determined wait times for patients with and without mental health diagnoses during crowded and noncrowded periods in the emergency department. Methods: We conducted a population-based retrospective cohort analysis of adults seen in 155 emergency departments in Ontario between April 2007 and March 2009. We compared wait times and triage scores for patients with mental illness to those for all other patients who presented to the emergency department during the study period. Results: The patients with mental illness (n = 51 381) received higher priority triage scores than other patients, regardless of crowding. The time to assessment by a physician was longer overall for patients with mental illness than for other patients (median 82, interquartile range [IQR] 41–147 min v. median 75 [IQR 36–140] min; p < 0.001). The median time from the decision to admit the patient to hospital to ward transfer was markedly shorter for patients with mental illness than for other patients (median 74 [IQR 15–215] min v. median 152 [IQR 45–605] min; p < 0.001). After adjustment for other variables, patients with mental illness waited 10 minutes longer to see a physician compared with other patients during noncrowded periods (95% confidence interval [CI] 8 to 11), but they waited significantly less time than other patients as crowding increased (mild crowding: −14 [95% CI −12 to −15] min; moderate crowding: −38 [95% CI −35 to −42] min; severe crowding: −48 [95% CI −39 to −56] min; p < 0.001). Interpretation: Patients with mental illness were triaged appropriately in Ontario’s emergency departments. These patients waited less time than other patients to see a physician under crowded conditions and only slightly longer under noncrowded conditions. PMID:23148052

76 FR 23708 - Safety Zone; Pierce County Department of Emergency Management Regional Water Exercise, East...

Science.gov (United States)

2011-04-28

...-AA00 Safety Zone; Pierce County Department of Emergency Management Regional Water Exercise, East... the Regional Water Rescue Exercise. Basis and Purpose The Pierce County, Washington, Department of... to read as follows: Sec. 165.T13-0251 Safety Zone; Pierce County Department of Emergency Management...

Making the Case for Irish through English: Eco-critical Politics of Language by Learners

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John L. Murphy

2010-03-01

Full Text Available This paper examines recent accounts by Americans who have learned Irish. Their narratives from the West of Ireland express what translation theorist Michael Cronin calls ‘individualist politics of language’. He claims that the English-speaking majority will determine the survival of 21st century Irish.  Cronin shifts Irish into a globalized, ‘late modern’ network. Foreign-born learners enter this network when they choose to study Irish. They counter the stereotype of Irish schoolchildren forced into rote recitation of a moribund language.  Patricia Monaghan combines goddess-worship with academic research into indigenous spirituality, place-name lore, literature, and the Irish environmental inheritance. Her travelogue and reports by five other American visitors to Gaeltachtaí are compared with John Montague and Éilís Ní Dhuibhne’s literary depictions of 20th-century Irish-born school-level learners.Feminist, post-colonial, and literary criticisms enrich understanding of how American students apply ecological and cultural strategies that seek to recover this indigenous language. Choosing to make the case for Irish, adult students share Cronin’s ‘individualist politics’. In English-language books, American advocates preserve and expand a linguistic ecology in which Irish may survive.

Between Irish National Cinema and Hollywood: Neil Jordan’s Michael Collins

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Raita Merivirta-Chakrabarti

2007-03-01

Full Text Available When Neil Jordan’s film Michael Collins was released in 1996, it was seen by some as a Hollywood epic, by others as a great national film. I would argue that Michael Collins combines these two traditions and occupies a space between Irish national cinema and Hollywood. The subject matter, the creative talent and the locations were Irish and the film was produced by using the Irish filmmaking infrastructure and the Irish government’s support mechanisms, but it was largely financed and distributed by a Hollywood studio. Also, to make it more appealing especially globally, but probably also locally (since Hollywood is now the international standard, it makes use of Hollywood conventions, making it accessible to international audiences as well. Despite the Hollywood mode, the fact remains that Michael Collins is a national film text, and Jordan does not make too many concessions to the non-Irish audiences.

Nurse-Physician Teamwork in the Emergency Department

OpenAIRE

Ajeigbe, David Oladipo

2012-01-01

Background: Teamwork gained momentum in the 1980s. Research studies in the military and aviation demonstrated that teamwork is essential to safety. There were limited studies dealing with the practice of teamwork between nurses and physicians in the Emergence Departments (EDs). Aims: Descriptive aim of the study was to examine differences between staff in the Interventional and Control Groups on perception of staff teamwork. The exploratory aim was to examine staff perception of job satisfac...

Workplace violence in the emergency department in the Kingdom of Saudi Arabia

OpenAIRE

ALSHEHRI, WALEED MOHAMMED A.

2017-01-01

This study explored workplace violence among emergency department nurses and doctors in public hospitals in Saudi Arabia for the first time. Workplace violence is prevalent among nurses and doctors and it has physical, psychological and emotional impact. There is a lack of safety measures, precautions and management support for victims. Most staff feel vulnerable to violence in the next 12 months of employment. The findings will inform Emergency Department managements and the Ministry of H...

Profiling the Cross-Border Funding of the Irish Banking System

OpenAIRE

Coates, Dermot; Everett, Mary

2013-01-01

Between 2002 and 2008, there was a surge in foreign funding ows to the Irish banking system. This unprecedented increase in in ows was a key driver of the credit boom in Ireland. In the wake of the domestic banking and global nancial crises, the Irish banking system experienced a sharp decrease in its foreign wholesale funding. This Economic Letter addresses two primary questions: (i) who funded the Irish banking system during the boom?; and (ii) how did foreign funding contract in the post-S...

Experiences of counselling in the emergency department during the waiting period: importance of family participation.

Science.gov (United States)

Paavilainen, Eija; Salminen-Tuomaala, Mari; Kurikka, Sirpa; Paussu, Paula

2009-08-01

To describe patients' experiences of counselling, defined as information giving and advice by nursing staff, in the emergency department. A particular focus was on the waiting period and on the importance of family participation in counselling. Counselling is a widely studied topic in nursing. Too little is known about counselling in emergency departments and especially about participation of family members and suitability of counselling for the patient's life situation. Descriptive quantitative study. Data were collected by questionnaires from patients (n = 107) visiting a hospital emergency department. The data were subjected to statistical analysis. Forty-two per cent of patients arrived at the emergency department with a family member: spouse or cohabiting partner, mother, father or daughter. Patients were fairly satisfied with the counselling. The presence of a family member was important to the majority of patients (75%). About half of the patients wanted information concerning their illness, condition and treatment to be given to their family members. Those visiting the department with a family member were more satisfied with counselling and felt that it promoted their participation in care. It is to encourage patients' family members to participate in counselling situations in emergency departments. However, the type of information passed on to family members should be carefully discussed and prepared. Patients' family members seem to be important partners in counselling situations. The presence of family members supports patients in the emergency department during the waiting period and helps them orientate in their situation. When family members are present, issues which patients wish to discuss should be carefully planned. Family presence should be encouraged in emergency departments.

Accumulation of technetium-99 in the Irish Sea?

International Nuclear Information System (INIS)

Leonard, Kinson S.; McCubbin, David; Bonfield, Rachel; McDonald, Paul; Service, Matthew; Conney, Stuart

2004-01-01

An assessment has been carried out to determine the impact of continued 99 Tc discharges into the Irish Sea from the nuclear fuels reprocessing plant at Sellafield. Samples of surface and bottom seawater and sediment have been collected from the Irish Sea and analysed for 99 Tc. The information has been used, together with supporting data, to determine the effect of summer stratification upon the seawater concentrations and to evaluate whether sediments provide a sink for 99 Tc. Hydrographic data provide clear evidence of thermal stratification of waters above the muddy sediment in the western Irish Sea. Surface water contained higher 99 Tc concentrations than bottom water, and concentrations were inversely related to water salinity. This inverse relationship was not observed in the eastern Irish Sea close to Sellafield. 99 Tc activities in surficial sediments were greatest (>20 Bq/kg) at sites closest to the Cumbrian coastline. Activity, from equivalent sampling sites, remained similar between surveys carried out in 1995 and 1998. The muted response of the seabed sediments, to fluctuations in the Sellafield discharges, compared with the water column is to be expected given that they reflect the integrated radionuclide discharge history

Pediatric wound care and management in the emergency department [digest].

Science.gov (United States)

Sanders, Jennifer E; Pade, Kathryn H

2017-10-23

Traumatic wounds and lacerations are common pediatric presenting complaints to emergency departments. Although there is a large body of literature on wound care, many emergency clinicians base management of wounds on theories and techniques that have been passed down over time. Therefore, controversial, conflicting, and unfounded recommendations are prevalent. This issue reviews evidence-based recommendations for wound care and management, including wound cleansing and irrigation, anxiolysis/sedation techniques, closure methods, and post-repair wound care. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].

The role of teamwork and communication in the emergency department: a systematic review.

Science.gov (United States)

Kilner, Emily; Sheppard, Lorraine A

2010-07-01

The aim of this study was to develop a systematic review using international research to describe the role of teamwork and communication in the emergency department, and its relevance to physiotherapy practice in the emergency department. Searches were conducted of CINAHL, Academic Search Premier, Scopus, Cochrane, PEDro, Medline, Embase, Amed and PubMed. Selection criteria included full-text English language research papers related to teamwork and/or communication based directly in the emergency department, involvement of any profession in the emergency department, publication in peer-reviewed journals, and related to adult emergency services. Studies were appraised using a validated critical appraisal tool. Fourteen eligible studies, all of mid-range quality, were identified. They demonstrated high levels of staff satisfaction with teamwork training interventions and positive staff attitudes towards the importance of teamwork and communication. There is moderate evidence that the introduction of multidisciplinary teams to the ED may be successful in reducing access block, and physiotherapists may play a role in this. The need for teamwork and communication in the ED is paramount, and their roles are closely linked, with the common significant purposes of improving patient safety, reducing clinical errors, and reducing waiting times. 2009 Elsevier Ltd. All rights reserved.

The Integration of Palliative Care into the Emergency Department

OpenAIRE

BASOL, Nursah

2015-01-01

SUMMARY: Palliative care (PC) is a new and developing area. It aims to provide the best possible quality of life for patients with life-limiting diseases. It does not primarily include life-extending therapies, but rather tries to help patients spend the rest of their lives in the best way. PC patients often are admitted to emergency departments during the course of a disease. The approach and management of PC include differences with emergency medicine. Thus, there are some problems while pr...

Is Bank Finance the Achilles' Heel of Irish SMEs?

Science.gov (United States)

Carey, Dermot; Flynn, Antoinette

2005-01-01

Purpose: The purpose of this research paper is to examine the implications of new banking regulations (Basel II) for the Irish SME sector. Training gaps are identified and recommendations to advance social capital networks are provided. Design/methodology/approach: The Irish SME dependence on external (bank) finance and their susceptibility to…

Emergency department visits during an Olympic gold medal television broadcast.

Science.gov (United States)

Redelmeier, Donald A; Vermeulen, Marian J

2011-01-01

Practice pattern variations are often attributed to physician decision-making with no accounting for patient preferences. To test whether a mass media television broadcast unrelated to health was associated with changes in the rate and characteristics of visits for acute emergency care. Time-series analysis of emergency department visits for any reason. Population-based sample of all patients seeking emergency care in Ontario, Canada. The broadcast day was defined as the Olympic men's gold medal ice hockey game final. The control days were defined as the 6 Sundays before and after the broadcast day. A total of 99 447 visits occurred over the 7 Sundays, of which 13 990 occurred on the broadcast day. Comparing the broadcast day with control days, we found no significant difference in the hourly rate of visits before the broadcast (544 vs 537, p = 0.41) or after the broadcast (647 vs 639, p = 0.55). In contrast, we observed a significant reduction in hourly rate of visits during the broadcast (647 vs 783, p television broadcasts can influence patient preferences and thereby lead to a decrease in emergency department visits.

The Role of Irish Language Teaching: Cultural Identity Formation or Language Revitalization?

Science.gov (United States)

Slatinská, Anna; Pecníková, Jana

2017-01-01

The focal point of the article is Irish language teaching in the Republic of Ireland. Firstly, we deal with the most significant documents where the status of the Irish language is being defined. In this respect, for the purposes of analysis, we have chosen the document titled "20 Year Strategy for the Irish language" which plays a…

‘Old Ireland and Himself’: William Orpen and the Conflicts of Irish Identity

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Roy Foster

2005-03-01

Full Text Available The Irish painter William Orpen (1878-1931, defined here as Ireland’s most ‘Spanish’ painter, was out of fashion for fifty years after his death; but he has recently been dramatically revalued, with his works fetching huge prices in salerooms and an unprecedentedly large exhibition of his work being mounted in London and subsequently Dublin. Best known for his Edwardian portraits and his devastating paintings of the First World War, he also produced a series of allegorical paintings of his native Ireland. These are discussed in this article, and linked to his admiration for J.M.Synge, his dislike of clericalism and repression in Irish life, and his celebration of sensuality. The same themes lie behind ‘Homage to Manet’, a celebrated group portrait which includes the Irish novelist George Moore and the art collector Hugh Lane —a close friend of Orpen’s. Orpen knew other figures of the cultural Revival, and his relation to them is discussed; as is the conflict of identity he experienced (like other middle-class Irish Protestants when the radicalisation of Irish politics and the outbreak of the First World War put a new strain on the allegiances of people who had previously thought of themselves as both ‘British’ and ‘Irish’. After the trauma of the War, and Irish separation, Orpen opted for Britain; but, it is argued, he was closer to elements of the Irish cultural revival, and more involved with Irish politics and Irish history, than is usually accepted.

Emergency department visual urinalysis versus laboratory urinalysis.

Science.gov (United States)

Worrall, James C

2009-11-01

The primary objective of this study was to compare the results of nurse-performed urinalysis (NPU) interpreted visually in the emergency department (ED) with laboratory performed urinalysis (LPU) interpreted by reflectance photometry. This was a prospective observational study based on a convenience sample from my emergency practice. Emergency nurses, who were unaware of the study, performed usual dipstick analysis before sending the same urine sample to the laboratory for testing. Of 140 urinalyses performed during the study period, 124 were suitable for analysis. When compared with the reference standard LPU, the NPU had an overall sensitivity of 100% (95% confidence interval [CI] 95%-100%) and a specificity of 49% (95% CI 33%-65%) for the presence of any 1 of blood, leukocyte esterase, nitrites, protein, glucose or ketones in the urine. Of 20 falsely positive NPUs, 18 were a result of the nurse recording 1 or more components as "trace" positive. Although NPU does not yield identical results to LPU, a negative LPU is expected when the initial NPU in the ED is negative.

Tumultuous atmosphere (physical, mental), the main barrier to emergency department inter-professional communication.

Science.gov (United States)

Jafari Varjoshani, Nasrin; Hosseini, Mohammad Ali; Khankeh, Hamid Reza; Ahmadi, Fazlollah

2014-08-22

A highly important factor in enhancing quality of patient care and job satisfaction of health care staff is inter-professional communication. Due to the critical nature of the work environment, the large number of staff and units, and complexity of professional tasks and interventions, inter-professional communication in an emergency department is particularly and exceptionally important. Despite its importance, inter-professional communication in emergency department seems unfavorable. Thus, this study was designed to explain barriers to inter-professional communication in an emergency department. This was a qualitative study with content analysis approach, based on interviews conducted with 26 participants selected purposively, with diversity of occupation, position, age, gender, history, and place of work. Interviews were in-depth and semi-structured, and data were analyzed using the inductive content analysis approach. In total, 251 initial codes were extracted from 30 interviews (some of the participants re-interviewed) and in the reducing trend of final results, 5 categories were extracted including overcrowded emergency, stressful emergency environment, not discerning emergency conditions, ineffective management, and inefficient communication channels. Tumultuous atmosphere (physical, mental) was the common theme between categories, and was decided to be the main barrier to effective inter-professional communication. Tumultuous atmosphere (physical-mental) was found to be the most important barrier to inter-professional communication. This study provided a better understanding of these barriers in emergency department, often neglected in most studies. It is held that by reducing environmental turmoil (physical-mental), inter-professional communication can be improved, thereby improving patient care outcomes and personnel job satisfaction.

[Quality management in emergency departments: Lack of uniform standards for fact-based controlling].

Science.gov (United States)

Ries, M; Christ, M

2015-11-01

The general high occupancy of emergency departments during the winter months of 2014/2015 outlined deficits in health politics. Whether on the regional, province, or federal level, verifiable and accepted figures to enable in depth analysis and fact-based controlling of emergency care systems are lacking. As the first step, reasons for the current situation are outlined in order to developed concrete recommendations for individual hospitals. This work is based on a selective literature search with focus on quality management, ratio driven management, and process management within emergency departments as well as personal experience with implementation of a key ratio system in a German maximum care hospital. The insufficient integration of emergencies into the DRG systematic, the role as gatekeeper between inpatient and outpatient care sector, the decentralized organization of emergency departments in many hospitals, and the inconsistent representation within the medical societies can be mentioned as reasons for the lack of key ratio systems. In addition to the important role within treatment procedures, emergency departments also have an immense economic importance. Consequently, the management of individual hospitals should promote implementation of key ratio systems to enable controlling of emergency care processes. Thereby the perspectives finance, employees, processes as well as partners and patients should be equally considered. Within the process perspective, milestones could be used to enable detailed controlling of treatment procedures. An implementation of key ratio systems without IT support is not feasible; thus, existing digital data should be used and future data analysis should already be considered during implementation of new IT systems.

CULTURAL NATIONALISM AND THE IRISH LITERARY REVIVAL

Directory of Open Access Journals (Sweden)

David Pierce

2002-12-01

Full Text Available The impact of cultural nationalism on the Insh Literary Revival is a topic of continuing interest for the cultural critic and literary historian alike. In recent years, with the Fa11 of the Berlin Wall, political scientists and others, suchas A.D. Smith, Ernest Gellner, and E.J. Hobsbawm, have also focused on the subject of nationalism. The intention here in this article is to revisit a familiar site in the light of these new ideas and to test their validity or appropriateness in the Irish context. The article, part of a larger project to be published in 2003 by Polity Press under the title A Cultural History of Twentieth-Century Irish Literature, is divided into 5 sections: What ish my Nation?; What is a Nation?; Do Nations Have Navels?; 1890s: Winds of Change; English As We Speak It In Ireland. Among Irish authors discussed are Hyde, Shaw. Yeats, Wilde, Lady Gregory, Joyce, and Beckett.

[Antidotes: use guidelines and minimun stock in an emergency department].

Science.gov (United States)

García-Martín, A; Torres Santos-Olmos, R

2012-01-01

To develop a guide for antidotes and other medications used to counteract poisoning, and define the stock in an emergency department, as a safety priority for the part-time pharmacist assigned to the unit. A search of specialist databases and web portals of the Spanish Society of Toxicology and the British National Poisons Information Service, as well as toxicology databases, TOXICONET, information from other hospitals, tertiary sources, Micromedex and Medline. The Guide contains 42 active ingredients and is accessible to the Pharmacy and Emergency departments in electronic format. A minimum emergency stock was agreed based on the daily treatment of a 100 kg patient. This information, including updated expiry dates, is available at the emergency department antidote stock facilities and in electronic format. On a monthly basis, the pharmacist reviews the need to replace any drugs, due to their expiry date or lack of use. The lack of evidence from high quality antidote studies, the variability due to the difficulties of updating sources and some geographical differences in their use means that decision-making can be difficult. It would be useful to have minimum quantity recommendations from societies of toxicology, regulatory agencies and organisations such as the Joint Commission on the Accreditation of Healthcare Organisations. It would also be useful to have a suprahospital risk assessment to optimise management and ensure the availability of antidotes which are expensive, have a limited shelf life, or of which demand is difficult to forecast. Copyright © 2011 SEFH. Published by Elsevier Espana. All rights reserved.

Antidote use in a pediatric emergency department

OpenAIRE

Martínez Sánchez, L; Almario Hernández, AF; Escuredo Argullós, L; Mação, P; Trenchs Sainz de la Maza, V; Luaces Cubells, C

2014-01-01

INTRODUCTION: Poisoning is an infrequent cause of consultation in a pediatric emergency department (PED), but it can be potentially serious. Pediatricians should know how to use the available antidotes properly. OBJECTIVES: To analyze the use of antidotes in a PED and to assess the suitability of their indications. MATERIALS AND METHODS: A retrospective review of antidote use in a PED between January 2008 and June 2012. Inclusion criteria were age younger than 18 years and cons...

Effect of Emergency Department and ICU Occupancy on Admission Decisions and Outcomes for Critically Ill Patients.

Science.gov (United States)

Mathews, Kusum S; Durst, Matthew S; Vargas-Torres, Carmen; Olson, Ashley D; Mazumdar, Madhu; Richardson, Lynne D

2018-05-01

ICU admission delays can negatively affect patient outcomes, but emergency department volume and boarding times may also affect these decisions and associated patient outcomes. We sought to investigate the effect of emergency department and ICU capacity strain on ICU admission decisions and to examine the effect of emergency department boarding time of critically ill patients on in-hospital mortality. A retrospective cohort study. Single academic tertiary care hospital. Adult critically ill emergency department patients for whom a consult for medical ICU admission was requested, over a 21-month period. None. Patient data, including severity of illness (Mortality Probability Model III on Admission), outcomes of mortality and persistent organ dysfunction, and hourly census reports for the emergency department, for all ICUs and all adult wards were compiled. A total of 854 emergency department requests for ICU admission were logged, with 455 (53.3%) as "accept" and 399 (46.7%) as "deny" cases, with median emergency department boarding times 4.2 hours (interquartile range, 2.8-6.3 hr) and 11.7 hours (3.2-20.3 hr) and similar rates of persistent organ dysfunction and/or death 41.5% and 44.6%, respectively. Those accepted were younger (mean ± SD, 61 ± 17 vs 65 ± 18 yr) and more severely ill (median Mortality Probability Model III on Admission score, 15.3% [7.0-29.5%] vs 13.4% [6.3-25.2%]) than those denied admission. In the multivariable model, a full medical ICU was the only hospital-level factor significantly associated with a lower probability of ICU acceptance (odds ratio, 0.55 [95% CI, 0.37-0.81]). Using propensity score analysis to account for imbalances in baseline characteristics between those accepted or denied for ICU admission, longer emergency department boarding time after consult was associated with higher odds of mortality and persistent organ dysfunction (odds ratio, 1.77 [1.07-2.95]/log10 hour increase). ICU admission decisions for

Does Spanish instruction for emergency medicine resident physicians improve patient satisfaction in the emergency department and adherence to medical recommendations?

Directory of Open Access Journals (Sweden)

Stoneking LR

2016-08-01

Full Text Available LR Stoneking,1 AL Waterbrook,1 J Garst Orozco,2 D Johnston,1 A Bellafiore,1 C Davies,3 T Nuño,1 J Fatás-Cabeza,4 O Beita,5 V Ng,1 KH Grall,6 W Adamas-Rappaport7 1Department of Emergency Medicine, University of Arizona, Tucson, AZ, 2Department of Emergency Medicine, Sinai Health System, Chicago, IL, 3Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ, 4Department of Spanish and Portuguese, University of Arizona, Tucson, AZ, 5Department of Family and Community Medicine, University of Arizona, Tucson, AZ, 6Department of Emergency Medicine, Regions Hospital, St Paul, MN, 7Department of Surgery, University of Arizona, Tucson, AZ, USA Background: After emergency department (ED discharge, Spanish-speaking patients with limited English proficiency are less likely than English-proficient patients to be adherent to medical recommendations and are more likely to be dissatisfied with their visit.Objectives: To determine if integrating a longitudinal medical Spanish and cultural competency curriculum into emergency medicine residency didactics improves patient satisfaction and adherence to medical recommendations in Spanish-speaking patients with limited English proficiency.Methods: Our ED has two Emergency Medicine Residency Programs, University Campus (UC and South Campus (SC. SC program incorporates a medical Spanish and cultural competency curriculum into their didactics. Real-time Spanish surveys were collected at SC ED on patients who self-identified as primarily Spanish-speaking during registration and who were treated by resident physicians from both residency programs. Surveys assessed whether the treating resident physician communicated in the patient’s native Spanish language. Follow-up phone calls assessed patient satisfaction and adherence to discharge instructions.Results: Sixty-three patients self-identified as primarily Spanish-speaking from August 2014 to July 2015 and were initially included in this pilot study

Verbal and physical violence in emergency departments: a survey of nurses in Istanbul, Turkey.

Science.gov (United States)

Pinar, Rukiye; Ucmak, Firdevs

2011-02-01

The aim of this study was to determine the perceived verbal and physical violence and related factors experienced by nurses in emergency settings. Studies on violence in emergency departments indicate an increasing frequency of these incidents. However, little is known about the violence experienced by the Turkish nurses working in emergency departments. Survey. The study population included 255 nurses. Data were collected using a questionnaire. Verbal violence was reported with a frequency of 91.4%. Of the nurses, 74.9% had been exposed to physical violence in at least several episodes during the previous 12 months. Patients' relatives were the main perpetrators, followed by patients, most of whom were male. After experiencing violence, most of the nurses reported that, they had felt fear and only 3% described that they took sick leave, while 80% did not report the incidences of violence they experienced. The nurses described that, after a violent incident, they sought support mainly from their colleagues in emergency departments rather than from the administration. Over half of the nurses (65%) felt safe 'none of the time' in emergency departments, and 89.8% of them described that patients and patient relatives may potentially exhibit violent behaviours towards the staff when they are first admitted to emergency department, while 73.7% believed that the staffing pattern and physical environment of their emergency departments were not adequate to prevent violence. Most of the nurses (83.5%) stated that they should be provided with the training that will help them prevent and manage violence as part of their in-service education, whereas 82.7% of them had not received any such training. The findings have implications for occupational health and safety from both employer and employee perspective. © 2010 Blackwell Publishing Ltd.

Emergency nurses’ perceptions of emergency department preparedness for an ebola outbreak: a qualitative descriptive study

OpenAIRE

Pincha Baduge, Mihirika Surangi De Silva

2017-01-01

Introduction: Ebola Virus Disease (EVD) is a highly contagious disease with a high mortality rate. The 2014 outbreak in West Africa grew uncontrollably, and on the 8th August 2014, the World Health Organization (WHO) declared the outbreak as a public health emergency of international concern. Emergency Departments (ED) in Australian health services commenced preparation and vigilance for people presenting with EVD like symptoms, so that any spread of the disease could be prevented. Researc...

A Rare Case in the Emergency Department: Holmes-Adie Syndrome

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Sahin COLAK

2015-03-01

Full Text Available SUMMARY: Holmes-Adie syndrome (HAS is a rare syndrome characterized by tonic pupil and the absence of deep tendon reflexes. HAS was first described in 1931 and is usually idiopathic, with incidences reported to be 4-7 per 100,000. Although tonic pupil is usually unilateral, it can also be bilateral. Enlarged and irregular pupil is usually noticed by the patient. Light reflex is weak or unresponsive. Another characteristic of HAS is the absence of deep tendon reflexes, and unilateral involvement is more common. This case report emphasizes that HAS should be considered in the differential diagnosis of patients presenting to the emergency department with anisocoria, and the dilute pilocarpine test can be used in diagnosis. Key words: Emergency department, Holmes-Adie syndrome, pilocarpine

Developing emergency department-based education about emergency contraception: adolescent preferences.

Science.gov (United States)

Mollen, Cynthia J; Miller, Melissa K; Hayes, Katie L; Wittink, Marsha N; Barg, Frances K

2013-11-01

The objective was to identify adolescent preferences for emergency department (ED)-based education about emergency contraception. This was a cross-sectional computerized survey, using adaptive conjoint analysis (ACA). Patients were eligible if they were females ages 14 through 19 years old and were seeking care in one of two urban EDs. Patients were excluded if they were too ill to participate in the survey or if they were non-English speaking. Participants completed a computerized survey that used ACA, a technique that can be used to assess patients' relative preferences for services. ACA uses the individual's answers to update and refine questions through trade-off comparisons, so that each respondent answers a customized set of questions. The survey assessed preferences for the following attributes of emergency contraception education: who should deliver the education, if anyone (e.g., nurse, doctor); how the education should be delivered (e.g., by a person or via video); how often the education should be offered if patients were to frequent the ED (e.g., every time or only when asking for it); length (e.g., 5 minutes, 10 minutes); and chief complaint that would trigger the education (e.g., headache or stomach pain). A total of 223 patients were enrolled (37.2% at Hospital 1 and 62.8% at Hospital 2). The mean (±SD) age of the participants was 16.1 (±1.3) years. Just over half (55%) reported a history of sexual activity; 8% reported a history of pregnancy. Overall, the participants preferred education that was delivered by a person, specifically a doctor or nurse. They preferred a slightly longer education session and preferred education directed at patients seeking care in the ED for complaints potentially related to sexual activity. Adolescents have specific preferences for how education about emergency contraception would best serve their needs. This information can inform clinicians as they work to improve adolescents' knowledge about pregnancy prevention

Consequences of peritonism in an emergency department setting

DEFF Research Database (Denmark)

Bjørsum-Meyer, Thomas; Schmidt, Thomas A.

2013-01-01

Background: In patients who were referred to the emergency department (ED) with abdominal pain, it is crucial to determine the presence of peritonism to allow for appropriate handling and subsequent referral to stationary departments. We aimed to assess the incidence of perceived peritonism...... on the patients with abdominal pain. Following a physical examination, the patients with abdominal pain were divided into those who had clinical signs of peritonism and those who did not. Results: Among the 1,270 patients admitted to the ED, 10% had abdominal pain. In addition, 41% of these patients were found...... to have signs indicative of peritonism, and 90% were admitted to the Department of Surgery (DS). Also, 24% of those patients with signs of peritonism and admission to the DS underwent surgical intervention in terms of laparotomy/laparoscopy. Five of the patients without peritonism underwent surgery...

Outward-Oriented Economic Development and the Irish Education System

Science.gov (United States)

Barry, Frank

2014-01-01

Most studies of the relationship between education and economic development focus on the line of causation running from the former to the latter. The present paper studies how the pattern of Irish development has influenced the structure of the Irish education system. The first section sets out the economic context of late industrialisation within…

Patient experience in the emergency department: inconsistencies in the ethic and duty of care.

Science.gov (United States)

Moss, Cheryle; Nelson, Katherine; Connor, Margaret; Wensley, Cynthia; McKinlay, Eileen; Boulton, Amohia

2015-01-01

To understand how people who present on multiple occasions to the emergency department experience their health professionals' moral comportment (ethic of care and duty of care); and to understand the consequences of this for 'people who present on multiple occasions' ongoing choices in care. People (n = 34) with chronic illness who had multiple presentations were interviewed about the role that emergency departments played within their lives and health-illness journey. Unprompted, all participants shared views about the appropriateness or inappropriateness of the care they received from the health professionals in the emergency departments they had attended. These responses raised the imperative for specific analysis of the data regarding the need for and experience of an ethic of care. Qualitative description of interview data (stage 3 of a multimethod study). The methods included further analysis of existing interviews, exploration of relevant literature, use of Tronto's ethic of care as a theoretical framework for analysis, thematic analysis of people who present on multiple occasions' texts and explication of health professionals' moral positions in relation to present on multiple occasions' experiences. Four moral comportment positions attributed by the people who present on multiple occasions to the health professionals in emergency department were identified: 'sustained and enmeshed ethic and duty of care', 'consistent duty of care', 'interrupted or mixed duty and ethic of care', and 'care in breach of both the ethic and duty of care'. People who present on multiple occasions are an important group of consumers who attend the emergency department. Tronto's phases/moral elements in an ethic of care are useful as a framework for coding qualitative texts. Investigation into the bases, outcomes and contextual circumstances that stimulate the different modes of moral comportment is needed. Findings carry implications for emergency department care of people who

Relationship between Bullying and Suicidal Behaviour in Youth presenting to the Emergency Department.

Science.gov (United States)

Alavi, Nazanin; Reshetukha, Taras; Prost, Eric; Antoniak, Kristen; Patel, Charmy; Sajid, Saad; Groll, Dianne

2017-07-01

Increasing numbers of adolescents are visiting emergency departments with suicidal ideation. This study examines the relationship between bullying and suicidal ideation in emergency department settings. A chart review was conducted for all patients under 18 years of age presenting with a mental health complaint to the emergency departments at Kingston General or Hotel Dieu Hospitals in Kingston, Canada, between January 2011 and January 2015. Factors such as age, gender, history of abuse, history of bullying, type and time of bullying, and diagnoses were documented. 77% of the adolescents had experienced bullying, while 68.9% had suicide ideation at presentation. While controlling for age, gender, grade, psychiatric diagnosis, and abuse, a history of bullying was the most significant predictor of suicidal ideation. Individuals in this study who reported cyber bullying were 11.5 times more likely to have suicidal ideation documented on presentation, while individuals reporting verbal bullying were 8.4 times more likely. The prevalence of bullying in adolescent patients presenting to emergency departments is high. The relationship found between suicidal ideation and bullying demonstrates that clinicians should ask questions about bullying as a risk factor for suicide ideation during the assessment of children and adolescents.

Ghost Stories, Ghost Estates: Melancholia in Irish Recession Literature

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Molly Slavin

2017-01-01

Full Text Available This article considers representations of melancholia in post-Celtic Tiger Irish literature. By situating their post-recession fictions in “ghost estates,” or largely uninhabited housing developments, Donal Ryan and Tana French present neoliberally-inflected varieties of melancholia for their contemporary readers to contemplate. The settings of the ghost estates – and the accompanying supernatural elements to the texts – call to mind ghosts of Ireland’s past and legacies of recent economically unsound policies, spurring the reader to think about the imagined loss of futurity that accompanied the Irish economic crash. “Ghost stories for ghost estates,” then, represent an important contribution to the growing field of post-recession Irish literature.

Propofol for procedural sedation and analgesia reduced dedicated emergency nursing time while maintaining safety in a community emergency department.

Science.gov (United States)

Reynolds, Joshua C; Abraham, Michael K; Barrueto, Fermin F; Lemkin, Daniel L; Hirshon, Jon M

2013-09-01

Procedural sedation and analgesia is a core competency in emergency medicine. Propofol is replacing midazolam in many emergency departments. Barriers to performing procedural sedation include resource utilization. We hypothesized that emergency nursing time is shorter with propofol than midazolam, without increasing complications. Retrospective analysis of a procedural sedation registry for two community emergency departments with combined census of 100,000 patients/year. Demographics, procedure, and ASA physical classification status of adult patients receiving procedural sedation between 2007-2010 with midazolam or propofol were analyzed. Primary outcome was dedicated emergency nursing time. Secondary outcomes were procedural success, ED length of stay, and complication rate. Comparative statistics were performed with Mann-Whitney, Kruskal-Wallis, chi-square, or Fisher's exact test. Linear regression was performed with log-transformed procedural sedation time to define predictors. Of 328 procedural sedation and analgesia, 316 met inclusion criteria, of which 60 received midazolam and 256 propofol. Sex distribution varied between groups (midazolam 3% male; propofol 55% male; P = 0.04). Age, procedure, and ASA status were not significantly different. Propofol had shorter procedural sedation time (propofol 32.5 ± 24.2 minutes; midazolam 78.7 ± 51.5 minutes; P differences between complication rates (propofol 14%; midazolam 13%; P = 0.88) or emergency department length of stay (propofol 262.5 ± 132.8 minutes; midazolam 288.6 ± 130.6 minutes; P = 0.09). Use of propofol resulted in shorter emergency nursing time and higher procedural success rate than midazolam with a comparable safety profile. Copyright © 2013 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

Availability of emergency contraception: a survey of hospital emergency department gynaecologists and emergency physicians in Piedmont, Italy.

Science.gov (United States)

Bo, Marco; Casagranda, Ivo; Charrier, Lorena; Gianino, Maria Michela

2012-10-01

To compare the knowledge and the willingness of emergency physicians and gynaecologists caring for women in Italian emergency departments (EDs) to prescribe levonorgestrel-only emergency contraceptive pills (LNG-EC pills). A cross-sectional survey was conducted in 2009; anonymous postal questionnaires were mailed to the medical staff working at the 30 EDs located in Piedmont (Italy). Emergency physicians and gynaecologists have similar knowledge of the pharmacokinetics and pharmacodynamics of LNG-EC pills, but do not feel at ease in prescribing these and consider the prescription of LNG-EC pills an inappropriate activity for ED staff. In Italy, unlike in most other European countries, LNG-EC pills are still prescription drugs. Thus it may be useful to further investigate the reasons why Italian ED medical staff do not feel the prescription of LNG-EC pills should be within their remit and whether women can successfully obtain the prescription from physicians working in other services that can be accessed around the clock.

Correlates of women's cancer screening and contraceptive knowledge among female emergency department patients

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Bock Beth C

2007-05-01

Full Text Available Abstract Background Lack of knowledge regarding preventive health services for women might impede campaigns to expand these services in the emergency department setting. For 18–55-year-old English-speaking women visiting an urban emergency department, we aimed to: (1 Ascertain their knowledge regarding the applicability, purpose, and recommended intervals of three women's cancer screening and three contraceptive methods; and (2 Determine if patient age, race/ethnicity, medical insurance status, and current or recent usage of these methods are associated with greater or lesser knowledge about them. Methods Emergency department-based survey on recent or current usage and knowledge about Pap smears, breast self-examinations, mammograms, condoms, birth control, and emergency contraception. Analyses included calculation of summary statistics and creation of multivariable logistic regression models. Results Of 1,100 patients eligible for the study, 69.9% agreed to participate. Most of the participants were Conclusion Although these female ED patients demonstrated strong knowledge on some women's cancer screening and contraceptive methods, there were several areas of knowledge deficit. Women without private medical insurance and those who have not used a particular cancer screening or contraceptive method demonstrated less knowledge. Reduced knowledge about women's cancer screening and contraceptive methods should be considered during clinical encounters and when instituting or evaluating emergency department-based initiatives that assess the need for these methods.

Assessment of orofacial pain management in a pediatric emergency department and at home after discharge.

Science.gov (United States)

Aguilar de la Red, Yurena; Manrique Martín, Gema; Guerrero Marquez, Gloria; González Herrero, Concepción; Vázquez López, Paula; Míguez Navarro, Concepción

2018-02-01

An inadequate pain management is common in the emergency department. Our objective was to analyze pain management among children with an orofacial infection or trauma in the emergency department and to assess compliance and satisfaction with analgesia prescribed at discharge. Cross-sectional, observational and analytical study in children attending the emergency department for an orofacial infection or trauma over 2 months. Pain management in the emergency department, analgesia prescribed at home and, following a call to parents, treatment provided and its adequacy to control pain were registered. In total, 252patients (mean age: 4.5 years, SD: 3.89) were included. Pain assessment was recorded at the triage for 8.7%, and in the medical report, for 3.6%. Analgesia was administered to 41.3% in the emergency room. At discharge, no analgesia was prescribed to 13.9%; scheduled analgesia, to 25.4%; and as needed, to 60.3%. Pediatricians prescribed scheduled analgesia more frequently than surgeons (34.4% versus 16.5%, p Pain assessment and management was scarce in the emergency department. The most common prescription was as needed, contrary to what is recommended in the guidelines. Analgesic control worked better for trauma injuries than for infections. Sociedad Argentina de Pediatría

Workload and casemix in Cape Town emergency departments.

Science.gov (United States)

Wallis, Lee A; Twomey, Michele

2007-12-01

Little is known about the nature of patients presenting to emergency departments (EDs) in South Africa. This study aimed to provide evidence on ED usage in Cape Town by studying patients at four community health centre (CHC) EDs, with details of the severity of their presentation and their disposal. A total of 16,392 patients presented in this 8-week prospective observational study, and 15,681 were included in the descriptive data analysis. One-quarter were children. There were clear and predictable peaks in attendance after 1600 hr and at weekends, with a steady stream of patients presenting overnight. Case severity was evenly distributed between emergency, urgent and routine care. Nearly 10% of patients were referred on to a higher level of care. The data from this study present a model for staffing and resource allocation. It has implications for the provision of emergency care in CHC EDs.

76 FR 16323 - Irish Potatoes Grown in Washington; Continuance Referendum

Science.gov (United States)

2011-03-23

...; FV11-946-1 CR] Irish Potatoes Grown in Washington; Continuance Referendum AGENCY: Agricultural... conducted among eligible Washington potato growers to determine whether they favor continuance of the marketing order regulating the handling of Irish potatoes grown in Washington. DATES: The referendum will be...

Regulation and registration as drivers of continuous professional competence for Irish pre-hospital practitioners: a discussion paper.

Science.gov (United States)

Knox, S; Dunne, S S; Hughes, M; Cheeseman, S; Dunne, C P

2016-05-01

The regulatory body responsible for the registration of Irish pre-hospital practitioners, the Pre-Hospital Emergency Care Council (PHECC), identified the need to implement a continuing professional competence (CPC) framework. The first cycle of CPC (focused on emergency medical technicians) commenced in November 2013 creating for the first time a formal relationship between continuing competence and registration to practice. To review current literature and to describe benefits and challenges relevant to CPC, regulation, registration and their respective contributions to professionalism of pre-hospital practitioners: advanced paramedics, paramedics and emergency medical technicians. Online search of cumulative index to nursing and allied health literature (CINAHL Plus with Full Text), Allied and Complementary Medicine (AMED) and 'Pubmed' databases using: 'Continuous Professional Development'; 'Continuous Professional Development'; 'emergency medical technician'; 'paramedic'; 'registration'; 'regulation'; and "profession' for relevant articles published since 2004. Additional policy documents, discussion papers, and guidance documents were identified from bibliographies of papers found. Reports, governmental policies for other healthcare professions, and professional developments internationally for allied professions (e.g., nursing, physiotherapy and medicine) link maintenance of competence with requirements for registration to practice. We suggest that evolving professionalisation of Irish paramedics should be affirmed through behaviours and competencies that incorporate adherence to professional codes of conduct, reflective practice, and commitment to continuing professional development. While the need for ambulance practitioner CPD was identified in Ireland almost a decade ago, PHECC now has the opportunity to introduce a model of CPD for paramedics linking competence and professionalism to annual registration.

Errors in fracture diagnoses in the emergency department--characteristics of patients and diurnal variation

DEFF Research Database (Denmark)

Hallas, Peter; Ellingsen, Trond

2006-01-01

Evaluation of the circumstances related to errors in diagnosis of fractures at an Emergency Department may suggest ways to reduce the incidence of such errors.......Evaluation of the circumstances related to errors in diagnosis of fractures at an Emergency Department may suggest ways to reduce the incidence of such errors....

Effects of electronic emergency-department whiteboards on clinicians' time distribution and mental workload

DEFF Research Database (Denmark)

Hertzum, Morten; Simonsen, Jesper

2016-01-01

Whiteboards are a central tool at emergency departments. We investigate how the substitution of electronic for dry-erase whiteboards affects emergency department clinicians’ mental workload and distribution of their time. With the electronic whiteboard, physicians and nurses spend more...... of their time in the work areas where other clinicians are present and whiteboard information is permanently displayed, and less in the patient rooms. Main reasons for these changes appear to be that the electronic whiteboard facilitates better timeouts and handovers. Physicians and nurses are, however......, in the patient rooms for longer periods at a time, suggesting a more focused patient contact. The physicians’ mental workload has increased during timeouts, whereas the nurses’ mental workload has decreased at the start of shifts when they form an overview of the emergency department. Finally, the secretaries...

Emergency Department Staff Beliefs About Self-Harm: A Thematic Framework Analysis.

Science.gov (United States)

Koning, Kate Louise; McNaught, Angela; Tuffin, Keith

2017-11-03

To explore the beliefs and attitudes of emergency department staff about self-harm behaviour. Existing studies looking at views regarding self-harm rely solely on the information provided by medical and nursing staff using a questionnaire format. No studies currently consider ancillary staff members' beliefs about self-harm, even though they also work with these patients. A thematic framework analysis of interview transcripts was carried out. Individual semi-structured interviews were conducted from December 2015 to February 2016. Fifteen medical, nursing, and ancillary staff members from a large, tertiary emergency department participated. There were 5 major themes identified-causes of self-harm are multifactorial; beliefs about self-harm can change over time; emergency departments should only focus on the physical; self-harm occurs on a spectrum; and the system has failed. The results suggest participants felt ill-prepared and lacking in appropriate training to help patients that self-harm, and furthermore they have little faith in the mental health system. Staff beliefs and attitudes may change over time with exposure to patients who self-harm, possibly becoming more positive in response to a greater understanding of why the self-harm behaviour is occurring.

Good Interdepartmental Relationships: The Foundations of a Solid Emergency Department

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Frank J. Edwards

2018-02-01

Full Text Available “No man is an island” said the English poet, John Donne, and nowhere can that statement be better appreciated than in a modern emergency department (ED. As emergency physicians, we work in the setting of a close knit team involving nurses, technicians, consultants, clerks, security guards and many more. On a macroscopic level as well, the ED itself needs productive relationships with every other department in the hospital. Back when the ED was staffed by physicians-in-training, general practitioners and moonlighting specialists, the care of patients was jealously divided between the long-entrenched traditional specialties. Anesthesiologists handled difficult airways; Surgeons took care of trauma; Radiologists did the ultrasounds and read all the films, and so forth. Emergency medicine—a specialty that encompassed parts of many disciplines—was initially met with skepticism and resistance from the traditional fields.   I have been in practice long enough to remember when anesthesiologists fought against emergency physicians doing RSI and how they tried to stop us from using propofol or ketamine for procedural sedation. Orthopedists wanted to be consulted before we reduced a shoulder. Surgeons got angry if you gave morphine to a belly pain patient. In the early 1990’s at the University of Rochester, my colleague, Dr. Steve White, had to sneak into the ED with his own portable ultrasound device (with its postage stamp sized screen, because to have done so openly would have brought down the wrath of radiologists who believed that ultrasonography belonged to their department alone. These turf battles are mostly a thing of the past, thanks to clinical studies conducted by our specialty that proved what we can and should do. But challenges regarding interdepartmental relationships still remain. In the following discussion we will look at current friction points between the ED and other departments, including radiology, anesthesia, surgery

Preanalytic Factors Associated With Hemolysis in Emergency Department Blood Samples.

Science.gov (United States)

Phelan, Michael P; Reineks, Edmunds Z; Schold, Jesse D; Hustey, Frederic M; Chamberlin, Janelle; Procop, Gary W

2018-02-01

- Hemolysis of emergency department blood samples is a common occurrence and has a negative impact on health care delivery. - To determine the effect of preanalytic factors (straight stick, intravenous [IV] line, needle gauge, location of blood draw, syringe versus vacuum tube use, tourniquet time) on hemolysis in emergency department blood samples. - A single 65 000-visit emergency department's electronic health record was queried for emergency department potassium results and blood draw technique for all samples obtained in calendar year 2014, resulting in 54 531 potassium results. Hemolyzed potassium was measured by hemolysis index. Comparisons of hemolysis by sampling technique were conducted by χ 2 tests. - Overall hemolysis was 10.0% (5439 of 54 531). Hemolysis among samples obtained from straight stick was significantly less than among those obtained with IV line (5.4% [33 of 615] versus 10.2% [4821 of 47 266], P < .001). For IV-placed blood draws, antecubital location had a statistically significant lower overall hemolysis compared with other locations: 7.4% (2117 of 28 786) versus 14.6% (2622 of 17 960) ( P < .001). For blood drawn with a syringe compared with vacuum, hemolysis was 13.0% (92 of 705) and 11.0% (1820 of 16 590), respectively ( P = .09, not significant). For large-gauge IV blood draws versus smaller-gauge IV lines, a lower hemolysis was also observed (9.3% [3882 of 41 571] versus 16.7% [939 of 5633]) ( P < .001). For IV-drawn blood with tourniquet time less than 60 seconds, hemolysis was 10.3% (1362 of 13 162) versus 13.9% for more than 60 seconds (532 of 3832), P < .001. - This study confirmed previous findings that straight stick and antecubital location are significantly associated with reduced hemolysis and indicated that shorter tourniquet time and larger gauge for IV draws were significantly associated with lower hemolysis.

78 FR 43890 - Privacy Act of 1974; Department of Homeland Security, Federal Emergency Management Agency-006...

Science.gov (United States)

2013-07-22

... titled, ``Department of Homeland Security/Federal Emergency Management Agency--006 Citizen Corps Database... DEPARTMENT OF HOMELAND SECURITY Office of the Secretary [Docket No. DHS-2013-0049] Privacy Act of 1974; Department of Homeland Security, Federal Emergency Management Agency--006 Citizen Corps Program...

DNW--"did not wait" or "demographic needing work": a study of the profile of patients who did not wait to be seen in an Irish emergency department.

LENUS (Irish Health Repository)

Gilligan, P

2009-11-01

Patients who fail to wait for medical assessment in the emergency department (ED) have been referred to in the international literature as "did not wait" (DNW) or "left without being seen" (LWBS) patients or, indeed, simply as "walkouts". This is taken as a performance indicator internationally. In common with many countries, Ireland has very considerable problems in the delivery of ED care due largely to inadequate resources and the inappropriate use of EDs as holding bays for admitted patients. This is the first study of this size to profile the DNW phenomenon in Ireland.

Using a balanced scorecard to improve the performance of an emergency department.

Science.gov (United States)

Huang, Shu-Hsin; Chen, Ping-Ling; Yang, Ming-Chin; Chang, Wen-Yin; Lee, Haw-Jenn

2004-01-01

The performance of the emergency department significantly improved after implementing the balanced scorecard including hours of continuing education attended by the staff, staff job satisfaction, the rate of incomplete laboratory tests within 30 minutes, the average monthly inappropriate return rate, and hospital profit. The results can assist administrators plan for the future. Although this was a pilot program for implementing a balanced scorecard in an emergency department, the indicators used in this study may also be reasonable for a hospital that has limited resources.

Ethical issues in the response to Ebola virus disease in US emergency departments: a position paper of the American College of Emergency Physicians, the Emergency Nurses Association and the Society for Academic Emergency Medicine.

Science.gov (United States)

Venkat, Arvind; Wolf, Lisa; Geiderman, Joel M; Asher, Shellie L; Marco, Catherine A; McGreevy, Jolion; Derse, Arthur R; Otten, Edward J; Jesus, John E; Kreitzer, Natalie P; Escalante, Monica; Levine, Adam C

2015-03-01

The 2014 outbreak of Ebola Virus Disease (EVD) in West Africa has presented a significant public health crisis to the international health community and challenged US emergency departments to prepare for patients with a disease of exceeding rarity in developed nations. With the presentation of patients with Ebola to US acute care facilities, ethical questions have been raised in both the press and medical literature as to how US emergency departments, emergency physicians, emergency nurses and other stakeholders in the healthcare system should approach the current epidemic and its potential for spread in the domestic environment. To address these concerns, the American College of Emergency Physicians, the Emergency Nurses Association and the Society for Academic Emergency Medicine developed this joint position paper to provide guidance to US emergency physicians, emergency nurses and other stakeholders in the healthcare system on how to approach the ethical dilemmas posed by the outbreak of EVD. This paper will address areas of immediate and potential ethical concern to US emergency departments in how they approach preparation for and management of potential patients with EVD. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

A Woman Alone: The Depictions of Spinsters in Irish Women’s Short Stories

Directory of Open Access Journals (Sweden)

Ann Wan-lih Chang

2015-03-01

Full Text Available This paper focuses on the manner in which single women are represented in contemporary Irish women’s short stories.  Typically in these stories, such women are portrayed as a distinctive social group within a society in which a traditionally negative image of the spinster has been reinforced by a dominant social ideology which has as objective the exertion of social control over women.  Contemporary Irish female writers attempt to ridicule this problematic “single-woman phobia” by demonstrating that this phenomenon is actually the result of women’s “selflessness” rather than the “selfishness” associated with the spinster stereotype.  Irish women’s stories demonstrate also a fundamental unfairness inherent within Irish society in which women are compelled to sacrifice their own lives and needs for the benefit of others by assuming a surrogate mothering role as “social mothers”.  Ironically, this paradox acts as the main obstacle preventing Irish spinsters from fulfilling their roles as wives and biological mothers.  In response, Irish female writers de-demonise the witch-like spinster stereotypes by deconstructing through their narratives those paradoxical social norms which have actually nurtured and reinforced negative perceptions of the “single women” within Irish society.

Water tubing-related injuries treated in US emergency departments, 1991-2009.

Science.gov (United States)

Heinsimer, Kevin R; Nelson, Nicolas G; Roberts, Kristin J; McKenzie, Lara B

2013-02-01

The objective was to describe the patterns and mechanisms of water tubing-related injuries treated in U.S. emergency departments. The National Electronic Injury Surveillance System was used to examine cases of water tubing-related injuries. Sample weights were used to calculate national estimates of water tubing-related injuries. Analyses were conducted in 2010. From 1991-2009 an estimated 69,471 injuries were treated in US emergency departments for water tubing-related injuries. The annual number of cases increased 250% over the 19-year study period (P tubing-related injuries differ for children and adults. Research is needed to determine how best to reduce these injuries.

Dysuria: An Uncommon Presentation in Emergency Department Following Bladder Neck Disruption

Directory of Open Access Journals (Sweden)

Ali Pourmand

2017-02-01

Full Text Available Prostate cancer is the most common life-threatening cancer diagnosed in men. Complications of prostatectomies vary and often include urinary incontinence, erectile dysfunction and pain, while other complications go unreported. While emergency physicians are already familiar with the more common post-operative complications presenting to their departments, including urinary retention, ileus, surgical site infections, venous thromboembolisms and urinary tract infections, they must have a high index of suspicion for rarer complications. We report a case of posterior bladder neck disruption as a complication of a robotic assisted laparoscopic prostatectomy that presented to the emergency department as dysuria and abdominal pain following urination.

E-FAST: A propos of hemopericardium in the Emergency Department

Directory of Open Access Journals (Sweden)

Alejandro Cardozo

2016-05-01

Full Text Available The extended-focused assessment with sonography in trauma is still recognized as a technique approach to patients whose trauma involves the chest and the abdomen, with the aim of ruling out conditions as pneumothorax, hemothorax, pericardial effusion/cardiac tamponade, and intraperitoneal free fluid. Although CT is the gold standard test, the inconvenience of moving unstable patients and the amount of time it takes to carry it out, makes it not always possible in the Emergency Department, which positions the ultrasound as an ideal tool in the evaluation of patients with trauma in the Emergency Department. In this case report, we presented the case of a patient who complains of multiple stab wounds, and the extended-focused assessment with sonography in trauma confirmed the diagnostic impressions.

Communication between nurses and physicians: strategies to surviving in the emergency department trenches.

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Abourbih, Daniel; Armstrong, Sherry; Nixon, Kirsty; Ackery, Alun D

2015-02-01

The emergency department (ED) is a challenging and stressful work environment where communication lapses can lead to negative health outcomes. This article offers strategies to Emergency Medicine residents, nurses and staff physicians on how to improve communication to optimize patient care. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Glass injuries seen in the emergency department of a South African district hospital

OpenAIRE

Nzaumvila, Doudou; Govender, Indiran; Kramer, Efraim B.

2015-01-01

BACKGROUND: The emergency department of Embhuleni Hospital frequently manages patients with glass-related injuries. This study assessed these injuries and the glass that caused them in more detail. AIM: The objectives of our study included determining the type of glass causing these injuries and describing the circumstances associated with different types of glass injuries. SETTING: The emergency department of Embhuleni Hospital in Elukwatini, Mpumalanga province, South Africa. METHODS: This ...

The Impact of Hospital Closures and Hospital and Population Characteristics on Increasing Emergency Department Volume: A Geographic Analysis.

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Lee, David C; Carr, Brendan G; Smith, Tony E; Tran, Van C; Polsky, Daniel; Branas, Charles C

2015-12-01

Emergency visits are rising nationally, whereas the number of emergency departments is shrinking. However, volume has not increased uniformly at all emergency departments. It is unclear what factors account for this variability in emergency volume growth rates. The objective of this study was to test the association of hospital and population characteristics and the effect of hospital closures with increases in emergency department volume. The study team analyzed emergency department volume at New York State hospitals from 2004 to 2010 using data from cost reports and administrative databases. Multivariate regression was used to evaluate characteristics associated with emergency volume growth. Spatial analytics and distances between hospitals were used in calculating the predicted impact of hospital closures on emergency department use. Among the 192 New York hospitals open from 2004 to 2010, the mean annual increase in emergency department visits was 2.7%, but the range was wide (-5.5% to 11.3%). Emergency volume increased nearly twice as fast at tertiary referral centers (4.8%) and nonurban hospitals (3.7% versus urban at 2.1%) after adjusting for other characteristics. The effect of hospital closures also strongly predicted variation in growth. Emergency volume is increasing faster at specific hospitals: tertiary referral centers, nonurban hospitals, and those near hospital closures. This study provides an understanding of how emergency volume varies among hospitals and predicts the effect of hospital closures in a statewide region. Understanding the impact of these factors on emergency department use is essential to ensure that these populations have access to critical emergency services.

Nurses' perception of nursing workforce and its impact on the managerial outcomes in emergency departments.

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Hu, Yi-Chun; Chen, Jih-Chang; Chiu, Hsiao-Ting; Shen, Hsi-Che; Chang, Wen-Yin

2010-06-01

(1) To understand nurses' subjective perceptions of the current nursing workforce in their emergency departments, (2) to examine the relationship between nurses' workforce perceptions and its impact on the managerial outcomes and (3) to analyse the correlation between nurses' characteristics and the scores on workforce perception. While the association between workforce perceptions and nurse outcomes is well-documented, few studies have examined how emergency department nurses perceive current workforce and related outcomes. A cross-sectional questionnaire survey. A self-reported workforce perception questionnaire was used to survey 538 registered nurses in the emergency departments of 19 hospitals in northern Taiwan, during May to October 2006. Data were analysed using descriptive statistics, chi-square test, independent t-test, Pearson correlation and one-way anova. The mean score of workforce perception was 6.28 points (total = 10 points). Both overtime (p = 0.02) and number of callbacks on days off (p = 0.01) were significantly correlated to current nursing workforce and hospital level. Older nurses tended to have more emergency department experience (r = 0.37; p = 0.01) and those with more emergency department experience tended to have vacation accumulation (r = 0.09; p = 0.04), overtime (r = 0.10; p = 0.03) and better perception of their emergency department's current workforce (r = 0.09; p = 0.05). Although nurses' perceptions were found to be only moderate, overtime and number of callbacks on days off are potential problems that should be addressed by nursing leaders to benefit future emergency nurses. The findings can help drive strategies to ensure adequate staffing, to stabilise the nursing workforce and to prevent nurses from burnout factors such as working long hours, unpredictable schedules and a stressful work environment that may impact both the quality of emergency care and the quality of the nurses' work environment.

Using Queuing Theory and Simulation Modelling to Reduce Waiting Times in An Iranian Emergency Department

OpenAIRE

Haghighinejad, Hourvash Akbari; Kharazmi, Erfan; Hatam, Nahid; Yousefi, Sedigheh; Hesami, Seyed Ali; Danaei, Mina; Askarian, Mehrdad

2016-01-01

Background: Hospital emergencies have an essential role in health care systems. In the last decade, developed countries have paid great attention to overcrowding crisis in emergency departments. Simulation analysis of complex models for which conditions will change over time is much more effective than analytical solutions and emergency department (ED) is one of the most complex models for analysis. This study aimed to determine the number of patients who are waiting and waiting time in emerg...

Lyme Disease: Emergency Department Considerations.

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Applegren, Nathan D; Kraus, Chadd K

2017-06-01

Lyme disease (LD) is the most common vector-borne illness in North America. Reported cases of LD have increased from approximately 10,000 cases annually in 1991 to >25,000 cases in 2014. Greater recognition, enhanced surveillance, and public education have contributed to the increased prevalence, as have geographic expansion and the number of infected ticks. Cases are reported primarily in the Northeastern United States, Wisconsin, and Minnesota, with children having the highest incidence of LD among all age groups. The increased incidence and prevalence of LD in the United States makes it increasingly more common for patients to present to the emergency department (ED) for tick bites and LD-related chief complaints, such as the characteristic erythema migrans skin manifestation. We sought to review the etiology of LD, describe its clinical presentations and sequela, and provide a practical classification and approach to ED management of patients with LD-related presentations. In this review, ED considerations for LD are presented and clinical presentations and management of the disease at different stages is discussed. Delayed sequelae that have significant morbidity, including Lyme carditis and Lyme neuroborreliosis, are discussed. Diagnostic tests and management are described in detail. The increasing prevalence and growing geographic reach of Lyme disease makes it critically important for emergency physicians to consider the diagnosis in patients presenting with symptoms suggestive of LD and to initiate appropriate treatment to minimize the potential of delayed sequelae. Special consideration should be made for the epidemiology of LD and a high clinical suspicion should be present for patients in endemic areas or with known exposures to ticks. Emergency physicians can play a critical role in the recognition, diagnosis, and treatment of LD. Copyright © 2017 Elsevier Inc. All rights reserved.

Emergency department nurses' experiences of occupational stress: A qualitative study from a public hospital in Bangkok, Thailand.

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Yuwanich, Nuttapol; Sandmark, Hélène; Akhavan, Sharareh

2015-10-30

Occupational stress has been a health-related issue among nurses for many decades. Emergency department nurses are frequently confronted with occupational stress in their workplace; in particular, they encounter stressful situations and unpredictable events. These encounters could make them feel more stressed than nurses in other departments. Research considering occupational stress from the perspective of Thai emergency department nurses is limited. This study aimed to explore nurses' perceptions of occupational stress in an emergency department. A qualitative approach was used to gain an understanding of nurses' experiences and perceptions regarding stress in their workplace. Semi-structured interviews were used for data collection. Twenty-one emergency department nurses working in a public hospital in Thailand were interviewed, and the data were analyzed using content analysis. The findings comprised three themes: (1) perceived stress, (2) consequences of stress, and (3) stress management. The results of this study can be used by hospital management to help them adopt effective strategies, such as support programs involving co-workers/supervisors, to decrease occupational stress among emergency department nurses. Future research that explores each of the themes found in this study could offer a more comprehensive understanding of nurses' occupational stress in the emergency department.

Irish Baking Book

OpenAIRE

Ross, Ruth Isabel

1995-01-01

Published by Gill & Macmillan, Goldenbridge, Dublin 8 in 1995 at a cost of £4.99 Irish pounds.Editorial consultant Roberta Reeners, Illustrations by Tom Brady, Design and print origination by Identikit Design Consultants Dublin, index compiled by Helen Litton, printed by the Guernsey Press Ltd. 98p., 19cm., paperback. Access the publisher's website here http://arrow.dit.ie/irckbooks/1006/thumbnail.jpg

Minority Language Advertising: A Profile of Two Irish-Language Newspapers

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Kelly-Holmes, Helen; Atkinson, David

2007-01-01

This paper investigates the Irish-language adscape through an analysis of the profile of two Irish-language newspapers, "Foinse," published in the Republic of Ireland, and "La," published in Northern Ireland. The advertising in both papers is analysed in terms of products and services advertised, advertisers represented and…

76 FR 33967 - Irish Potatoes Grown in Southeastern States; Suspension of Marketing Order Provisions

Science.gov (United States)

2011-06-10

... IR] Irish Potatoes Grown in Southeastern States; Suspension of Marketing Order Provisions AGENCY... suspends the marketing order for Irish potatoes grown in Southeastern states (order), and the rules and regulations implemented thereunder, through March 1, 2014. The order regulates the handling of Irish potatoes...

Emergency department characteristics and capabilities in Beijing, China.

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Wen, Leana S; Xu, Jun; Steptoe, Anne P; Sullivan, Ashley F; Walline, Joseph H; Yu, Xuezhong; Camargo, Carlos A

2013-06-01

Emergency Departments (EDs) are a critical, yet heterogeneous, part of international emergency care. We sought to describe the characteristics, resources, capabilities, and capacity of EDs in Beijing, China. Beijing EDs accessible to the general public 24 h per day/7 days per week were surveyed using the National ED Inventories survey instrument (www.emnet-nedi.org). ED staff were asked about ED characteristics during the calendar year 2008. Thirty-six EDs participated (88% response rate). All were located in hospitals and were independent hospital departments. Participating EDs saw a median of 80,000 patients (interquartile range 40,000-118,508). The vast majority (91%; 95% confidence interval [CI] 78-98%) had a contiguous layout, with medical and surgical care provided in one area. Most EDs (55%) saw only adults; 39% saw both adults and children, and 6% saw only children. Availability of technological and consultant resource in EDs was high. The typical ED length of stay was between 1 and 6 h in 49% of EDs (95% CI 32-67%), whereas in the other half, patients reportedly remained for over 6 h; 36% (95% CI 21-54%) of respondents considered their ED over capacity. Beijing EDs have high volume, long length of stay, and frequent reports of EDs being over capacity. To meet its rapidly growing health needs in urban areas, China should consider improving urban ED capacity and training more Emergency Medicine specialists capable of efficiently staffing its crowded EDs. Copyright © 2013 Elsevier Inc. All rights reserved.

Quality and safety implications of emergency department information systems.

Science.gov (United States)

Farley, Heather L; Baumlin, Kevin M; Hamedani, Azita G; Cheung, Dickson S; Edwards, Michael R; Fuller, Drew C; Genes, Nicholas; Griffey, Richard T; Kelly, John J; McClay, James C; Nielson, Jeff; Phelan, Michael P; Shapiro, Jason S; Stone-Griffith, Suzanne; Pines, Jesse M

2013-10-01

The Health Information Technology for Economic and Clinical Health Act of 2009 and the Centers for Medicare & Medicaid Services "meaningful use" incentive programs, in tandem with the boundless additional requirements for detailed reporting of quality metrics, have galvanized hospital efforts to implement hospital-based electronic health records. As such, emergency department information systems (EDISs) are an important and unique component of most hospitals' electronic health records. System functionality varies greatly and affects physician decisionmaking, clinician workflow, communication, and, ultimately, the overall quality of care and patient safety. This article is a joint effort by members of the Quality Improvement and Patient Safety Section and the Informatics Section of the American College of Emergency Physicians. The aim of this effort is to examine the benefits and potential threats to quality and patient safety that could result from the choice of a particular EDIS, its implementation and optimization, and the hospital's or physician group's approach to continuous improvement of the EDIS. Specifically, we explored the following areas of potential EDIS safety concerns: communication failure, wrong order-wrong patient errors, poor data display, and alert fatigue. Case studies are presented that illustrate the potential harm that could befall patients from an inferior EDIS product or suboptimal execution of such a product in the clinical environment. The authors have developed 7 recommendations to improve patient safety with respect to the deployment of EDISs. These include ensuring that emergency providers actively participate in selection of the EDIS product, in the design of processes related to EDIS implementation and optimization, and in the monitoring of the system's ongoing success or failure. Our recommendations apply to emergency departments using any type of EDIS: custom-developed systems, best-of-breed vendor systems, or enterprise systems

Incidence and Cost of Ankle Sprains in United States Emergency Departments

Science.gov (United States)

Shah, Shweta; Thomas, Abbey C.; Noone, Joshua M.; Blanchette, Christopher M.; Wikstrom, Erik A.

2016-01-01

Background: Ankle sprains represent a common injury in emergency departments, but little is known about common complications, procedures, and charges associated with ankle sprains in emergency departments. Hypothesis: There will be a higher incidence of ankle sprains among younger populations (≤25 years old) and in female patients. Complications and procedures will differ between ankle sprain types. Lateral ankle sprains will have lower health care charges relative to medial and high ankle sprains. Study Design: Descriptive epidemiological study. Level of Evidence: Level 3. Methods: A cross-sectional study of the 2010 Nationwide Emergency Department Sample was conducted. Outcomes such as charges, complications, and procedures were compared using propensity score matching between lateral and medial as well as lateral and high ankle sprains. Results: The sample contained 225,114 ankle sprains. Female patients sustained more lateral ankle sprains (57%). After propensity score adjustment, lateral sprains incurred greater charges than medial ankle sprains (median [interquartile range], $1008 [$702-$1408] vs $914 [$741-$1108]; P sprain of the foot (2.96% vs 0.70%, P ankle sprain events. Among procedures, medial ankle sprains were more likely to include diagnostic radiology (97.91% vs 83.62%, P ankle sprains (0.87% vs 2.79%, P ankle sprains than lateral ankle sprains (24 [6.06%] vs 1 [0.25%], P Ankle sprain emergency department visits account for significant health care charges in the United States. Age- and sex-related differences persist among the types of ankle sprains. Clinical Relevance: The health care charges associated with ankle sprains indicate the need for additional preventive measures. There are age- and sex-related differences in the prevalence of ankle sprains that suggest these demographics may be risk factors for ankle sprains. PMID:27474161

Comparison in maternal body composition between Caucasian Irish and Indian women.

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Farah, N; Murphy, M; Ramphul, M; O'Connor, N; Kennelly, M M; Turner, M J

2011-08-01

The use of body mass index (BMI) for the diagnosis of obesity has limitations, especially when comparing ethnic groups with different body proportions. The aim of this prospective study was to compare maternal body composition in early pregnancy between Caucasian Irish and Indian women. A total of 81 Indian women and 81 Irish Caucasian women were matched for age, parity and BMI. Maternal weight and height were measured, and body composition analysed using bioelectrical impedance. The Irish women were taller and weighed more than the Indian women (pIndian women had a higher total body fat percentage, visceral fat level and high fat percentage than the Irish women (p=0.024, 0.001 and 0.001, respectively). Our findings suggest that lower BMI cut-offs should be used for screening for gestational diabetes mellitus in Indian women attending our antenatal services.

Emergency department surge: models and practical implications.

Science.gov (United States)

Nager, Alan L; Khanna, Kajal

2009-08-01

Emergency Department crowding has long been described. Despite the daily challenges of managing emergency department volume and acuity; a surge response during a disaster entails even greater challenges including collaboration, intervention, and resourcefulness to effectively carry out pediatric disaster management. Understanding surge and how to respond with appropriate planning will lead to success. To achieve this, we sought to analyze models of surge; review regional and national data outlining surge challenges and factors that impact surge; and to outline potential solutions. We conducted a systemic review and included articles and documents that best described the theoretical and practical basis of surge response. We organized the systematic review according to the following questions: What are the elements and models that are delineated by the concept of surge? What is the basis for surge response based on regional and national published sources? What are the broad global solutions? What are the major lessons observed that will impact effective surge capacity? Multiple models of surge are described including public health, facility-based and community-based; a 6-tiered response system; and intrinsic or extrinsic surge capacity. In addition, essential components (4 S's of surge response) are described along with regional and national data outlining surge challenges, impacting factors, global solutions, and lesions observed. There are numerous shortcomings regionally and nationally affecting our ability to provide an effective and coordinated surge response. Planning, education, and training will lead to an effective pediatric disaster management response.

Host Students' Perspectives of Intercultural Contact in an Irish University

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Dunne, Ciaran

2009-01-01

Given the increasing numbers of international students in Ireland and the lack of attention afforded to host culture students in existing research on intercultural relations in higher education, a grounded theory study was conducted in an Irish university exploring host (Irish) students' perspectives on intercultural contact. The study focused on…

Improved age constraints for the retreat of the Irish Sea Ice Stream

Science.gov (United States)

Smedley, Rachel; Chiverrell, Richard; Duller, Geoff; Scourse, James; Small, David; Fabel, Derek; Burke, Matthew; Clarke, Chris; McCarroll, Danny; McCarron, Stephen; O'Cofaigh, Colm; Roberts, David

2016-04-01

BRITICE-CHRONO is a large (> 45 researchers) consortium project working to provide an extensive geochronological dataset constraining the rate of retreat of a number of ice streams of the British-Irish Ice Sheet following the Last Glacial Maximum. When complete, the large empirical dataset produced by BRITICE-CHRONO will be integrated into model simulations to better understand the behaviour of the British-Irish Ice Sheet in response to past climate change, and provide an analogue for contemporary ice sheets. A major feature of the British-Irish Ice Sheet was the dynamic Irish Sea Ice Stream, which drained a large proportion of the ice sheet and extended to the proposed southern limit of glaciation upon the Isles of Scilly (Scourse, 1991). This study will focus on a large suite of terrestrial samples that were collected along a transect of the Irish Sea basin, covering the line of ice retreat from the Isles of Scilly (50°N) in the south, to the Isle of Man (54°N) in the north; a distance of 500 km. Ages are determined for both the eastern and western margins of the Irish Sea using single-grain luminescence dating (39 samples) and terrestrial cosmogenic nuclide dating (10 samples). A Bayesian sequence model is then used in combination with the prior information determined for deglaciation to integrate the geochronological datasets, and assess retreat rates for the Irish Sea Ice Stream. Scourse, J.D., 1991. Late Pleistocene stratigraphy and palaeobotany of the Isles of Scilly. Philosophical Transactions of the Royal Society of London B334, 405 - 448.

[Loyal frequent users of hospital emergency departments: the FIDUR project].

Science.gov (United States)

Fernández Alonso, Cesáreo; Romero Pareja, Rodolfo; Rivas García, Aristides; Jiménez Gallego, Rosa; Majo Carbajo, Yolanda; Aguilar Mulet, Juan Mariano

2016-02-01

To describe the characteristics of frequent users of hospital emergency departments and analyze whether characteristics varied in relation to how revisits were distributed over the course of the year studied. Retrospective study of patients over the age of 14 years who were treated in a hospital emergency department at least 10 times in 2013. Patients were identified in 17 public hospitals in the Spanish autonomous community of Madrid. Data related to the first and successive visits were gathered and analyzed by quarter year. We included 2340 patients with a mean (SD) age of 54 (21) years. A total of 1361 (58.%) were women, 1160 (50%) had no concomitant diseases, 1366 (58.2%) were substance abusers, and 25 (1.1%) were homeless. During the first visit, 2038 (87.1%) complained of a recent health problem, and 289 (12.4%) were admitted. Sixty (2.6%) patients concentrated their revisits in a single quarters 335 (14.3%) in 2 quarters, 914 (39.1%) in 3, and 1005 (42.9%) in 4. Patients whose revisits were distributed over more quarters were older (> 65 years), had more concomitant conditions, were on more medications (P women (P = .012) and more likely to have a specific diagnosis (P loyally comes to the same emergency department over the course of a year. Patients whose revisits are dispersed over a longer period have more complex problems and use more resources during their initial visit.

An integration of Emergency Department Information and Ambulance Systems.

Science.gov (United States)

Al-Harbi, Nada; El-Masri, Samir; Saddik, Basema

2012-01-01

In this paper we propose an Emergency Department Information System that will be integrated with the ambulance system to improve the communication, enhance the quality of provided emergency services and facilitate information sharing. The proposed system utilizes new advanced technologies such as mobile web services that overcome the problems of interoperability between different systems, HL7 and GPS. The system is unique in that it allows ambulance officers to locate the nearest specialized hospital and allows access to the patient's electronic health record as well as providing the hospital with required information to prepare for the incoming patient.

[Chest pain in the emergency department : Differential diagnosis and diagnostic strategy].

Science.gov (United States)

Köhnlein, T

2017-01-01

Chest pain as the leading symptom in emergency patients can have numerous causes and requires an immediate and targeted diagnostic and therapeutic strategy. Clinical scoring systems facilitate risk assessment for individual patients. In the emergency department, critical factors for success are defined professional qualification standards for physicians and nursing staff combined with a well-functioning organization of all technical procedures.

Risk of influenza transmission in a hospital emergency department during the week of highest incidence.

Science.gov (United States)

Esteve-Esteve, Miguel; Bautista-Rentero, Daniel; Zanón-Viguer, Vicente

2018-02-01

To estimate the risk of influenza transmission in patients coming to a hospital emergency department during the week of highest incidence and to analyze factors associated with transmission. Retrospective observational analysis of a cohort of patients treated in the emergency room during the 2014-2015 flu season. The following variables were collected from records: recorded influenza diagnosis, results of a rapid influenza confirmation test, point of exposure (emergency department, outpatient clinic, or the community), age, sex, flu vaccination or not, number of emergency visits, time spent in the waiting room, and total time in the hospital. We compiled descriptive statistics and performed bivariate and multivariate analyses by means of a Poisson regression to estimate relative risk (RR) and 95% CIs. The emergency department patients had a RR of contracting influenza 3.29 times that of the communityexposed population (95% CI, 1.53-7.08, P=.002); their risk was 2.05 times greater than that of outpatient clinic visitors (95% CI, 1.04-4.02, P=.036). Emergency patients under the age of 15 years had a 5.27 greater risk than older patients (95% CI, 1.59-17.51; P=.007). The RR of patients visiting more than once was 11.43 times greater (95% CI, 3.58-36.44; P<.001). The risk attributable to visiting the emergency department risk was 70.5%, whereas risk attributable to community exposure was 2%. The risk of contracting influenza is greater for emergency department patients than for the general population or for patients coming to the hospital for outpatient clinic visits. Patients under the age of 15 years incur greater risk.

Southern Hospitality: How We Changed the NPO Practice in the Emergency Department.

Science.gov (United States)

Denton, Traci D

2015-07-01

In the Vanderbilt Medical Center adult emergency department, the practice has been to keep patients on "nothing by mouth" (NPO) status throughout their assessment, diagnostic, and treatment phases. As a result, most patients have NPO status for a period of several hours to days. The consequences are patient discomfort, hunger, thirst, dehydration, interruptions in routine medication schedules, poor glucose control, and compromised acid/base balance. The purpose of this project was to modify the NPO practice in the adult emergency department. A survey of nursing staff perceptions demonstrated both staff and patient dissatisfaction with the NPO practice. Responses to postdischarge satisfaction surveys demonstrated that patients experienced some discomfort because of hunger or thirst. A search of the literature revealed that the American Society of Anesthesiologists (ASA) adopted guidelines in 1999 that patients should fast 6 hours from solids and 2 hours from liquids preoperatively. These guidelines were implemented in the adult emergency department using the Standard Rollout Process. Physician order sets for the emergency department and the ED chest pain unit were modified to reflect the ASA guidelines. After implementation of the ASA guidelines, a follow-up survey of nursing staff showed increased staff and patient satisfaction. After implementation, the patient satisfaction survey demonstrated an increase in patients who reported "no discomfort" because of hunger or thirst. No adverse outcomes or delays were reported in relation to the change in NPO standards. This change in practice resulted in improved satisfaction for patents and staff. The ASA guidelines have been in existence for more than a decade. They are evidence based. The role of the nurse is to advocate for the patient. Nurses need to be proactive in determining the timing of procedures and asking physicians to give diet orders that are in accordance with the ASA guidelines. Copyright © 2015 Emergency

Alcohol-related Injuries at an Emergency Department in Eastern Taiwan

Directory of Open Access Journals (Sweden)

Yin-Ming Li

2006-01-01

Conclusion: Injuries were alcohol related in one out of seven patients this study from an emergency department in eastern Taiwan. Ongoing epidemiologic monitoring of the prevalence and nature of alcohol abuse among patients visiting the ED are urgently needed.

Contemporary Irish identity on the Emerald Isle of the Caribbean

DEFF Research Database (Denmark)

McAtackney, Laura; Ryzewski, Krysta; Cherry, John F

2014-01-01

In recent decades, the island of Montserrat has been noticeably repositioning itself within the Caribbean as a place with a unique Irish heritage. Using the tag-line ‘the Emerald Isle of the Caribbean’, there has been an explicit attempt to evoke images of a verdant, green island with a long Irish...

Irish International Cultural and Educational Exchange: Two Models for Inspiration

DEFF Research Database (Denmark)

Bøss, Michael

2006-01-01

An account of the cultural and educational foreign policies of Denmark and Canada and a discussion of their relevance for the future of Irish foreign policy.......An account of the cultural and educational foreign policies of Denmark and Canada and a discussion of their relevance for the future of Irish foreign policy....

Debbie Ging, Men and Masculinities in Irish Cinema

OpenAIRE

Epinoux, Estelle

2013-01-01

Men and Masculinities in Irish Cinema was written by Debbie Ging, who is a lecturer in Film and Media Studies at Dublin City University’s School of Communications in Ireland. Her book falls into the field of media studies and more precisely film studies. It is divided into nine chapters which interweave the notions of gender, nation, identity and masculinity. The author centres her research around the concept of masculinity, unveiling its multiple understandings within the context of Irish so...

Trauma in elderly patients evaluated in a hospital emergency department in Konya, Turkey: a retrospective study

Directory of Open Access Journals (Sweden)

Kara H

2013-12-01

Full Text Available Hasan Kara,1 Aysegul Bayir,1 Ahmet Ak,1 Murat Akinci,1 Necmettin Tufekci,1 Selim Degirmenci,1 Melih Azap21Department of Emergency Medicine, Selçuk University, Konya, Turkey; 2Department of Emergency Medicine, Konya Numune Hospital, Konya, TurkeyPurpose: Trauma is a common cause of admission to the hospital emergency department. The purpose of this study was to evaluate the cause of admission, clinical characteristics, and outcomes of patients aged ≥65 years admitted to an emergency department in Turkey because of blunt trauma.Materials and methods: Medical records were retrospectively reviewed for 568 patients (314 women and 254 men aged ≥65 years who were admitted to an emergency department of a tertiary care hospital.Results: Trauma was caused by low-energy fall in 379 patients (67%, traffic accident in 79 patients (14%, high-energy fall in 69 patients (12%, and other causes in 41 patients (7%. The most frequent sites of injury were the lower extremity, thorax, upper extremity, and head. The femur was the most frequent fracture site. After evaluation in the emergency department, 377 patients (66% were hospitalized. There were 31 patients (5% who died. Risk of hospitalization after trauma was significantly associated with trauma to the lower extremity, thorax, and spine; fractures of the femur and rib; and intracranial injury.Conclusion: Emergency department admission after trauma in patients aged $65 years is common after low-energy falls, and most injuries occur to the extremities. It is important to focus on prevention of falls to decrease the frequency of trauma in the elderly.Keywords: fall, femur, fracture, injury

Bridging environmental and financial cost of dairy production: A case study of Irish agricultural policy.

Science.gov (United States)

Chen, Wenhao; Holden, Nicholas M

2018-02-15

The Irish agricultural policy 'Food Harvest 2020' is a roadmap for sectoral expansion and Irish dairy farming is expected to intensify, which could influence the environmental and economic performance of Irish milk production. Evaluating the total environmental impacts and the real cost of Irish milk production is a key step towards understanding the possibility of sustainable production. This paper addresses two main issues: aggregation of environmental impacts of Irish milk production by monetization, to understand the real cost of Irish milk production, including the environmental costs; and the effect of the agricultural policy 'Food Harvest 2020' on total cost (combining financial cost and environmental cost) of Irish milk production. This study used 2013 Irish dairy farming as a baseline, and defined 'bottom', 'target' and 'optimum' scenarios, according to the change of elementary inputs required to meet agricultural policy ambitions. The study demonstrated that the three monetization methods, Stepwise 2006, Eco-cost 2012 and EPS 2000, could be used for aggregating different environmental impacts into monetary unit, and to provide an insight for evaluating policy related to total environmental performance. The results showed that the total environmental cost of Irish milk production could be greater than the financial cost (up to €0.53/kg energy corrected milk). The dairy expansion policy with improved herbage utilization and fertilizer application could reduce financial cost and minimize the total environmental cost of per unit milk produced. Copyright © 2017 Elsevier B.V. All rights reserved.

Estimating Uncompensated Care Charges at Rural Hospital Emergency Departments

Science.gov (United States)

Bennett, Kevin J.; Moore, Charity G.; Probst, Janice C.

2007-01-01

Context: Rural hospitals face multiple financial burdens. Due to federal law, emergency departments (ED) provide a gateway for uninsured and self-pay patients to gain access to treatment. It is unknown how much uncompensated care in rural hospitals is due to ED visits. Purpose: To develop a national estimate of uncompensated care from patients…

Advocating Commodification: An Ethnographic Look at the Policing of Irish as a Commercial Asset

Science.gov (United States)

Brennan, Sara C.

2018-01-01

Based on ethnographic fieldwork in two towns in the Republic of Ireland, this article explores the local negotiation, endorsement, and contestation of two community-level Irish language advocacy organizations' attempts to regulate the use of Irish in business by mobilizing discourses of language commodification to position Irish as a commercial…

Investment in Edification: Reflections on Irish Education Policy since Independence

Science.gov (United States)

O'Connor, Muiris

2014-01-01

Beginning with a historical review of Irish education policy since the establishment of the Irish Free State in 1922, this paper focuses on the issue of investment in education through the lens of the "Investment in Education" report. Following this historical review, the author explores how the legacy of the past continues to define the…

Comparison in maternal body composition between Caucasian Irish and Indian women.

LENUS (Irish Health Repository)

Farah, N

2012-02-01

The use of body mass index (BMI) for the diagnosis of obesity has limitations, especially when comparing ethnic groups with different body proportions. The aim of this prospective study was to compare maternal body composition in early pregnancy between Caucasian Irish and Indian women. A total of 81 Indian women and 81 Irish Caucasian women were matched for age, parity and BMI. Maternal weight and height were measured, and body composition analysed using bioelectrical impedance. The Irish women were taller and weighed more than the Indian women (p<0.001). At any given BMI, the Indian women had a higher total body fat percentage, visceral fat level and high fat percentage than the Irish women (p=0.024, 0.001 and 0.001, respectively). Our findings suggest that lower BMI cut-offs should be used for screening for gestational diabetes mellitus in Indian women attending our antenatal services.

The use of high‐flow nasal cannula in the pediatric emergency department

Directory of Open Access Journals (Sweden)

Katherine N. Slain

2017-11-01

Conclusions: High‐flow nasal cannula should be considered for pediatric emergency department patients with respiratory distress not requiring immediate endotracheal intubation; prospective, pediatric emergency department‐specific trials are needed to better determine responsive patient populations, ideal high‐flow nasal cannula settings, and comparative efficacy vs. other respiratory support modalities.

Management of inflammatory bowel disease flares in the emergency department [digest].

Science.gov (United States)

Burg, Michael D; Riccoboni, Steven T; Nusbaum, Jeffrey; Gupta, Nachi

2017-11-22

Because of the chronic relapsing nature of inflammatory bowel disease (IBD), emergency clinicians frequently manage patients with acute flares and complications. IBD patients present with an often-broad range of nonspecific signs and symptoms, and it is essential to differentiate a mild flare from a life-threatening intra-abdominal process. Recognizing extraintestinal manifestations and the presence of infection are critical. This issue reviews the literature on management of IBD flares in the emergency department, including laboratory testing, imaging, and identification of surgical emergencies, emphasizing the importance of coordination of care with specialists on treatment plans and offering patients resources for ongoing support. [Points & Pearls is a digest of Emergency Medicine Practice.].

Mortality Patterns In The Accident And Emergency Department Of An ...

African Journals Online (AJOL)

Mortality Patterns In The Accident And Emergency Department Of An Urban Hospital In Nigeria. ... Nigerian Journal of Clinical Practice ... subset being 4.6:1 and 1.2:1 respectively Most of the cases were of non-traumatic origin (79.8%), with the ...

Drinking water turbidity and emergency department visits for gastrointestinal illness in Atlanta, 1993-2004.

Science.gov (United States)

Tinker, Sarah C; Moe, Christine L; Klein, Mitchel; Flanders, W Dana; Uber, Jim; Amirtharajah, Appiah; Singer, Philip; Tolbert, Paige E

2010-01-01

The extent to which drinking water turbidity measurements indicate the risk of gastrointestinal illness is not well understood. Despite major advances in drinking water treatment and delivery, infectious disease can still be transmitted through drinking water in the United States, and it is important to have reliable indicators of microbial water quality to inform public health decisions. The objective of our study was to assess the relationship between gastrointestinal illness, quantified through emergency department visits, and drinking water quality, quantified as raw water and filtered water turbidity measured at the treatment plant. We examined the relationship between turbidity levels of raw and filtered surface water measured at eight major drinking water treatment plants in the metropolitan area of Atlanta, Georgia, and over 240,000 emergency department visits for gastrointestinal illness during 1993-2004 among the population served by these plants. We fit Poisson time-series statistical regression models that included turbidity in a 21-day distributed lag and that controlled for meteorological factors and long-term time trends. For filtered water turbidity, the results were consistent with no association with emergency department visits for gastrointestinal illness. We observed a modest association between raw water turbidity and emergency department visits for gastrointestinal illness. Our results suggest that source water quality may contribute modestly to endemic gastrointestinal illness in the study area. The association between turbidity and emergency department visits for gastrointestinal illness was only observed when raw water turbidity was considered; filtered water turbidity may not serve as a reliable indicator of modest pathogen risk at all treatment plants.

Perceived Facilitators and Barriers to Local Health Department Workers' Participation in Infectious Disease Emergency Responses.

Science.gov (United States)

Rutkow, Lainie; Paul, Amy; Taylor, Holly A; Barnett, Daniel J

Local health departments play a key role in emergency preparedness and respond to a wide range of threats including infectious diseases such as seasonal influenza, tuberculosis, H1N1, Ebola virus disease, and Zika virus disease. To successfully respond to an infectious disease outbreak, local health departments depend upon the participation of their workforce; yet, studies indicate that sizable numbers of workers would not participate in such a response. The reasons why local health department workers participate, or fail to participate, in infectious disease responses are not well understood. To understand why local health department workers are willing, or not willing, to report to work during an infectious disease response. From April 2015 to January 2016, we conducted 28 semistructured interviews with local health department directors, preparedness staff, and nonpreparedness staff. Interviews were conducted with individuals throughout the United States. We interviewed 28 individuals across 3 groups: local health department directors (n = 8), preparedness staff (n = 10), and nonpreparedness staff (n = 10). Individuals' descriptions of why local health department workers are willing, or not willing, to report to work during an infectious disease response. Factors that facilitate willingness to respond to an infectious disease emergency included availability of vaccines and personal protective equipment; flexible work schedule and childcare arrangements; information sharing via local health department trainings; and perceived commitments to one's job and community. Factors that hinder willingness to respond to an infectious disease emergency included potential disease exposure for oneself and one's family; logistical considerations for care of children, the elderly, and pets; and perceptions about one's role during an infectious disease response. Our findings highlight opportunities for local health departments to revisit their internal policies and engage in

Emergency department admissions are more profitable than non-emergency department admissions.

Science.gov (United States)

Henneman, Philip L; Lemanski, Michael; Smithline, Howard A; Tomaszewski, Andrew; Mayforth, Janice A

2009-02-01

We compare the contribution margin per case per hospital day of emergency department (ED) admissions with non-ED admissions in a single hospital, a 600-bed, academic, tertiary referral, Level I trauma center with an annual ED census of 100,000. This was a retrospective comparison of the contribution margin per case per day for ED and non-ED inpatient admissions for fiscal years 2003, 2004, and 2005 (October 1 through September 30). Contribution margin is defined as net revenue minus total direct costs; it is then expressed per case per hospital day. Service lines are a set of linked patient care services. Observation admissions and outpatient services are not included. Resident expenses (eg, salary and benefits) and revenue (ie, Medicare payment of indirect medical expenses and direct medical expenses) are not included. Overhead expenses are not included (eg, building maintenance, utilities, information services support, administrative services). For fiscal year 2003 through fiscal year 2005, there were 51,213 ED and 57,004 non-ED inpatient admissions. Median contribution margin per day for ED admissions was higher than for non-ED admissions: ED admissions $769 (interquartile range $265 to $1,493) and non-ED admissions $595 (interquartile range $178 to $1,274). Median contribution margin per day varied by site of admissions, by diagnosis-related group, by service line, and by insurance type. In summary, ED admissions in our institution generate a higher contribution margin per day than non-ED admissions.

The perceived impact of an emergency department immediate reporting service: An exploratory survey

International Nuclear Information System (INIS)

Snaith, Beverly; Hardy, Maryann

2013-01-01

Background: Immediate reporting, commonly referred to as a ‘hot reporting’, has been advocated as a method of effectively supporting clinical decision making. However, its implementation nationally has been limited with poor understanding of its value in practice. Method: A cross sectional attitudinal survey was distributed to emergency department clinicians (medical and nursing staff) and radiographers to explore perceptions of an immediate reporting service in terms of its influence on professional role and autonomy, patient care and service quality. Results: A total of 87 (n = 87/155; 56.1%) completed questionnaires were returned. The findings suggest that significant support for immediate reporting exists. Immediate reporting is believed to improve service quality, reduce clinical errors and provide opportunity for image interpretation skills development. However, responses were not consistent across clinical professions and staff grades. Conclusion: The immediate reporting of emergency department images is perceived to benefit patient, emergency department clinicians and hospital organisation

Forecasting Hospitalization and Emergency Department Visit Rates for Chronic Obstructive Pulmonary Disease. A Time-Series Analysis.

Science.gov (United States)

Gershon, Andrea; Thiruchelvam, Deva; Moineddin, Rahim; Zhao, Xiu Yan; Hwee, Jeremiah; To, Teresa

2017-06-01

Knowing trends in and forecasting hospitalization and emergency department visit rates for chronic obstructive pulmonary disease (COPD) can enable health care providers, hospitals, and health care decision makers to plan for the future. We conducted a time-series analysis using health care administrative data from the Province of Ontario, Canada, to determine previous trends in acute care hospitalization and emergency department visit rates for COPD and then to forecast future rates. Individuals aged 35 years and older with physician-diagnosed COPD were identified using four universal government health administrative databases and a validated case definition. Monthly COPD hospitalization and emergency department visit rates per 1,000 people with COPD were determined from 2003 to 2014 and then forecasted to 2024 using autoregressive integrated moving average models. Between 2003 and 2014, COPD prevalence increased from 8.9 to 11.1%. During that time, there were 274,951 hospitalizations and 290,482 emergency department visits for COPD. After accounting for seasonality, we found that monthly COPD hospitalization and emergency department visit rates per 1,000 individuals with COPD remained stable. COPD prevalence was forecasted to increase to 12.7% (95% confidence interval [CI], 11.4-14.1) by 2024, whereas monthly COPD hospitalization and emergency department visit rates per 1,000 people with COPD were forecasted to remain stable at 2.7 (95% CI, 1.6-4.4) and 3.7 (95% CI, 2.3-5.6), respectively. Forecasted age- and sex-stratified rates were also stable. COPD hospital and emergency department visit rates per 1,000 people with COPD have been stable for more than a decade and are projected to remain stable in the near future. Given increasing COPD prevalence, this means notably more COPD health service use in the future.

Emergency Department Presentations following Tropical Cyclone Yasi.

Directory of Open Access Journals (Sweden)

Peter Aitken

Full Text Available Emergency departments see an increase in cases during cyclones. The aim of this study is to describe patient presentations to the Emergency Department (ED of a tertiary level hospital (Townsville following a tropical cyclone (Yasi. Specific areas of focus include changes in: patient demographics (age and gender, triage categories, and classification of diseases.Data were extracted from the Townsville Hospitals ED information system (EDIS for three periods in 2009, 2010 and 2011 to coincide with formation of Cyclone Yasi (31 January 2011 to six days after Yasi crossed the coast line (8 February 2012. The analysis explored the changes in ICD10-AM 4-character classification and presented at the Chapter level.There was a marked increase in the number of patients attending the ED during Yasi, particularly those aged over 65 years with a maximum daily attendance of 372 patients on 4 Feb 2011. The most marked increases were in: Triage categories--4 and 5; and ICD categories--diseases of the skin and subcutaneous tissue (L00-L99, and factors influencing health care status (Z00-Z99. The most common diagnostic presentation across all years was injury (S00-T98.There was an increase in presentations to the ED of TTH, which peaked in the first 24-48 hours following the cyclone and returned to normal over a five-day period. The changes in presentations were mostly an amplification of normal attendance patterns with some altered areas of activity. Injury patterns are similar to overseas experience.

Physician Assistants Contribution to Emergency Department Productivity

Directory of Open Access Journals (Sweden)

Christopher Brook, MD

2012-05-01

Full Text Available Introduction: The objective of this report is to determine physician assistant (PA productivity in anacademic emergency department (ED and to determine whether shift length or department censusimpact productivity.Methods: A retrospective chart review was conducted at a tertiary ED during June and July of 2007.Productivity was calculated as the mean number of patients seen each hour. Analysis of variance wasused to compare the productivity of different length shifts, and linear regression analysis was used toassess the relationship between productivity and department volume.Results: One hundred sixty PA shifts were included. Shifts ranged from 4 to 13 hours. Meanproductivity was 1.16 patients per hour (95% confidence interval [CI] ¼ 1.12–1.20. Physicianassistants generated a mean of 2.35 relative value units (RVU per hour (95% CI¼1.98–2.72. Therewas no difference in productivity on different shift lengths (P¼0.73. There was no correlation betweendepartmental census and productivity, with an R2 (statistical term for the coefficient of determination of0.01.Conclusion: In the ED, PAs saw 1.16 patients and generated 2.35 RVUs per hour. The length of theshift did not affect productivity. Productivity did not fluctuate significantly with changing departmentalvolume.

Forensic patients in the emergency department: Who are they and how should we care for them?

Science.gov (United States)

Filmalter, Celia J; Heyns, T; Ferreira, R

2017-10-16

Patients who suffer violent, crime related injuries are likely to seek medical assistance in emergency departments. Forensic patients may not disclose the cause of their injuries leading to the impairment of evidence. We explored healthcare providers' perceptions of forensic patients and how they should be cared for. The perceptions of physicians and nurses regarding the profiles and care of forensic patients were explored in three urban emergency departments. The data were collected through a talking wall and analysed collaboratively, with the participants, using content analysis. Healthcare providers in emergency departments differentiated between living and deceased forensic patients. Healthcare providers identified living forensic patients as victims of sexual assault, assault, gunshots and stab wounds, and abused children. Deceased patients included patients that were dead on arrival or died in the emergency departments. Healthcare providers acknowledged that evidence should be collected, preserved and documented. Every trauma patient in the emergency department should be treated asa forensic patient until otherwise proven. If healthcare providers are unable to identify forensic patients and collect the evidence present, the patients' human right to justice will be violated. Copyright © 2017 Elsevier Ltd. All rights reserved.

Medical Identity Theft in the Emergency Department: Awareness is Crucial

Directory of Open Access Journals (Sweden)

Michelino Mancini

2014-11-01

Full Text Available Medical Identity theft in the emergency department (ED can harm numerous individuals, and many frontline healthcare providers are unaware of this growing concern. The two cases described began as typical ED encounters until red flags were discovered upon validating the patient’s identity. Educating all healthcare personnel within and outside the ED regarding the subtle signs of medical identity theft and implementing institutional policies to identify these criminals will discourage further fraudulent behavior. [West J Emerg Med. 2014;15(7:–0.

Patients with Borderline Personality Disorder in Emergency Departments

Science.gov (United States)

Shaikh, Untara; Qamar, Iqra; Jafry, Farhana; Hassan, Mudasar; Shagufta, Shanila; Odhejo, Yassar Islamail; Ahmed, Saeed

2017-01-01

Borderline personality disorder (BPD) patients, when in crisis, are frequent visitors of emergency departments (EDs). When these patients exhibit symptoms such as aggressiveness, impulsivity, intense anxiety, severe depression, self-harm, and suicidal attempts or gestures, diagnosis, and treatment of the BPD becomes challenging for ED doctors. This review will, therefore, outline advice to physicians and health-care providers who face this challenging patient population in the EDs. Crisis intervention should be the first objective of clinicians when dealing with BPD in the emergency. For the patients with agitation, symptom-specific pharmacotherapy is usually recommended, while for non-agitated patients, short but intensive psychotherapy especially dialectical behavior therapy (DBT) has a positive effect. Although various psychotherapies, either alone or integrated, are preferred modes of treatment for this group of patients, the effects of psychotherapies on BPD outcomes are small to medium. Proper risk management along with developing a positive attitude and empathy toward these patients will help them in normalizing in an emergency setting after which treatment course can be decided. PMID:28824467

Emergency department operations and management education in emergency medicine training

Institute of Scientific and Technical Information of China (English)

Bret A Nicks; Darrell Nelson

2012-01-01

BACKGROUND:This study was undertaken to examine the current level of operations and management education within US-based Emergency Medicine Residency programs.METHODS:Residency program directors at all US-based Emergency Medicine Residency programs were anonymously surveyed via a web-based instrument.Participants indicated their levels of residency education dedicated to documentation,billing/coding,core measure/quality indicator compliance,and operations management.Data were analyzed using descriptive statistics for the ordinal data/Likert scales.RESULTS:One hundred and six(106)program directors completed the study instrument of one hundred and fifty-six(156)programs(70%).Of these,82.6%indicated emergency department(ED)operations and management education within the training curriculum.Dedicated documentation training was noted in all but 1 program(99%).Program educational offerings also included billing/coding(83%),core measure/quality indicators(78%)and operations management training(71%).In all areas,the most common means of educating came through didactic sessions and direct attending feedback or 69%-94%and 72%-98%respectively.Residency leadership was most confident with resident understanding of quality documentation(80%)and less so with core measures(72%),billing/coding/RVUs(58%),and operations management tools(23%).CONCLUSIONS:While most EM residency programs integrate basic operational education related to documentation and billing/coding,a smaller number provide focused education on the dayto-day management and operations of the ED.Residency leadership perceives graduating resident understanding of operational management tools to be limited.All respondents value further resident curriculum development of ED operations and management.

Windscale experiment. A study of Windscale's pollution of the Irish Sea

Energy Technology Data Exchange (ETDEWEB)

Blackith, R

1984-01-01

The discharge of radioactive waste into the Irish Sea from the Windscale reprocessing plant in Cumbria is discussed from an Irish viewpoint. A history of accidents at the plant is reviewed, and past, present and future levels of discharge to the environment are outlined. The effect on the Irish population of discharges to the marine environment is evaluated by consideration of the food chain and the exposure pathways to man, in particular the concentration of radioactive caesium and plutonium in the flesh of fish in the Irish Sea. The general health effects attributed to radiation exposures are given, and a cluster of Downs Syndrome babies born to mothers who were at the same school in Co. Louth is attributed to increased exposure during the 1957 fire at the Windscale plant. The author concludes that, because of military implications and the need for plutonium for nulcear weapons, the reprocessing plant will continue to operate, but with greatly reduced levels of discharges permitted.

Use of telehealth in the management of non-critical emergencies in rural or remote emergency departments: a systematic review.

Science.gov (United States)

du Toit, Marie; Malau-Aduli, Bunmi; Vangaveti, Venkat; Sabesan, Sabe; Ray, Robin A

2017-01-01

Background Telehealth has been used extensively in emergency departments to improve healthcare provision. However, its impact on the management of non-critical emergency presentations within rural and remote emergency department settings has not been adequately explored. The objective of this systematic review is to identify how telehealth has been used to assist in the management of non-critical presentations in rural and remote emergency departments and the outcomes. Methods Articles were identified through database searches of CINAHL, Cochrane, MEDLINE (OVID), Informit and SCOPUS, as well as the screening of relevant article reference and citation lists. To determine how telehealth can assist in the management of non-critical emergencies, information was extracted relating to telehealth programme model, the scope of service and participating health professionals. The outcomes of telehealth programmes were determined by analysing the uptake and usage of telehealth, the impact on altering a diagnosis or management plan as well as patient disposition including patient transfer, discharge, local hospital admission and rates of discharge against medical advice. Results Of the 2532 identified records, 15 were found to match the eligibility criteria and were included in the review. Uptake and usage increased for telehealth programmes predominantly utilised by nursing staff with limited local medical support. Teleconsultation conservatively altered patient diagnosis or management in 18-66% of consultations. Although teleconsultation was associated with increased patient transfer rates, unnecessary transfers were reduced. Simultaneously, an increase in local hospital admission was noted and fewer patients were discharged home. Discharge against medical advice rates were low at 0.9-1.1%. Conclusion The most widely implemented hub-and-spoke telehealth model could be incorporated into existing referral frameworks. Telehealth programmes may assist in reducing unnecessary

Procedures and Collaborative Information Seeking: A Study of Emergency Departments

DEFF Research Database (Denmark)

Hertzum, Morten; Reddy, Madhu

2015-01-01

Information seeking is a central and inherently collaborative activity in the emergency department (ED) which is the common entry point to hospitals for nearly all acute patients. In this paper, we investigate how ED clinicians’ collabo-rative information seeking (CIS) is shaped by the procedures...

Five easy equations for patient flow through an emergency department

DEFF Research Database (Denmark)

Madsen, Thomas Lill; Kofoed-Enevoldsen, Allan

2011-01-01

Queue models are effective tools for framing management decisions and Danish hospitals could benefit from awareness of such models. Currently, as emergency departments (ED) are under reorganization, we deem it timely to empirically investigate the applicability of the standard "M/M/1" queue model...

The introduction of the Manchester triage scale to an emergency department in the Republic of Ireland.

LENUS (Irish Health Repository)

Cronin, J G

2012-02-03

Triage is an integral part of the modern emergency department. The use of a recognised triage system has many advantages for the emergency department including reference to a recognised decision-making structure and support in the form of a professionally accepted and validated system. As part of a programme of internal change the Manchester triage system (MTS) was introduced to an emergency department in the Republic of Ireland. This article outlines the introduction of this method of triage and cites the domestic and international drivers of the change.

Irish nurses’ and midwives’ understanding and experiences of empowerment

OpenAIRE

Corbally, Melissa; Scott, Anne; Matthews, Anne; MacGabhann, Liam; Murphy, Catriona

2007-01-01

Aim This study explored conceptualisations of empowerment amongst Irish nurses and midwives. Background Current literature on the meaning of empowerment in the literature lacks consensus. As a result there is a likelihood that empowerment will be conceptualised differently between managers and sub-ordinates. Method In order to get a sense of how Irish practitioners viewed empowerment, ten focus groups were held in locations throughout Ireland (n = 93). A national distribution of par...

The impact of a temporary ice-rink on an emergency department service.

LENUS (Irish Health Repository)

Clarke, Heather J

2012-02-03

BACKGROUND: A temporary ice-rink opened close to Cork city for 6 weeks from 30 November 2003. During this time, a number of patients presented to the local emergency departments with ice-skating-related injuries. We documented these injuries. METHODS: All patients presenting to emergency departments in Cork city with ice-skating-related complaints were included. Information on age and sex, mechanism of injury, diagnosis, follow-up\\/disposition and ambulance service utilization was recorded. RESULTS: One hundred and twenty-five ice-rink-related attendances were reported at Cork emergency departments, representing 1.25% of total attendances. One hundred and twenty-three patients presented with skating-related injuries and two with medical complaints occurring at the ice-rink: 70.8% were female patients and 29.2% were male patients. In the 4-14-year age group, however, 48.5% were girls and 51.5% were boys. Most injuries were directly due to falls; 5.6% were due to skate blades. The commonest site of injury was the upper limb. Fractures and dislocations accounted for 53.9% of injuries, with 20.5% of these requiring orthopaedic admission. Lacerations and digital injuries accounted for 7.1%, with 11% of these required admission for surgery. One minor head injury was reported. 38.1% had soft tissue injuries. Fifteen patients were transported by ambulance. These attendances represented a minimum overall cost of 77,510 euro to the local health service. CONCLUSIONS: A temporary ice-rink had a significant impact on local emergency departments. Currently, there is no specific legislation in Ireland relating to public health and safety in ice-rinks. We recommend consultation with local public bodies before opening such facilities, and appropriate regulation.

Entangled geographies of "Irish" finance

NARCIS (Netherlands)

Hendrikse, R.P.

2013-01-01

This paper dissects the financial crisis through an analysis of financial development in Ireland. Although a single system, Irish finance is split in two. Illustrative of national financial developments, this paper details how public officials aimed to create a financial center in Cork. Exemplifying

Patterns of 'at-home' alcohol-related injury presentations to emergency departments.

Science.gov (United States)

Bunker, Naomi; Woods, Cindy; Conway, Jane; Barker, Ruth; Usher, Kim

2017-01-01

This study aimed to establish the scale of alcohol-related injuries originating in the home. Despite recent media and public attention on alcohol-related injuries occurring at licensed venues, many occur in other locations including the home. A retrospective observational study. Emergency department surveillance data sourced from the Queensland Injury Surveillance Unit were interrogated for alcohol-related emergency department presentations from 2003-2012 (n = 12,296). Descriptive analysis was undertaken to assess alcohol involvement in injury, and analysis of variance was used to determine the differences among group means and their associated presentations. The relationship between demographic variables and injury location was assessed using p value of domestic violence by spouse or partner (n = 510), 59·5% occurred 'at home'. This is the first study to investigate alcohol-related injuries occurring at home. The home accounts for a greater proportion of injuries than the frequently assessed licensed premises location. Further research is required to validate these findings in a wider setting. A public health campaign is required to minimise harm associated with alcohol-related injuries in the home, and nurses are positioned to inform health policy makers around this issue. Furthermore, emergency department nurses are in a unique position to provide brief interventions around safe alcohol consumption and injury prevention. © 2016 John Wiley & Sons Ltd.

Disruptive Behaviors in an Emergency Department: the Perspective of Physicians and Nurses

Directory of Open Access Journals (Sweden)

Maryam Maddineshat

2016-09-01

Full Text Available Introduction: Disruptive behaviors cause many problems in the workplace, especially in the emergency department (ED.This study was conducted to assess the physician’s and nurse’s perspective toward disruptive behaviors in the emergency department. Methods: In this cross-sectional study a total of 45 physicians and 110 nurses working in the emergency department of five general hospitals in Bojnurd participated. Data were collected using a translated, changed, and validated questionnaire (25 item. The collected data were analyzed by SPSS ver.13 software. Results: Findings showed that physicians gave more importance to nurse-physician relationships in the ED when compared to nurses’ perspective (90% vs. 70%. In this study, 81% of physicians and 52% of nurses exhibited disruptive behaviors. According to the participants these behaviors could result in adverse outcomes, such as stress (97%, job dissatisfaction and can compromise patient safety (53%, quality of care (72%, and errors (70%. Conclusion: Disruptive behaviors could have a negative effects on relationships and collaboration among medical staffs, and on patients’ quality of care as well. It is essential to provide some practical strategies for prevention of these behaviors.

Hospitalisation in an emergency department short-stay unit compared to an internal medicine department is associated with fewer complications in older patients - an observational study

DEFF Research Database (Denmark)

Strøm, Camilla; Mollerup, Talie Khadem; Kromberg, Laurits Schou

2017-01-01

Medicine Department (IMD). METHODS: Observational study evaluating adverse events during hospitalisation in non-emergent, age-matched, internal medicine patients ≥75 years, acutely admitted to either the SSU or the IMD at Holbaek Hospital, Denmark, from January to August, 2014. Medical records were......, unplanned readmission, and nosocomial infection. CONCLUSIONS: Adverse events of hospitalisation were significantly less common in older patients acutely admitted to an Emergency Department Short-stay Unit as compared to admission to an Internal Medicine Department.......BACKGROUND: Older patients are at particular risk of experiencing adverse events during hospitalisation. OBJECTIVE: To compare the frequencies and types of adverse events during hospitalisation in older persons acutely admitted to either an Emergency Department Short-stay Unit (SSU) or an Internal...

Rehospitalizations and Emergency Department Visits after Hospital Discharge in Patients Receiving Maintenance Hemodialysis.

Science.gov (United States)

Harel, Ziv; Wald, Ron; McArthur, Eric; Chertow, Glenn M; Harel, Shai; Gruneir, Andrea; Fischer, Hadas D; Garg, Amit X; Perl, Jeffrey; Nash, Danielle M; Silver, Samuel; Bell, Chaim M

2015-12-01

Clinical outcomes after a hospital discharge are poorly defined for patients receiving maintenance in-center (outpatient) hemodialysis. To describe the proportion and characteristics of these patients who are rehospitalized, visit an emergency department, or die within 30 days after discharge from an acute hospitalization, we conducted a population-based study of all adult patients receiving maintenance in-center hemodialysis who were discharged between January 1, 2003, and December 31, 2011, from 157 acute care hospitals in Ontario, Canada. For patients with more than one hospitalization, we randomly selected a single hospitalization as the index hospitalization. Of the 11,177 patients included in the final cohort, 1926 (17%) were rehospitalized, 2971 (27%) were treated in the emergency department, and 840 (7.5%) died within 30 days of discharge. Complications of type 2 diabetes mellitus were the most common reason for rehospitalization, whereas heart failure was the most common reason for an emergency department visit. In multivariable analysis using a cause-specific Cox proportional hazards model, the following characteristics were associated with 30-day rehospitalization: older age, the number of hospital admissions in the preceding 6 months, the number of emergency department visits in the preceding 6 months, higher Charlson comorbidity index score, and the receipt of mechanical ventilation during the index hospitalization. Thus, a large proportion of patients receiving maintenance in-center hemodialysis will be readmitted or visit an emergency room within 30 days of an acute hospitalization. A focus on improving care transitions from the inpatient setting to the outpatient dialysis unit may improve outcomes and reduce healthcare costs. Copyright © 2015 by the American Society of Nephrology.

Emergency department characteristics and capabilities in Bogotá, Colombia.

Science.gov (United States)

Bustos, Yury; Castro, Jenny; Wen, Leana S; Sullivan, Ashley F; Chen, Dinah K; Camargo, Carlos A

2015-12-01

Emergency departments (EDs) are a critical, yet heterogeneous, part of international emergency care. The National ED Inventories (NEDI) survey has been used in multiple countries as a standardized method to benchmark ED characteristics. We sought to describe the characteristics, resources, capabilities, and capacity of EDs in the densely populated capital city of Bogotá, Colombia. Bogotá EDs accessible to the general public 24/7 were surveyed using the 23-item NEDI survey used in several other countries ( www.emnet-nedi.org ). ED staff were asked about ED characteristics with reference to calendar year 2011. Seventy EDs participated (82 % response). Most EDs (87 %) were located in hospitals, and 83 % were independent hospital departments. The median annual ED visit volume was approximately 50,000 visits. Approximately 90 % (95 % confidence interval (CI) 80-96 %) had a contiguous layout, with medical and surgical care provided in one area. Almost all EDs saw both adults and children (91 %), while 6 % saw only adults and 3 % saw only children. Availability of technological and consultant resources in EDs was variable. Nearly every ED had cardiac monitoring (99 %, 95 % CI 92-100 %), but less than half had a dedicated CT scanner (39 %, 95 % CI 28-52 %). While most EDs were able to treat trauma 24/7 (81 %, 95 % CI 69-89 %), few could manage oncological (22 %, 95 % CI 13-34 %) or dental (3 %, 95 % CI 0-11 %) emergencies 24/7. The typical ED length-of-stay was between 1 and 6 h in 59 % of EDs (95 % CI, 46-70 %), while most others reported that patients remained for >6 h (39 %). Almost half of respondents (46 %, 95 % CI 34-59 %) reported their ED was over capacity. Bogotá EDs have high annual visit volumes and long length-of-stay, and half are over capacity. To meet the emergency care needs of people in Bogotá and other large cities, Colombia should consider improving urban ED capacity and training more emergency medicine specialists capable of efficiently staffing its

Violence in the emergency department: a survey of health care workers.

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Fernandes, C M; Bouthillette, F; Raboud, J M; Bullock, L; Moore, C F; Christenson, J M; Grafstein, E; Rae, S; Ouellet, L; Gillrie, C; Way, M

1999-11-16

Violence in the workplace is an ill-defined and underreported concern for health care workers. The objectives of this study were to examine perceived levels of violence in the emergency department, to obtain health care workers' definitions of violence, to determine the effect of violence on health care workers and to determine coping mechanisms and potential preventive strategies. A retrospective written survey of all 163 emergency department employees working in 1996 at an urban inner-city tertiary care centre in Vancouver. The survey elicited demographic information, personal definition of violence, severity of violence, degree of stress as a result of violence and estimate of the number of encounters with violence in the workplace in 1996. The authors examined the effects of violence on job performance and job satisfaction, and reviewed coping and potential preventive strategies. Of the 163 staff, 106 (65%) completed the survey. A total of 68% (70/103) reported an increased frequency of violence over time, and 60% (64/106) reported an increased severity. Most of the respondents felt that violence included witnessing verbal abuse (76%) and witnessing physical threats or assaults (86%). Sixty respondents (57%) were physically assaulted in 1996. Overall, 51 respondents (48%) reported impaired job performance for the rest of the shift or the rest of the week after an incident of violence. Seventy-seven respondents (73%) were afraid of patients as a result of violence, almost half (49%) hid their identities from patients, and 78 (74%) had reduced job satisfaction. Over one-fourth of the respondents (27/101) took days off because of violence. Of the 18 respondents no longer working in the emergency department, 12 (67%) reported that they had left the job at least partly owing to violence. Twenty-four-hour security and a workshop on violence prevention strategies were felt to be the most useful potential interventions. Physical exercise, sleep and the company of

Oncologic emergencies in a cancer center emergency department and in general emergency departments countywide and nationwide.

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Yang, Zhi; Yang, Runxiang; Kwak, Min Ji; Qdaisat, Aiham; Lin, Junzhong; Begley, Charles E; Reyes-Gibby, Cielito C; Yeung, Sai-Ching Jim

2018-01-01

Although cancer patients (CPs) are increasingly likely to visit emergency department (ED), no population-based study has compared the characteristics of CPs and non-cancer patients (NCPs) who visit the ED and examined factors associated with hospitalization via the ED. In this study, we (1) compared characteristics and diagnoses between CPs and NCPs who visited the ED in a cancer center or general hospital; (2) compared characteristics and diagnoses between CPs and NCPs who were hospitalized via the ED in a cancer center or general hospital; and (3) investigated important factors associated with such hospitalization. We analyzed patient characteristic and diagnosis [based on International Classification of Diseases-9 (ICD-9) codes] data from the ED of a comprehensive cancer center (MDACC), 24 general EDs in Harris County, Texas (HCED), and the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 1/1/2007-12/31/2009. Approximately 3.4 million ED visits were analyzed: 47,245, 3,248,973, and 104,566 visits for MDACC, HCED, and NHAMCS, respectively, of which 44,143 (93.4%), 44,583 (1.4%), and 632 (0.6%) were CP visits. CPs were older than NCPs and stayed longer in EDs. Lung, gastrointestinal (excluding colorectal), and genitourinary (excluding prostate) cancers were the three most common diagnoses related to ED visits at general EDs. CPs visiting MDACC were more likely than CPs visiting HCED to be privately insured. CPs were more likely than NCPs to be hospitalized. Pneumonia and influenza, fluid and electrolyte disorders, and fever were important predictive factors for CP hospitalization; coronary artery disease, cerebrovascular disease, and heart failure were important factors for NCP hospitalization. CPs consumed more ED resources than NCPs and had a higher hospitalization rate. Given the differences in characteristics and diagnoses between CPs and NCPs, ED physicians must pay special attention to CPs and be familiar with their unique set of oncologic

Using data to drive emergency department design: a metasynthesis.

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Welch, Shari J

2012-01-01

There has been an uptick in the field of emergency department (ED) operations research and data gathering, both published and unpublished. This new information has implications for ED design. The specialty suffers from an inability to have these innovations reach frontline practitioners, let alone design professionals and architects. This paper is an attempt to synthesize for design professionals the growing data regarding ED operations. The following sources were used to capture and summarize the research and data collections available regarding ED operations: the Emergency Department Benchmarking Alliance database; a literature search using both PubMed and Google Scholar search engines; and data presented at conferences and proceedings. Critical information that affects ED design strategies is summarized, organized, and presented. Data suggest an optimal size for ED functional units. The now-recognized arrival and census curves for the ED suggest a department that expands and contracts in response to changing census. Operational improvements have been dearly identified and are grouped into three categories: input, throughput, and outflow. Applications of this information are suggested. The sentinel premise of this meta-synthesis is that data derived from improvement work in the area of ED operations has applications for ED design. EDs can optimize their functioning by marrying good processes and operations to good design. This review paper is an attempt to bring this new information to the attention of the multidisciplinary team of architects, designers, and clinicians.

[Emergency department triage: independent nursing intervention?].

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Corujo Fontes, Sergio José

2014-03-01

The branch hospital triage aimed at, as well as exercised by nurses, has evolved to meet their needs to organize and make visible the nurses' duties. However, it is still not properly considered as independent nursing intervention. Evidencing practice triage nurse in hospital as experienced by their protagonists disclosed the possible causes of this paradoxical competence. In a sample of 41 nurses, of the 52 possible with previous experience in hospital triage in the Emergency Department of the Hospital General Dr. José Molina Orosa in Lanzarote, the nurses themselves carried out an opinion survey that group together statements about different aspects of the triaje nurse. In its results, 65.8% of those polled thought the triaje nursing training to be deficient and even though nearly half 48.7%, was considered competent to decide the level of emergency, 46.3% disagreed to take this task part of their duty. It is conclusive that the training received in hospital triage, regulated and sustained, is deficient, that is the main reason why professionals have their doubts to take on an activity they are not familiar with. Triage systems do not record the entire outcome of the nursing work and nursing methodology does not seem to be quite indicative for this task.

What Factors Affect Physicians’ Decisions to Prescribe Opioids in Emergency Departments?

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Lauren E. Sinnenberg BA

2017-01-01

Full Text Available Objective: With 42% of all emergency department visits in the United States related to pain, physicians who work in this setting are tasked with providing adequate pain management to patients with varying primary complaints and medical histories. Complicating this, the United States is in the midst of an opioid overdose epidemic. State governments and national organizations have developed guidelines and legislation to curtail opioid prescriptions in acute care settings, while also incentivizing providers for patient satisfaction and completeness of pain control. In order to inform future policies that focus on provider pain medication prescribing, we sought to characterize the factors physicians weigh when considering treating pain with opioids in the emergency department. Methods: We conducted and transcribed open-ended, semistructured qualitative interviews with 52 physicians at a national emergency medicine conference. Results: Participants reported a wide range of factors contributing to their opioid prescribing patterns related to three domains: 1 provider assessment of pain characteristics, 2 patient-based considerations, and 3 practice environment. Pain characteristics include the characteristics of various acute and chronic pain syndromes, including physicians’ empathy due to their own experiences with pain. Patient characteristics include “trustworthiness,” race and ethnicity, and the concern for risk of misuse. Factors related to the practice environment include hospital policy, legislation/regulation, and guidelines. Conclusion: The decision to prescribe opioids to patients in the emergency department is complex and nuanced. Physicians are interested in guidance and are concerned about the competing pressures placed on their opioid prescribing due to incentives related to patient satisfaction scores on one hand and inflexible policies that do not allow for individualized, patient-centered decisions on the other.

Is the Price Right?: Stereotypes, Co-Production Policy and Irish Television.

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Gibbons, Luke

The purpose of this paper is to examine how recent demand for greater realism in portrayals of Irish life in the television and film industries serves to authenticate existing stereotypes and romantic images which characterize "Irishness" in the popular imagination rather than refute or undermine them. Discussions of a political thriller…

Currents in the Eastern Irish Sea

International Nuclear Information System (INIS)

Howarth, M.J.

1983-01-01

Low level radioactive waste is discharged from the nuclear re-processing plant at Sellafield, Cumbria. Its movement away from the discharge point is determined by the Irish Sea's dynamics, both for the soluble compounds and for those compounds which become attached to the sediment. Near Sellafield the tidal currents are weak and parallel to the shore, becoming stronger east/west to the north and south of the Isle of Man. Wind driven currents near Sellafield are predominantly north-westward, strongest near the coast, and oppose the other low frequency currents. Hence, the soluble effluent will initially be dispersed parallel to the shore by the weak tidal currents, moving episodically, southeastward during weak winds and northwestward during storms. Eventually it will leave the Irish Sea, flowing northward through the North Channel. (author)

Epidemiological characteristics of pediatric epistaxis presenting to the emergency department.

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Shay, Sophie; Shapiro, Nina L; Bhattacharyya, Neil

2017-12-01

Investigate the epidemiological characteristics of pediatric epistaxis in the emergency department setting. Cross-sectional study using national databases. Children (age epistaxis were extracted from the State Emergency Department Databases for New York, Florida, Iowa, and California for the calendar year 2010. Associated diagnoses, procedures, encounter characteristics, and demographic data were examined. There were 18,745 cases of pediatric epistaxis (mean age 7.54 years, 57.4% male). Overall, 6.9% of patients underwent procedures to control epistaxis, of which 93.5% had simple anterior epistaxis control. The distribution of pediatric epistaxis was highest in spring and summer months (p epistaxis presentations (38.8%, p epistaxis control procedure performed (p epistaxis control procedure (p epistaxis control procedure compared to those of minority backgrounds (p epistaxis are uninvolved cases that do not require procedural intervention. The overrepresentation of low socioeconomic status patients may suggest an overutilization of emergency services for minor cases of epistaxis, and perhaps a lack of access to primary care providers. This is the first study to evaluate racial and socioeconomic factors in relationship to pediatric epistaxis. Further investigation is needed to better elucidate these potential disparities. Copyright © 2017 Elsevier B.V. All rights reserved.

Organising methods and member recruitment in Irish Trade Unions

OpenAIRE

Turner, Thomas; O'Sullivan, Michelle; D'Art, Daryl

2011-01-01

peer-reviewed Purpose This paper explores the recruiting and organising methods used by Irish full-time union officials to recruit new members in the private sector of the economy. Design/methodology/approach The analysis is based on a survey of full-time union officials in eight Irish trade unions. Findings Results indicate that the use of organising techniques by officials had no significant impact on changes in membership numbers but did have a significant and po...

The Irish glaciated margin: processes and environments of deglaciation.

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McCarron, Stephen; Monteys, Xavier; Scott, Gill

2015-04-01

High resolution bathymetric data for Donegal Bay and parts of the western Irish Continental Shelf have become available in recent years due to the Irish National Seabed Survey [INSS] (2000-2009). Relative to onshore glacigenic landform preservation and visibility on the shelf and on the floor of Donegal Bay is excellent. Here we describe some of the the data, paying particular attention to the area close to the north Mayo coastline. We discuss inferred connections between well exposed and age constrained glacial geology along the coastal fringe and the submarine evidence of deglcial processes and timing. It is argued that the sediment and landform assemblage within the Bay is derived from multiple, lobate extensions of the last British Irish Ice Sheet into the Donegal Bay topographic low from source areas to the southeast (north Mayo) and east/northeast (Sligo and Donegal/Fermanagh) during overall deglaciation (Termination 1).

Caring for inpatient boarders in the emergency department: improving safety and patient and staff satisfaction.

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Bornemann-Shepherd, Melanie; Le-Lazar, Jamie; Makic, Mary Beth Flynn; DeVine, Deborah; McDevitt, Kelly; Paul, Marcee

2015-01-01

Hospital capacity constraints lead to large numbers of inpatients being held for extended periods in the emergency department. This creates concerns with safety, quality of care, and dissatisfaction of patients and staff. The aim of this quality-improvement project was to improve satisfaction and processes in which nurses provided care to inpatient boarders held in the emergency department. A quality-improvement project framework that included the use of a questionnaire was used to ascertain employee and patient dissatisfaction and identify opportunities for improvement. A task force was created to develop action plans related to holding and caring for inpatients in the emergency department. A questionnaire was sent to nursing staff in spring 2012, and responses from the questionnaire identified improvements that could be implemented to improve care for inpatient boarders. Situation-background-assessment-recommendation (SBAR) communications and direct observations were also used to identify specific improvements. Post-questionnaire results indicated improved satisfaction for both staff and patients. It was recognized early that the ED inpatient area would benefit from the supervision of an inpatient director, managers, and staff. Outcomes showed that creating an inpatient unit within the emergency department had a positive effect on staff and patient satisfaction. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

The transmission and interpretation of emergency department radiographs.

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James, J J; Grabowski, W; Mangelsdorff, A D

1982-08-01

Twenty-five radiographic studies representative of the spectrum of trauma cases that might present to an emergency department were selected from actual cases presenting at Brooke Army Medical Center (BAMC) in San Antonio, Texas. The studies were then transmitted from a local television studio via satellite back to BAMC and three other Army hospitals. A panel of 29 physicians (11 radiologists, 7 emergency physicians, and 11 others from various specialty areas) viewed the images on commercial grade television sets and attempted to make a diagnosis. The diagnostic accuracy of the radiologists (86%) was significantly better than that of the other two groups (77% each). However, given the overall expense of a teleradiology network, this difference in accuracy - especially when translated into clinically significant errors - might not justify the establishment of such a network in terms of cost-effectiveness.

Pseudologia Fantastica in the Emergency Department: A Case Report and Review of the Literature

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Robyn Thom

2017-01-01

Full Text Available Psychiatrists commonly encounter deception in the emergency department. This article presents the case of a patient who presents to the emergency department with an unusual and elaborate web of deceptions along multiple themes including feigning medical illness, multiple losses, and grandiose academic and athletic achievements. We review the clinical characteristics of pseudologia fantastica and discuss how this patient’s constellation of malingering, factitious disorder, and personality disorder suggests this diagnosis.

Exercise portrayal in children’s television programs: analysis of the UK and Irish programming

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Scully P

2016-09-01

Full Text Available Paul Scully,1 Orlaith Reid,1 Alan P Macken,1–3 Mark Healy,4 Jean Saunders,4 Des Leddin,3,5 Walter Cullen,3 Colum P Dunne,3 Clodagh S O’Gorman1–3,5 1The Children’s Ark, University Hospital Limerick, Limerick, 2National Children’s Research Centre, Dublin, 3Centre for Interventions in Infection, Inflammation & Immunity (4i, Graduate Entry Medical School, 4C-Star, University of Limerick, Limerick, Ireland; 5Department of Medicine, Dalhousie University, Halifax, Canada Background: Television watching is obesogenic due to its sedentary nature and programming content, which influences children. Few studies have examined exercise placement within children-specific programming. This study aimed to investigate the frequency and type of exercise placement in children-specific television broadcasts and to compare placements on the UK and Irish television channels.Methods: Content analysis for five weekdays’ worth of children-specific television broadcasting totaling 82.5 hours on both the UK (British Broadcasting Corporation and Irish (Radió Teilifís Éireann television channels was performed. For the purposes of comparing the UK and Irish placements, analysis was restricted to programming broadcast between 6 am and 11.30 am. Exercise placements were coded based on type of activity, activity context, activity motivating factors and outcome, and characters involved.Results: A total of 780 cues were recorded during the total recording period. A wide variety of sports were depicted, but dancing-related cues were most commonly seen (n=163, 23.3%, with the majority of cues being of mild (n=365, 65.9% or moderate (n=172, 31.0% intensity. The majority of cues were associated with a positive outcome (n=404, 61.4%, and social motivations were most commonly seen (n=289, 30.3%. The Irish and the UK portrayals were broadly similar.Conclusion: This study highlights the wide variety of sports portrayed and the active effort undertaken by television

Intentional and unintentional poisoning in Pakistan: a pilot study using the Emergency Departments surveillance project.

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Khan, Nadeem; Pérez-Núñez, Ricardo; Shamim, Nudrat; Khan, Uzma; Naseer, Naureen; Feroze, Asher; Razzak, Junaid; Hyder, Adnan A

2015-01-01

Acute poisoning is one of the most common reasons for emergency department visits around the world. In Pakistan, the epidemiological data on poisoning is limited due to an under developed poison information surveillance system. We aim to describe the characteristics associated with intentional and unintentional poisoning in Pakistan presenting to emergency departments. The data was extracted from the Pakistan National Emergency Department Surveillance (Pak-NEDS) which was an active surveillance conducted between November 2010 and March 2011. All patients, regardless of age, who presented with poisoning to any of Pakistan's seven major tertiary care centers' emergency departments, were included. Information about patient demographics, type of poisoning agent, reason for poisoning and outcomes were collected using a standard questionnaire. Acute poisoning contributed to 1.2% (n = 233) of patients with intentional and unintentional injuries presenting to EDs of participating centers. Of these, 68% were male, 54% were aged 19 to 44 and 19% were children and adolescents (<18 years). Types of poisoning included chemical/gas (43.8%), drug/medicine (27%), alcohol (16.7%) and food/plant (6%). In half of all patients the poisoning was intentional. A total of 11.6% of the patients were admitted and 6.6% died. Poisoning causes more morbidity and mortality in young adults in Pakistan compared to other age groups, half of which is intentional. Improving mental health, regulatory control for hazardous chemicals and better access to care through poison information centers and emergency departments will potentially help control the problem.

Associations between grass and weed pollen and emergency department visits for asthma among children in Montreal.

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Héguy, Léa; Garneau, Michelle; Goldberg, Mark S; Raphoz, Marie; Guay, Frédéric; Valois, Marie-France

2008-02-01

Asthma among children is a major public health problem worldwide. There are increasing number of studies suggesting a possible association between allergenic pollen and exacerbations of asthma. In the context of global climate change, a number of future climate and air pollution scenarios predict increases in concentrations of pollen, an extension of the pollen season, and an increase in the allergenicity of pollen. The goal of the present study is to evaluate the short-term effects of exposure to grass and weed pollen on emergency department visits and readmissions for asthma among children aged 0-9 years living in Montreal between April and October, 1994-2004. Time-series analyses were carried out using parametric log-linear overdispersed Poisson models that were adjusted for temporal variations, daily weather conditions (temperature, atmospheric pressure), and gaseous air pollutants (ozone and nitrogen dioxide). We have found positive associations between emergency department visits and concentrations of grass pollen 3 days after exposure. The effect of grass pollen was higher on emergency department readmissions as compared to initial visits. Weak negative associations were found between weed pollen (including ragweed pollen) and emergency department visits 2 days after exposure. The data indicate that among children, emergency department visits increased with increasing concentrations of grass pollen.

Should diagnosis codes from emergency department data be used for case selection for emergency department key performance indicators?

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Howell, Stuart C; Wills, Rachael A; Johnston, Trisha C

2014-02-01

The aim of the present study was to assess the suitability of emergency department (ED) discharge diagnosis for identifying patient cohorts included in the definitions of key performance indicators (KPIs) that are used to evaluate ED performance. Hospital inpatient episodes of care with a principal diagnosis that corresponded to an ED-defined KPI were extracted from the Queensland Hospital Admitted Patient Data Collection (QHAPDC) for the year 2010-2011. The data were then linked to the corresponding ED patient record and the diagnoses applied in the two settings were compared. The asthma and injury cohorts produced favourable results with respect to matching the QHAPDC principal diagnosis with the ED discharge diagnosis. The results were generally modest when the QHAPDC principal diagnosis was upper respiratory tract infection, poisoning and toxic effects or a mental health diagnosis, and were quite poor for influenza. There is substantial variation in the capture of patient cohorts using discharge diagnosis as recorded on Queensland Hospital Emergency Department data. WHAT IS KNOWN ABOUT THE TOPIC? There are several existing KPIs that are defined according to the diagnosis recorded on ED data collections. However, there have been concerns over the quality of ED diagnosis in Queensland and other jurisdictions, and the value of these data in identifying patient cohorts for the purpose of assessing ED performance remains uncertain. WHAT DOES THIS PAPER ADD? This paper identifies diagnosis codes that are suitable for use in capturing the patient cohorts that are used to evaluate ED performance, as well as those codes that may be of limited value. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? The limitations of diagnosis codes within ED data should be understood by those seeking to use these data items for healthcare planning and management or for research into healthcare quality and outcomes.

Irish women who seek abortions in England.

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Francome, C

1992-01-01

In 1991, 4158 women from Ireland and 1766 from Northern Ireland traveled to England for abortions. This situation has been ignored by Irish authorities. The 1992 case of the 14-year old seeking an abortion in England finally caught legal attention. This study attempts to help define who these abortion seekers are. Questionnaires from 200 Irish abortion seeking women attending private Marie Stopes clinics in London and the British Pregnancy Advisory Services clinic in Liverpool between September 1988 and December 1990 were analyzed. Findings pertain to demographic characteristics, characteristics of first intercourse, family discussion of sexual activity, and contraceptive use. From this limited sample, it appears that Irish women are sexually reserved and without access to modern methods of birth control and abortion. Sex is associated with shame and guilt. 23% had intercourse before the age of 18 years and 42% after the age of 20. 76% were single and 16% were currently married. 95% were Catholic; 33% had been to church the preceding Sunday and 68% within the past month. Basic information about menstruation is also limited and procedures such as dilatation and curettage may be performed selectively. 28% of married women were uninformed about menstruation prior to its onset. Only 24% had been using birth control around the time of pregnancy. The reason for nonuse was frequently the unexpectedness of intercourse. 62% of adults and 66% of women believe in legalizing abortion in Ireland. British groups have tried to break through the abortion information ban by sending telephone numbers of abortion clinics to Irish firms for distribution to employees. On November 25, 1992, in the general election, there was approval of constitutional amendments guaranteeing the right to travel for abortions and to receive information on abortion access. The amendment to allow abortion to save the life of the mother was not accepted.

Training and Developing Non-Irish Workers: The Perspectives of Interested Stakeholders

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Prendergast, Mary

2016-01-01

Purpose: This paper aims to explore the challenges facing Irish organisations in the training and development of non-Irish workers. It analyses the importance of fluency in the host country's language and the approach taken by organisations in relation to language training. In-depth semi-structured interviews provide significant insights for the…

Early Reading Strategies in Irish and English: Evidence from Error Types

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Parsons, Christine E.; Lyddy, Fiona

2009-01-01

For the majority of people in Ireland, Irish is a second language acquired primarily through the schooling system. This study examined the reading strategies children used in response to English and Irish words (presented in isolation), through an analysis of their oral reading errors. Children in their 4th year of schooling attending…

An organizational metamodel for hospital emergency departments.

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Kaptan, Kubilay

2014-10-01

I introduce an organizational model describing the response of the hospital emergency department. The hybrid simulation/analytical model (called a "metamodel") can estimate a hospital's capacity and dynamic response in real time and incorporate the influence of damage to structural and nonstructural components on the organizational ones. The waiting time is the main parameter of response and is used to evaluate the disaster resilience of health care facilities. Waiting time behavior is described by using a double exponential function and its parameters are calibrated based on simulated data. The metamodel covers a large range of hospital configurations and takes into account hospital resources in terms of staff and infrastructures, operational efficiency, and the possible existence of an emergency plan; maximum capacity; and behavior both in saturated and overcapacitated conditions. The sensitivity of the model to different arrival rates, hospital configurations, and capacities and the technical and organizational policies applied during and before a disaster were investigated. This model becomes an important tool in the decision process either for the engineering profession or for policy makers.

Square-Toed Boots and Felt Hats: Irish Revolutionaries and the Invasion of Canada (1848-1871

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Marta Ramón-García

2010-03-01

Full Text Available The Fenian movement was born in 1858 as an alliance between the Irish Republican Brotherhood, a revolutionary secret society, and the Fenian Brotherhood, an Irish-American organisation intended to supply this society with funds and trained officers. This was not the first time that Irish nationalists on both sides of the Atlantic had tried to cooperate, but it was the first time that there was a steady arrangement in place. The Fenian partnership was extremely successful on the surface, but it was undermined by fundamental differences in customs, political attitudes and ultimate goals between Irish and American Fenians. The clearest evidence of these differences was afforded by the Fenian Brotherhood’s successive attempts to invade Canada between 1866 and 1871. As military episodes the Canadian raids were negligible; as Irish revolutionary attempts they seem absurd. However, they were a perfectly coherent manifestation of the Irish-American “hyphenated identity”. The present article traces the parallel evolution of the Irish Republican Brotherhood and the Fenian Brotherhood up to 1866, and reconstructs the cultural and political reasons for the revival of the Canadian scheme, the ensuing split in the Fenian Brotherhood, and the final collapse of the Fenian alliance.

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.

The perception of the patient safety climate by professionals of the emergency department.

Science.gov (United States)

Rigobello, Mayara Carvalho Godinho; Carvalho, Rhanna Emanuela Fontenele Lima de; Guerreiro, Juliana Magalhães; Motta, Ana Paula Gobbo; Atila, Elizabeth; Gimenes, Fernanda Raphael Escobar

2017-07-01

The aim of this study was to assess the patient safety climate from the perspective of healthcare professionals working in the emergency department of a hospital in Brazil. Emergency departments are complex and dynamic environments. They are prone to adverse events that compromise the quality of care provided and reveal the importance of patient safety culture and climate. This was a quantitative, descriptive, cross-sectional study. The Safety Attitudes Questionnaire (SAQ) - Short Form 2006 was used for data collection, validated and adapted into Portuguese. The study sample consisted of 125 participants. Most of the participants were female (57.6%) and had worked in emergency department for more than 10years (56.8%). Sixty-two participants (49.6%) were nursing professionals. The participants demonstrated satisfaction with their jobs and dissatisfaction with the actions of management with regard to safety issues. Participants' perceptions about the patient safety climate were found to be negative. Knowledge of professionals' perceptions of patient safety climate in the context of emergency care helps with assessments of the safety culture, contributes to improvement of health care, reduces adverse events, and can focus efforts to improve the quality of care provided to patients. Copyright © 2017 Elsevier Ltd. All rights reserved.

Factors that influence the development of compassion fatigue, burnout, and compassion satisfaction in emergency department nurses.

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Hunsaker, Stacie; Chen, Hsiu-Chin; Maughan, Dale; Heaston, Sondra

2015-03-01

The purpose of this study was twofold: (a) to determine the prevalence of compassion satisfaction, compassion fatigue, and burnout in emergency department nurses throughout the United States and (b) to examine which demographic and work-related components affect the development of compassion satisfaction, compassion fatigue, and burnout in this nursing specialty. This was a nonexperimental, descriptive, and predictive study using a self-administered survey. Survey packets including a demographic questionnaire and the Professional Quality of Life Scale version 5 (ProQOL 5) were mailed to 1,000 selected emergency nurses throughout the United States. The ProQOL 5 scale was used to measure the prevalence of compassion satisfaction, compassion fatigue, and burnout among emergency department nurses. Multiple regression using stepwise solution was employed to determine which variables of demographics and work-related characteristics predicted the prevalence of compassion satisfaction, compassion fatigue, and burnout. The α level was set at .05 for statistical significance. The results revealed overall low to average levels of compassion fatigue and burnout and generally average to high levels of compassion satisfaction among this group of emergency department nurses. The low level of manager support was a significant predictor of higher levels of burnout and compassion fatigue among emergency department nurses, while a high level of manager support contributed to a higher level of compassion satisfaction. The results may serve to help distinguish elements in emergency department nurses' work and life that are related to compassion satisfaction and may identify factors associated with higher levels of compassion fatigue and burnout. Improving recognition and awareness of compassion satisfaction, compassion fatigue, and burnout among emergency department nurses may prevent emotional exhaustion and help identify interventions that will help nurses remain empathetic and

The core faecal bacterial microbiome of Irish Thoroughbred racehorses.

Science.gov (United States)

O' Donnell, M M; Harris, H M B; Jeffery, I B; Claesson, M J; Younge, B; O' Toole, P W; Ross, R P

2013-12-01

In this study, we characterized the gut microbiota in six healthy Irish thoroughbred racehorses and showed it to be dominated by the phyla Firmicutes, Bacteroidetes, Proteobacteria, Verrucomicrobia, Actinobacteria, Euryarchaeota, Fibrobacteres and Spirochaetes. Moreover, all the horses harboured Clostridium, Fibrobacter, Faecalibacterium, Ruminococcus, Eubacterium, Oscillospira, Blautia Anaerotruncus, Coprococcus, Treponema and Lactobacillus spp. Notwithstanding the sample size, it was noteworthy that the core microbiota species assignments identified Fibrobacter succinogenes, Eubacterium coprostanoligenes, Eubacterium hallii, Eubacterium ruminantium, Oscillospira guillermondii, Sporobacter termiditis, Lactobacillus equicursoris, Treponema parvum and Treponema porcinum in all the horses. This is the first study of the faecal microbiota in the Irish thoroughbred racehorse, a significant competitor in the global bloodstock industry. The information gathered in this pilot study provides a foundation for veterinarians and other equine health-associated professionals to begin to analyse the microbiome of performance of racehorses. This study and subsequent work may lead to alternate dietary approaches aimed at minimizing the risk of microbiota-related dysbiosis in these performance animals. Although Irish thoroughbreds are used nationally and internationally as performance animals, very little is known about the core faecal microbiota of these animals. This is the first study to characterize the bacterial microbiota present in the Irish thoroughbred racehorse faeces and elucidate a core microbiome irrespective of diet, animal management and geographical location. © 2013 The Society for Applied Microbiology.

The use of high-flow nasal cannula in the pediatric emergency department

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Katherine N. Slain

Full Text Available Abstract Objectives: To summarize the current literature describing high-flow nasal cannula use in children, the components and mechanisms of action of a high-flow nasal cannula system, the appropriate clinical applications, and its role in the pediatric emergency department. Sources: A computer-based search of PubMed/MEDLINE and Google Scholar for literature on high-flow nasal cannula use in children was performed. Data summary: High-flow nasal cannula, a non-invasive respiratory support modality, provides heated and fully humidified gas mixtures to patients via a nasal cannula interface. High-flow nasal cannula likely supports respiration though reduced inspiratory resistance, washout of the nasopharyngeal dead space, reduced metabolic work related to gas conditioning, improved airway conductance and mucociliary clearance, and provision of low levels of positive airway pressure. Most data describing high-flow nasal cannula use in children focuses on those with bronchiolitis, although high-flow nasal cannula has been used in children with other respiratory diseases. Introduction of high-flow nasal cannula into clinical practice, including in the emergency department, has been associated with decreased rates of endotracheal intubation. Limited prospective interventional data suggest that high-flow nasal cannula may be similarly efficacious as continuous positive airway pressure and more efficacious than standard oxygen therapy for some patients. Patient characteristics, such as improved tachycardia and tachypnea, have been associated with a lack of progression to endotracheal intubation. Reported adverse effects are rare. Conclusions: High-flow nasal cannula should be considered for pediatric emergency department patients with respiratory distress not requiring immediate endotracheal intubation; prospective, pediatric emergency department-specific trials are needed to better determine responsive patient populations, ideal high-flow nasal cannula

[Gender influence on health related quality of life among resident physicians working in an emergency department].

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Fernández-Prada, María; González-Cabrera, Joaquín; Torres G, Francisco; Iribar-Ibabe, Concepción; María Peinado, José

2014-02-01

The high emotional burden of physicians working in emergency departments may affect their quality of life perception. To evaluate health related quality of life among resident physicians performing shifts at an emergency department. Seventy one physicians aged 26,3 ± 1,7 years (47 women), working as residents in an emergency department, answered the short version of the Short-Form Health Survey Questionnaire (SF-36®). This questionnaire analyses eight domains: physical function, body pain, general health, vitality, social function, emotional role and mental health. Women had a significantly worse perception than a reference population in four dimensions of the SF-36, especially mental health and social functioning. Men had scores similar to the reference population. Among women, vitality is the best predictor of mental health and social functioning. Women working as residents in an emergency department have a worse perception of their quality of life than men performing the same job.

Negative opinions about cancer screening and contraceptive measures by female emergency department patients.

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Merchant, Roland C; Gee, Erin M; Bock, Beth C; Becker, Bruce M; Clark, Melissa A

2008-11-01

We sought to determine the extent to which adult female emergency department participants viewed two women's cancer screening and two contraceptive measures negatively. The study also explored the relationship between having a negative opinion about these measures and participant demography, lack of knowledge, and lack of usage of these measures. Few women expressed negative opinions about these measures. Lack of knowledge about and lack of use of these measures were associated with having negative opinions on these cancer screening and contraceptive measures. Having any negative opinion about one cancer screening or contraceptive measure was associated with a higher risk of having any negative opinion on another measure. The results suggest that influencing opinion and knowledge about these measures might impact the success of emergency department-based cancer screening and contraceptive health programs. Editors' Strategic Implications: Emergency departments (and primary care settings) provide key opportunities for prevention. Replication is needed, but the authors present important data on knowledge, attitudes, and characteristics that might influence women's receptivity to consent to and engage in behaviors consistent with prevention, screening, and health promotion.

Alcohol-Related Emergency Department Visits Associated with Collegiate Football Games

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Shook, Janice; Hiestand, Brian C.

2011-01-01

Objective: In 2003, after several post-college football game riots, multiple strategies including strict enforcement of open container laws were instituted by the authors' city and university. The authors compared alcohol-related visits to the on-campus emergency department (ED) associated with home football games in 2002 and 2006, hypothesizing…

Moderate sensitivity and high specificity of emergency department administrative data for transient ischemic attacks.

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Yu, Amy Y X; Quan, Hude; McRae, Andrew; Wagner, Gabrielle O; Hill, Michael D; Coutts, Shelagh B

2017-09-18

Validation of administrative data case definitions is key for accurate passive surveillance of disease. Transient ischemic attack (TIA) is a condition primarily managed in the emergency department. However, prior validation studies have focused on data after inpatient hospitalization. We aimed to determine the validity of the Canadian 10th International Classification of Diseases (ICD-10-CA) codes for TIA in the national ambulatory administrative database. We performed a diagnostic accuracy study of four ICD-10-CA case definition algorithms for TIA in the emergency department setting. The study population was obtained from two ongoing studies on the diagnosis of TIA and minor stroke versus stroke mimic using serum biomarkers and neuroimaging. Two reference standards were used 1) the emergency department clinical diagnosis determined by chart abstractors and 2) the 90-day final diagnosis, both obtained by stroke neurologists, to calculate the sensitivity, specificity, positive and negative predictive values (PPV and NPV) of the ICD-10-CA algorithms for TIA. Among 417 patients, emergency department adjudication showed 163 (39.1%) TIA, 155 (37.2%) ischemic strokes, and 99 (23.7%) stroke mimics. The most restrictive algorithm, defined as a TIA code in the main position had the lowest sensitivity (36.8%), but highest specificity (92.5%) and PPV (76.0%). The most inclusive algorithm, defined as a TIA code in any position with and without query prefix had the highest sensitivity (63.8%), but lowest specificity (81.5%) and PPV (68.9%). Sensitivity, specificity, PPV, and NPV were overall lower when using the 90-day diagnosis as reference standard. Emergency department administrative data reflect diagnosis of suspected TIA with high specificity, but underestimate the burden of disease. Future studies are necessary to understand the reasons for the low to moderate sensitivity.

Radioactivity Monitoring of the Irish Environment 2010-2011

International Nuclear Information System (INIS)

McGinnity, P.; Currivan, L.; Dowdall, A.; Hanley, O.; Kelleher, K.; McKittrick, L.; Pollard, D.; Somerville, S.; Wong, J.; McMahon, C.

2012-11-01

This report presents the results of the environmental radioactivity monitoring programme carried out by the Radiological Protection Institute of Ireland RPII during 2010 and 2011. The RPII has routinely monitored levels of radioactivity in the Irish environment since 1982 and this is the latest in the RPII's series of environmental monitoring reports. The RPII reviews and updates its environmental programme annually to ensure it remains relevant and continues to focus on the most important sources of radioactivity in the environment. The data presented in this report confirm that while the levels of artificial radioactivity in the Irish environment are detectable, they are low. They do not pose a significant risk to the human health of the Irish population. Trace amounts of radioactive isotopes consistent with the Fukushima nuclear accident were detected in air, rainwater and milk samples during the period March to May 2011. These increases in levels of radioactivity were not of concern from a public health point of view. For the remainder of the reporting period, activity concentrations of radionuclides in airborne particles were low and consistent with measurements made in recent years. Radioactivity levels in milk, mixed diet and a wide range of foodstuffs were low and, for the majority of samples, below the detection limits. All drinking waters tested were found to be in compliance with the total indicative dose defined in national and EU legislation. The doses incurred by the Irish public in 2010 and 2011 as a result of artificial radioactivity in the marine environment are small when compared to dose limits or to natural radiation doses received by the Irish public. The doses to the most exposed individuals, members of the oyster and mussel farmers critical group, were approximately 0.02 per cent and 0.05 per cent of the annual dose limit of 1000 microsieverts for members of the public from practices involving controllable sources of radiation in 2010 and

[Psychoactive drugs use and related visits of adolescents to the emergency department].

Science.gov (United States)

Arias Constantí, Vanessa; Sanz Marcos, Nuria; Trenchs Sainz de La Maza, Victoria; Curcoy Barcenilla, Ana I; Matalí Costa, Josep; Luaces Cubells, Carles

2010-05-08

To describe psychoactive substances (PS)-related visits of adolescents to the emergency department and to explore possible differential features in patients according to the kind of PS consumed. Observational and analytic study. PS-related visits of adolescents to the emergency department during 30 months were studied. Patients were divided in two groups: those with alcohol intoxication only (Group_1) and those with other PS (Group_2) and they were compared. 333 consults were included, corresponding to 321 patients. Their mean age was 16,1 years (SD:1,1 years). Two hundred sixty-two(78,7%) were alcohol-related visits, and 110(33%) were related with another PS consumption. Of the 262 alcohol-related visits, 223 were only related with alcohol(Group_1), while the other 110 visits made up Group_2. Group_2 was composed of more males, more adolescents placed in Institutional Care and more adolescents with psychiatric records than Group_1. Likewise, distribution of Group_2 visits was less predictable than distribution of Group_1. PS consumption is a frequent major complaint in an Emergency Department. There are more poly-intoxications in males with psycho-social problems. In those cases, consumption seems to happen regardless of the time in the day or the day of the week.

Acute asthma severity identification of expert system flow in emergency department

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Sharif, Nurul Atikah Mohd; Ahmad, Norazura; Ahmad, Nazihah; Desa, Wan Laailatul Hanim Mat

2017-11-01

Integration of computerized system in healthcare management help in smoothening the documentation of patient records, highly accesses of knowledge and clinical practices guideline, and advice on decision making. Exploit the advancement of artificial intelligent such as fuzzy logic and rule-based reasoning may improve the management of emergency department in terms of uncertainty condition and medical practices adherence towards clinical guideline. This paper presenting details of the emergency department flow for acute asthma severity identification with the embedding of acute asthma severity identification expert system (AASIES). Currently, AASIES is still in preliminary stage of system validation. However, the implementation of AASIES in asthma bay management is hope can reduce the usage of paper for manual documentation and be a pioneer for the development of a more complex decision support system to smoothen the ED management and more systematic.

Of Mermaids and Changelings: Human Rights, Folklore and Contemporary Irish Language Poetry

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Rióna Ní Fhrighil

2017-10-01

Full Text Available This article investigates the intersection of human rights discourse, Irish folklore and contemporary Irish-language poetry. The author contends that contemporary Irish-language poets Louis de Paor and Nuala Ní Dhomhnaill exploit the multi-faceted nature of international folklore motifs, along with their local variants, to represent human rights violations in their poetry. Focusing specifically on the motif of the changeling in De Paor’s poetry and on the motif of the mermaid in Ní Dhomhnaill’s, the author traces how folklore material is reimagined in ways that eschew uncomplicated transnational solidarity but which engender empathetic settlement.

Risk for Repeat Emergency Department Visits for Violent Injuries in Youth Firearm Victims

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Hyun Ja Lim

2009-01-01

Full Text Available Objective To identify significant risk factors associated with repeat emergency department (ED. Visits for violent injuries in youth firearm victims. Methods The study subjects of this retrospective cohort study were firearm victims aged 18 and younger presenting to a Pediatric Emergency Department/Trauma Center at Children's Hospital of Wisconsin between 1990 and 1995. The primary outcome was subsequent Emergency Department visits (REDV at any emergency department in Milwaukee for a violent injury. Results A total of 495 subjects were eligible for the present study in the pediatric firearm victim's ED visit database. Eighty-five percent (n = 420 were males and 82% were African-Americans. Mean age was 15 years old (s.d = ±3.6. A majority of them had a single-parent family. Eighty-eight subjects (17.8% had a prior history of ED visit due to violence. During the study time, 201 subjects had at least one REDV. In the multivariable model, a subject without a social worker consulting at the hospital were more likely to have REDV compared to subjects with a social worker consulting (O.R = 1.749; p-value = 0.047, controlling for guardian and disposition. Subjects disposed to detention center or police custody were more likely to have REDV compared to subjects disposed to home or a hospital (O.R = 5.351; p-value = 0.003. Conclusion Our analysis indicates that individuals with guardians, those who did not receive social worker intervention on their initial visit, and those discharged in police custody were associated with increased repeat ED visits due to a violent injury.

An exploration of emergency department presentations related to high heel footwear in Victoria, Australia, 2006-2010.

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Williams, Cylie M; Haines, Terry P

2014-01-23

Many women are warned against the dangers of wearing high heel footwear however there is limited empirical evidence demonstrating an association between wearing high heel with injury. Gait laboratory testing has found a higher heel height placed the foot in a position that increases the risk of ankle sprain. Women have also been surveyed about wearing high heels and approximately half of those reported inconvenience and pain after wearing a high heel shoe. This study aims to explore emergency department presentations of injuries and the estimated costs that have been directly attributed to wearing high heeled footwear within Victoria, Australia during 2006-2010. The Victorian Emergency Minimum Dataset (VEMD) was searched for all injuries attributed to wearing high heel footwear presenting to emergency departments in Victoria Australia, between the years of 2006-2010. The VEMD produced a report detailing sex, age at presentation, month of presentation, time of day of presentation, day of presentation, location that injury occurred and type of injury for presentation. Monash Health in Victoria Australia, provided emergency department estimates for injury types to calculate an estimated cost of an acute injury related to wearing high heel footwear. There were 240 injuries presenting to Victorian emergency departments directly attributed to wearing high heeled footwear. The majority of people injured were women (n = 236) and all were less than 55 years of age. More injuries presented on a Sunday (n = 83) and more in the 8 am-12 pm time bracket (n = 64). There were also more injuries presenting in the months of November, December and January (n = 80). The most commonly injured body part was the ankle (n = 123). The emergency department estimate of the cost of these injuries over this time-frame was almost $72,000 (mean of $316.72 per presentation). People who wear high heel footwear on weekends appear to be at higher risk for injury that leads to

The Irish organic food market: shortfalls, opportunities and the need for research.

Science.gov (United States)

Tobin, Rachel; Larkin, Tracey; Moane, Siobhan

2011-09-01

In 2009 the Irish organic food market was forecasted to grow from €120 m to €239 m by 2013; however, recent figures set its value at just €90 m. An estimated 70% of this market is imported. Surveys of Irish consumers reveal that 66% of consumers prefer to buy local produce and most organic consumers are buying organic at supermarkets. This evidence reveals that Irish producers must trade at supermarkets, and promote 'local produce' to ensure their produce reach the majority of buyers. Seventy-eight % of organic rejecters state price and 21% state unawareness of the benefits as reasons for not buying organic. Many Irish consumers are buying organic food on the perceived belief that it is healthier, safer and tastes better; however, a review of studies on organic versus conventional foods in terms of health benefits, safety and sensory quality has shown that existing data is limited in scope and fails to show a clear trend. The review concludes with the need for a comprehensive study of a range of organic and conventional foods available to the Irish consumer in order to determine if differences in organic cultivation result in statistically significant differences in health linked compounds and sensory quality. Copyright © 2011 Society of Chemical Industry.

Real exchange-rates, co-integration and purchasing power parity - Irish experience in the EMS

OpenAIRE

Thom, R

1989-01-01

Dickey-Fuller and Co-Integration techniques are used to test the hypothesis that co-movements in Irish nominal exchange rates and relative prices are consistent with the implications of Purchasing Power Parity. The data reject PPP between Ireland and the US. Results from Irish/UK and Irish/German data are less decisive against the possibility that linear combinations of the nominal exchange rate and corresponding relative prices are stationary series.

An exploration of emergency nurses' perceptions, attitudes and experience of teamwork in the emergency department.

Science.gov (United States)

Grover, Elise; Porter, Joanne E; Morphet, Julia

2017-05-01

Teamwork may assist with increased levels of efficiency and safety of patient care in the emergency department (ED), with emergency nurses playing an indispensable role in this process. A descriptive, exploratory approach was used, drawing on principles from phenomenology and symbolic interactionism. Convenience, purposive sampling was used in a major metropolitan ED. Semi structured interviews were conducted, audio recorded, and transcribed verbatim. Transcripts were analysed using thematic analysis. Three major themes emerged from the data. The first theme 'when teamwork works' supported the notion that emergency nurses perceived teamwork as a positive and effective construct in four key areas; resuscitation, simulation training, patient outcomes and staff satisfaction. The second theme 'team support' revealed that back up behaviour and leadership were critical elements of team effectiveness within the study setting. The third theme 'no time for teamwork' centred around periods when teamwork practices failed due to various contributing factors including inadequate resources and skill mix. Outcomes of effective teamwork were valued by emergency nurses. Teamwork is about performance, and requires a certain skill set not necessarily naturally possessed among emergency nurses. Building a resilient team inclusive of strong leadership and communication skills is essential to being able to withstand the challenging demands of the ED. Copyright © 2017 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

How Much Time Do Unhospitalized Patients Applying for Emergency Services Stay in Emergency Department

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Mansur Kürsad Erkuran

2013-12-01

Full Text Available INTRODUCTION: The patients applying to a emergency service may stay longer than necessary for diagnosis, monitoring and treatment. This can be due to the inadequacy of the treatment performed in emergency department or to the absence of the required unit in the hospital. In this study, we analyzed the waiting period of the patients who have not been hospitalized. METHODS: The patients applying to Bolu İzzet Baysal Public Hospital Emergency Unit between 24.11.2009 and 25.08.2011 have been studied regarding their application date, the season, and their waiting period in the emergency unit. The data have been analyzed using the statistics software Package for the Social Sciences (SPSS, Inc., Chicago, IL, version 17.0 for Windows. The chi-square χ2 test has been used for the determination of the percentage distribution and significance and p<0,05 has been considered significant. RESULTS: 4215 patients applying to Bolu İzzet Baysal Public Hospital Emergency Unit between 24.11.2009 and 25.08.2011 and monitored without hospitalization have been studied. The patients mainly presented during spring (p<0.05. The application occurred more often between 20.00 PM – 23.59 PM (p<0.005. The mean duration of the accept-standby of the patients in emergency unit was 09±12 (minimum 0 minute, maximum 130 minutes. The patients waited 0,26 ±70 minutes in emergency unit examination (minimum 0 minute, maximum 1292 minutes. The total waiting time in emergency unit was 52 ±100 minutes (minimum 10, maximum 1435 minutes. DISCUSSION AND CONCLUSION: In this study, we observed that the duration of the hospitalization in emergency unit is longer than the ideal duration.

"The Balancing Act"--Irish Part-Time Undergraduate Students in Higher Education

Science.gov (United States)

Darmody, Merike; Fleming, Bairbre

2009-01-01

While the numbers of part-time students has increased in higher education in Ireland, little is known about these students or about how they balance their study and other commitments. Drawing on a larger study on Irish students' experiences in higher education, this article attempts to address this gap in research and reports on Irish part-time…

Advanced Concepts and Controversies in Emergency Department Pain Management.

Science.gov (United States)

Motov, Sergey M; Nelson, Lewis S

2016-06-01

Pain is the most common complaint for which patients come to the emergency department (ED). Emergency physicians are responsible for pain relief in a timely, efficient, and safe manner in the ED. The improvement in our understanding of the neurobiology of pain has balanced the utilization of nonopioid and opioid analgesia, and simultaneously has led to more rational and safer opioid prescribing practices. This article reviews advances in pain management in the ED for patients with acute and chronic pain as well as describes several newer strategies and controversies. Copyright © 2016 Elsevier Inc. All rights reserved.

Low compliance with a validated system for emergency department triage

DEFF Research Database (Denmark)

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

2011-01-01

Bispebjerg Hospital has introduced a triage system at the Emergency Department (ED) based on "primary criteria" and a physiological scoring system named the Bispebjerg Early Warning Score (BEWS). A BEWS is calculated on the basis of five vital signs which are accessible bedside. Patients who have...... a "primary criterion" or a BEWS = 5 are presumed to be critically ill or severely injured and should be received by a multidisciplinary team, termed the Emergency Call (EC) and Trauma Call (TC), respectively. The aim of this study was to examine compliance with this triage system at Bispebjerg Hospital....

Future enhanced clinical role of pharmacists in Emergency Departments in England: multi-site observational evaluation.

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Hughes, Elizabeth; Terry, David; Huynh, Chi; Petridis, Konstantinos; Aiello, Matthew; Mazard, Louis; Ubhi, Hirminder; Terry, Alex; Wilson, Keith; Sinclair, Anthony

2017-08-01

Background There are concerns about maintaining appropriate clinical staffing levels in Emergency Departments. Pharmacists may be one possible solution. Objective To determine if Emergency Department attendees could be clinically managed by pharmacists with or without advanced clinical practice training. Setting Prospective 49 site cross-sectional observational study of patients attending Emergency Departments in England. Method Pharmacist data collectors identified patient attendance at their Emergency Department, recorded anonymized details of 400 cases and categorized each into one of four possible options: cases which could be managed by a community pharmacist; could be managed by a hospital pharmacist independent prescriber; could be managed by a hospital pharmacist independent prescriber with additional clinical training; or medical team only (unsuitable for pharmacists to manage). Impact indices sensitive to both workload and proportion of pharmacist manageable cases were calculated for each clinical group. Main outcome measure Proportion of cases which could be managed by a pharmacist. Results 18,613 cases were observed from 49 sites. 726 (3.9%) of cases were judged suitable for clinical management by community pharmacists, 719 (3.9%) by pharmacist prescribers, 5202 (27.9%) by pharmacist prescribers with further training, and 11,966 (64.3%) for medical team only. Impact Indices of the most frequent clinical groupings were general medicine (13.18) and orthopaedics (9.69). Conclusion The proportion of Emergency Department cases that could potentially be managed by a pharmacist was 36%. Greatest potential for pharmacist management was in general medicine and orthopaedics (usually minor trauma). Findings support the case for extending the clinical role of pharmacists.

The Age-Related Association of Movement in Irish Adolescent Youth

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Diarmuid Lester

2017-10-01

Full Text Available (1 Background: Research has shown that post-primary Irish youth are insufficiently active and fail to reach a level of proficiency across basic movement skills. The purpose of the current research was to gather cross-sectional baseline data on Irish adolescent youth, specifically the prevalence of movement skills and patterns, in order to generate an overall perspective of movement within the first three years (Junior Certificate level of post-primary education. (2 Methods: Data were collected on adolescents (N = 181; mean age: 14.42 ± 0.98 years, attending two, mixed-gender schools. Data collection included 10 fundamental movement skills (FMS and the seven tests within the Functional Movement Screen (FMS™. The data set was analysed using the Statistical Package for Social Sciences (SPSS version 20.0 for Windows. (3 Results: Overall, levels of actual mastery within fundamental and functional movement were low. There were statistically significant age-related differences observed, with a progressive decline as age increased in both the object control (p = 0.002 FMS sub-domain, and the in-line lunge (p = 0.048 test of the FMS™. (4 Conclusion: In summary, we found emerging evidence that school year group is significantly associated with mastery of movement skills and patterns. Results from the current study suggest that developing a specifically tailored movement-oriented intervention would be a strategic step towards improving the low levels of adolescent fundamental and functional movement proficiency.

Point-of-care ultrasound education for non-physician clinicians in a resource-limited emergency department.

Science.gov (United States)

Stolz, Lori A; Muruganandan, Krithika M; Bisanzo, Mark C; Sebikali, Mugisha J; Dreifuss, Bradley A; Hammerstedt, Heather S; Nelson, Sara W; Nayabale, Irene; Adhikari, Srikar; Shah, Sachita P

2015-08-01

To describe the outcomes and curriculum components of an educational programme to train non-physician clinicians working in a rural, Ugandan emergency department in the use of POC ultrasound. The use of point-of-care ultrasound was taught to emergency care providers through lectures, bedsides teaching and hands-on practical sessions. Lectures were tailored to care providers' knowledge base and available therapeutic means. Every ultrasound examination performed by these providers was recorded over 4.5 years. Findings of these examinations were categorised as positive, negative, indeterminate or procedural. Other radiologic studies ordered over this same time period were also recorded. A total of 22,639 patients were evaluated in the emergency department by emergency care providers, and 2185 point-of-care ultrasound examinations were performed on 1886 patients. Most commonly used were the focused assessment with sonography in trauma examination (53.3%) and echocardiography (16.4%). Point-of-care ultrasound studies were performed more frequently than radiology department-performed studies. Positive findings were documented in 46% of all examinations. We describe a novel curriculum for point-of-care ultrasound education of non-physician emergency practitioners in a resource-limited setting. These non-physician clinicians integrated ultrasound into clinical practice and utilised this imaging modality more frequently than traditional radiology department imaging with a large proportion of positive findings. © 2015 John Wiley & Sons Ltd.

Pharmaceutical advertising in emergency departments.

Science.gov (United States)

Marco, Catherine A

2004-04-01

Promotion of prescription drugs represents a growing source of pharmaceutical marketing expenditures. This study was undertaken to identify the frequency of items containing pharmaceutical advertising in clinical emergency departments (EDs). In this observational study, emergency physician on-site investigators quantified a variety of items containing pharmaceutical advertising present at specified representative times and days, in clinical EDs. Measurements were obtained by 65 on-site investigators, representing 22 states. Most EDs in this study were community EDs (87% community and 14% university or university affiliate), and most were in urban settings (50% urban, 38% suburban, and 13% rural). Investigators measured 42 items per ED (mean = 42; median = 31; interquartile range of 14-55) containing pharmaceutical advertising in the clinical area. The most commonly observed items included pens (mean 15 per ED; median 10), product brochures (mean 5; median 3), stethoscope labels (mean 4; median 2), drug samples (mean 3; median 0), books (mean 3.4), mugs (mean 2.4), and published literature (mean 3.1). EDs with a policy restricting pharmaceutical representatives in the ED had significantly fewer items containing pharmaceutical advertising (median 7.5; 95% CI = 0 to 27) than EDs without such a policy (median 35; 95% CI = 27 to 47, p = 0.005, nonparametric Wilcoxon two-sample test). There were no differences in quantities of pharmaceutical advertising for EDs in community compared with university settings (p = 0.5), rural compared with urban settings (p = 0.3), or annual ED volumes (p = 0.9). Numerous items containing pharmaceutical advertising are frequently observed in EDs. Policies restricting pharmaceutical representatives in the ED are associated with reduced pharmaceutical advertising.

Understanding management and support for domestic violence and abuse within emergency departments: A systematic literature review from 2000-2015.

Science.gov (United States)

Hinsliff-Smith, Kathryn; McGarry, Julie

2017-12-01

To identify, review and critically evaluate published empirical studies concerned with the prevalence, management and support for survivors of domestic violence and abuse who present at emergency department. Domestic violence and abuse is a global phenomenon with a wealth of studies that explore the different aspects of the issue including the economic, social and health effects on survivors and on society as a whole. Emergency department is widely recognised as one healthcare facility where domestic violence and abuse survivors will often disclose domestic violence and abuse. In the UK, National Institute of Clinical Excellence produced guidelines in 2014 requiring all sectors of health care and those they work alongside to recognise support and manage survivors of domestic violence and abuse. Whilst there is an increasing body of research on domestic violence and abuse, limited synthesised work has been conducted in the context of domestic violence and abuse within emergency department. This review encompasses empirical studies conducted in emergency department for screening interventions, management and support for domestic violence and abuse patients including prevalence. This review included studies that included emergency department staff, emergency department service users and domestic violence and abuse survivors. A systematic approach across five electronic bibliographic databases found 35 studies meeting the inclusion criteria published between 2000-2015. From the 35 studies, four descriptive overarching themes were identified (i) prevalence of domestic violence and abuse in emergency department, (ii) use of domestic violence and abuse screening tools and emergency department interventions, (iii) current obstacles for staff working in emergency department and (iv) emergency department users and survivor perspectives. Having knowledgeable and supportive emergency department staff can have a positive benefit for the longer-term health of the domestic

Preparedness of emergency departments in northwest England for managing chemical incidents: a structured interview survey

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Walter Darren

2007-12-01

Full Text Available Abstract Background A number of significant chemical incidents occur in the UK each year and may require Emergency Departments (EDs to receive and manage contaminated casualties. Previously UK EDs have been found to be under-prepared for this, but since October 2005 acute hospital Trusts have had a statutory responsibility to maintain decontamination capacity. We aimed to evaluate the level of preparedness of Emergency Departments in North West England for managing chemical incidents. Methods A face-to-face semi-structured interview was carried out with the Nurse Manager or a nominated deputy in all 18 Emergency Departments in the Region. Results 16/18 departments had a written chemical incident plan but only 7 had the plan available at interview. All had a designated decontamination area but only 11 felt that they were adequately equipped. 12/18 had a current training programme for chemical incident management and 3 had no staff trained in decontamination. 13/18 could contain contaminated water from casualty decontamination and 6 could provide shelter for casualties before decontamination. Conclusion We have identified major inconsistencies in the preparedness of North West Emergency Departments for managing chemical incidents. Nationally recognized standards on incident planning, facilities, equipment and procedures need to be agreed and implemented with adequate resources. Issues of environmental safety and patient dignity and comfort should also be addressed.

A framework for implementation, education, research and clinical use of ultrasound in emergency departments by the Danish Society for Emergency Medicine

DEFF Research Database (Denmark)

Laursen, Christian B; Nielsen, Klaus; Riishede, Minna

2014-01-01

The first Danish Society for Emergency Medicine (DASEM) recommendations for the use of clinical ultrasound in emergency departments has been made. The recommendations describes what DASEM believes as being current best practice for training, certification, maintenance of acquired competencies...

Vitamin D intake and status in Irish elderly women and adolescent girls

DEFF Research Database (Denmark)

McCarthy, D.; Collins, A.; O’Brien, M.

2006-01-01

Aim To assess vitamin D status during summer and winter in Irish girls and elderly women, and to estimate vitamin D intake in these two age-groups. Methods Ambulatory free-living, elderly Irish women (aged 70-76 years; n = 43) and girls (aged 11-13 years; n = 17) were recruited. Fasting serums we...... collected during August/ September 2002 and February/March 2003 and analysed for 25 (OH) D by HPLC. Results Mean daily intakes of vitamin D were 4.6 mu g and 2.1 mu g in elderly women and girls, respectively Serum 25 (OH) D was significantly lower (P......Aim To assess vitamin D status during summer and winter in Irish girls and elderly women, and to estimate vitamin D intake in these two age-groups. Methods Ambulatory free-living, elderly Irish women (aged 70-76 years; n = 43) and girls (aged 11-13 years; n = 17) were recruited. Fasting serums were...

Workplace violence against clinicians in Cypriot emergency departments: a national questionnaire survey.

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Vezyridis, Paraskevas; Samoutis, Alexis; Mavrikiou, Petroula M

2015-05-01

To identify perceived prevalence, characteristics, precipitating factors and suggestions for improving workplace violence in all nine public emergency departments in the Cyprus Republic. Workplace violence is a common phenomenon in emergency departments, but little is known about this phenomenon in Cyprus. A retrospective cross-sectional survey. Two hundred and twenty of 365 emergency nurses (85·7%) and doctors (14·3%) participated in this study, of which 62% were female. Data were collected via a Greek language version of the Violent Incident Form. Additional questions examined perceived frequencies, encouragement for reporting, satisfaction with actions taken and suggestions for improvement. Descriptive analysis, chi-square tests and multiple logistic regression analyses were used to describe and associate characteristics with workplace prevalence. During the previous 12 months, the vast majority of nurses and doctors (76·2%) were exposed to verbal abuse (88·8%), mainly by relatives or friends of the patient (59·1%). Relatively inexperienced clinicians were at greater risk. Waiting time was identified as the most significant organisational factor. Alcohol intoxication, substance abuse and mental illness were individual factors for workplace violence. Severe underreporting (72·2%) and a belief that workplace violence is part of the work (74·1%) were also identified. Workplace violence was highly correlated with several factors, including a lack of encouragement for reporting, a feeling in advance that a violent incident was about to happen and having to handle the incident personally. Suggestions for improvement included more security measures (26·7%) and public education about the proper use of emergency services (15·2%). Verbal abuse is common in Cypriot emergency departments, but clinicians are increasingly worried about physical assaults. Training, security policies, encouragement of reporting and support for staff after a violent incident are needed

[Epidemiological characteristics in suicidal adolescents seen in the Emergency Department].

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Margarit Soler, Adriana; Martínez Sanchez, Lídia; Martínez Monseny, Antonio; Trenchs Sainz de la Maza, Victoria; Picouto González, María Dolores; Villar Cabeza, Francisco; Luaces Cubells, Carles

2016-07-01

Suicide attempt in adolescents is a major global health problem. In order to prevent them, the risks factors need to be identified. The present study evaluates the clinical and epidemiological aspects of adolescent patients after attempted suicide, who were seen in an emergency department. Description of retrospective study of patients younger than 18 years who visited emergency department unit after a suicide attempt, during the period from 2008 to 2012. A total of 241 patients were included, of whom 203 were female. The median age of the patients was 15.6 years. Psiquiatric history was present in 65.1% of the patients. The most frequent suicide mechanism was drug overdose (94.2%). Attempted suicide ideation was more common in males and in patients with previous attempts, and were also more related to sequels. Moreover, patients with an overdose were associated with psychiatric history and clinical toxicity. Patients with any of the following characteristics; male, psychiatric history, a history of previous suicide attempts and/or clinical toxicity at the time of the visit in the emergency center, were more associated suicidal ideation before the attempt. Therefore, they had greater severity and risk repeating the attempt. They require a careful psychiatric evaluation and close monitoring. Copyright © 2015 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

Brief Report: Factors Associated with Emergency Department Visits for Epilepsy among Children with Autism Spectrum Disorder

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Zhang, Wanqing; Baranek, Grace; Boyd, Brian

2018-01-01

We examined how demographic and clinical characteristics differ between emergency department (ED) visits for epilepsy (EP cohort) and ED visits for other reasons (non-EP cohort) in children with ASD. The data were drawn from the 2009 and 2010 Nationwide Emergency Department Sample. We performed both univariate and multivariate analyses to compare…

The economic role of the Emergency Department in the health care continuum: applying Michael Porter's five forces model to Emergency Medicine.

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Pines, Jesse M

2006-05-01

Emergency Medicine plays a vital role in the health care continuum in the United States. Michael Porters' five forces model of industry analysis provides an insight into the economics of emergency care by showing how the forces of supplier power, buyer power, threat of substitution, barriers to entry, and internal rivalry affect Emergency Medicine. Illustrating these relationships provides a view into the complexities of the emergency care industry and offers opportunities for Emergency Departments, groups of physicians, and the individual emergency physician to maximize the relationship with other market players.

Ketamine as a first-line treatment for severely agitated emergency department patients.

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Riddell, Jeff; Tran, Alexander; Bengiamin, Rimon; Hendey, Gregory W; Armenian, Patil

2017-07-01

Emergency physicians often need to control agitated patients who present a danger to themselves and hospital personnel. Commonly used medications have limitations. Our primary objective was to compare the time to a defined reduction in agitation scores for ketamine versus benzodiazepines and haloperidol, alone or in combination. Our secondary objectives were to compare rates of medication redosing, vital sign changes, and adverse events in the different treatment groups. We conducted a single-center, prospective, observational study examining agitation levels in acutely agitated emergency department patients between the ages of 18 and 65 who required sedation medication for acute agitation. Providers measured agitation levels on a previously validated 6-point sedation scale at 0-, 5-, 10-, and 15-min after receiving sedation. We also assessed the incidence of adverse events, repeat or rescue medication dosing, and changes in vital signs. 106 patients were enrolled and 98 met eligibility criteria. There was no significant difference between groups in initial agitation scores. Based on agitation scores, more patients in the ketamine group were no longer agitated than the other medication groups at 5-, 10-, and 15-min after receiving medication. Patients receiving ketamine had similar rates of redosing, changes in vital signs, and adverse events to the other groups. In highly agitated and violent emergency department patients, significantly fewer patients receiving ketamine as a first line sedating agent were agitated at 5-, 10-, and 15-min. Ketamine appears to be faster at controlling agitation than standard emergency department medications. Copyright © 2017 Elsevier Inc. All rights reserved.