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National Health Statistics Reports Jun 2024Objectives-This report describes emergency department (ED) visits by homeless status and sex. Methods-Nationally representative estimates were calculated from data...
Objectives-This report describes emergency department (ED) visits by homeless status and sex. Methods-Nationally representative estimates were calculated from data collected in the 2016-2021 National Hospital Ambulatory Medical Care Survey, an annual national probability sample survey of ED visits in the United States. Visits by people experiencing homelessness were defined using data on patient residence from medical records. Visits by males and females experiencing homelessness are compared with each other and with visits by males and females not experiencing homelessness. Results-During 2016-2021, approximately 981,000 and 460,000 ED visits were made annually by males and females experiencing homelessness, respectively. Significant differences by sex were found for this population for many ED visit characteristics, including arrival by ambulance, diagnoses, and chronic conditions. ED visits by males and females experiencing homelessness also differed significantly from ED visits by males and females not experiencing homelessness based on age, geographic region, expected source of payment, primary diagnosis, chronic conditions, and other characteristics. Conclusion-This report highlights certain differences by sex among the population experiencing homelessness who visited the ED and compares them with people who visited the ED but were not experiencing homelessness.
Topics: Humans; Ill-Housed Persons; Emergency Service, Hospital; United States; Male; Female; Adult; Middle Aged; Adolescent; Young Adult; Aged; Health Care Surveys; Sex Factors; Child; Child, Preschool; Infant; Emergency Room Visits
PubMed: 38912857
DOI: No ID Found -
BMJ Open Jun 2024To explore students' and facilitators' experiences of using a developed digital activity for interprofessional learning (IPL) focusing on critically ill patient...
Facilitating interprofessional learning: experiences of using a digital activity for training handover of critically ill patients between a primary health care centre and ambulance services - a qualitative study.
OBJECTIVE
To explore students' and facilitators' experiences of using a developed digital activity for interprofessional learning (IPL) focusing on critically ill patient handovers from a primary healthcare (PHC) centre to the ambulance service.
DESIGN
A qualitative study design was employed, and the reporting of this study adheres to the Consolidated criteria for Reporting Qualitative research guidelines for qualitative studies.
SETTING
A PHC centre and the ambulance service in Stockholm, Sweden.
PARTICIPANTS
A total of 31 participants were included in the study: 22 students from five different healthcare professions, seven facilitators and two observers.
INTERVENTION
A digital IPL activity was developed to overcome geographical distances, and the scenario included the handover of a critically ill patient from personnel within the PHC centre to the ambulance service personnel for transport to an emergency department. Four digital IPL activities were conducted in 2021.
RESULTS
The digital IPL activity eliminated the issue of geographical distance for students and facilitators, and it enabled the students to find an interprofessional model for collaboration through reasoning, by communicating and sharing knowledge with the support of a common structure. Participants perceived the digital IPL activity and scenario as authentic, feasible and facilitated IPL. Using a case with an acute and life-threatening condition was a success factor for students to experience high realism in their IPL on patient safety, handover, care and treatment.
CONCLUSION
The developed digital IPL activity facilitated the students' IPL and demonstrated potential sustainability as the digital approach supported overcoming geographical distances for both students and facilitators. By using a scenario involving an authentic case focusing on handovers of a critically ill patient, IPL, feasibility and acceptability were supported. However, it is crucial to emphasise that a comprehensive evaluation, both quantitative and qualitative, over an extended period of clinical rotations and involving a larger group of students is still warranted to ensure continuous improvement and development.
Topics: Humans; Qualitative Research; Patient Handoff; Sweden; Primary Health Care; Ambulances; Critical Illness; Male; Female; Interprofessional Relations; Adult; Interprofessional Education
PubMed: 38908853
DOI: 10.1136/bmjopen-2023-083585 -
Frontiers in Nutrition 2024With the prevalence of high body mass index (HBMI) increasing over the past 30 years, it is essential to examine the impact of obesity on kidney cancer. This study...
PURPOSE
With the prevalence of high body mass index (HBMI) increasing over the past 30 years, it is essential to examine the impact of obesity on kidney cancer. This study aims to explore the attributable burden of kidney cancer associated with HBMI and its proportion at different levels.
METHODS AND MATERIALS
The data used in this research were obtained from the Global Burden of Diseases Study 2019. We utilized DisMod-MR 2.1, a Bayesian meta-regression tool, to estimate the burden of kidney cancer attributable to HBMI, which was measured by age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life years rate (ASDR). Correlation analysis was conducted by the Spearman rank order correlation method. The temporal trends were analyzed by estimating the estimated annual percentage change (EAPC).
RESULTS
Globally in 2019, there were a total of 31.7 thousand deaths and 751.89 thousand disability-adjusted life years (DALYs) attributable to kidney cancer caused by HBMI, increased by 183.1 and 164%, respectively. Over the period from 1990 to 2019, the burden of kidney cancer attributable to HBMI increased in all regions, with the most significant increases occurring in Low-middle socio-demographic index (SDI) and Low SDI regions. At the national level, countries with lower SDI had lower ASMR and ASDR compared to developed nations. However, the EAPC values, which indicate the rate of increase, were significantly higher in these countries than in developed nations. Furthermore, across all years from 1990 to 2019, males experienced a greater and more rapidly increasing burden of kidney cancer attributable to HBMI than females.
CONCLUSION
As the population grows and dietary patterns shift, the burden of kidney cancer attributable to HBMI is expected to become even more severe. Males and developed regions have borne a heavier burden from 1990 to 2019. However, the EAPC values for both ASMR and ASDR were higher in males but not in regions with higher SDI values.
PubMed: 38903629
DOI: 10.3389/fnut.2024.1358017 -
Journal of the Formosan Medical... Jun 2024Ambulance-based telestroke may be a promising solution to improving stroke care. We assessed the technical feasibility and reliability of prehospital evaluations using...
BACKGROUND
Ambulance-based telestroke may be a promising solution to improving stroke care. We assessed the technical feasibility and reliability of prehospital evaluations using commercial mobile phones with fifth-generation wireless communication technology.
METHODS
Six standardized patients portrayed scripted stroke scenarios during ambulance transport in an urban city and were remotely evaluated by independent raters using tablets (three neurologists and three emergency physicians) in a hospital, assisted by paramedics (trained in National Institute of Health Stroke Scale [NIHSS] assessment) in the ambulance; commercial cellular networks were utilized for videoconferencing transmission. The primary outcomes were mean difference (MD) and correlation of NIHSS scores between the face-to-face and remote assessments. We also examined the Bland-Altman plot for itemized NIHSS components, and Kaplan-Meier curves were used to compare the differences in the duration of the two evaluations between neurologists and emergency physicians.
RESULTS
We conducted 32 ambulance runs and successfully completed all NIHSS examinations. No significant difference was found between the face-to-face and remote evaluations (MD, 0.782; 95% confidence interval [CI], -0.520-0.395). The correlation of NIHSS scores between the two methods was 0.994 (95% CI, 0.945-1.026), and three items exhibited the highest frequency of runs, with score differences between the two methods. There were no significant differences between neurologists and emergency physicians in the mean evaluation duration and NIHSS scores for the two methods.
CONCLUSION
Prehospital evaluation using commercial mobile phones with fifth-generation wireless communication technology is feasible and reliable during ambulance transport in urban areas. Emergency physicians and neurologists performed similarly in stroke evaluations.
PubMed: 38902123
DOI: 10.1016/j.jfma.2024.06.016 -
Computer Methods and Programs in... May 2024Objective First responders' mandatory reports of mental health episodes requiring emergency hospital care contain rich information about patients and their needs. In...
"The reasons you believe …": An exploratory study of text driven evidence gathering and prediction from first responder records justifying state authorised intervention for mental health episodes.
Objective First responders' mandatory reports of mental health episodes requiring emergency hospital care contain rich information about patients and their needs. In Queensland (Australia) much of the information contained in Emergency Examination Authorities (EEAs) remains unused. We propose and demonstrate a methodology to extract and translate vital information embedded in reports like EEAs and to use it to investigate the extreme propensity of incidence of serious mental health episodes. Methods The proposed method integrates clinical, demographic, spatial and free text information into a single data collection. The data is subjected to exploratory analysis for spatial pattern recognition leading to an observational epidemiology model for the association of maximum spatial recurrence of EEA episodes. Results Sentiment analysis revealed that among EEA presentations hospital and health service (HHS) region #4 had the lowest proportion of positive sentiments (18 %) compared to 33 % for HHS region #1 pointing to spatial differentiation of sentiments immanent in mandated free text which required more detailed analysis. At the postcode geographical level, we found that variation in maximum spatial recurrence of EEAs was significantly positively associated with spatial range of sentiments (0.29, p < 0.001) and the postcode-referenced sex ratio (0.45, p = 0.01). The volatility of sentiments significantly correlated with extremes of recurrence of EEA episodes. The predicted (probabilistic) incidence rate when mapped reflected this correlation. Conclusions The paper demonstrates the efficacy of integrating, machine extracted, human sentiments (as potential surrogates) with conventional exposure variables for evidence-based methods for mental health spatial epidemiology. Such insights from informatics-driven epidemiological observations may inform the strategic allocation of health system resources to address the highest levels of need and to improve the standard of care for mental patients while also enhancing their safe and humane treatment and management.
PubMed: 38901271
DOI: 10.1016/j.cmpb.2024.108257 -
Air Medical Journal 2024This observational study provides an overview of the implementation and impact of the helipad at the Bucharest Emergency University Hospital, Romania. The helipad,... (Observational Study)
Observational Study
Flight to Recovery: Impact of a Rooftop Helipad Air Ambulance Service at the Emergency University Hospital of Bucharest-A Caseload Analysis of the First 3 Years After Its Implementation.
OBJECTIVE
This observational study provides an overview of the implementation and impact of the helipad at the Bucharest Emergency University Hospital, Romania. The helipad, established in April 2019, is the only rooftop medical helipad in Bucharest authorized for day and night flights. Its influence extends beyond the local region, enabling the hospital to receive patients from various cities across Romania. The helipad has particularly strengthened the hospital's capabilities in cardiology, neurovascular emergencies, and neonatal care. Patients with acute myocardial infarctions or strokes can now be swiftly transported to the hospital for immediate intervention, whereas critically ill newborns can receive specialized care at the earliest stages of their lives. The objective of this article was to present a comprehensive timeline of the helipad's implementation and to demonstrate its transformative role in improving patient transportation, enhancing medical interventions, and elevating the overall efficiency of the health care facility.
METHODS
The study is a retrospective regional caseload analysis based on data gathered from the Emergency Department of the University Emergency Hospital of Bucharest database. We included all 215 air transfer missions registered between December 2019 and December 2022, exactly 3 years apart from the beginning of the program.
RESULTS
The findings provide valuable insights into patient demographics, case distribution, and trends, highlighting the importance of specialized medical interventions at the University Emergency Hospital of Bucharest. In particular, the mean age of patients treated at the hospital was 55.9 years, with a higher representation of males (156) than females (59). The average duration of hospitalization was 10.68 days. The study also examined transportation statistics, showing a decrease in the average number of transports per month over the years. Cardiologic cases accounted for the highest frequency (62.8%) among the analyzed categories followed by neurosurgery (8.8%) and neurologic cases (8.4%).
CONCLUSION
The analysis provides important insights into patient demographics, case distribution, and trends. The findings highlight the significance of specialized medical interventions, particularly in cardiology and neurosurgery, which accounted for the majority of the cases. The implementation of the helipad has greatly improved patient transportation and facilitated timely medical assistance.
Topics: Air Ambulances; Humans; Hospitals, University; Retrospective Studies; Female; Male; Emergency Service, Hospital; Middle Aged; Adult; Aged; Transportation of Patients; Infant, Newborn
PubMed: 38897695
DOI: 10.1016/j.amj.2024.03.002 -
Air Medical Journal 2024Intoxicated patients are often encountered by emergency medical services (eg, in cases of recreational drug use, accidental ingestion, or inhalation of toxic substances...
OBJECTIVE
Intoxicated patients are often encountered by emergency medical services (eg, in cases of recreational drug use, accidental ingestion, or inhalation of toxic substances or [attempted] suicide). Earlier research showed that a physician-staffed helicopter emergency medical service (P-HEMS) is regularly dispatched for intoxicated patients. However, it is still unclear if there is added value of P-HEMS compared with standard care provided by an ambulance crew. The aim of this study was to analyze the contribution of additional expertise and equipment that P-HEMS brings to the prehospital scene.
METHODS
In this retrospective study, we searched the database of the helicopter emergency medical service Lifeliner 1 serving the northwestern quadrant of the Netherlands for cases that involved intoxications from January 2013 to July 2020. Patients were included in this study if the primary reason for P-HEMS dispatch was intoxication. The types of intoxication were categorized as (illicit/recreational) drug related, suicide attempt, or accidental. The agents were categorized as stimulants, depressants, hallucinogenic, cannabinoids, and other substances such as bleach or insulin. Patient characteristics, vital signs, and the therapeutic interventions performed were recorded for analysis.
RESULTS
In our study period, P-HEMS was dispatched 23,878 times. Of these dispatches, a total of 259 cases were included for further analysis. The majority of patients were male (64.5%). Sixty-six patients (25.5%) had an intoxication of depressant agents alone, whereas 60 patients (23.2%) had an intoxication with a combination of agents. With 159 (61.4%) patients, the majority of cases involved recreational drug intoxications. Unintentional intoxications were treated in 27 (10.4%) patients, whereas 73 (28.2%) cases involved suicide attempts. In 159 patients (61.4%), prehospital endotracheal intubation was required; the vast majority was performed by the helicopter emergency medical service physician. Specific antidotes were administered in 56 (21.6%) of the cases.
CONCLUSION
In this study, we found that P-HEMS crews might complement usual prehospital care by ambulance crews for patients with severe intoxications by bringing advanced skills (eg, airway management and specific antidotes) to the scene.
Topics: Humans; Retrospective Studies; Air Ambulances; Netherlands; Male; Female; Adult; Emergency Medical Services; Middle Aged; Young Adult; Suicide, Attempted; Physicians; Adolescent; Aged
PubMed: 38897693
DOI: 10.1016/j.amj.2024.01.010 -
Resuscitation Plus Jun 2024PARAMEDIC2 was a medicines trial comparing adrenaline with placebo in out-of-hospital cardiac arrest (OHCA). At the time, United Kingdom (UK) Emergency Medical Systems...
BACKGROUND
PARAMEDIC2 was a medicines trial comparing adrenaline with placebo in out-of-hospital cardiac arrest (OHCA). At the time, United Kingdom (UK) Emergency Medical Systems (EMS) were inexperienced in delivering such research.
AIM
To identify barriers and facilitators to delivery of the PARAMEDIC2 (Adrenaline) trial by five UK NHS EMS.
METHODS
This qualitative study took a grounded theory approach to thematic analysis of workshop data. Members of the trial teams from each service attended a workshop in November 2018 and discussed their experiences in answer to two prompt questions. Data were coded and themes presented.
RESULTS
Three main themes were identified: and . The study provided an opportunity for recruiting paramedics and research paramedics to demonstrate their . Research paramedics felt it was part of their professional duty to initiate discussions with the patient/family regarding the trial rather than leave this task to the hospital teams as would usually happen. was reflected by prioritising trial training and further development of research paramedics. By these means, research culture was developed. The such as geographical challenges were often addressed with technological solutions and through building relationships with internal teams.
CONCLUSION
Barriers to trial delivery included infrequent exposure to the condition of interest and lack of continuity in research paramedic roles. Facilitators identified included flexibility of the research protocol, and organisational investment in the development of research paramedics.Participating in PARAMEDIC2 was challenging for the EMS involved, but ultimately strengthened their research culture.
PubMed: 38894855
DOI: 10.1016/j.resplu.2024.100617 -
Journal of Korean Medical Science Jun 2024We performed a nationwide analysis to evaluate the impact of the early coronavirus disease 2019 (COVID-19) pandemic on emergency department (ED) visits by adult cancer...
Impact of the Early COVID-19 Pandemic on Emergency Department Visits of Adult Cancer Patients With Fever or Respiratory Symptoms: A Korean Nationwide Population-Based Study, 2016-2020.
BACKGROUND
We performed a nationwide analysis to evaluate the impact of the early coronavirus disease 2019 (COVID-19) pandemic on emergency department (ED) visits by adult cancer patients having COVID-like symptoms.
METHODS
We analyzed the National Emergency Department Information System (NEDIS) data on ED visits by adult cancer patients who presented with chief complaints of fever or respiratory symptoms (FRS) indicative of COVID-19, from 2016 to 2020. An interrupted time series analysis with a quasi-Poisson regression model was performed, adjusting for seasonality and time, to evaluate whether underlying trends for monthly ED visits and the in-hospital mortality rate (%) per month changed with the pandemic among these patients. We also estimated the adjusted odds ratio (aOR) of in-hospital deaths among cancer patients using multivariable logistic regression analysis.
RESULTS
ED visits by cancer patients with FRS decreased during the COVID-19 pandemic (relative risk [RR] with 95% confidence interval [CI]: slope change, 0.99 [0.98-1.00] and step change, 0.84 [0.76-0.92]). However, the in-hospital mortality rate (%) for these patients was increased (slope change, 1.14 [1.04-1.25] and step change, 0.99 [0.98-1.01]). Factors such as urgent triage status, ambulance use, and treatment in hospitals with fewer than 300 staffed beds significantly contributed to increased aOR of in-hospital deaths during the COVID-19 pandemic compared to the pre-pandemic period.
CONCLUSION
Further studies are needed to highlight the importance of ED service preparation in planning and managing resources for cancer patients during future pandemics.
Topics: Humans; COVID-19; Emergency Service, Hospital; Neoplasms; Republic of Korea; Hospital Mortality; Male; Female; Middle Aged; Fever; Adult; SARS-CoV-2; Aged; Odds Ratio; Pandemics; Emergency Room Visits
PubMed: 38887201
DOI: 10.3346/jkms.2024.39.e187 -
Research Square Jun 2024Accurate identification of acute coronary syndrome (ACS) in the prehospital sestting is important for timely treatments that reduce damage to the compromised myocardium....
Accurate identification of acute coronary syndrome (ACS) in the prehospital sestting is important for timely treatments that reduce damage to the compromised myocardium. Current machine learning approaches lack sufficient performance to safely rule-in or rule-out ACS. Our goal is to identify a method that bridges this gap. To do so, we retrospectively evaluate two promising approaches, an ensemble of gradient boosted decision trees (GBDT) and selective classification (SC) on consecutive patients transported by ambulance to the ED with chest pain and/or anginal equivalents. On the task of ACS classification with 23 prehospital covariates, we found the fusion of the two (GBDT+SC) improves the best reported sensitivity and specificity by 8% and 23% respectively. Accordingly, GBDT+SC is safer than current machine learning approaches to rule-in and rule-out of ACS in the prehospital setting.
PubMed: 38883709
DOI: 10.21203/rs.3.rs-4437265/v1