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Systolic Blood Pressure and Biochemical Assessment of Adherence: A Cross-Sectional Analysis in the Emergency Department.
McNaughton CD, Brown NJ, Rothman RL, Liu D, Kabagambe EK, Levy PD, Self WH, Storrow AB, Collins SP, Roumie CL
(2017) Hypertension 70: 307-314
MeSH Terms: Aged, Antihypertensive Agents, Biomarkers, Blood Pressure, Blood Pressure Determination, Cross-Sectional Studies, Emergency Medical Services, Emergency Service, Hospital, Female, Health Literacy, Humans, Hypertension, Male, Mass Spectrometry, Medication Adherence, Medication Therapy Management, Middle Aged, United States
Show Abstract · Added June 28, 2017
Elevated blood pressure (BP) is common in the emergency department (ED), but the relationship between antihypertensive medication adherence and BP in the ED is unclear. This cross-sectional study tested the hypothesis that higher antihypertensive adherence is associated with lower systolic BP (SBP) in the ED among adults with hypertension who sought ED care at an academic hospital from July 2012 to April 2013. Biochemical assessment of antihypertensive adherence was performed using a mass spectrometry blood assay, and the primary outcome was average ED SBP. Analyses were stratified by number of prescribed antihypertensives (<3, ≥3) and adjusted for age, sex, race, insurance, literacy, numeracy, education, body mass index, and comorbidities. Among 85 patients prescribed ≥3 antihypertensives, mean SBP for adherent patients was 134.4 mm Hg (±26.1 mm Hg), and in adjusted analysis was -20.8 mm Hg (95% confidence interval, -34.2 to -7.4 mm Hg; =0.003) different from nonadherent patients. Among 176 patients prescribed <3 antihypertensives, mean SBP was 135.5 mm Hg (±20.6 mm Hg) for adherent patients, with no difference by adherence in adjusted analysis (+2.9 mm Hg; 95% confidence interval, -4.7 to 10.5 mm Hg; =0.45). Antihypertensive nonadherence identified by biochemical assessment was common and associated with higher SBP in the ED among patients who had a primary care provider and health insurance and who were prescribed ≥3 antihypertensives. Biochemical assessment of antihypertensives could help distinguish medication nonadherence from other contributors to elevated BP and identify target populations for intervention.
© 2017 American Heart Association, Inc.
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18 MeSH Terms
Anaphylaxis after zoster vaccine: Implicating alpha-gal allergy as a possible mechanism.
Stone CA, Hemler JA, Commins SP, Schuyler AJ, Phillips EJ, Peebles RS, Fahrenholz JM
(2017) J Allergy Clin Immunol 139: 1710-1713.e2
MeSH Terms: Allergens, Anaphylaxis, Drug-Related Side Effects and Adverse Reactions, Emergency Medical Services, Epinephrine, Excipients, Female, Galactose, Gelatin, Herpes Zoster Vaccine, Humans, Hypersensitivity, Immunity, Heterologous, Immunoglobulin E, Middle Aged
Added March 30, 2020
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MeSH Terms
Fractional exhaled nitric oxide change in pediatric patients after emergency department care of asthma exacerbations.
Karlin E, Gebretsadik T, Peebles RS, Hartert TV, Langley EW, Arnold DH
(2015) Ann Allergy Asthma Immunol 114: 149-51
MeSH Terms: Adolescent, African Americans, Anti-Asthmatic Agents, Asthma, Breath Tests, Child, Child, Preschool, Disease Progression, Emergency Medical Services, European Continental Ancestry Group, Exhalation, Female, Forced Expiratory Volume, Humans, Male, Nitric Oxide
Added January 20, 2015
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16 MeSH Terms
Validity and reliability assessment of detailed scoring checklists for use during perioperative emergency simulation training.
McEvoy MD, Hand WR, Furse CM, Field LC, Clark CA, Moitra VK, Nietert PJ, O'Connor MF, Nunnally ME
(2014) Simul Healthc 9: 295-303
MeSH Terms: Checklist, Clinical Competence, Computer Simulation, Emergency Medical Services, Humans, Perioperative Care, Reproducibility of Results
Show Abstract · Added October 17, 2015
INTRODUCTION - Few valid and reliable grading checklists have been published for the evaluation of performance during simulated high-stakes perioperative event management. As such, the purposes of this study were to construct valid scoring checklists for a variety of perioperative emergencies and to determine the reliability of scores produced by these checklists during continuous video review.
METHODS - A group of anesthesiologists, intensivists, and educators created a set of simulation grading checklists for the assessment of the following scenarios: severe anaphylaxis, cerebrovascular accident, hyperkalemic arrest, malignant hyperthermia, and acute coronary syndrome. Checklist items were coded as critical or noncritical. Nonexpert raters evaluated 10 simulation videos in a random order, with each video being graded 4 times. A group of faculty experts also graded the videos to create a reference standard to which nonexpert ratings were compared. P < 0.05 was considered significant.
RESULTS - Team leaders in the simulation videos were scored by the expert panel as having performed 56.5% of all items on the checklist (range, 43.8%-84.0%), and 67.2% of the critical items (range, 30.0%-100%). Nonexpert raters agreed with the expert assessment 89.6% of the time (95% confidence interval, 87.2%-91.6%). No learning curve development was found with repetitive video assessment or checklist use. The κ values comparing nonexpert rater assessments to the reference standard averaged 0.76 (95% confidence interval, 0.71-0.81).
CONCLUSIONS - The findings indicate that the grading checklists described are valid, are reliable, and could be used in perioperative crisis management assessment.
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7 MeSH Terms
Regional systems of care demonstration project: Mission: Lifeline STEMI Systems Accelerator: design and methodology.
Bagai A, Al-Khalidi HR, Sherwood MW, Muñoz D, Roettig ML, Jollis JG, Granger CB
(2014) Am Heart J 167: 15-21.e3
MeSH Terms: American Heart Association, Cardiology Service, Hospital, Delivery of Health Care, Integrated, Efficiency, Organizational, Emergency Medical Services, Health Services Research, Humans, Myocardial Infarction, Outcome Assessment, Health Care, Regional Health Planning, Research Design, United States, Urban Health Services
Show Abstract · Added March 7, 2014
ST-segment elevation myocardial infarction (STEMI) systems of care have been associated with significant improvement in use and timeliness of reperfusion. Consequently, national guidelines recommend that each community should develop a regional STEMI care system. However, significant barriers continue to impede widespread establishment of regional STEMI care systems in the United States. We designed the Regional Systems of Care Demonstration Project: Mission: Lifeline STEMI Systems Accelerator, a national educational outcome research study in collaboration with the American Heart Association, to comprehensively accelerate the implementation of STEMI care systems in 17 major metropolitan regions encompassing >1,500 emergency medical service agencies and 450 hospitals across the United States. The goals of the program are to identify regional gaps, barriers, and inefficiencies in STEMI care and to devise strategies to implement proven recommendations to enhance the quality and consistency of care. The study interventions, facilitated by national faculty with expertise in regional STEMI system organization in partnership with American Heart Association representatives, draw upon specific resources with proven past effectiveness in augmenting regional organization. These include bringing together leading regional health care providers and institutions to establish common commitment to STEMI care improvement, developing consensus-based standardized protocols in accordance with national professional guidelines to address local needs, and collecting and regularly reviewing regional data to identify areas for improvement. Interventions focus on each component of the reperfusion process: the emergency medical service, the emergency department, the catheterization laboratory, and inter-hospital transfer. The impact of regionalization of STEMI care on clinical outcomes will be evaluated.
© 2014.
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13 MeSH Terms
Applications of justification and optimization in medical imaging: examples of clinical guidance for computed tomography use in emergency medicine.
Sierzenski PR, Linton OW, Amis ES, Courtney DM, Larson PA, Mahesh M, Novelline RA, Frush DP, Mettler FA, Timins JK, Tenforde TS, Boice JD, Brink JA, Bushberg JT, Schauer DA
(2014) J Am Coll Radiol 11: 36-44
MeSH Terms: Emergency Medical Services, Emergency Medicine, Guideline Adherence, Practice Guidelines as Topic, Radiation Protection, Radiology, Tomography, X-Ray Computed, United States
Show Abstract · Added March 7, 2014
Availability, reliability, and technical improvements have led to continued expansion of computed tomography (CT) imaging. During a CT scan, there is substantially more exposure to ionizing radiation than with conventional radiography. This has led to questions and critical conclusions about whether the continuous growth of CT scans should be subjected to review and potentially restraints or, at a minimum, closer investigation. This is particularly pertinent to populations in emergency departments, such as children and patients who receive repeated CT scans for benign diagnoses. During the last several decades, among national medical specialty organizations, the American College of Emergency Physicians and the American College of Radiology have each formed membership working groups to consider value, access, and expedience and to promote broad acceptance of CT protocols and procedures within their disciplines. Those efforts have had positive effects on the use criteria for CT by other physician groups, health insurance carriers, regulators, and legislators.
Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.
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8 MeSH Terms
Among emergency physicians, use of the term "Sickler" is associated with negative attitudes toward people with sickle cell disease.
Glassberg J, Tanabe P, Richardson L, Debaun M
(2013) Am J Hematol 88: 532-3
MeSH Terms: Anemia, Sickle Cell, Attitude of Health Personnel, Emergency Medical Services, Humans, Physician-Patient Relations
Added November 27, 2013
1 Communities
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5 MeSH Terms
Risk stratification in acute heart failure: rationale and design of the STRATIFY and DECIDE studies.
Collins SP, Lindsell CJ, Jenkins CA, Harrell FE, Fermann GJ, Miller KF, Roll SN, Sperling MI, Maron DJ, Naftilan AJ, McPherson JA, Weintraub NL, Sawyer DB, Storrow AB
(2012) Am Heart J 164: 825-34
MeSH Terms: Acute Disease, Adolescent, Adult, Ambulatory Care, Cost-Benefit Analysis, Decision Support Techniques, Emergency Medical Services, Heart Failure, Humans, Length of Stay, Patient Admission, Patient Discharge, Prospective Studies, Research Design, Risk Assessment, Treatment Outcome, Young Adult
Show Abstract · Added March 2, 2014
BACKGROUND - A critical challenge for physicians facing patients presenting with signs and symptoms of acute heart failure (AHF) is how and where to best manage them. Currently, most patients evaluated for AHF are admitted to the hospital, yet not all warrant inpatient care. Up to 50% of admissions could be potentially avoided and many admitted patients could be discharged after a short period of observation and treatment. Methods for identifying patients that can be sent home early are lacking. Improving the physician's ability to identify and safely manage low-risk patients is essential to avoiding unnecessary use of hospital beds.
METHODS - Two studies (STRATIFY and DECIDE) have been funded by the National Heart Lung and Blood Institute with the goal of developing prediction rules to facilitate early decision making in AHF. Using prospectively gathered evaluation and treatment data from the acute setting (STRATIFY) and early inpatient stay (DECIDE), rules will be generated to predict risk for death and serious complications. Subsequent studies will be designed to test the external validity, utility, generalizability and cost-effectiveness of these prediction rules in different acute care environments representing racially and socioeconomically diverse patient populations.
RESULTS - A major innovation is prediction of 5-day as well as 30-day outcomes, overcoming the limitation that 30-day outcomes are highly dependent on unpredictable, post-visit patient and provider behavior. A novel aspect of the proposed project is the use of a comprehensive cardiology review to correctly assign post-treatment outcomes to the acute presentation.
CONCLUSIONS - Finally, a rigorous analysis plan has been developed to construct the prediction rules that will maximally extract both the statistical and clinical properties of every data element. Upon completion of this study we will subsequently externally test the prediction rules in a heterogeneous patient cohort.
Copyright © 2012 Mosby, Inc. All rights reserved.
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2 Members
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17 MeSH Terms
ACR Appropriateness Criteria(®) acute nonspecific chest pain-low probability of coronary artery disease.
Hoffmann U, Venkatesh V, White RD, Woodard PK, Carr JJ, Dorbala S, Earls JP, Jacobs JE, Mammen L, Martin ET, Ryan T, White CS
(2012) J Am Coll Radiol 9: 745-50
MeSH Terms: Acute Coronary Syndrome, Acute Disease, Cardiac Catheterization, Cardiac Imaging Techniques, Chest Pain, Coronary Angiography, Coronary Artery Disease, Diagnosis, Differential, Emergency Medical Services, Humans, Magnetic Resonance Imaging, Practice Guidelines as Topic, Radiation Dosage, Radiography, Thoracic, Risk Assessment, Tomography, X-Ray Computed
Show Abstract · Added February 15, 2014
This document outlines the usefulness of available diagnostic imaging for patients without known coronary artery disease and at low probability for having coronary artery disease who do not present with classic signs, symptoms, or electrocardiographic abnormalities indicating acute coronary syndrome but rather with nonspecific chest pain leading to a differential diagnosis, including pulmonary, gastrointestinal, or musculoskeletal pathologies. A number of imaging modalities are available to evaluate the broad spectrum of possible pathologies in these patients, such as chest radiography, multidetector CT, MRI, ventilation-perfusion scans, cardiac perfusion scintigraphy, transesophageal and transthoracic echocardiography, PET, spine and rib radiography, barium esophageal and upper gastrointestinal studies, and abdominal ultrasound. It is considered appropriate to start the assessment of these patients with a low-cost, low-risk diagnostic test such as a chest x-ray. Contrast-enhanced gated cardiac and ungated thoracic multidetector CT as well as transthoracic echocardiography are also usually considered as appropriate in the evaluation of these patients as a second step if necessary. A number of rest and stress single-photon emission CT myocardial perfusion imaging, ventilation-perfusion scanning, aortic and chest MR angiographic, and more specific x-ray and abdominal examinations may be appropriate as a third layer of testing, whereas MRI of the heart or coronary arteries and invasive testing such as transesophageal echocardiography or selective coronary angiography are not considered appropriate in these patients. Given the low risk of these patients, it is mandated to minimize radiation exposure as much as possible using advanced and appropriate testing protocols. The ACR Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.
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16 MeSH Terms
Implementation of a standardized pathway for the treatment of cardiac arrest patients using therapeutic hypothermia: "CODE ICE".
Hollenbeck RD, Wells Q, Pollock J, Kelley MB, Wagner CE, Cash ME, Scott C, Burns K, Jones I, Fredi JL, McPherson JA
(2012) Crit Pathw Cardiol 11: 91-8
MeSH Terms: Aged, Cardiopulmonary Resuscitation, Coma, Critical Pathways, Decision Support Systems, Clinical, Emergency Medical Services, Female, Heart Arrest, Humans, Hypothermia, Induced, Male, Middle Aged, Out-of-Hospital Cardiac Arrest, Retrospective Studies, Tertiary Care Centers, Treatment Outcome
Show Abstract · Added February 28, 2014
Out-of-hospital cardiac arrest is common and is associated with high mortality. The majority of in-hospital deaths from resuscitated victims of cardiac arrest are due to neurologic injury. Therapeutic hypothermia (TH) is now recommended for the management of comatose survivors of cardiac arrest. The rapid triage and standardized treatment of cardiac arrest patients can be challenging, and implementation of a TH program requires a multidisciplinary team approach. In 2010, we revised our institution's TH protocol, creating a "CODE ICE" pathway to improve the timely and coordinated care of cardiac arrest patients. As part of CODE ICE, we implemented comprehensive care pathways including measures such as a burst paging system and computerized physician support tools. "STEMI on ICE" integrates TH with our regional ST-elevation myocardial infarction network. Retrospective data were collected on 150 consecutive comatose cardiac arrest victims treated with TH (n = 82 pre-CODE ICE and n = 68 post-CODE ICE) from 2007 to 2011. After implementation of CODE ICE, the mean time to initiation of TH decreased from 306 ± 165 minutes to 196 ± 144 minutes (P < 0.001), and the time to target temperature decreased from 532 ± 214 minutes to 392 ± 215 minutes (P < 0.001). There was no significant change in survival or neurologic outcome at hospital discharge. Through the implementation of CODE ICE, we were able to reduce the time to initiation of TH and time to reach target temperature. Additional studies are needed to determine the effect of CODE ICE and similar pathways on clinical outcomes after cardiac arrest.
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16 MeSH Terms