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Department Use (department + use)

Distribution by Scientific Domains
Medical Sciences75%

Kinds of Department Use

  • emergency department use
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    Selected Abstracts

    Distances to Emergency Department and to Primary Care Provider's Office Affect Emergency Department Use in Children

    ACADEMIC EMERGENCY MEDICINE, Issue 5 2009
    Annameika Ludwick MD
    Abstract Objectives:, Patients of all ages use emergency departments (EDs) for primary care. Several studies have evaluated patient and system characteristics that influence pediatric ED use. However, the issue of proximity as a predictor of ED use has not been well studied. The authors sought to determine whether ED use by pediatric Medicaid enrollees was associated with the distance to their primary care providers (PCPs), distance to the nearest ED, and distance to the nearest children's hospital. Methods:, This historical cohort study included 26,038 children age 18 and under, assigned to 332 primary care practices affiliated with a Medicaid health maintenance organization (HMO). Predictor variables were distance from the child's home to his or her PCP site, distance from home to the nearest ED, and distance from home to the nearest children's hospital. The outcome variable was each child's ED use. A negative binomial model was used to determine the association between distance variables and ED use, adjusted for age, sex, and race, plus medical and primary care site characteristics previously found to influence ED use. Distance variables were divided into quartiles to test for nonlinear associations. Results:, On average, children made 0.31 ED visits/person/year. In the multivariable model, children living greater than 1.19 miles from the nearest ED had 11% lower ED use than those living within 0.5 miles of the nearest ED (risk ratio [RR] = 0.89, 95% CI = 0.81 to 0.99). Children living between 1.54 and 3.13 miles from their PCPs had 13% greater ED use (RR = 1.13, 95% CI = 1.03 to 1.24) than those who lived within 0.7 miles of their PCP. Conclusions:, Geographical variables play a significant role in ED utilization in children, confirming the importance of system-level determinants of ED use and creating the opportunity for interventions to reduce geographical barriers to primary care. [source]

    Emergency Department Use of Intravenous Procainamide for Patients with Acute Atrial Fibrillation or Flutter

    ACADEMIC EMERGENCY MEDICINE, Issue 12 2007
    Ian G. Stiell MD
    Objectives Acute atrial fibrillation and flutter are very common arrhythmias seen in emergency department (ED) patients, but there is no consensus for their optimal management. The objective of this study was to examine the efficacy and safety of intravenous (IV) procainamide for acute atrial fibrillation or flutter. Methods This health records review included a consecutive cohort of ED patients with acute-onset atrial fibrillation or atrial flutter who received IV procainamide at one university hospital ED during a five-year period. The standard clinical protocol involved IV infusion of 1 g of procainamide over 60 minutes, followed by electrical cardioversion if necessary. A trained observer extracted data from the original clinical records. Outcome measurements included conversion to sinus rhythm, adverse events, and relapse up to seven days. Results The 341 study patients had a mean age of 63.9 years (SD ± 15.5 years), and 56.6% were male. The conversion rates were 52.2% (95% confidence interval = 47% to 58%) for 316 atrial fibrillation cases and 28.0% (95% confidence interval = 13% to 46%) for 25 atrial flutter cases. Mean dose given was 860.7 mg (SD ± 231.2 mg), and median time to conversion was 55 minutes. Adverse events occurred in 34 cases (10.0%): hypotension, 8.5%; bradycardia, 0.6%; atrioventricular block, 0.6%; and ventricular tachycardia, 0.3%. There were no cases of torsades de pointes, cerebrovascular accident, or death. Most patients (94.4%) were discharged home, but 2.9% of patients returned with a recurrence of atrial fibrillation within seven days. Conclusions This study of acute atrial fibrillation or flutter patients treated in the ED with IV procainamide suggests that this treatment is safe and effective in this setting. Procainamide should be prospectively compared with other ED strategies. [source]

    INVESTIGATING RACIAL PROFILING BY THE MIAMI-DADE POLICE DEPARTMENT: A MULTIMETHOD APPROACH

    CRIMINOLOGY AND PUBLIC POLICY, Issue 1 2007
    GEOFFREY P. ALPERT
    Research Summary The perception and existence of biased policing or racial profiling is one of the most difficult issues facing contemporary American society. Citizens from minority communities have focused their concerns on the improper use of race by law enforcement officers. The current research uses a complex methodological approach to investigate claims that the Miami-Dade, Florida Police Department uses race improperly for the purposes of making traffic stops and conducting post-stop activities. The results are mixed in that the officer's aggregate actions do not show a pattern of discriminatory actions toward minority citizens when making a traffic stop, but results of post-stop activities do show some disparate treatment of minorities. Policy Implications Five specific policy recommendations are made to reduce the perception or reality of racial profiling by the police. First, police departments must have clear policies and directives explaining the proper use of race in decision making. Second, officers must be trained and educated in the overall impact of using race as a factor in deciding how to respond to a citizen. Third, the department must maintain a data-collection and analytic system to monitor the activities of their officers as it pertains to the race of the citizen. The fourth police recommendation involves the use of record checks in the field that can set in motion a process that results in the detention and arrest of citizens. Fifth, the completion of a record of interrogation for later intelligence has implications for the citizen. The use of this intelligence tool must depend on suspicion rather than on the race of the citizen. [source]

    How many cisplatin administration protocols does your department use?

    EUROPEAN JOURNAL OF CANCER CARE, Issue 1 2010
    A.P. GREYSTOKE bsc, mbchb, registrar medical oncology
    GREYSTOKE A.P., JODRELL D.I., CHEUNG M., RIVANS I. & MACKEAN M.J. (2009) European Journal of Cancer Care19, 80,90 How many cisplatin administration protocols does your department use? The introduction, 30 years ago, of the co-administration of appropriate hydration and ensuring a diuresis occurs during the administration of cisplatin was important in its development, allowing clinically significant doses to be given with acceptable rates of toxicity. The clinical usage of cisplatin has increased and hydration protocols have been amended to increase patient comfort and reduce resource utilization. We suspected that this had led to unnecessary variations in practice both in clinical trials and subsequently in the clinic. Therefore, we reviewed practice in the Edinburgh Cancer Centre and discovered that 25 different hydration protocols were in use, with wide variation in dilution of cisplatin, total fluid administered, use of electrolyte (potassium and magnesium) supplementation and diuretics. These differences are a reflection of adoption of variations in hydration regimes published in pivotal clinical trials. A review of the available evidence relating to cisplatin associated hydration regimens was performed and recommendations will be made for the future design of evidence-based protocols. [source]

    Building a Partnership to Evaluate School-Linked Health Services: The Cincinnati School Health Demonstration Project

    JOURNAL OF SCHOOL HEALTH, Issue 10 2005
    Barbara L. Rose
    Partners from the Cincinnati Health Department, Cincinnati Public Schools, Cincinnati Children's Hospital Medical Center, and The Health Foundation of Greater Cincinnati wanted to determine if levels of school-linked care made a difference in student quality of life, school connectedness, attendance, emergency department use, and volume of referrals to health care specialists. School nurses, principals and school staff, parents and students, upper-level managers, and health service researchers worked together over a 2.5-year period to learn about and use new technology to collect information on student health, well-being, and outcome measures. Varying levels of school health care intervention models were instituted and evaluated. A standard model of care was compared with 2 models of enhanced care and service. The information collected from students, parents, nurses, and the school system provided a rich database on the health of urban children. School facilities, staffing, and computer technology, relationship building among stakeholders, extensive communication, and high student mobility were factors that influenced success and findings of the project. Funding for district-wide computerization and addition of school health staff was not secured by the end of the demonstration project; however, relationships among the partners endured and paved the way for future collaborations designed to better serve urban school children in Cincinnati. (J Sch Health. 2005;75(10):363-369) [source]

    The burden of emergency department use for sickle-cell disease: An analysis of the national emergency department sample database,

    AMERICAN JOURNAL OF HEMATOLOGY, Issue 10 2010
    Sophie Lanzkron
    No abstract is available for this article. [source]

    Maternal depressive symptoms and adherence to therapy in inner-city children with Asthma

    CHILD: CARE, HEALTH AND DEVELOPMENT, Issue 4 2004
    Richard Reading
    Maternal depressive symptoms and adherence to therapy in inner-city children with Asthma . Bartlet, S.J., Krishnan, J.A., Riekert, K.A., Butz, A.M., Malveaux, F.J. & Rand, C.S. ( 2004 ) Pediatrics113 , 229 , 237 . Context Little is known about how depressive symptoms in mothers affects illness management in inner-city children with asthma. Objective The goal was to determine how maternal depressive symptoms influence child medication adherence, impact of the child's asthma on the mother, and maternal attitudes and beliefs. Methods Baseline and 6-month surveys were administered to 177 mothers of young minority children with asthma in inner-city Baltimore, MD and Washington, DC. Medication adherence, disruptiveness of asthma, and select attitudes toward illness and asthma therapy were measured. Six-month data (n = 158) were used to prospectively evaluate long-term symptom control and emergency department use. Independent variables included asthma morbidity, age, depressive symptoms and other psychosocial data. Results No difference in child asthma morbidity was observed between mothers high and low in depressive symptoms. However, mothers with high depressive symptoms reported significantly more problems with their child using inhalers properly [odds ratio (OR) 5.0, 95% confidence interval (CI) 1.3,18.9] and forgetting doses (OR 4.2, 95% CI 1.4,12.4). Depressive symptoms were also associated with greater emotional distress and interference with daily activities caused by the child's asthma, along with less confidence in asthma medications, ability to control asthma symptoms and self-efficacy to cope with acute asthma episodes. In addition, depressed mothers reported less understanding about their child's medications and use (OR 7.7, 95% CI 1.7,35.9). Baseline asthma morbidity, maternal depression scores and family income were independently associated with asthma symptoms 6 months later, whereas medication adherence was not predictive of subsequent asthma morbidity or emergency department use. Conclusions Maternal depressive symptoms were not associated with child asthma morbidity but were associated with a constellation of beliefs and attitudes that may significantly influence adherence to asthma medications and illness management. Identifying and addressing poor psychological adjustment in mothers is important when developing a child's asthma treatment and may facilitate parent,provider communication, medication adherence and asthma management among inner-city children. [source]