Demand for hospital emergency departments：a conceptual understanding

BACKGROUND： Emergency departments （EDs） are critical to the management of acute illnessand injury, and the provision of health system access. However, EDs have become increasinglycongested due to increased demand, increased complexity of care and blocked access to ongoingcare （access block）. Congestion has clinical and organisational implications. This paper aims todescribe the factors that appear to infl uence demand for ED services, and their interrelationships asthe basis for further research into the role of private hospital EDs.DATA SOURCES： Multiple databases （PubMed, ProQuest, Academic Search Elite and ScienceDirect） and relevant journals were searched using terms related to EDs and emergency health needs.Literature pertaining to emergency department utilisation worldwide was identified, and articlesselected for further examination on the basis of their relevance and signifi cance to ED demand.RESULTS： Factors influencing ED demand can be categorized into those describing thehealth needs of the patients, those predisposing a patient to seeking help, and those relating topolicy factors such as provision of services and insurance status. This paper describes the factorsinfl uencing ED presentations, and proposes a novel conceptual map of their interrelationship.CONCLUSION： This review has explored the factors contributing to the growing demand forED care, the infl uence these factors have on ED demand, and their interrelationships depicted in theconceptual model.

The potential contributions of traditional Chinese medicine to emergency medicine

BACKGROUND:Despite the fact that traditional Chinese medicine(TCM) has been developed and used to treat acute and urgent illness for many thousands of years.TCM has been widely perceived in western societies that TCM may only be effective to treat chronic diseases.The aim of this article is to provide some scientific evidence regarding the application of TCM in emergency medicine and its future potential.METHODS:Multiple databases(PubMed,ProQuest,Academic Search Elite and Science Direct) were searched using the terms:Traditional Chinese Medicine/ Chinese Medicine,Emergency Medicine,China.In addition,three leading TCM Journals in China were searched via Oriprobe Information Services for relevant articles(published from 1990—2012).Particular attention was paid to those articles that are related to TCM treatments or combined medicine in dealing with intensive and critical care.RESULTS:TCM is a systematic traditional macro medicine.The clinical practice of TCM is guided by the TCM theoretical framework- a methodology founded thousands of years ago.As the methodologies between TCM and Biomedicine are significantly different,it provides an opportunity to combine two medicines,in order to achieve clinical efficacy.Nowadays,combined medicine has become a common clinical model particular in TCM hospitals in China.CONCLUSIONS:It is evident that TCM can provide some assistance in emergency although to combine them in practice is still its infant form and is mainly at TCM hospitals in China.The future effort could be put into TCM research,both in laboratories and clinics,with high quality designs,so that TCM could be better understood and then applied in emergency medicine.

Emergency department use among patients from residential aged care facilities under a Hospital in the Nursing Home scheme in public hospitals in Queensland Australia

BACKGROUND: Hospital emergency department(ED) use by patients from residential aged care facilities(RACFs) is not always appropriate, and this calls for interventions to avoid some unnecessary uses. This study aims to compare patterns of ED use by RACF patients with and without a Hospital in the Nursing Home(Hi NH) program.METHODS: RACF patients presenting to EDs of a hospital with and a hospital without this program during pre- and post-intervention periods were included. Data on patient demographics and ED presentation characteristics were obtained from the Emergency Department Information System database, and were analysed by descriptive and comparative statistics.RESULTS: In both hospitals, most RACF residents presenting to EDs were aged between 75–94 years, female, triaged at scale 3 to 5, and transferred on weekdays and during working hours. Almost half of them were subsequently admitted to hospitals. In accordance with the ICD-10-AM diagnostic coding system, diagnoses that consistently ranked among the top three reasons for visiting the two hospitals before and after intervention included Chapter XIX: injury and poisoning and Chapter X: respiratory diseases. Associated with the intervention, significant decreases in the numbers of presentations per 1 000 RACF beds were identified among patients diagnosed with Chapter XI: digestive diseases [rate ratio(95%CI): 0.09(0.04, 0.22); P<0.0001] and Chapter XXI: factors influencing health status and contact with health services [rate ratio(95%CI): 0.22(0.07, 0.66); P=0.007].CONCLUSION: The Hi NH program may reduce the incidence of RACF residents visiting EDs for diagnoses of Chapter XI and Chapter XXI.

Language affects length of stay in emergency departments in Queensland public hospitals

BACKGROUND:A long length of stay(LOS) in the emergency department(ED) associated with overcrowding has been found to adversely affect the quality of ED care.The objective of this study is to determine whether patients who speak a language other than English at home have a longer LOS in EDs compared to those whose speak only English at home.METHODS:A secondary data analysis of a Queensland state-wide hospital EDs dataset(Emergency Department Information System) was conducted for the period,1 January 2008 to 31 December 2010.RESULTS:The interpreter requirement was the highest among Vietnamese speakers(23.1%)followed by Chinese(19.8%) and Arabic speakers(18.7%).There were significant differences in the distributions of the departure statuses among the language groups(Chi-squared=3236.88,P<0.001).Compared with English speakers,the Beta coefficient for the LOS in the EDs measured in minutes was among Vietnamese,26.3(95%Cl:22.1-30.5);Arabic,10.3(95%Cl:7.3-13.2);Spanish,9.4(95%CI:7.1-11.7);Chinese,8.6(95%Cl:2.6-14.6);Hindi,4.0(95%Cl:2.2-5.7);Italian,3.5(95%Cl:1.6-5.4);and German,2.7(95%Cl:1.0-4.4).The final regression model explained 17%of the variability in LOS.CONCLUSION:There is a close relationship between the language spoken at home and the LOS at EDs,indicating that language could be an important predictor of prolonged LOS in EDs and improving language services might reduce LOS and ease overcrowding in EDs in Queensland's public hospitals.

Surface-Enhanced Raman Scattering of Hydrogen Plasma-Treated Few-Layer MoTe_(2)

Two-dimensional surface-enhanced Raman scattering(SERS)substrates have drawn intense attention due to their excellent spectral reproducibility,high uniformity and perfect anti-interference ability.However,the inferior detection sensitivity and low enhancement have limited the practical application of two-dimensional SERS substrates.To address this issue,we propose that the interaction between the MoTe_(2) substrate and the analyte rhodamine 6G molecules could be remarkably enhanced by the introduced p-doping effect and lattice distortion of MoTe_(2) via hydrogen plasma treatment.After the treatment,the SERS is greatly improved,the enhancement factor of probe molecules reaches 1.83×10^(6) as well as the limit of detection concentration reaches 10^(−13) M.This method is anticipated to afford new enhancement probability for other 2D materials,even non-metal oxide semiconductor SERS substrates.

流体多参数超声波测量仪设计

针对目前流体测量仪测量参数单一的问题,提出了一种用超声波技术测量流体多参数的方法。当传播距离不变时,利用超声波在流体中的传播速度间接得到流体的体积流量、密度、质量流量。由于流体流量、密度等参数均受温度影响,故设计过程中以温度作为参考信号,为所求参数就行实时补偿。同时,测量仪以FPGA为控制核心,实现高速信号采集与处理,以软件插补算法实现超声波传播时间的精密计算,使测量结果更加稳定可靠。

Immigrants and the utilization of hospital emergency departments

BACKGROUND:Immigrants with language barriers are at high risk of having poor access to health care services.However,several studies have indicated that immigrants tend to use emergency departments(EDs) as their primary source of care at the expense of primary care.This may place an additional burden on already overcrowded EDs and lead to a low level of patient satisfaction with ED care.The study was to review if immigrants utilize ED care differently from host populations and to assess immigrants' satisfaction with ED care.DATA SOURCES:Studies about immigrants' utilization of EDs in Australia and worldwide were reviewed.RESULTS:There are conflicting results in the literature about the pattern of ED care use among immigrants.Some studies have shown higher utilization by immigrants compared to host populations and others have shown lower utilization.Overall,immigrants use ED care heavily,make inappropriate visits to EDs,have a longer length of stay in EDs,and are less satisfied with ED care as compared to host populations.CONCLUSIONS:Immigrants might use ED care differently from host populations due to language and cultural barriers.There is sparse Australian literature regarding immigrants' access to health care including ED care.To ensure equity,further research is needed to inform policy when planning health care provision to immigrants.