BACKGROUND:It has been estimated that up to one third of all emergency department(ED)visits may be"inappropriate"or non-emergent.Factors that have been speculated to be associated with non-emergent use have ...BACKGROUND:It has been estimated that up to one third of all emergency department(ED)visits may be"inappropriate"or non-emergent.Factors that have been speculated to be associated with non-emergent use have been noted to include low socioeconomic status,lack of access to primary care,lack of insurance,convenience of"on demand care"and the patient's individual perception of their complaint urgency.The objective of this study is to identify the reasons contributing to self-perceived non-emergent adult emergency department visits during primary care physician office hours of operation.METHODS:This study was a single-center,descriptive study with questionnaire.The questionnaire was collected from patients meeting exclusion/inclusion criteria who were triaged into an acute or fast track part of the emergency department during regular business hours on Monday through Friday,8:00 am-5:00 pm during the months of July 2011 and August 2011.Questionnaire data were categorical and summarized using counts and percentages.Data collected included patient demographics,information about the patient's primary care provider,and information about the emergency department visit in question.All responses were compared among patients with visits considered to be non-emergent to those considered to be emergent by using individual chi-square tests.RESULTS:There were 262 patients available for the study.The patients were grouped according to their perception of the severity of their complaints.Roughly half of the patients placed themselves into the non-emergent category(n=129),whereas the other half of the patients categorized themselves into the emergent group(n=131).There were statistically significant differences in marital status and employment status between the two groups.It was found that 61.5%of the non-emergent patients were single,while 58.3%of the emergent patients were married.In the non-emergent group,59.7%were unemployed,but in the emergent group 60.3%were employed(P<0.05).However,no other factors were significantly different.CONCLUSIONS:Our study did not identify a statistically significant factor to the reasoning behind why patients choose the emergency department over a primary care physician during regular office hours.The only significant demographic indicating who was more likely to make this choice during the specified time frame was being single and employed with perceived non-emergent complaint.Patients without insurance and/or without a primary care physician were no more likely to visit the emergency department with a self-perceived non-emergent issue than patients with insurance and/or with an established primary care physician.展开更多
BACKGROUND Glenohumeral dislocation is a common injury that may predispose patients to chronic pain and instability.However,there is a paucity of current data available regarding the epidemiological trends of this inj...BACKGROUND Glenohumeral dislocation is a common injury that may predispose patients to chronic pain and instability.However,there is a paucity of current data available regarding the epidemiological trends of this injury.AIM To provide an updated,comparative assessment of the epidemiology of shoulder dislocations presenting to emergency departments in the United States.We also sought to analyze patient demographic risk factors and consumer products associated with dislocation events.METHODS Data were obtained from the national electronic injury surveillance system database for glenohumeral dislocations between 2012 and 2021.Incidence,age,sex,and injury characteristics were analyzed using weighted population statistics as well as incidence rates and 95%confidence intervals(CI).RESULTS In total,an estimated 773039 shoulder dislocations(CI:640598-905481)presented to emergency rooms across the United States during the study period.The annual incidence rate was 23.96 per 100000 persons and the average patient age at the time of injury was 37.1 years.Significantly more male patients sustained dislocations than female patients(537189,69.5%,vs 235834,30.5%,P<0.001).With regard to associated consumer products,sports and recreation equipment were involved in the highest proportion of incidents(44.31%),followed by home structures and construction materials(21.22%),and home furnishings,fixtures,and accessories(21.21%).Regarding product sub-groups,stairs,ramps,landings,floors was cited in the greatest number of cases(131745).CONCLUSION The national annual incidence rate of glenohumeral dislocations throughout the study period was approximately 23.92 per 100000 persons.Male adolescents sustained the highest proportion of dislocations,with a peak incidence in age group 15-20 years,predominantly secondary to participation in sporting and recreational activities.Conversely,women experienced a relatively consistent incidence of dislocation throughout their lifespan.After age 63,the incidence rate of dislocations in females was found to surpass that observed in males.展开更多
Ptanning the design of the emergency department （ED） is a complex process. Hospital readers and architects must consider many complex and interdependent factors, including evolving market demands, patient volume, ca...Ptanning the design of the emergency department （ED） is a complex process. Hospital readers and architects must consider many complex and interdependent factors, including evolving market demands, patient volume, care models, operational processes, staffing, and medical equipment. The application of digital toots, such as discrete event simulation （DES） and space syntax analysis （SSA）, arrows hospital administrators and designers to quantitativety and objectively optimize their facilities. This paper presents a case study that utitized both DES and SSA to optimize the care process and to design the space in an ED environment. DES was apptied in three phases： master planning, process improvement in the existing ED, and designing the new ED. SSA was used to compare the new design with the existing layout to evatuate the effectiveness of the new design in supporting visuat surveiltance and care coordination. This case study demonstrates that DES and SSA are effective toots for facilitating decision-making retated to design, reducing capital and operational costs, and improving organizational performance. DES focuses on operational processes and care flow. SSA complements DES with its strength in linking space to human behavior. Combining both tools can lead to high-performance ED design and can extend to broad applications in health care.展开更多
The concern about the role of aerosols as to their effect in the Earth-Atmosphere system requires observation at multiple temporal and spatial scales. The Moderate Resolution Imaging Spectroradiameters （MODIS） is th...The concern about the role of aerosols as to their effect in the Earth-Atmosphere system requires observation at multiple temporal and spatial scales. The Moderate Resolution Imaging Spectroradiameters （MODIS） is the main aerosol optical depth （AOD） monitoring satellite instrument, and its accuracy and uncertainty need to be validated against ground based measurements routinely. The comparison between two ground AOD measurement programs, the United States Department of Agriculture （USDA） Ultmviolet-B Monitoring and Research Program （UVMRP） and the Aerosol Robotic Network （AERONET） program, confirms the consistency between them. The intercomparison between the MODIS AOD, the AERONET AOD, and the UVMRP AOD suggests that the UVMRP AOD measurements are suited to be an alternative ground-based validation source for satellite AOD products. The experiments show that the spatial-temporal dependency between the MODIS AOD and the UVMRP AOD is positive in the sense that the MODIS AOD compare more favorably with the UVMRP AOD as the spatial and temporal intervals are increased. However, the analysis shows that the optimal spatial interval for all time windows is defined by an angular subtense of around 1° to 1.25°, while the optimal time window is around 423 to 483 minutes at most spatial intervals. The spatial-temporal approach around 1.25° ＆ 423 minutes shows better agreement than the prevalent strategy of 0.25° ＆ 60 minutes found in other similar investigations.展开更多
文摘BACKGROUND:It has been estimated that up to one third of all emergency department(ED)visits may be"inappropriate"or non-emergent.Factors that have been speculated to be associated with non-emergent use have been noted to include low socioeconomic status,lack of access to primary care,lack of insurance,convenience of"on demand care"and the patient's individual perception of their complaint urgency.The objective of this study is to identify the reasons contributing to self-perceived non-emergent adult emergency department visits during primary care physician office hours of operation.METHODS:This study was a single-center,descriptive study with questionnaire.The questionnaire was collected from patients meeting exclusion/inclusion criteria who were triaged into an acute or fast track part of the emergency department during regular business hours on Monday through Friday,8:00 am-5:00 pm during the months of July 2011 and August 2011.Questionnaire data were categorical and summarized using counts and percentages.Data collected included patient demographics,information about the patient's primary care provider,and information about the emergency department visit in question.All responses were compared among patients with visits considered to be non-emergent to those considered to be emergent by using individual chi-square tests.RESULTS:There were 262 patients available for the study.The patients were grouped according to their perception of the severity of their complaints.Roughly half of the patients placed themselves into the non-emergent category(n=129),whereas the other half of the patients categorized themselves into the emergent group(n=131).There were statistically significant differences in marital status and employment status between the two groups.It was found that 61.5%of the non-emergent patients were single,while 58.3%of the emergent patients were married.In the non-emergent group,59.7%were unemployed,but in the emergent group 60.3%were employed(P<0.05).However,no other factors were significantly different.CONCLUSIONS:Our study did not identify a statistically significant factor to the reasoning behind why patients choose the emergency department over a primary care physician during regular office hours.The only significant demographic indicating who was more likely to make this choice during the specified time frame was being single and employed with perceived non-emergent complaint.Patients without insurance and/or without a primary care physician were no more likely to visit the emergency department with a self-perceived non-emergent issue than patients with insurance and/or with an established primary care physician.
文摘BACKGROUND Glenohumeral dislocation is a common injury that may predispose patients to chronic pain and instability.However,there is a paucity of current data available regarding the epidemiological trends of this injury.AIM To provide an updated,comparative assessment of the epidemiology of shoulder dislocations presenting to emergency departments in the United States.We also sought to analyze patient demographic risk factors and consumer products associated with dislocation events.METHODS Data were obtained from the national electronic injury surveillance system database for glenohumeral dislocations between 2012 and 2021.Incidence,age,sex,and injury characteristics were analyzed using weighted population statistics as well as incidence rates and 95%confidence intervals(CI).RESULTS In total,an estimated 773039 shoulder dislocations(CI:640598-905481)presented to emergency rooms across the United States during the study period.The annual incidence rate was 23.96 per 100000 persons and the average patient age at the time of injury was 37.1 years.Significantly more male patients sustained dislocations than female patients(537189,69.5%,vs 235834,30.5%,P<0.001).With regard to associated consumer products,sports and recreation equipment were involved in the highest proportion of incidents(44.31%),followed by home structures and construction materials(21.22%),and home furnishings,fixtures,and accessories(21.21%).Regarding product sub-groups,stairs,ramps,landings,floors was cited in the greatest number of cases(131745).CONCLUSION The national annual incidence rate of glenohumeral dislocations throughout the study period was approximately 23.92 per 100000 persons.Male adolescents sustained the highest proportion of dislocations,with a peak incidence in age group 15-20 years,predominantly secondary to participation in sporting and recreational activities.Conversely,women experienced a relatively consistent incidence of dislocation throughout their lifespan.After age 63,the incidence rate of dislocations in females was found to surpass that observed in males.
文摘Ptanning the design of the emergency department （ED） is a complex process. Hospital readers and architects must consider many complex and interdependent factors, including evolving market demands, patient volume, care models, operational processes, staffing, and medical equipment. The application of digital toots, such as discrete event simulation （DES） and space syntax analysis （SSA）, arrows hospital administrators and designers to quantitativety and objectively optimize their facilities. This paper presents a case study that utitized both DES and SSA to optimize the care process and to design the space in an ED environment. DES was apptied in three phases： master planning, process improvement in the existing ED, and designing the new ED. SSA was used to compare the new design with the existing layout to evatuate the effectiveness of the new design in supporting visuat surveiltance and care coordination. This case study demonstrates that DES and SSA are effective toots for facilitating decision-making retated to design, reducing capital and operational costs, and improving organizational performance. DES focuses on operational processes and care flow. SSA complements DES with its strength in linking space to human behavior. Combining both tools can lead to high-performance ED design and can extend to broad applications in health care.
文摘The concern about the role of aerosols as to their effect in the Earth-Atmosphere system requires observation at multiple temporal and spatial scales. The Moderate Resolution Imaging Spectroradiameters （MODIS） is the main aerosol optical depth （AOD） monitoring satellite instrument, and its accuracy and uncertainty need to be validated against ground based measurements routinely. The comparison between two ground AOD measurement programs, the United States Department of Agriculture （USDA） Ultmviolet-B Monitoring and Research Program （UVMRP） and the Aerosol Robotic Network （AERONET） program, confirms the consistency between them. The intercomparison between the MODIS AOD, the AERONET AOD, and the UVMRP AOD suggests that the UVMRP AOD measurements are suited to be an alternative ground-based validation source for satellite AOD products. The experiments show that the spatial-temporal dependency between the MODIS AOD and the UVMRP AOD is positive in the sense that the MODIS AOD compare more favorably with the UVMRP AOD as the spatial and temporal intervals are increased. However, the analysis shows that the optimal spatial interval for all time windows is defined by an angular subtense of around 1° to 1.25°, while the optimal time window is around 423 to 483 minutes at most spatial intervals. The spatial-temporal approach around 1.25° ＆ 423 minutes shows better agreement than the prevalent strategy of 0.25° ＆ 60 minutes found in other similar investigations.
