AIM: To evaluate the positive predictive value of abdominal non-prepared computed tomography (CT) for diagnosing intestinal lumen or wall lesions in patients presenting to the emergency room (ER) with abdominal compla...AIM: To evaluate the positive predictive value of abdominal non-prepared computed tomography (CT) for diagnosing intestinal lumen or wall lesions in patients presenting to the emergency room (ER) with abdominal complaints.METHODS: For 1-year we prospectively evaluated all ER patients hospitalized after abdominal CT scan detected either intraluminal or intestinal wall lesions. These patients underwent colonoscopy serving as gold standard. Patients with prior abdominal pathology or CT findings of appendicitis or diverticulitis were excluded.RESULTS: Five hundred and sixty-eight abdominopelvic CT scans were performed in the ER, 96 had positive colonic findings. Sixty-two patients were excluded, 46 because of diverticulitis or appendicitis, 16 because of prior abdominal pathology. Of the remaining 34 patients, 14 did not undergo colonoscopy during hospitalization.Twenty eligible patients were included in the study. The positive predictive value of the CT scans performed in the ER was calculated to be 45% (95% CI 25-67).CONCLUSION: CT findings correlated with colonoscopic findings only in approximately half of the cases. Relying on non-prepared CT scan findings in planning patient management and colonoscopy may lead to unnecessary diagnostic work-ups.展开更多
Several notable issues arise from overcrowding in an emergency department (ED) for both patients and staff. Longer wait times, higher ambulance diversion rates, longer stays, higher incidence of medical errors, higher...Several notable issues arise from overcrowding in an emergency department (ED) for both patients and staff. Longer wait times, higher ambulance diversion rates, longer stays, higher incidence of medical errors, higher rates of patient mortality, and greater harm to hospitals due to financial losses are some of these problems. Collaboration is crucial in the healthcare industry since it determines the team’s hourly performance in managing patient care. By using Walker and Avant’s (2011) concept analysis method, the author reviewed the literature to better understand ED crowding, to ensure that patients receive safe treatment in a timely manner, and to highlight best practices that can be identified through concept analysis and practice evaluations. In conducting this concept analysis, Walker and Avant’s framework was applied to examine the nature of the findings selected for the advancement of the concept. Everyone working in the ED, from those who determine policy to those on the front lines continually encounter new obstacles, but has little or no time to formulate fresh concepts or reconsider how ED treatment is provided. Overcrowding occurs when the number of patients requiring attention, awaiting transfer, or undergoing diagnosis and treatment exceeds the physical capacity of ED staff. If a clear plan is not in place to increase and improve services in proportion to a growing population, this situation will persist.展开更多
In recent years, more attentions have been paid to the association between climate change and human health. Increasing and more variable global surface temperature is one of the key climatic change factors which have ...In recent years, more attentions have been paid to the association between climate change and human health. Increasing and more variable global surface temperature is one of the key climatic change factors which have been consistently reported about the effect on human health. So far, more researches have revealed that temperature lead not only to direct deaths and illnesses but also to aggravation of cardiovascular and respiratory diseases. Typically, the relationship between temperature and mortality or morbidity is V-, U-, or J- shaped, with optimum temperature corresponding to the lowest point in the temperature mortality curve.展开更多
Background: The use of ketamine for relief of procedure-related pain is limited in our environment. Ketamine, a phencyclidine derivative commonly used for induction and maintenance of anaesthesia, is administered rout...Background: The use of ketamine for relief of procedure-related pain is limited in our environment. Ketamine, a phencyclidine derivative commonly used for induction and maintenance of anaesthesia, is administered routinely via the intravenous and intramuscular routes. One of the concerns while using ketamine for analgesia via these two routes is that the drug may produce anaesthesia, rather than analgesia alone. Aims and Objectives: We sought to find out if ketamine given via the oral route could be used to provide analgesia during minor orthopaedic procedures in the emergency room. We also wanted to find out if there were side-effects peculiar to the oral route. Methods: A prospective observational pilot study in consecutive patientswith fractures/dislocation in our Emergency Room was recruited into the study. All patients gave informed consent. Reduction of fractures was done 15 minutes following the administration of ketamine 5 mg/kg orally. The patients were observed during and after the procedure and the findings entered into a proforma. The data obtained were analyzed using simple statistical methods and the results presented in a table. The findings are discussed. Results: There were 9 males and 2 females with an age range of 4 yrs to 48 yrs. Pain levels were assessed using verbal rating scales. Seven patients (64%) had severe pain before administration of ketamine while 2 patients (18%) each had mild and moderate pain respectively. Four patients had Colle’s fracture only and 1 patient had a Colle’s fracture with a supracondylar femoral fracture. Two patients had tibial fractures, one patient had a complete knee dislocation, while 2 others had ulnar/radial fractures. One other patient had humeral and tibial fractures. For up to 15 minutes after the procedures all but one patient were pain-free. Five (5) patients (45.5%) were noticed to have drowsiness, 3 patients (27%) were sedated while 2 patients (18%) had no side-effects at all. Five (5) patients (45.5%) reported excellent analgesia while 6 patients (64%) said the intra and post procedure analgesia was very good. Conclusions: Oral ketamine may be useful in providing analgesia for minor procedures in the emergency room. Ketamine when sweetened with a soda drink appears to be palatable with a rapid onset of action and few side effects. Thus ketamine given orally may be a cheaper and more accessible option for effective pain-relief in the emergency room. There is a need to conduct more studies on a larger number of patients.展开更多
INTRODUCTION Worldwide, cancer is an important cause of mortality in children aged over 1 year. Numerically, the major cancers include acute lymphoblastic leukemia, CNS tumors and lymphomas. Cancer incidence is increa...INTRODUCTION Worldwide, cancer is an important cause of mortality in children aged over 1 year. Numerically, the major cancers include acute lymphoblastic leukemia, CNS tumors and lymphomas. Cancer incidence is increasing in children globally as well as in Pakistan but the etiology is poorly understood. There are an estimated 160 000 new cases and 90 000 deaths per year worldwide in children aged under 15 years.The exact incidence in Pakistan is not known as there is no national tumor registry展开更多
Purpose of the work was to quantify the workloads and the neurologist’s commitment in ER, to verify the management of urgencies and appropriateness of neurological counseling requests. Neurologic emergencies are freq...Purpose of the work was to quantify the workloads and the neurologist’s commitment in ER, to verify the management of urgencies and appropriateness of neurological counseling requests. Neurologic emergencies are frequent in elderly patients and are associated with high morbidity and mortality. Due to the aging population, neurologic pathologies in emergency room (ER) are widely expected to increase. The role of the neurologist in this context is controversial. Methods: in 14 operative units of neurology a prospective collection of neurological evaluations in ER was carried out using boards of detection of the most frequent neurological clinical pictures seen in the course of a week. Data were collected from 738 cases. Attention was focused on cerebrovascular diseases (CVD), impairment of consciousness, epilepsy, headache, dizziness, head trauma and disorders of the peripheral nervous system (PNS). Achievements: neurological consultations were on average 5% of total accesses to ER. The most common pathology seen was ischemic stroke. After counseling most patients were discharged home. The CVD required the greatest commitment to the specialist. The usefulness of the specialized neurological “filter” has been confirmed in a non-simple operative context, aimed at optimizing the appropriateness of the hospitalization and the economy of the diagnostic path.展开更多
When a major public health emergency comes,people are forced to be isolated at home.During the period of residential isolation by epidemic,use of indoor space in high-rise residential buildings puts forward higher req...When a major public health emergency comes,people are forced to be isolated at home.During the period of residential isolation by epidemic,use of indoor space in high-rise residential buildings puts forward higher requirements for the health and variability of indoor space in addition to meeting the basic living needs.By analyzing the current situation and characteristics of living room space design of high-rise residence,combined with basic health protection awareness of residents and environmental sanitation requirements,this paper explores the basic functions of living room space design,and puts forward suggestions on space optimization design.展开更多
Objective:Hospital readmission after surgery is one of the major contributors to the increased healthcare cost.Robotic-assisted hysterectomy(RAH)is an innovative surgical procedure most commonly performed within the l...Objective:Hospital readmission after surgery is one of the major contributors to the increased healthcare cost.Robotic-assisted hysterectomy(RAH)is an innovative surgical procedure most commonly performed within the last decade.The purpose of this study was to analyze the effects on hospital readmission patterns and emergency room(ER)visits within 60 days of discharge for women who had RAH versus laparoscopic hysterectomy(LH)in an academic community hospital in Texas.Method:We performed a retrospective study of women with RAH or LH.We used the univariate and multivariate logistic regression to examine the impact of patients'risk factors,the type of surgery,age,number of comorbidities,and duration of surgery on the 60-day hospital readmissions and ER visits.Results:A total of 291 cases with RAH or LH for benign and malignant indications were examined.The number of comorbidities and duration of surgery were similar between the two treatment groups(p>0.05).Patients in the RAH group were younger than the LH group(RAH:45.4±9.9 y,LH:49.8±11.5 y,p<0.05).No significant difference neither in hospital readmission or ER visits between the two groupswas observed(p?0.544 and p=0.109,respectively).Younger age and longer duration of surgery were significantly associated with a higher risk of ER visits(p<0.05).Conclusion:RAH is comparable with LH in hospital readmissions and ER visits.The younger age and longer operation time could lead to ER visits.展开更多
Introduction: Occupational stress has negative effects on employee’s health and organizational productivity. Nurses in emergency department are more exposed to stress than nurses in other departments. Aim: To explore...Introduction: Occupational stress has negative effects on employee’s health and organizational productivity. Nurses in emergency department are more exposed to stress than nurses in other departments. Aim: To explore nurses’ experiences of occupational stress in emergency departments in private hospitals in Bangkok, Thailand. Design: A descriptive qualitative design, with a deductive approach based on the Job Demand-Control-Support model was used. Methods: Fifteen emergency department nurses at two different hospitals were interviewed and the data were analyzed using a manifest content analysis. Results: Three main categories: “work context is an issue”, “consequences of reactions to stress”, and “coping with work stress”, including seven sub-categories emerged from the data analysis. Conclusion: The patients’ and their relatives’ behaviors were experienced as the primary stressor at the private hospital, in addition to excessive work tasks. Other important stressors were misunderstanding and conflicts between emergency department nurses and the other health care professionals, presumably related to hierarchy and power relations between health care professions. Creating a better working environment and a balance between the number of patients and nurses would reduce workload and stress, encourage ED nurses to stay in the profession and ultimately maintain patient safety.展开更多
Patients present to the emergency department with critical and complex medical conditions that require a broad scope of medicine to achieve patient outcomes. Emergency medicine physicians are recognizing the importanc...Patients present to the emergency department with critical and complex medical conditions that require a broad scope of medicine to achieve patient outcomes. Emergency medicine physicians are recognizing the importance and positive outcomes that arise when palliative care teams are consulted in the emergency room. Today, medical schools, residency programs, and emergency departments are requiring palliative care curriculum apart of their education. However, there continues to be a gap in early initiation of palliative care in emergency medicine. Nurse practitioners are becoming pivotal in the emergency department, and patients are considering them key providers in their medical journey. The role of an advanced practice nurse in an emergency room may be optimal for the early onset of palliative care consultation. This manuscript examines current knowledge that explores the background of palliative care, the current practice in the emergency department, the positive outcomes and gaps that still exist today, and the increasing role of an advanced practice nurse in the emergency room and their impact on palliative care initiation.展开更多
Objective:To determine the characteristics and risk factors of drug dependence among patients who were administered drugs with addictive potential(DAP)in an emergency department(ED).Methods:This retrospective cross-se...Objective:To determine the characteristics and risk factors of drug dependence among patients who were administered drugs with addictive potential(DAP)in an emergency department(ED).Methods:This retrospective cross-sectional study included patients who were administered DAP 3 or more times in the emergency room between September 1,2019 and March 1,2020.The demographic and baseline information were recorded.All the prescibed DAP,the reasons to use these drugs,secondary drug dependence,the department where DAP were first prescribed,types of doctors who preferred to prescribed DAP,and the risk factors for the development of drug dependence were determined.Results:A total of 3000 patients were screened from medical records,and among them,80 patients developed drug dependence.Drug dependence only developed for tramadol(n=57,71.3%),diazepam(n=11,13.8%),and biperiden(n=12,15.0%).Tramadol was the most frequently prescribed drug(n=57,71.3%).The most common reason for drug dependence was psychiatric disorders(n=29,36.3%).Drug dependence developed in renal colic patients due to the administration of tramadol(n=7,100%).On the contrary,dependence to biperiden were mainly developed in patients with psychiatric complaints(n=12,41.4%).The rate of secondary drug dependence was 15%(n=12).Of the Biperiden users,41.7%developed secondary drug dependence on diazepam.Most DAP were first prescribed in the ED(n=52,65%),and the specialist preferred to prescribe DAP(n=43,53.8%).For the development of dependence,the presence of renal colic(OR:3.387,95%confidence interval(CI):1.473-7.788,P=0.004)and low back pain(OR:5.778,95%CI:2.779-12.014,P<0.001)were the risk factors.Conclusions:Most DAP were first prescribed in the ED compared to other departments,and specialist are preferred to use DAP.Tramadol is the most commonly used drugs caused drug dependence.Psychiatric disorder patients are easier to develope drug dependence.Furthermore,renal colic and low back pain patients needs more attention to avert drug dependence.展开更多
目的构建急诊抢救室气管切开患者人工气道管理方案,并探讨其应用价值。方法通过查阅文献、总结临床经验,采用Delphi法构建急诊抢救室气管切开患者人工气道管理方案。前瞻性选取2022年2~11月首都医科大学附属北京同仁医院急诊抢救室收治...目的构建急诊抢救室气管切开患者人工气道管理方案,并探讨其应用价值。方法通过查阅文献、总结临床经验,采用Delphi法构建急诊抢救室气管切开患者人工气道管理方案。前瞻性选取2022年2~11月首都医科大学附属北京同仁医院急诊抢救室收治的141例实施气管切开术的患者作为研究对象,采用随机数字表法分为改良组与传统组。传统组采用常规人工气道管理干预,改良组采用基于Delphi法构建的人工气道管理方案干预,2组均连续干预至转出本科室。比较2组患者临床指标、痰液性状、动脉血气指标及术后并发症。结果改良组建立人工气道时间、机械通气时间、单次吸痰时间短于传统组,每日吸痰次数少于传统组,首次插管成功率高于传统组,差异有统计学意义(P<0.05)。干预1 d、干预3 d改良组患者痰液性状明显优于传统组,差异有统计学意义(P<0.05)。与干预前比较,2组患者干预1 d及干预3 d PaO_(2)呈现上升趋势,且各个时点之间比较差异有统计学意义(P<0.05);但组间、组间时点交互比较差异无统计学意义(P>0.05);与干预前比较,2组患者干预1 d及干预3 d PaCO_(2)均呈现出下降趋势,且各个时点,组间与时点交互比较差异有统计学意义(P<0.05),但组间比较,差异无统计学意义(P>0.05)。比较2组患者术后并发症,改良组明显低于传统组,差异有统计学意义(P<0.05)。结论构建急诊抢救室气管切开患者人工气道管理方案可有效减少术后并发症、缩短建立人工气道、机械通气与单次吸痰时间,减少吸痰次数,提高首次插管成功率,改善痰液性状。展开更多
文摘AIM: To evaluate the positive predictive value of abdominal non-prepared computed tomography (CT) for diagnosing intestinal lumen or wall lesions in patients presenting to the emergency room (ER) with abdominal complaints.METHODS: For 1-year we prospectively evaluated all ER patients hospitalized after abdominal CT scan detected either intraluminal or intestinal wall lesions. These patients underwent colonoscopy serving as gold standard. Patients with prior abdominal pathology or CT findings of appendicitis or diverticulitis were excluded.RESULTS: Five hundred and sixty-eight abdominopelvic CT scans were performed in the ER, 96 had positive colonic findings. Sixty-two patients were excluded, 46 because of diverticulitis or appendicitis, 16 because of prior abdominal pathology. Of the remaining 34 patients, 14 did not undergo colonoscopy during hospitalization.Twenty eligible patients were included in the study. The positive predictive value of the CT scans performed in the ER was calculated to be 45% (95% CI 25-67).CONCLUSION: CT findings correlated with colonoscopic findings only in approximately half of the cases. Relying on non-prepared CT scan findings in planning patient management and colonoscopy may lead to unnecessary diagnostic work-ups.
文摘Several notable issues arise from overcrowding in an emergency department (ED) for both patients and staff. Longer wait times, higher ambulance diversion rates, longer stays, higher incidence of medical errors, higher rates of patient mortality, and greater harm to hospitals due to financial losses are some of these problems. Collaboration is crucial in the healthcare industry since it determines the team’s hourly performance in managing patient care. By using Walker and Avant’s (2011) concept analysis method, the author reviewed the literature to better understand ED crowding, to ensure that patients receive safe treatment in a timely manner, and to highlight best practices that can be identified through concept analysis and practice evaluations. In conducting this concept analysis, Walker and Avant’s framework was applied to examine the nature of the findings selected for the advancement of the concept. Everyone working in the ED, from those who determine policy to those on the front lines continually encounter new obstacles, but has little or no time to formulate fresh concepts or reconsider how ED treatment is provided. Overcrowding occurs when the number of patients requiring attention, awaiting transfer, or undergoing diagnosis and treatment exceeds the physical capacity of ED staff. If a clear plan is not in place to increase and improve services in proportion to a growing population, this situation will persist.
基金supported by the Gong-Yi Program of China Meteorological Administration (GYHY201106034)the National Science & Technology Infrastructure Foundation of China (2005DKA32403)the National Key Project of the Scientific and Technical Supporting Programs (2012BAJ18B08)
文摘In recent years, more attentions have been paid to the association between climate change and human health. Increasing and more variable global surface temperature is one of the key climatic change factors which have been consistently reported about the effect on human health. So far, more researches have revealed that temperature lead not only to direct deaths and illnesses but also to aggravation of cardiovascular and respiratory diseases. Typically, the relationship between temperature and mortality or morbidity is V-, U-, or J- shaped, with optimum temperature corresponding to the lowest point in the temperature mortality curve.
文摘Background: The use of ketamine for relief of procedure-related pain is limited in our environment. Ketamine, a phencyclidine derivative commonly used for induction and maintenance of anaesthesia, is administered routinely via the intravenous and intramuscular routes. One of the concerns while using ketamine for analgesia via these two routes is that the drug may produce anaesthesia, rather than analgesia alone. Aims and Objectives: We sought to find out if ketamine given via the oral route could be used to provide analgesia during minor orthopaedic procedures in the emergency room. We also wanted to find out if there were side-effects peculiar to the oral route. Methods: A prospective observational pilot study in consecutive patientswith fractures/dislocation in our Emergency Room was recruited into the study. All patients gave informed consent. Reduction of fractures was done 15 minutes following the administration of ketamine 5 mg/kg orally. The patients were observed during and after the procedure and the findings entered into a proforma. The data obtained were analyzed using simple statistical methods and the results presented in a table. The findings are discussed. Results: There were 9 males and 2 females with an age range of 4 yrs to 48 yrs. Pain levels were assessed using verbal rating scales. Seven patients (64%) had severe pain before administration of ketamine while 2 patients (18%) each had mild and moderate pain respectively. Four patients had Colle’s fracture only and 1 patient had a Colle’s fracture with a supracondylar femoral fracture. Two patients had tibial fractures, one patient had a complete knee dislocation, while 2 others had ulnar/radial fractures. One other patient had humeral and tibial fractures. For up to 15 minutes after the procedures all but one patient were pain-free. Five (5) patients (45.5%) were noticed to have drowsiness, 3 patients (27%) were sedated while 2 patients (18%) had no side-effects at all. Five (5) patients (45.5%) reported excellent analgesia while 6 patients (64%) said the intra and post procedure analgesia was very good. Conclusions: Oral ketamine may be useful in providing analgesia for minor procedures in the emergency room. Ketamine when sweetened with a soda drink appears to be palatable with a rapid onset of action and few side effects. Thus ketamine given orally may be a cheaper and more accessible option for effective pain-relief in the emergency room. There is a need to conduct more studies on a larger number of patients.
文摘INTRODUCTION Worldwide, cancer is an important cause of mortality in children aged over 1 year. Numerically, the major cancers include acute lymphoblastic leukemia, CNS tumors and lymphomas. Cancer incidence is increasing in children globally as well as in Pakistan but the etiology is poorly understood. There are an estimated 160 000 new cases and 90 000 deaths per year worldwide in children aged under 15 years.The exact incidence in Pakistan is not known as there is no national tumor registry
文摘Purpose of the work was to quantify the workloads and the neurologist’s commitment in ER, to verify the management of urgencies and appropriateness of neurological counseling requests. Neurologic emergencies are frequent in elderly patients and are associated with high morbidity and mortality. Due to the aging population, neurologic pathologies in emergency room (ER) are widely expected to increase. The role of the neurologist in this context is controversial. Methods: in 14 operative units of neurology a prospective collection of neurological evaluations in ER was carried out using boards of detection of the most frequent neurological clinical pictures seen in the course of a week. Data were collected from 738 cases. Attention was focused on cerebrovascular diseases (CVD), impairment of consciousness, epilepsy, headache, dizziness, head trauma and disorders of the peripheral nervous system (PNS). Achievements: neurological consultations were on average 5% of total accesses to ER. The most common pathology seen was ischemic stroke. After counseling most patients were discharged home. The CVD required the greatest commitment to the specialist. The usefulness of the specialized neurological “filter” has been confirmed in a non-simple operative context, aimed at optimizing the appropriateness of the hospitalization and the economy of the diagnostic path.
文摘When a major public health emergency comes,people are forced to be isolated at home.During the period of residential isolation by epidemic,use of indoor space in high-rise residential buildings puts forward higher requirements for the health and variability of indoor space in addition to meeting the basic living needs.By analyzing the current situation and characteristics of living room space design of high-rise residence,combined with basic health protection awareness of residents and environmental sanitation requirements,this paper explores the basic functions of living room space design,and puts forward suggestions on space optimization design.
文摘Objective:Hospital readmission after surgery is one of the major contributors to the increased healthcare cost.Robotic-assisted hysterectomy(RAH)is an innovative surgical procedure most commonly performed within the last decade.The purpose of this study was to analyze the effects on hospital readmission patterns and emergency room(ER)visits within 60 days of discharge for women who had RAH versus laparoscopic hysterectomy(LH)in an academic community hospital in Texas.Method:We performed a retrospective study of women with RAH or LH.We used the univariate and multivariate logistic regression to examine the impact of patients'risk factors,the type of surgery,age,number of comorbidities,and duration of surgery on the 60-day hospital readmissions and ER visits.Results:A total of 291 cases with RAH or LH for benign and malignant indications were examined.The number of comorbidities and duration of surgery were similar between the two treatment groups(p>0.05).Patients in the RAH group were younger than the LH group(RAH:45.4±9.9 y,LH:49.8±11.5 y,p<0.05).No significant difference neither in hospital readmission or ER visits between the two groupswas observed(p?0.544 and p=0.109,respectively).Younger age and longer duration of surgery were significantly associated with a higher risk of ER visits(p<0.05).Conclusion:RAH is comparable with LH in hospital readmissions and ER visits.The younger age and longer operation time could lead to ER visits.
文摘Introduction: Occupational stress has negative effects on employee’s health and organizational productivity. Nurses in emergency department are more exposed to stress than nurses in other departments. Aim: To explore nurses’ experiences of occupational stress in emergency departments in private hospitals in Bangkok, Thailand. Design: A descriptive qualitative design, with a deductive approach based on the Job Demand-Control-Support model was used. Methods: Fifteen emergency department nurses at two different hospitals were interviewed and the data were analyzed using a manifest content analysis. Results: Three main categories: “work context is an issue”, “consequences of reactions to stress”, and “coping with work stress”, including seven sub-categories emerged from the data analysis. Conclusion: The patients’ and their relatives’ behaviors were experienced as the primary stressor at the private hospital, in addition to excessive work tasks. Other important stressors were misunderstanding and conflicts between emergency department nurses and the other health care professionals, presumably related to hierarchy and power relations between health care professions. Creating a better working environment and a balance between the number of patients and nurses would reduce workload and stress, encourage ED nurses to stay in the profession and ultimately maintain patient safety.
文摘Patients present to the emergency department with critical and complex medical conditions that require a broad scope of medicine to achieve patient outcomes. Emergency medicine physicians are recognizing the importance and positive outcomes that arise when palliative care teams are consulted in the emergency room. Today, medical schools, residency programs, and emergency departments are requiring palliative care curriculum apart of their education. However, there continues to be a gap in early initiation of palliative care in emergency medicine. Nurse practitioners are becoming pivotal in the emergency department, and patients are considering them key providers in their medical journey. The role of an advanced practice nurse in an emergency room may be optimal for the early onset of palliative care consultation. This manuscript examines current knowledge that explores the background of palliative care, the current practice in the emergency department, the positive outcomes and gaps that still exist today, and the increasing role of an advanced practice nurse in the emergency room and their impact on palliative care initiation.
文摘Objective:To determine the characteristics and risk factors of drug dependence among patients who were administered drugs with addictive potential(DAP)in an emergency department(ED).Methods:This retrospective cross-sectional study included patients who were administered DAP 3 or more times in the emergency room between September 1,2019 and March 1,2020.The demographic and baseline information were recorded.All the prescibed DAP,the reasons to use these drugs,secondary drug dependence,the department where DAP were first prescribed,types of doctors who preferred to prescribed DAP,and the risk factors for the development of drug dependence were determined.Results:A total of 3000 patients were screened from medical records,and among them,80 patients developed drug dependence.Drug dependence only developed for tramadol(n=57,71.3%),diazepam(n=11,13.8%),and biperiden(n=12,15.0%).Tramadol was the most frequently prescribed drug(n=57,71.3%).The most common reason for drug dependence was psychiatric disorders(n=29,36.3%).Drug dependence developed in renal colic patients due to the administration of tramadol(n=7,100%).On the contrary,dependence to biperiden were mainly developed in patients with psychiatric complaints(n=12,41.4%).The rate of secondary drug dependence was 15%(n=12).Of the Biperiden users,41.7%developed secondary drug dependence on diazepam.Most DAP were first prescribed in the ED(n=52,65%),and the specialist preferred to prescribe DAP(n=43,53.8%).For the development of dependence,the presence of renal colic(OR:3.387,95%confidence interval(CI):1.473-7.788,P=0.004)and low back pain(OR:5.778,95%CI:2.779-12.014,P<0.001)were the risk factors.Conclusions:Most DAP were first prescribed in the ED compared to other departments,and specialist are preferred to use DAP.Tramadol is the most commonly used drugs caused drug dependence.Psychiatric disorder patients are easier to develope drug dependence.Furthermore,renal colic and low back pain patients needs more attention to avert drug dependence.
文摘目的构建急诊抢救室气管切开患者人工气道管理方案,并探讨其应用价值。方法通过查阅文献、总结临床经验,采用Delphi法构建急诊抢救室气管切开患者人工气道管理方案。前瞻性选取2022年2~11月首都医科大学附属北京同仁医院急诊抢救室收治的141例实施气管切开术的患者作为研究对象,采用随机数字表法分为改良组与传统组。传统组采用常规人工气道管理干预,改良组采用基于Delphi法构建的人工气道管理方案干预,2组均连续干预至转出本科室。比较2组患者临床指标、痰液性状、动脉血气指标及术后并发症。结果改良组建立人工气道时间、机械通气时间、单次吸痰时间短于传统组,每日吸痰次数少于传统组,首次插管成功率高于传统组,差异有统计学意义(P<0.05)。干预1 d、干预3 d改良组患者痰液性状明显优于传统组,差异有统计学意义(P<0.05)。与干预前比较,2组患者干预1 d及干预3 d PaO_(2)呈现上升趋势,且各个时点之间比较差异有统计学意义(P<0.05);但组间、组间时点交互比较差异无统计学意义(P>0.05);与干预前比较,2组患者干预1 d及干预3 d PaCO_(2)均呈现出下降趋势,且各个时点,组间与时点交互比较差异有统计学意义(P<0.05),但组间比较,差异无统计学意义(P>0.05)。比较2组患者术后并发症,改良组明显低于传统组,差异有统计学意义(P<0.05)。结论构建急诊抢救室气管切开患者人工气道管理方案可有效减少术后并发症、缩短建立人工气道、机械通气与单次吸痰时间,减少吸痰次数,提高首次插管成功率,改善痰液性状。
