Significant changes have occurred in the intensity of treatment of children with severe asthma in the last decade. The objectives of this study are 1) to describe the changes in treatment of asthmatic children needing care in the intensive care unit (ICU) initially treated in our emergency department (ED) in 1983 to 1985 (I) and in 1990 to 1992 (II), and 2) to examine if these changes correspond to changes in clinical outcomes.
Retrospective descriptive study.
All asthmatic children less than 18 years old treated in the ED and admitted to the ICU directly or via the ward with a primary diagnosis of asthma.
Pediatric tertiary care hospital.
A total of 89 ICU admissions were required for patients initially treated in our ED, 54 in 1983 to 1985 and 35 in 1990 to 1992. In 1985, 29.7% of asthma patients required hospital admission and 0.5% needed ICU admission, while 30.7 and 0.7% required hospital and ICU admission, respectively, in 1992. Admissions to the ICU directly via the ED were similar in both time periods (I, 27; II, 30), while those admitted to the ICU via the ward decreased significantly (I, 27; II, 5; P
The transfer of experiences gained after prehospital medical responses to major incidents has largely been nonsystematic, and better-structured reporting methods have been advocated. A consensus-based template was recently created and implemented as an open-access website. This qualitative study assessed the feasibility of using the template and reporting site.
Informants who had used or who had been asked to use the template were interviewed. The semi-structured interviews were transcribed verbatim, and the transcripts were analyzed by using an inductive approach based on grounded theory methodology.
The major theme identified was a need for "defining purpose" as explained by the minor themes "relevance," "scope," "resources," and "usefulness." Informants reported that the template content needed to be revised and that the scope and rationale behind each question should be conveyed to the user. Resources necessary for reporting and clarity regarding the aim and outcome also need to be communicated to users and policy-makers. The interface between informants and the template is critical.
Informants considered the template and website useful but reported that the workload exceeded their expectations. Despite pilot testing of the template before implementation, early revision of the template is recommended. (Disaster Med Public Health Preparedness. 2017;11:403-406).
Retrospective cohort with linkage of administrative data sets.
To describe the patterns (for example, number of visits by year post-injury) and characteristics of the emergency department (ED) visits (for example, acuity level, timing of visits, reasons for visits) made by persons with traumatic spinal cord injury (TSCI) over a 6-year period following injury.
Rates of ED utilization and reasons for ED visits were calculated between the fiscal years 2003-2009. Reasons for visits were categorized by acuity level: potentially preventable visits were defined as visits related to ambulatory sensitive conditions; low acuity and high acuity visits were defined by the Canadian Triage and Acuity Scale.
The total number of ED visits for the 6-year period is 4403 (n=1217). Of these visits, 752 (17%) were classified as potentially preventable, 1443 (33%) as low acuity and 2208 (50%) as high acuity. The majority of patients, regardless of acuity level, did not see a primary care practitioner on the day of the ED visit and most visits occurred during the weekday (Mon-Fri 0700-1659 hours). ED use was highest in the first year but remained high over the subsequent years. For potentially preventable visits, the majority of visits were related to urinary tract infections (n=385 visits, 51.2%), followed by pneumonia (n=91, 12.1%).
Given the high rates of ED use for low acuity and potentially preventable conditions, these results suggest that the ED is being used as an inappropriate substitute for primary care for individuals with TSCI 50% of the time.
Novel information computer system introduced at the first aid station of Novosibirsk has improved effectiveness of ambulance transport and emergency teams; quickened the process of reporting information to the head of the station and higher medical institutions as well as responding to requests; facilitated control over continuous education of the staff and planning of relevant educational programs.
Comparative description of two groups of population--seeking and not seeking emergency medical care--is presented. To demonstrate dynamics of appealability for particular types of medical care official statistics data from 1999 to 2003 was used. To explore characteristics of health and self-care behavior in population seeking medical care data of survey carried out during 1999-2000 on various national territories was applied. In respondents seeking out-patient and in-patient care during a year demand in emergency medical care was higher in men than in women. In both genders this demand increases successively with age whereas contingent of persons who evaded extreme deterioration of health during a year reaches its maximum at the age of 30-49. More direct involvement of patient care institutions is needed with such patients as males, older people, indigent and least educated persons who are much less than others inclined and capable to obtain completeness and effectiveness of one's diagnostic and treatment.
The results of a study carried out at basic health service institutions in 7 cities of the country and dealing with the forms, occurrence, character and duration of psychopathological symptoms in patients with acute poisonings are presented. The annual scope and expenses of a psychiatrist's consultative work at a specialized division are determined. It was found desirable to have one staff psychiatrist per each 50 patients treated at the division. The initial prerequisites and method of calculating that rate are described.