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Depression Symptoms and Risk Factors in Adult Emergency Department Patients: A Multisite Cross-Sectional Prevalence Survey  [PDF]
Nancy Khav,Tracey J. Weiland,George A. Jelinek,Jonathan C. Knott,Michael Salzberg
ISRN Emergency Medicine , 2013, DOI: 10.1155/2013/965103
Abstract: Objectives. To identify the proportion of adult emergency department (ED) patients who screen positive for depression. Secondary aims were to identify factors associated with a positive depression screen and determine predictors of a positive depression screen. Methods. This cross-sectional, prevalence survey of ED patients was conducted at two inner-city hospitals. 350 ED patients were screened for depression using the Patient Health Questionnaire-9 (PHQ-9). Clinical and demographic risk factors were examined through medical records and additional questionnaires. Results. Of 350 participants screened, 50 (14.3%; 95% CI = 11.0–18.4%) screened positive. Independent predictors of depression risk included self-reported depression and/or a previous diagnosis of depression (OR = 8.345; 95% CI = 3.524–19.762), seeing a mental health service provider in the past 6 months (OR = 4.518; 95% CI = 2.107–9.690), and previous discussion about mental health with a local doctor (OR = 2.369; 95% CI = 1.025–5.475). Conclusion. ED patients were found to be at a higher risk of depression than the general population. ED-based depression screening, particularly of high-risk populations, has the potential to increase case detection rates and allow earlier management of these patients. Further research and validation of an ED-based depression screening tool are required. 1. Introduction It is important to detect depression in the emergency department (ED). Depression may contribute to the clinical presentation via self-harm or somatisation; it may be an important focus for post-ED care, and even though its management is not usually the responsibility of the ED, ED staff can have an important role in informing patients of the nature of their problem and engaging them in appropriate care; and, like all health care sectors, the ED can contribute to the public health task of detecting depression, which is known to be widely underrecognised and undertreated. In detecting depression, the clinical assessment is primary, but screening using validated depression rating scales is an important complementary method. Depression is highly prevalent in the general population but almost certainly of greater prevalence in the ED population. In the general population, depression is the second leading cause of disability worldwide [1], a significant risk factor for suicide [1], and associated with increased comorbidity and mortality [2, 3], decreased adherence to medication and treatment [4], higher healthcare utilization and costs [4], and reduced quality of life [5]. In Australia, depression
A cross-sectional study of the self-report of stress among emergency department patients
Nirenberg Ted,Baird Janette,Harrington Magdalena,Mello Michael
Journal of Emergencies, Trauma and Shock , 2009,
Abstract: Background: There is a lack of information about the prevalence of stress and types of stressors experienced by Emergency Department (ED) patients. Objective: The present aim is to study the prevalence of stress, types of stressful situations and the relationship with other health issues within the ED population. Materials and Methods: This is a cross-sectional study performed in an ED at a level-1 urban trauma center for four months. An anonymous survey was offered to adult non critically ill patients who were admitted in the ED. They were divided on the basis of gender, age and level of stress and were asked about their demographics, reasons for their ED visit and health issues including stress, tobacco, alcohol and marijuana use, weight concern and health. Chi-square for the categorical variables and unpaired t-tests for continuous variables were conducted. Results: We interviewed 1797 patients, over 66% reported that they felt stressed on at least a weekly basis, and over 45% indicated that they felt stressed more than twice per week. While both young and old were equally stressed, females reported significantly more stress. Family, finances and work are the most frequently cited stressors. Different age groups reported different types of stressors. Overall, those patients reporting being stressed more frequently reported more high risk behaviors including cigarette and marijuana use and health problems including being overweight, being depressed, and having sleeping problems and chronic fatigue. Conclusions: Considering the high frequency of ED patients that report frequent stress and high risk behaviors, their ED visit may be an excellent opportunity to provide a referral or an intervention for stress reduction.
Who is Ready to Change Illicit Drug Use Behavior: An Emergency Department Study
Kenneth A. Frausto and Shahrzad Bazargan-Hejazi
Substance Abuse: Research and Treatment , 2012,
Abstract: Objective: To identify emergency department patients who are ready to change their illicit drug use behavior. Methods: A cross-sectional study of 198 Emergency Department patients at least 18 years old, seeking emergency department services, using at least one illicit drug, and scoring positive for alcohol problem based on CAGE score ≥ 1. Results: Of the patients, 46% were “not ready” to change their drug behavior, 21% and 33% were “unsure” and “ready”, respectively. Our results identified that “Readiness to change alcohol behavior” [t (197) = 3.37, p ≤ 0.001], health insurance [t (197) = -3.011, p ≤ 0.003], number of drug use [t (197) = 2.88, p ≤ 0.004], and drug-related injury [t (197) = 1.98, p ≤ 0.049] were related to readiness to change illicit drug behavior. Conclusion: Our results re-iterate the need for intervention programs that focus on screening and treatment for both drugs and alcohol.
Who is Ready to Change Illicit Drug Use Behavior: An Emergency Department Study
Kenneth A. Frausto,Shahrzad Bazargan-Hejazi
Substance Abuse: Research and Treatment , 2009,
Abstract: Objective: To identify emergency department patients who are ready to change their illicit drug use behavior. Methods: A cross-sectional study of 198 Emergency Department patients at least 18 years old, seeking emergency department services, using at least one illicit drug, and scoring positive for alcohol problem based on CAGE score ≥ 1. Results: Of the patients, 46% were “not ready” to change their drug behavior, 21% and 33% were “unsure” and “ready”, respectively. Our results identified that “Readiness to change alcohol behavior” [t (197) = 3.37, p ≤ 0.001], health insurance [t (197) = -3.011, p ≤ 0.003], number of drug use [t (197) = 2.88, p ≤ 0.004], and drug-related injury [t (197) = 1.98, p ≤ 0.049] were related to readiness to change illicit drug behavior. Conclusion: Our results re-iterate the need for intervention programs that focus on screening and treatment for both drugs and alcohol.
Patient preferences for emergency department-initiated tobacco interventions: a multicenter cross-sectional study of current smokers
Esther K Choo, Ashley F Sullivan, Frank LoVecchio, John N Perret, Carlos A Camargo, Edwin D Boudreaux
Addiction Science & Clinical Practice , 2012, DOI: 10.1186/1940-0640-7-4
Abstract: ED patients at 10 US medical centers were surveyed about preferences for hypothetical smoking cessation interventions and specific counseling styles. Multivariable linear regression determined correlates of receptivity to bedside counseling.Three hundred seventy-five patients were enrolled; 46% smoked at least one pack of cigarettes per day, and 11% had a smoking-related diagnosis. Most participants (75%) reported interest in at least one intervention. Medications were the most popular (e.g., nicotine replacement therapy, 54%), followed by linkages to hotlines or other outpatient counseling (33-42%), then counseling during the ED visit (33%). Counseling styles rated most favorably involved individualized feedback (54%), avoidance skill-building (53%), and emphasis on autonomy (53%). In univariable analysis, age (r = 0.09), gender (average Likert score = 2.75 for men, 2.42 for women), education (average Likert score = 2.92 for non-high school graduates, 2.44 for high school graduates), and presence of smoking-related symptoms (r = 0.10) were significant at the p < 0.10 level and thus were retained for the final model. In multivariable linear regression, male gender, lower education, and smoking-related symptoms were independent correlates of increased receptivity to ED-based smoking counseling.In this multicenter study, smokers reported receptivity to ED-initiated interventions. However, there was variability in individual preferences for intervention type and counseling styles. To be effective in reducing smoking among its patients, the ED should offer a range of tobacco intervention options.Tobacco remains the leading preventable cause of morbidity and mortality in the United States (US), increasing the risk of coronary artery disease, stroke, lung cancer, and chronic obstructive pulmonary disease and accounting for 443,000 deaths (nearly 1 in 5) each year [1]. Tobacco use and tobacco-related illnesses are common among emergency department (ED) patients. Studies pe
Comparison of balance assessment modalities in emergency department elders: a pilot cross-sectional observational study
Jeffrey M Caterino, Rowan Karaman, Vinay Arora, Jacqueline L Martin, Brian C Hiestand
BMC Emergency Medicine , 2009, DOI: 10.1186/1471-227x-9-19
Abstract: We conducted a cross-sectional observational study of patients ≥ 60 years old being discharged from the ED. Patient history of falls in the past week, month, 6 months, and year was obtained. Balance plate center of pressure excursion (COP) measurements and TUG testing times were recorded. COP was recorded under four conditions: normal stability eyes open (NSEO) and closed (NSEC), and perturbed stability eyes open and closed. Correlation between TUG and COP scores was measured. Univariate logistic regression was used to identify the relationship between patient-provided falls history and the two testing modalities. Proportions, likelihood ratios, and receiver-operating-characteristic (ROC) curves for prediction of previous falls were reported.Fifty-three subjects were enrolled, 11% had fallen in the previous week and 42% in the previous year. There was no correlation between TUG and any balance plate measurements. In logistic regression, neither testing modality was associated with prior history of falls (p > 0.05 for all time periods). Balance plate NSEO and NSEC testing cutoffs could be identified which were 83% sensitive and had a negative likelihood ratio (LR-) of 0.3 for falls in the past week. TUG testing was not useful for falls in the past week, but performed best for more distant falls in the past month, 6 months, or year. TUG cutoffs with sensitivity over 80% and LR(-) of 0.17-0.32 could be identified for these time periods.Over 40% of community-dwelling elder ED patients report a fall within the past year. Balance plate and TUG testing were feasibly conducted in an ED setting. There is no relationship between scores on balance plate and TUG testing in these patients. In regression analysis, neither modality was significantly associated with patient provided history of falls. These modalities should not be adopted for screening purposes in elders in the ED setting without validation in future studies or as part of multi-factorial risk assessment.More than o
Residential traffic exposure and children's emergency department presentation for asthma: a spatial study
Gavin Pereira, AJBM De Vos, Angus Cook
International Journal of Health Geographics , 2009, DOI: 10.1186/1476-072x-8-63
Abstract: The study population consisted of 1809 children aged between 0 and 19 years who had presented at an ED between 2002 and 2006 and were resident in a south-west metropolitan area of Perth traversed by major motorways. We used a 1:2 matched case-control study with gastroenteritis and upper limb injury as the control conditions. To estimate exposure to traffic emissions, we used 4 contrasting methods and 2 independently derived sources of traffic data (video-monitored traffic counts and those obtained from the state government road authority). The following estimates of traffic exposure were compared: (1) a point pattern method, (2) a distance-weighted traffic exposure method, (3) a simple distance method and (4) a road length method.Risk estimates were sensitive to socio-economic gradients and the type of exposure method that was applied. Unexpectedly, a range of apparent protective effects were observed for some exposure metrics. The kernel density measure demonstrated more than a 2-fold (OR 2.51, 95% CI 2.00 - 3.15) increased risk of asthma ED presentation for the high exposure group compared to the low exposure group.We assessed exposure using traffic data from 2 independent sources and compared the results of 4 different exposure metric types. The results indicate that traffic congestion may be one of the most important aspects of traffic-related exposures, despite being overlooked in many studies on the exacerbation of asthma.There is increasing evidence that residential proximity to major roadways is associated with an elevated risk of asthma exacerbation. A number of epidemiological analyses of the localised impact of traffic emissions have demonstrated associations with airway inflammation and lung function changes, and it has been suggested that these effects may be more detrimental in asthmatics due to their already compromised pulmonary function [1]. Brugge et al (2007) reviewed a number of studies conducted in urban areas in the United States and Western Eu
Walk-ins seeking treatment at an emergency department or general practitioner out-of-hours service: a cross-sectional comparison
Corinne Chmiel, Carola A Huber, Thomas Rosemann, Marco Zoller, Klaus Eichler, Patrick Sidler, Oliver Senn
BMC Health Services Research , 2011, DOI: 10.1186/1472-6963-11-94
Abstract: In 2007 and 2009 data was collected covering all consecutive patient-doctor encounters at the ED of a hospital and all those occurring as a result of contacting a GP-C over two evaluation periods of one month each. Comparison was made between a GP-C and the ED of the Waid City Hospital in Zurich. Patient characteristics, time and source of referral, diagnostic interventions and mode of discharge were evaluated. Medical problems were classified according to the International Classification of Primary Care (ICPC-2). Patient characteristics were compared using non-parametric tests and multiple logistic regression analysis was applied to investigate independent determinants for contacting a GP-C or an ED.Overall a total of 2974 patient encounters were recorded. 1901 encounters were walk-ins and underwent further analysis (ED 1133, GP-C 768). Patients consulting the GP-C were significantly older (58.9 vs. 43.8 years), more often female (63.5 vs. 46.9%) and presented with non-injury related medical problems (93 vs. 55.6%) in comparison with patients at the ED. Independent determining factors for ED consultation were injury, male gender and younger age. Walk-in distribution in both settings was equal over a period of 24 hours and most common during daytime hours (65%).Outpatient care was predominant in both settings but significantly more so at the GP-C (79.9 vs. 85.7%).We observed substantial differences between the two emergency settings in a non gate-keeping health care system. Knowledge of the distribution of diagnoses, their therapy, of diagnostic measures and of the factors which determine the patients' choice of the ED or the GP-C is essential for the efficient allocation of resources and the reduction of costs.In most industrialised countries the number of patients seeking non-urgent care at EDs (emergency departments) is increasing immensely [1-6]. In hospitals in Zurich, Switzerland, the number of emergency medical encounters has doubled in the last 10 years with
Time related admissions and outcomes of trauma patient at an emergency department  [PDF]
Nurettin Kahramansoy,Hayri Erkol,Necla Gürbüz,Feyzi Kurt
Medical Journal of Bakirk?y , 2012,
Abstract: Objective: Admission time of patients to emergency department (ED) vary. In certain times patient density increases and may have negative effect on morbidity and mortality of the patients. The aim of this study is to investigate the distribution of trauma characteristics and outcomes of the patients admitted to the ED with respect to elements of time. Material and Methods: This is a retrospective, cross-sectional study, which includes all the trauma patients admitted to an ED at eastern Turkey between January 2006 and December 2007. Results: The daily average of the total patients per physician was about 230. There were 6185 trauma patients analyzed. The number of patients and the percents of injured body regions per month increased towards summer. The highest percent was 31.9 for head-neck injury in August. The daily distribution of strike (68%) and motor vehicle injury (25.5%) were high in Thursday and Friday respectively. Only thoracodorsal injury (9.2%) in Sunday was significantly high. Frequencies of outcomes did not show difference in days. Number of admissions were low between 5:00-7:59 (≤1.3%) and increased from 08:00 onwards, peaked at 17 (8.6%), and decreased again at later hours of the day. The distribution of trauma mechanisms followed a similar trend. The percents of hospitalized and transferred patients were found to be significantly low between 00:00-06:59. However, distribution of mortality was regular. However 42.6% of the mortalities occurred between 13:00-18:59. Conclusion: There is high patient load in the ED. It is highest in summer and also in the afternoon and evening. Furthermore the transfers and the hospitalizations are remarkably high in these times. The ED needs to be supported with all types of personnel and technical equipment at the times indicated above.
Capnography Use in the Emergency Department  [PDF]
Orhan ?INAR
Turkish Journal of Emergency Medicine , 2011,
Abstract: Capnography is the measurement of carbon dioxide partial pressure from the airway during respiration. This non-invazive method can provide us real-time information on metabolism, perfusion and ventilation. Current emergency guidelines are suggesting the use of capnograph for confirming endotracheal intubation. Moreover, it has the potential to be use in many different clinical situations in the emergency department. Aim of this review is to discuss the clinical applications of capnography in the emergency department.
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