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Prevalence of Hematuria among Emergency Department Healthcare Workers  [PDF]
Ho-Hsing Lin, Chi-Wen Juan, Li-Ya Lin, Chi-Wei Lee, Chien-Jen Huang
International Journal of Clinical Medicine (IJCM) , 2014, DOI: 10.4236/ijcm.2014.519154
Abstract: Background: In Taiwan, emergency departments are so busy that it is not uncommon for staffs (doctors and nurses) to be deprived of their lunch breaks or breaks to go to the restroom. As a consequence, during their busy shifts some emergency department healthcare workers choose to limit their water intake and no time to micturate which are both risk factors of urinary tract infection or urolithiasis. Hematuria is a common laboratory finding due to urinary tract infection and urolithiasis. Objective: To assess the prevalence of hematuria among the emergency department healthcare workers, we conducted a retrospective study in a district hospital in Taiwan. Documented data included those of healthcare workers who worked in the emergency department, as well as other departments of the same hospital. Methods: We reviewed the three-year records of general body checkup of hospital staffs who served in the emergency room and other departments of the same hospital between January 1, 2009 and December 31, 2011. Statistical software SPSS statistical analysis of survey data recovery is applied; data and test results by the questionnaire analysis patterns are associated with the urinary system abnormalities to ANOVA analysis to explore the hospital group whether there is a significant sex differences, and the other to analyze and verify the correlation analysis to the Scheffe post-hoc comparison method. Results: A higher prevalence of hematuria was observed among emergency department healthcare workers when compared with their colleagues who work in other departments of the same hospital. Female workers have higher risk of urinary system abnormalities than male workers. Nurses in the urinary system abnormalities are higher than other positions category. Shift work system has a negative effect on the urinary system. Conclusion: In conclusion, hematuria is more prevalent among emergency department healthcare workers than healthcare workers working in the inpatient wards. Hematuria might well be due to urinary tract infection which in turns caused by the overwhelmingly busy nature of the emergency department duty that deprived the emergency department healthcare workers from frequent voiding and sufficient intake of fluid.
Automated electronic medical record sepsis detection in the emergency department  [PDF]
Su Q. Nguyen,Edwin Mwakalindile,James S. Booth,Vicki Hogan,Jordan Morgan,Charles T. Prickett,John P. Donnelly,Henry E. Wang
PeerJ , 2015, DOI: 10.7717/peerj.343
Abstract: Background. While often first treated in the emergency department (ED), identification of sepsis is difficult. Electronic medical record (EMR) clinical decision tools offer a novel strategy for identifying patients with sepsis. The objective of this study was to test the accuracy of an EMR-based, automated sepsis identification system.
Estimation of the Prevalence of Undiagnosed and Diagnosed HIV in an Urban Emergency Department  [PDF]
William M. Reichmann,Rochelle P. Walensky,Amy Case,Anna Novais,Christian Arbelaez,Jeffrey N. Katz,Elena Losina
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0027701
Abstract: To estimate the prevalence of undiagnosed HIV, the prevalence of diagnosed HIV, and proportion of HIV that is undiagnosed in populations with similar demographics as the Universal Screening for HIV in the Emergency Room (USHER) Trial and the Brigham and Women's Hospital (BWH) Emergency Department (ED) in Boston, MA. We also sought to estimate these quantities within demographic and risk behavior subgroups.
Domestic violence against women: Incidence and prevalence in an emergency department population  [cached]
Journal of Nursing Education and Practice , 2012, DOI: 10.5430/jnep.v2n4p145
Abstract: Objectives: A majority of women entering the hospital emergency departments and walk-in clinics in Sydney are likely to have a history of domestic violence. Domestic violence involves a physical injury, emotional and/or psychological threat by a male partner. The aim is to identify this group of women and to intervene early by referring them to counseling and other services. Method: A prospective study was conducted to screen women of domestic violence who agreed to participate and who were accessing the Emergency Department during three months of the study period in May to July 2011. The validated Hurt Insult Threatening Screening tool (HITS) consisting of 4 questions was used. Data was analysed using descriptive statistics and two-group comparisons. The incidence and one month cumulative prevalence rates of DV were calculated with 95% confidence interval and correlates of DV were examined. Results: Of 239 women in Sydney, who previously sought emergency care and completed the questionnaires, 102 (47%) had experienced threats or injuries from a current male partner in their lives. Physicians and nurses in emergency department failed to detect the history of domestic violence in women seeking treatment. Of the 239 women in the study with a male partner, 11.7% accessed the emergency room for acute domestic violence, but only 13% of these said they either told or were asked about domestic violence by the health practitioner. Conclusion: The incidence of acute domestic violence is not as common among the women visiting the emergency department as previously reported. Although the cumulative prevalence of domestic violence is strikingly high, women who have experienced domestic violence are seldom identified by the emergency department professionals.
Prevalence of Genetic Disorders in Pediatric Emergency Department Al Galaa Teaching Hospital  [PDF]
N.A. Meguid,S.M. El Bayoumi,N.F. Hamdi,W.N. Amen
Pakistan Journal of Biological Sciences , 2003,
Abstract: To determine the prevalence and patterns of presentation of cases with suspected genetic disorders among neonatal pediatric emergency department. A retrospective and prospective review of pediatric emergency department admissions at Al Galaa Teaching Hospital among one year; suspected infants with genetic disorder are prone to full clinical evaluation with special emphasis on any associated anomalies or facial malformations, meticulous pedigree construction, chromosomal analysis for karyotyping and metabolic studies when indicated. Infants with suspected genetic diseases represent 11.1% among patients admitted to PED. Of these 50% were related to single gene disorders, 22% had chromosomal aberrations, 20% were due to multifactorial etiology and 8% had sporadic isolated anomalies. Parental consanguinity was found in 40% of these cases. We concluded that genetic disorders due to single gene defect are the most common pattern of malformations. This could be related to the high consanguinity rate among Egyptian population. Also emphasized that it is important for emergency physicians, neonatologists and pediatricians to be familiar with common genetic diseases, their acute presentations and complications. Awareness of underlying genetic disorders and accurate diagnosis are required for appropriate management and proper counseling.
Successful Introduction of an Emergency Department Electronic Heal th Record  [cached]
Douglas A. Propp
Western Journal of Emergency Medicine : Integrating Emergency Care with Population Health , 2012,
Abstract: Our emergency department had always relied on a paper-based infrastructure. Our goal was to convert to a paperless, efficient, easily accessible, technologically advanced system to support optimal care. We outline our sequential successful transformation, and describe the resistance, costs, incentives and benefits of the change. Critical factors contributing to the significant change included physician leadership, training and the rate of the endorsed change. We outline various tactics, tools, challenges and unintended benefits and problems.
Prevalence, Health and Demographic Characteristics of Emergency Department Patients with Diabetes  [cached]
Menchine, Michael D,Vishwanath, Anita,Arora, Sanjay
Western Journal of Emergency Medicine : Integrating Emergency Care with Population Health , 2010,
Abstract: Objective: To determine the prevalence of diabetes in Southern California emergency department (ED) patients and describe the self-reported general health, demographic and social characteristics of these patients with diabetes. Methods: Between April 2008 and August 2008, non-critical patients at two Southern California EDs completed a 57-question survey about their chronic medical conditions, general health, social and demographic characteristics. Results: 11.3% of the 1,303 patients surveyed had diabetes. Patients with diabetes were similar to ED patients without diabetes with respect to gender, ethnicity and race. However, patients with diabetes were older (51 vs. 41), less likely to have a high school education (64.0% vs. 84.7%), less likely to speak English (44.9% vs. 55.4%), and less likely to be uninsured (33.3% vs. 49.5%). Additionally, patients with diabetes had markedly lower self-reported physical health scores (37.1 vs. 45.8) and mental component score and mental health scores (42.0 vs. 47.4) compared with ED patients without diabetes. Conclusion: In this study of two Southern California EDs, 11.3% of surveyed patients had diabetes. These patients were often poorly educated, possessed limited English language skills and poor physical health. ED personnel and diabetes educators should be mindful of these findings when designing interventions for ED patients with diabetes. [West J Emerg Med. 2010; 11(5):419-422.]
Prevalence and predictors of hypoxemia in acute respiratory infections presenting to pediatric emergency department  [cached]
Singhi S,Deep A,Kaur H
Indian Journal of Critical Care Medicine , 2003,
Abstract: Rational & Objective: Early detection of hypoxemia and oxygen therapy improves the outcome of children with acute respiratory illnesses (ARI). However, facility to measure oxygen saturation (SpO2) is not available in many health facilities of resource poor countries. We have studied prevalence of hypoxemia in children with ARI and examined value of various clinical signs to predict hypoxemia. Subjects & Methods: Consecutive children, aged 2 months - 59 months, with respiratory symptom(s) attending the pediatric emergency service between Oct 2001 to December 2002 were studied. Presence or absence of cough, nasal flaring, ability to feed/drink, cyanosis, chestwall indrawing, wheeze, tachypnoea (respiratory rate >50/min in children up to 11 months and >40/min up to 59 months), crepitations on auscultation and oxygen saturation (SpO2, by Nellcore pulse oximeter) and clinical diagnosis were recorded. Results: Of 2216 children studied 266 (11.9%) had hypoxemia (SpO2 £90%). It was seen in 73.8% of 126 patients with WHO defined very severe pneumonia, 25.8% of 331 patients with severe pneumonia, 11% of 146 patients with bronochiolitis and 6.5% of 338 patients with acute asthma. Most sensitive indicators of hypoxemia were chestwall indrawing (sensitivity-90%, negative predictive value -98%) and crepitations (sensitivity-75%, negative predictive value 95.7%) while the best positive predictive value was seen with cyanosis (71.4%) and inability to feed (47.6%). Nasal flaring had the good balance of sensitivity (64%), specificity (82%) and positive predictive value (33%) among the signs studied. Conclusion: None of the clinical signs of respiratory distress had all the attributes of a good predictors of hypoxemia. Chest wall indrawing was the most sensitive and 'inability to feed/ drink' was the most specific indicator.
Prevalence and demographics of methicillin resistant Staphylococcus aureus in culturable skin and soft tissue infections in an urban emergency department
Christian H Jacobus, Christopher J Lindsell, Sabrina D Leach, Gregory J Fermann, Amy Kressel, Laura E Rue
BMC Emergency Medicine , 2007, DOI: 10.1186/1471-227x-7-19
Abstract: This was a prospective observational cohort study conducted over three months in 2005. A convenience sample of patients with culturable skin infections presenting to a busy, urban emergency department was enrolled. Demographic and risk factor information was collected by structured interview. The predictive value of each risk factor for MRSA, as identified by culture, was tested using univariable logistic regression, and a multivariable predictive model was developed.Patients were 43% black, 40% female and mean age was 39 years (SD 14 years). Of the 182 patients with cultures, prevalence of MRSA was 58% (95%CI 50% to 65%). Significant predictors of MRSA were youth, lower body mass index, sexual contact in the past month, presence of an abscess cavity, spontaneous infection, and incarceration. The multivariable model had a C-statistic of 0.73 (95%CI 0.67 to 0.79) with four significant variables: age, group living, abscess cavity, and sexual contact within one month.In this population of emergency department patients, MRSA skin infection was related to youth, recent sexual contact, presence of abscess, low body mass index, spontaneity of infection, incarceration or contact with an inmate, and group home living.Over the last decade, methicillin resistant Staphylococcus aureus (MRSA) skin infections have become increasingly prevalent in the emergency department (ED) [1,2]. While MRSA was historically limited to intensive care unit settings and to people in close contact with hospitals, there has been a recent increase in MRSA among people who have not had contact with the health care system [3]. As the number of patients with community-acquired MRSA grows, so does the need for emergency physicians to appropriately identify and treat MRSA infections.The prevalence of MRSA in the emergency department setting has been demonstrated as on the order of 60% in patients with culturable skin and soft tissue infections [1,2]. A recent report on MRSA prevalence concludes by sugges
The Prevalence of Undiagnosed HIV Infection in Those Who Decline HIV Screening in an Urban Emergency Department  [PDF]
M. Czarnogorski,J. Brown,V. Lee,J. Oben,I. Kuo,R. Stern,G. Simon
AIDS Research and Treatment , 2011, DOI: 10.1155/2011/879065
Abstract: Objective. To determine the prevalence of occult HIV infection in patients who decline routine HIV testing in an urban emergency department. Design, Setting, and Patients. Discarded blood samples were obtained from patients who had declined routine ED HIV testing. After insuring that the samples came from patients not known to be HIV positive, they were deidentified, and rapid HIV testing was preformed using 5?μL of whole blood. Main Outcome Measures. The prevalence of occult HIV infection in those who declined testing compared with prevalence in those who accepted testing. Results. 600 consecutive samples of patients who declined routine HIV screening were screened for HIV. Twelve (2%) were reactive. Over the same period of time, 4845 patients accepted routine HIV testing. Of these, 35 (0.7%) were reactive. The difference in the prevalence of HIV infection between those who declined and those who accepted testing was significant ( ). The relative risk of undetected HIV infection in the group that declined testing was 2.74 times higher (95% CI 1.44–5.18) compared with those accepted testing. Conclusion. The rate of occult HIV infection is nearly three-times higher in those who decline routine ED HIV testing compared with those who accept such testing. Interventions are urgently needed to decrease the opt-out rate in routine ED HIV testing settings. 1. Introduction The Centers for Disease Control and Prevention (CDC) has estimated that approximately 1–1.2 million people in the US are infected with HIV. Of these, one-quarter are unaware of their infection [1, 2]. In 2006, the CDC recommended that routine HIV screening be expanded to many outpatient settings including emergency departments (EDs). Specifically, the CDC recommended that screening for HIV infection be routinely performed for all patients aged 13–64, in settings where the prevalence of undiagnosed HIV infection in the patient population is more than 0.1% [3]. The CDC also recommended that testing programs use an opt-out approach in which patients are informed that the test will be done unless they decline. Several emergency departments have instituted these recommendations, including The George Washington University Hospital (GWUH), which began to offer routine opt-out ED HIV testing in September 2006 [4, 5]. Since the program’s inception, the GWUH-ED has offered free rapid HIV testing to over 32,000 individuals. Approximately 44% of eligible patients decline an ED HIV test, and the HIV seroprevalence rate among those who accepted testing is 0.7% [4, 6]. Our prior work demonstrated that the
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