Articles: emergency-services.
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Eur. J. Intern. Med. · Jan 2025
Prospective study of risk factors for community-acquired acute kidney injury.
Causes and risk factors for community-acquired acute kidney injury (CA-AKI) have not been thoroughly studied. The aim of this study was to examine the risk factors for CA-AKI. ⋯ Events in the setting of acute illness and medication use, including OTC NSAIDs, may play a greater role in the development of CA-AKI than comorbid conditions. Frequent use of OTC NSAIDs is a concern and should be addressed in view of serious adverse effects.
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Abdominal pain is the most common reason for visit (RFV) to the emergency department (ED) for adults, yet no standardized diagnostic pathway exists for abdominal pain. Optimal management is age-specific; symptoms, diagnoses, and prognoses differ between young and old adults. Availability and knowledge of the effectiveness of various imaging modalities have also changed over time. We compared diagnostic imaging rates for younger versus older adults to identify practice patterns of abdominal imaging across age groups over time. ⋯ Despite more abdominal pain ED visits and increased imaging rates per visit, test positivity continues to rise. Our findings do not support claims that CT and ultrasound are being used less appropriately over time, but demonstrate widespread use of X-rays, which are potentially ineffective for abdominal pain.
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Intersex people make up 1.7-4% of the population of North America. A recent scoping review of emergency department (ED) relevant literature for the care of sexual and gender minorities found almost no representation of this population. Intersex people have unique equity, diversity, and inclusion needs in the ED, so we undertook a review of international guidelines to identify ED-relevant recommendations. ⋯ A systematic review of the literature for ED-relevant guidelines for the care of Intersex populations returned no results. Given the risk of increasing barriers to care for intersex people, and the increasing use of the ED for primary care, the requirements of Intersex people need to be investigated and integrated into future development of a CPG for care of sexual and gender minority populations in the ED.
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Patient-centered care (PCC) is an essential component of high-quality health, yet patients with non-English language preferences (NELP) experience worse PCC outcomes. Additionally, there are likely unique aspects to PCC for patients with NELP in the emergency department (ED). To inform the development of strategies to improve PCC for NELP in the ED, we sought to understand how Spanish-speaking ED patients experience care and the factors that influenced their perceptions of the patient-centeredness of that care. ⋯ We now have a more nuanced understanding of how Spanish-speaking patients with NELP experience PCC in the ED and what matters to them. Several of the themes identified in this analysis add details about what matters to patients within the domains of previous PCC definitions. This suggests that the conceptualization of PCC may vary based on the setting where care is provided and the population who is receiving this care. Future work should consider patient population and setting when conceptualizing PCC.
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Band neutrophil count greater than 10 % of the white blood cell differential (bandemia) has been associated with severe infections in emergency department (ED) patients. In January 2023, our ED instituted a critical alert for bandemia. We performed a retrospective chart review of two cohorts of emergency department patients, before and after initiation of critical alert. After critical alert initiation for bandemia, there was a 4.6-fold higher incidence of bandemia with similar baseline patient characteristics.