scholarly journals A Multivariable Model of Parent Satisfaction, Pain, and Opioid Administration in a Pediatric Emergency Department

2021 ◽  
Vol 22 (5) ◽  
pp. 1167-1175
Author(s):  
Candice Donaldson ◽  
Theodore Heyming ◽  
Louis Ehwerhemuepha ◽  
Brooke Jenkins ◽  
Michelle Fortier ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pediatric Patients ◽  
Opioid Analgesic ◽  
Parent Satisfaction ◽  
The United States ◽  
Pain Severity ◽  
Pediatric Care ◽  
Opioid Administration ◽  
The Impact ◽  
The Relationship

Introduction: Children and adolescents are not impervious to the unprecedented epidemic of opioid misuse in the United States. In 2016 more than 88,000 adolescents between the ages of 12–17 reported misusing opioid medication, and evidence suggests that there has been a rise in opioid-related mortality for pediatric patients. A major source of prescribed opioids for the treatment of pain is the emergency department (ED). The current study sought to assess the complex relationship between opioid administration, pain severity, and parent satisfaction with children’s care in a pediatric ED. Methods: We examined data from a tertiary pediatric care facility. A health survey questionnaire was administered after ED discharge to capture the outcome of parental likelihood of providing a positive facility rating. We abstracted patient demographic, clinical, and top diagnostic information using electronic health records. Data were merged and multivariable models were constructed. Results: We collected data from 15,895 pediatric patients between the ages of 0–17 years (mean = 6.69; standard deviation = 5.19) and their parents. Approximately 786 (4.94%) patients were administered an opioid; 8212 (51.70%) were administered a non-opioid analgesic; and 3966 (24.95%) expressed clinically significant pain (pain score >/= 4). Results of a multivariable regression analysis from these pediatric patients revealed a three-way interaction of age, pain severity, and opioid administration (odds ratio 1.022, 95% confidence interval, 1.006, 1.038, P = 0.007). Our findings suggest that opioid administration negatively impacted parent satisfaction of older adolescent patients in milder pain who were administered an opioid analgesic, but positively influenced the satisfaction scores of parents of younger children who were administered opioids. When pain levels were severe, the relationship between age and patient experience was not statistically significant. Conclusion: This investigation highlights the complexity of the relationship between opioid administration, pain severity, and satisfaction, and suggests that the impact of opioid administration on parent satisfaction is a function of the age of the child.

scholarly journals The impact of coronavirus disease 2019 (COVID-19) on alternatives to opioids protocol for opioid reduction in emergency department

2021 ◽  
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Length Of Stay ◽  
Pain Control ◽  
The United States ◽  
Left Without Being Seen ◽  
Significant Difference ◽  
Opioid Administration ◽  
One Year ◽  
The Impact

The United States (US) is in the midst of both an opioid epidemic and COVID-19 pandemic. The Alternatives to Opioids (ALTO) approach is a useful strategy of utilizing non-opioid options as the first-line pain therapy in the emergency department (ED). Since the COVID-19 pandemic began, more than 40 states have reported a rise in opioid-related deaths. Since there is a potential increasing need for pain management due to limited outpatient resources during the COVID-19 pandemic, it is unclear whether the COVID-19 has affected the effectiveness of the ALTO protocol in reducing opioid administration in the ED. To investigate the impact of COVID-19 on the usage of the ALTO protocol for opioid reduction, this retrospective cohort study was performed to compare patients receiving pain medication in an urban ED during the COVID-19 pandemic (March to August 2020) and patients during the same period from one year prior. The primary outcome was the change in ED opioid administration and out-patient opioid prescriptions. All opioid dosages were converted to morphine milligram equivalents (MME) for data analysis. Secondary outcomes included changes in ALTO medication use, patient satisfaction with pain control, ED length of stay, and rate of left without being seen (LWBS). The mean prescribed MME per discharged patient visit was significantly lower in the COVID-19 pandemic group (3.16 ± 0.31 versus 7.72± 0.31, p < 0.001). There was no significant difference in ED opioid administration, patient satisfaction with pain control, ED length of stay, and rate of LWBS between both groups. In conclusion, during the COVID-19 pandemic, the ALTO protocol can reduce out-patient opioid usage without changing opioid administration in the ED.

scholarly journals The health and relationship dynamics of late-life couples: a systematic review of the literature

2009 ◽  
Vol 29 (3) ◽  
pp. 455-480 ◽  
Author(s):  
RUTH B. WALKER ◽  
MARY A. LUSZCZ
Keyword(s):  
Systematic Review ◽  
Marital Quality ◽  
Late Life ◽  
The United States ◽  
Health It ◽  
Social Emotional ◽  
Marital Relations ◽  
The Impact ◽  
The Relationship ◽  
Adequate Communication

ABSTRACTLate-life husband and wife relationships are increasingly recognised as an important factor in promoting wellbeing, particularly in terms of the health, social, emotional, financial and practical needs of older people. Knowledge of marital dynamics and how they affect both members of a couple remains scarce. This systematic review aimed to identify and appraise research that has focused explicitly on the dynamics of the relationship, as evinced by data frombothspouses. Implementing rigorous identification strategies, 45 articles were identified and reviewed. These studies were grouped into three broad thematic areas: marital relations and satisfaction; concordance in emotional state or physical health; and the interplay between marital quality and wellbeing. The issues found to affect marital relations and satisfaction in late life included equality of roles, having adequate communication, and transitions to living apart. There is strong evidence for couple concordance in depression, that marital relationships affect ill-health, longevity and recovery from illness, and reciprocally that ill-health impacts on the marriage itself. The research also suggests important gender differences in the impact of marital dynamics on health. It has led to the conclusion that there is a need for more diverse studies of late-life marriages, particularly ones that examine the dynamics of non-traditional elderly couples and that extend beyond a predominant focus on the Caucasian population of the United States.

A Dynamic Theory of Populism in Power

2021 ◽  
Author(s):  
Julio F. Carrión
Keyword(s):  
Regime Change ◽  
Dynamic Theory ◽  
Empirical Relationship ◽  
The United States ◽  
Democratic Governance ◽  
Theory Of Change ◽  
Popular Participation ◽  
The Andes ◽  
The Impact ◽  
The Relationship

The relationship between populism and democracy is a hotly debated topic. Some believe that populism is inherently bad for democracy because it is anti-pluralist and confrontational. Others argue that populism can reinvigorate worn-out democracies in need of an infusion of greater popular participation. This book advances this debate by examining the empirical relationship between populism in power and democracy. Does populism in power always lead to regime change, that is, the demise of democracy? The answer is no. The impact of populism on democracy depends on the variety of populism in power: the worst outcomes in democratic governance are found under unconstrained populism. This book discusses the conditions that explain how populism becomes unconstrained, and advances a dynamic theory of change that shows how the late victories of populists build on early ones, resulting in greater power asymmetries. The book analyzes five populist presidencies in the Andes. In four of them (Bolivia, Ecuador, Peru, and Venezuela), populism became unconstrained and regime change followed. In one case, Colombia, populism in power was contained and democracy survived. The concluding chapter places the Andean cases in comparative perspective and discusses how unconstrained populism in other cases (Nicaragua and Hungary) also lead to the end of electoral democracy. Where populism in power was constrained (Honduras and the United States), regime change did not materialize. This book advances a theory of populism that help us understand how democracies transition into non-democracies. To that extent, the book illuminates the processes of democratic erosion in our time.

The Impact of Energy on the Adoption of Conservation Tillage in the United States

1998 ◽  
Vol 9 (5) ◽  
pp. 549-568
Author(s):  
Noel D. Uri
Keyword(s):  
United States ◽  
Crude Oil ◽  
Conservation Tillage ◽  
The United States ◽  
Structural Instability ◽  
Special Importance ◽  
The Real ◽  
Real Price ◽  
The Impact ◽  
The Relationship

The impact of energy on the adoption of conservation tillage is of special importance in addressing concerns about the effect of agricultural production on the environment in the United States. It is the subject of this paper. After establishing that a relationship exists between the price of energy and the adoption of conservation tillage via cointegration techniques, the relationship is quantified. It is shown that while the real price of crude oil, the proxy used for the price of energy, does not affect the rate of adoption of conservation tillage, it does impact the extent to which it is used. Finally, there is no structural instability in the relationship between the relative use of conservation tillage and the real price of crude oil over the period 1963 to 1997.

scholarly journals Prediction and comparison of the impact of COVID-19 epidemic on the financial industry of major countries based on neural intelligent algorithm

2020 ◽  
Vol 39 (6) ◽  
pp. 8831-8838
Author(s):  
Bin Wang ◽  
Qingyuan Zhou
Keyword(s):  
United States ◽  
Global Economy ◽  
Mutual Influence ◽  
The United States ◽  
Household Consumption ◽  
Intermediate Input ◽  
Financial Industry ◽  
Government Consumption ◽  
The Impact ◽  
The Relationship

The global economy appears the trend of anti-globalization under the influence of COVID-19. Based on the input-output table of lead database from 2006 to 2020, this paper divides the factors that affect the development of financial industry in China, the United States and Russia into six aspects: price, intermediate input, household consumption, government consumption, export and import. ADGA-BP neural network model is proposed in this paper, which is based on six aspects of price, intermediate input, consumer, government consumption, export and import. The intermediate input is decomposed from the perspective of industrial structure to study the interrelationship between financial industry and other industries in the three countries. The results show that the intermediate input is the main factor in the development of financial industry in the three countries, but the source industries of the intermediate input are not the same; the two factors of household consumption and price are closely related to the development of financial industry in the three countries, and they all play a role in promoting China, while the relationship between household consumption and the United States and between price and Russia is reverse; Government consumption only has a significant impact on Russia; from the perspective of mutual influence, the mutual investment between the financial industry of China and the United States is relatively large, while the relationship between the Russian financial industry and the two countries is relatively weak. It shows that under the background of covid-19, the development of financial industry is affected.

Income and healthcare financing system in the United States: an asymmetric analysis

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Mehdi Barati ◽  
Hadiseh Fariditavana
Keyword(s):  
The United States ◽  
Set Covering ◽  
Healthcare Financing ◽  
Financing System ◽  
Data Set ◽  
Content Type ◽  
Funding Sources ◽  
Distributed Lag ◽  
The Impact ◽  
The Relationship

PurposeThe purpose of this study is to first assess how the US healthcare financing system is influenced by income variation. Then, it examines whether or not the impact of income variation is asymmetric.Design/methodology/approachFor the analyses of this paper, the autoregressive distributed lag (ARDL) model is implemented to a data set covering the period from 1960 to 2018.FindingsThe results provide evidence that major funding sources of aggregate healthcare expenditure (HCE) respond differently to changes in income. The results also imply that the effect of income is not always symmetric.Originality/valueMany studies have attempted to identify the relationship between income and HCE. A common feature of past studies is that they have only focused on aggregate HCE, while one might be interested in knowing how major funders of aggregate HCE would be affected by changes in income. Another common feature of past studies is that they have assumed that the relationship between income and HCE is symmetric.

The Impact of Social Injustice on Public Health

2019 ◽  
pp. 3-20
Author(s):  
Barry S. Levy
Keyword(s):  
Human Rights ◽  
Social Justice ◽  
Equal Opportunity ◽  
The United States ◽  
Social Injustice ◽  
Adverse Health Effects ◽  
Human Needs ◽  
Adverse Health ◽  
The Impact ◽  
The Relationship

Social injustice creates conditions that adversely affect the health of individuals and communities. It denies individuals and groups equal opportunity to have their basic human needs met. It violates fundamental human rights. It represents a lack of fairness or equity. This chapter provides two broad definitions of social injustice. It gives examples of social injustice, both within the United States and internationally. It describes adverse health effects related to social injustice. And it outlines ways in which health professionals and others can work to minimize social injustice and its adverse health consequences. Text boxes describe concepts of social justice, as well as the relationship between science and social justice. The Appendix to the chapter contains the Universal Declaration of Human Rights.

scholarly journals The Value of Local Heatwave Impact Assessment: A Case-Crossover Analysis of Hospital Emergency Department Presentations in Tasmania, Australia

2019 ◽  
Vol 16 (19) ◽  
pp. 3715 ◽  
Author(s):  
Sharon L. Campbell ◽  
Tomas A. Remenyi ◽  
Grant J. Williamson ◽  
Christopher J. White ◽  
Fay H. Johnston
Keyword(s):  
Emergency Department ◽  
Capacity Planning ◽  
Conditional Logistic Regression ◽  
Hospital Emergency Department ◽  
Hospital Emergency ◽  
Case Crossover ◽  
Crossover Analysis ◽  
The Impact ◽  
The Relationship ◽  
Local Research

Heatwaves have been identified as a threat to human health, with this impact projected to rise in a warming climate. Gaps in local knowledge can potentially undermine appropriate policy and preparedness actions. Using a case-crossover methodology, we examined the impact of heatwave events on hospital emergency department (ED) presentations in the two most populous regions of Tasmania, Australia, from 2008–2016. Using conditional logistic regression, we analyzed the relationship between ED presentations and severe/extreme heatwaves for the whole population, specific demographics including age, gender and socio-economic advantage, and diagnostic conditions that are known to be impacted in high temperatures. ED presentations increased by 5% (OR 1.05, 95% CI 1.01–1.09) across the whole population, by 13% (OR 1.13, 95% CI 1.03–1.24) for children 15 years and under, and by 19% (OR 1.19, 95% CI 1.04–1.36) for children 5 years and under. A less precise association in the same direction was found for those over 65 years. For diagnostic subgroups, non-significant increases in ED presentations were observed for asthma, diabetes, hypertension, and atrial fibrillation. These findings may assist ED surge capacity planning and public health preparedness and response activities for heatwave events in Tasmania, highlighting the importance of using local research to inform local practice.

The impact of beta-lactam allergy labels on hospitalized children

2020 ◽  
pp. 1-7
Author(s):  
Trahern W. Jones ◽  
Nora Fino ◽  
Jared Olson ◽  
Adam L. Hersh
Keyword(s):  
Length Of Stay ◽  
Pediatric Patients ◽  
The United States ◽  
Adverse Outcomes ◽  
Hospitalized Children ◽  
Beta Lactam ◽  
Healthcare Facilities ◽  
Antibiotic Allergy ◽  
Hospitalization Costs ◽  
The Impact

Abstract Background and objectives: Antibiotic allergy labels are common and are frequently inaccurate. Previous studies among adults demonstrate that β-lactam allergy labels may lead to adverse outcomes, including prescription of broader-spectrum antibiotics, increased costs, and increased lengths of stay, among others. However, data among pediatric patients are lacking, especially in the United States. In this study, we sought to determine the impact of β-lactam allergy labels in hospitalized children with regards to clinical and economic outcomes. Method: This retrospective cohort study included pediatric patients 30 days to 17 years old, hospitalized at Intermountain Healthcare facilities from 2007 to 2017, who received ≥1 dose of an antibiotic during their admission. Patients with β-lactam allergies were matched to nonallergic patients based on age, sex, clinical service line, admission date, academic children’s hospital or other hospital admission, and the presence of chronic, comorbid conditions. Outcomes included receipt of broader-spectrum antibiotics, clinical outcomes including length of stay and readmission, and antibiotic and hospitalization costs. Results: In total, 38,906 patients were identified. The prevalence of antibiotic allergy increased from 0.9% among those < 1 year peaked at 10.6% by age 17. Patients with β-lactam allergy received broader-spectrum antibiotics and experienced higher antibiotic costs than nonallergic controls. However, there were no differences in the length of stay, readmission rates, or total number of days of antibiotics between allergic and nonallergic patients. Conclusions: Hospitalized pediatric patients with β-lactam allergy labels receive broader-spectrum antibiotics and experience increased antibiotic costs. This represents an important opportunity for allergy delabeling and antibiotic stewardship.

scholarly journals A survey of caregiver acculturation and acceptance of silver diamine fluoride treatment for childhood caries

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Anjali Kumar ◽  
Dana Cernigliaro ◽  
Mary E. Northridge ◽  
Yinxiang Wu ◽  
Andrea B. Troxel ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
The United States ◽  
Cross Sectional Study ◽  
Caries Experience ◽  
Cross Sectional ◽  
Silver Diamine Fluoride ◽  
Fluoride Treatment ◽  
Logistic Regression Models ◽  
Health Related ◽  
The Relationship

Abstract Background Interest in aqueous silver diamine fluoride (SDF) has been growing as a treatment for caries arrest. A cross-sectional study was conducted to identify factors associated with caregiver acceptance of SDF treatment for children presenting with caries at 8 Federally Qualified Health Centers. The study purpose was to examine associations between caregiver acceptance of SDF treatment for children with caries and (1) sociodemographic and acculturation characteristics of caregivers and (2) clinical assessments of the children by dentists. Methods A caregiver survey collected information on: sociodemographic characteristics; acculturation characteristics, measured using the validated Short Acculturation Scale for Hispanics (SASH); perceived benefits and barriers of SDF treatment, including caregiver comfort; and perceived health-related knowledge. Chart reviews were conducted to assess: the medical / dental insurance of pediatric patients; cumulative caries experience, measured using decayed, missing, filled teeth total scores (dmft / DMFT); whether operating room treatment was needed; and a record of caregiver acceptance of SDF treatment (the outcome measure). Standard logistic regression models were developed for caregiver acceptance of SDF treatment for their children as the binary outcome of interest (yes / no) to calculate unadjusted odds ratios (OR) and adjusted ORs for covariates of interest. Results Overall, 434 of 546 caregivers (79.5%) accepted SDF treatment for their children. A U-shaped relationship between caregiver odds of accepting SDF treatment and age group of pediatric patients was present, where caregivers were most likely to accept SDF treatment for their children who were either < 6 years or 9–14 years, and least likely to accept SDF treatment for children 6 to < 9 years. The relationship between acculturation and caregiver acceptance of SDF treatment depended upon whether or not caregivers were born in the United States: greater acculturation was associated with caregiver acceptance of SDF treatment among caregivers born in this country, and lower acculturation was associated with caregiver acceptance of SDF treatment among caregivers born elsewhere. Conclusions Caregiver acceptance of SDF treatment is high; child’s age and caregiver comfort are associated with acceptance. Providers need to communicate the risks and benefits of evidence-based dental treatments to increasingly diverse caregiver and patient populations.

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