Computed tomography for non-traumatic headache in the emergency department and the impact of follow-up testing on altering the initial diagnosis

2015 ◽  
Vol 22 (5) ◽  
pp. 521-525 ◽  
Author(s):  
Jeffrey S. Quon ◽  
Rafael Glikstein ◽  
Christopher S. Lim ◽  
Betty Anne Schwarz
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Initial Diagnosis ◽  
The Impact

scholarly journals Community-based aftercare following an emergency department presentation for attempted suicide or high risk for suicide: study protocol for a non-randomised controlled trial

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Vida V. Bliokas ◽  
Alex R. Hains ◽  
Jonathan A. Allan ◽  
Luise Lago ◽  
Rebecca Sng
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Suicide Attempt ◽  
Repeated Measures ◽  
Hospital Emergency Department ◽  
Hospital Emergency ◽  
Community Based ◽  
Treatment As Usual ◽  
The Impact

Abstract Background Suicide is a major public health issue worldwide. Those who have made a recent suicide attempt are at high risk for dying by suicide in the future, particularly during the period immediately following departure from a hospital emergency department. As such the transition from hospital-based care to the community is an important area of focus in the attempt to reduce suicide rates. There is a need for evaluation studies to test the effectiveness of interventions directed to this stage (termed ‘aftercare’ interventions). Methods A controlled non-randomised two group (intervention vs treatment-as-usual control) design, using an intention-to-treat model, will evaluate the effectiveness of a suicide prevention aftercare intervention providing follow-up after presentations to a hospital emergency department as a result of a suicide attempt or high risk for suicide. The intervention is a community-based service, utilising two meetings with a mental health clinician and follow-up contacts by peer workers via a combination of face-to-face and telephone for four weeks, with the option of extension to 12 weeks. Seventy-five participants of the intervention service will be recruited to the study and compared to 1265 treatment-as-usual controls. The primary hypotheses are that over 12 months, those who participate in the aftercare follow-up intervention are less likely than controls to present to a hospital emergency department for a repeat suicide attempt or because of high risk for suicide, will have fewer re-presentations during this period and will have lower all-cause mortality. As a secondary aim, the impact of the intervention on suicide risk factors for those who participate in the service will be evaluated using pre- and post-intervention repeated measures of depression, anxiety, stress, hopelessness, belongingness, burdensomeness, and psychological distress. Enrolments into the study commenced on 1 November 2017 and are anticipated to cease in November 2019. Discussion The study aims to contribute to the understanding of effective interventions for individuals who have presented to a hospital emergency department as a result of a suicide attempt or at high risk for suicide and provide evidence in relation to interventions that incorporate peer-workers. Trial registration ACTRN12618001701213. Registered on 16 October 2018. Retrospectively registered.

The Functional Endoscopic Approach to Inflammatory Sinus Disease: Current Perspectives and Technique Modifications

1988 ◽  
Vol 2 (3) ◽  
pp. 89-96 ◽  
Author(s):  
David W. Kennedy ◽  
S. James Zinreich
Keyword(s):  
Computed Tomography ◽  
Surgical Techniques ◽  
The United States ◽  
Endoscopic Examination ◽  
Lessons Learned ◽  
Current Status ◽  
Sinus Disease ◽  
Technical Modifications ◽  
The Impact

Endoscopic examination and pleuridirectional polytomography provided some important insights into the pathogenesis of inflammatory sinus disease. These insights have been further refined by the increasing utilization of endoscopy in medical therapy and surgical follow-up, and by the use of computed tomography for diagnosis. The aim of this paper is to review the current status of the diagnosis of chronic inflammatory sinus disease and of functional endoscopic surgical techniques. The impact of this approach on previously held theoretical and diagnostic concepts is evaluated. Technical modifications made since the surgery was first introduced in the United States and the lessons learned from close postsurgical endoscopic examination are presented.

Aneurysm Volumes After Endovascular Repair of Ruptured vs Intact Aortic Aneurysms: A Retrospective Observational Study

2020 ◽  
pp. 152660282096248
Author(s):  
José Oliveira-Pinto ◽  
Rita Soares-Ferreira ◽  
Nelson F. G. Oliveira ◽  
Elke Bouwens ◽  
Frederico M. Bastos Gonçalves ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Late Complications ◽  
Aortic Aneurysms ◽  
First Year ◽  
Volume Changes ◽  
Tertiary Referral ◽  
Abdominal Aortic ◽  
The Mean ◽  
The Impact

Purpose To compare changes in abdominal aortic aneurysm (AAA) sac volume between endovascular aneurysm repairs (EVAR) performed for ruptured (rEVAR) vs intact (iEVAR) AAAs and to determine the impact of early volume shrinkage on future complications. Materials and Methods A retrospective analysis was performed of all patients undergoing standard infrarenal EVAR from 2002 to 2016 at a tertiary referral institution. Only patients with degenerative AAAs and with 30-day and 1-year computed tomography angiography (CTA) imaging were included. Early sac shrinkage was defined as a volume sac reduction >10% between the first (<30-day) and the 1-year CTA. The primary endpoint was to compare AAA sac volume changes between patients undergoing rEVAR (n=51; mean age 71.0±8.5 years; 46 men) vs iEVAR (n=393; mean age 72.3±7.5 years; 350 men). Results are reported as the mean difference with the interquartile range (IQR Q1, Q3). The secondary endpoint was freedom from aneurysm-related complications after 1 year as determined by regression analysis; the results are presented as the hazard ratio (HR) and 95% confidence interval (CI). Results At baseline, the rEVAR group had larger aneurysms (p<0.001) and shorter (p<0.001) and more angulated (p=0.028) necks. Aneurysm sac volume decreased more in the rEVAR group during the first year [−26.3% (IQR −38.8%, −12.5%)] vs the iEVAR group [−11.9% (IQR −27.5%, 0); p<0.001]. However, after the first year, the change in sac volume was similar between the groups [−3.8% (IQR −32.9%, 31.9%) for rEVAR and −1.5% (IQR −20.9%, 13.6%) for iEVAR, p=0.74]. Endoleak occurrence during follow-up was similar between the groups. In the overall population, patients with early sac shrinkage had a lower incidence of complications after the 1-year examination (adjusted HR 0.59, 95% CI 0.39 to 0.89, p=0.01). Conclusion EVAR patients treated for rupture have more pronounced aneurysm sac shrinkage compared with iEVAR patients during the first year after EVAR. Patients presenting with early shrinkage are less likely to encounter late complications. These parameters may be considered when tailoring surveillance protocols.

scholarly journals Serial coronary computed tomography angiography-verified coronary plaque progression: comparison of stented patients with or without diabetes

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Rui Shi ◽  
Ke Shi ◽  
Zhi-gang Yang ◽  
Ying-kun Guo ◽  
Kai-yue Diao ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Diabetic Patients ◽  
Plaque Progression ◽  
Coronary Computed Tomography ◽  
Number Of Patients ◽  
The Impact

Abstract Background Patients with Diabetes mellitus (DM) are susceptible to coronary artery disease (CAD). However, the impact of DM on plaque progression in the non-stented segments of stent-implanted patients has been rarely reported. This study aimed to evaluate the impact of DM on the prevalence, characteristics and severity of coronary computed tomography angiography (CCTA) verified plaque progression in stented patients. A comparison between diabetic and non-diabetic patients was performed. Methods A total of 98 patients who underwent clinically indicated serial CCTAs arranged within 1 month before and at least 6 months after percutaneous coronary intervention (PCI) were consecutively included. All the subjects were categorized into diabetic group (n = 36) and non-diabetic groups (n = 62). Coronary stenosis extent scores, segment involvement scores (SIS), segment stenosis scores (SSS) at baseline and follow-up CCTA were quantitatively assessed. The prevalence, characteristics and severity of plaque progression was evaluated blindly to the clinical data and compared between the groups. Results During the median 1.5 year follow up, a larger number of patients (72.2% vs 40.3%, P = 0.002), more non-stented vessels (55.7% vs 23.2%, P < 0.001) and non-stented segments (10.3% vs 4.4%, P < 0.001) showed plaque progression in DM group, compared to non-DM controls. More progressive lesions in DM patients were found to be non-calcified plaques (31.1% vs 12.8%, P = 0.014) or non-stenotic segments (6.6% vs 3.0%, p = 0.005) and were more widely distributed on left main artery (24.2% vs 5.2%, p = 0.007), the right coronary artery (50% vs 21.1%, P = 0.028) and the proximal left anterior artery (33.3% vs 5.1%, P = 0.009) compared to non-DM patients. In addition, DM patients possessed higher numbers of progressive segments per patient, ΔSIS and ΔSSS compared with non-DM individuals (P < 0.001, P = 0.029 and P < 0.001 respectively). A larger number of patients with at least two progressive lesions were found in the DM group (P = 0.006). Multivariate logistic regression analysis demonstrated that DM (OR: 4.81; 95% CI 1.64–14.07, P = 0.004) was independently associated with plaque progression. Conclusions DM is closely associated with the prevalence and severity of CCTA verified CAD progression. These findings suggest that physicians should pay attention to non-stent segments and the management of non-stent segment plaque progression, particularly to DM patients.

Evaluation of Early Versus Late Postdischarge Medication Reconciliation on Readmission Rates and Emergency Department Visits

2017 ◽  
Vol 31 (3) ◽  
pp. 279-283 ◽  
Author(s):  
Tina Joseph ◽  
Rebecca A. Barros ◽  
Elise Kim ◽  
Bupendra Shah
Keyword(s):  
Emergency Department ◽  
Clinical Pharmacist ◽  
Medication Reconciliation ◽  
Emergency Department Visits ◽  
Optimal Timing ◽  
Significant Difference ◽  
The Impact ◽  
Late Group ◽  
Hospital Use

Background: The current literature speculates ideal postdischarge follow-up focusing on transitions from hospital to home can range anywhere between 48 hours and 2 weeks. However, there is a lack of evidence regarding the optimal timing of follow-up visit to prevent readmissions. Objective: The purpose of this study is to evaluate the impact of early (<48 hours) versus late (48 hours-14 days) postdischarge medication reconciliation on readmissions and emergency department (ED) use. Methods: In this retrospective study, data for patients who had a clinic visit with a primary care provider (PCP), clinical pharmacist, or both for postdischarge medication reconciliation were reviewed. Primary outcome included hospital use rate at 30 days. Secondary outcomes included hospital use rate at 90 days and hospital use rate with a postdischarge PCP follow-up visit, clinical pharmacist, or both at 30 days. Results: One hundred sixty patients were included in the analysis: 31 early group patients and 129 late group patients. There was no significant difference on hospital use at 30 days in patients who received early or late groups (32.3% vs 21.8%, P = .947). There was also no significant difference on hospital use at 90 days in patients in early versus late group (51.6% vs 50.3%, P = .842). The type of provider (PCP vs pharmacists) conducting postdischarge medication reconciliation did not show significance on hospital use at 30 days (19.9% vs 21.4%, P = .731). Conclusion: Results from this study suggest patients can be seen up to 14 days postdischarge for medication reconciliation with no significant difference on hospital use.

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