Adult and Pediatric Mild and Moderate Head Injury Management in Scandinavian Countries

Neurotrauma ◽  
2018 ◽  
pp. 123-128
Author(s):  
Zandra Olivecrona ◽  
Johan Undén

The Scandinavian Neurotrauma Committee (SNC) was initiated by the Scandinavian Neurosurgical Society to improve the care of neurotrauma patients. The SNC has presented evidence-based guidelines for initial management of minimal, mild, and moderate head injuries. Separate guidelines are presented for children and adults. The biomarker S100β‎ is included in the adult guidelines in an attempt to reduce computed tomography (CT) usage and costs. The aim of the guidelines is to guide physicians in the emergency department during initial management of adult and pediatric patients with minimal, mild, and moderate head injuries, specifically to decide which patients are to receive CT scanning, admission, or discharge from the emergency department.

2020 ◽  
Vol 16 (3) ◽  
Author(s):  
Adam K Stanley ◽  
Ashton Barnett-Vanes ◽  
Matthew J Reed

Over a billion Peripheral Intra-Venous Cannulas (PIVC) are used globally every year with at least 25 million sold annually in the UK.1,2 The NHS spends an estimated £29m of its annual acute sector budget on PIVC procurement3 and around 70% of all hospitalised patients require at least one PIVC during their stay.4 Despite their extensive and routine use, PIVC failure rates are reported as high as 50-69%.5-7 In addition, many PIVCs remain unused following insertion, particularly in the Emergency Department (ED).8,9 The risk factors for PIVC failure are not well understood and the literature has found extensive regional variation in practice when it comes to PIVC insertion and management.1,7,10 While various technologies have been developed to address these issues, there remains a need for standardised, evidence-based guidelines.


CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S105-S106
Author(s):  
P. Doran ◽  
G. Sheppard ◽  
B. Metcalfe

Introduction: Canadians are the second largest consumers of prescription opioids per capita in the world. Emergency physicians tend to prescribe stronger and larger quantities of opioids, while family physicians write the most opioid prescriptions overall. These practices have been shown to precipitate future dependence, toxicity and the need for hospitalization. Despite this emerging evidence, there is a paucity of research on emergency physicians’ opioid prescribing practices in Canada. The objectives of this study were to describe our local emergency physicians’ opioid prescribing patterns both in the emergency department and upon discharge, and to explore factors that impact their prescribing decisions. Methods: Emergency physicians from two urban, adult emergency departments in St. John's, Newfoundland were anonymously surveyed using a web-based survey tool. All 42 physicians were invited to participate via email during the six-week study period and reminders were sent at weeks two and four. Results: A total of 21 participants responded to the survey. Over half of respondents (57.14%) reported that they “often” prescribe opioids for the treatment of acute pain in the emergency department, and an equal number of respondents reported doing so “sometimes” at discharge. Eighty-five percent of respondents reported most commonly prescribing intravenous morphine for acute pain in the emergency department, and over thirty-five percent reported most commonly prescribing oral morphine upon discharge. Patient age and risk of misuse were the most frequently cited factors that influenced respondents’ prescribing decisions. Only 4 of the 22 respondents reported using evidence-based guidelines to tailor their opioid prescribing practices, while an overwhelming majority (80.95%) believe there is a need for evidence-based opioid prescribing guidelines for the treatment of acute pain. Sixty percent of respondents completed additional training in safe opioid prescribing, yet less than half of respondents (42.86%) felt they could help to mitigate the opioid crisis by prescribing fewer opioids in the emergency department. Conclusion: Emergency physicians frequently prescribe opioids for the treatment of acute pain and new evidence suggests that this practice can lead to significant morbidity. While further research is needed to better understand emergency physicians’ opioid prescribing practices, our findings support the need for evidence-based guidelines for the treatment of acute pain to ensure patient safety.


2012 ◽  
Vol 54 (8) ◽  
pp. 1041-1045 ◽  
Author(s):  
Anthony W. Chow ◽  
Michael S. Benninger ◽  
Itzhak Brook ◽  
Jan L. Brozek ◽  
Ellie J. C. Goldstein ◽  
...  

Abstract Evidence-based guidelines for the diagnosis and initial management of suspected acute bacterial rhinosinusitis in adults and children were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America comprising clinicians and investigators representing internal medicine, pediatrics, emergency medicine, otolaryngology, public health, epidemiology, and adult and pediatric infectious disease specialties. Recommendations for diagnosis, laboratory investigation, and empiric antimicrobial and adjunctive therapy were developed.


PEDIATRICS ◽  
2013 ◽  
Vol 131 (Supplement 1) ◽  
pp. S103-S109 ◽  
Author(s):  
Lara W. Johnson ◽  
Janie Robles ◽  
Amanda Hudgins ◽  
Shea Osburn ◽  
Devona Martin ◽  
...  

2019 ◽  
Vol 27 (6) ◽  
pp. 557-562
Author(s):  
Heinrich Weber ◽  
Gaylene Bassett ◽  
Doris Bartl ◽  
Mohd Mohd Yusof ◽  
Sukhwinder Sohal ◽  
...  

2020 ◽  
Vol 40 (1) ◽  
pp. 72-80 ◽  
Author(s):  
Laura D. Scherer ◽  
Victoria A. Shaffer ◽  
Tanner Caverly ◽  
Jeff DeWitt ◽  
Brian J. Zikmund-Fisher

Purpose. People vary in their general preferences for more v. less health care, and the validated Medical Maximizing-Minimizing Scale (MMS) reliably measures this orientation. Medical maximizers (people scoring highly on the MMS) prefer to receive more health care visits, medications, tests, and treatments, whereas minimizers prefer fewer services. However, it is unclear how maximizing-minimizing preferences relate to willingness to pursue appropriate health care. We hypothesized that minimizers are at increased risk of rejecting evidence-based high-benefit care and that maximizers are at risk of wanting low-benefit care. Design. In total, 785 US adults recruited through an online panel expressed preferences to receive or forgo a health care intervention in 18 hypothetical scenarios. In 8 scenarios, the intervention was high benefit per evidence-based guidelines. In the remaining 10 scenarios, the intervention was low benefit. We assessed associations between participants’ MMS score and their preferences for medical intervention in each scenario using regression analyses that adjusted for hypochondriasis, health risk tolerance, health status, and demographic variables. Results. MMS score was significantly associated with preferences in all 18 scenarios after adjusting for other variables. The MMS uniquely explained 11% of the variance in preferences for high-benefit care and 29% of the variance in preferences for low-benefit care. Differences between strong minimizers (10th percentile) and strong maximizers (90th percentile) across the 18 scenarios ranged from 5.6 to 32.3 points on a 1 to 100 preference scale. Conclusions. The MMS reliably predicts people’s willingness to pursue appropriate care, both when appropriate care means taking high-benefit actions and when appropriate care means avoiding low-benefit actions. Targeting and tailoring messages according to maximizing-minimizing preferences might increase the effectiveness of both efforts to reduce overutilization of low-benefit services and campaigns to support uptake of high-benefit care.


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