scholarly journals Ill, Itinerant, and Insured: The Top 20 Users of Emergency Departments in Baltimore City

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Barbara Y. DiPietro ◽  
Dana Kindermann ◽  
Stephen M. Schenkel
Keyword(s):  
Emergency Departments ◽  
Social Factor ◽  
Homeless People ◽  
Chronic Illnesses ◽  
Limb Pain ◽  
Baltimore City ◽  
Administrative Records ◽  
Immunodeficiency Virus ◽  
High Acuity ◽  
Alteration Of Consciousness

The purpose of this study was to document the clinical and demographic characteristics of the 20 most frequent users of emergency departments (EDs) in one urban area. We reviewed administrative records from three EDs and two agencies providing services to homeless people in Baltimore City. The top 20 users accounted for 2,079 visits at the three EDs. Their mean age was 48, and median age was 51. Nineteen patients visited at least 2 EDs, 18 were homeless, and 13 had some form of public insurance. The vast majority of visits (86%) were triaged as moderate or high acuity. The five most frequent diagnoses were limb pain (n=9), lack of housing (n=6), alteration of consciousness (n=6), infection with human immunodeficiency virus (HIV) (n=5), and nausea/vomiting (n=5). Hypertension, HIV infection, diabetes, substance abuse, and alcohol abuse were the most common chronic illnesses. The most frequent ED users were relatively young, accounted for a high number of visits, used multiple EDs, and often received high triage scores. Homelessness was the most common characteristic of this patient group, suggesting a relationship between this social factor and frequent ED use.

Sexually Transmitted Infection Screening Among Gay, Bisexual, and Other Men Who Have Sex With Men Prescribed Pre-exposure Prophylaxis in Baltimore City, Maryland

2019 ◽  
Vol 71 (10) ◽  
pp. 2637-2644 ◽  
Author(s):  
Christina Schumacher ◽  
Linxuan Wu ◽  
Aruna Chandran ◽  
Errol Fields ◽  
Ashley Price ◽  
...  
Keyword(s):  
Sexual Practices ◽  
Anatomic Site ◽  
Transmitted Infection ◽  
Baltimore City ◽  
Sti Prevention ◽  
Screening Guidelines ◽  
Sexually Transmitted ◽  
Immunodeficiency Virus ◽  
Sex With Men ◽  
Exposure Prophylaxis

Abstract Background Human immunodeficiency virus pre-exposure prophylaxis (PrEP) clinical guidelines recommend men who have sex with men (MSM) PrEP users be screened biannually for syphilis and gonorrhea/chlamydia at all anatomic sites. We sought to determine the proportion screened and positive by STI and anatomic site at PrEP initiation and PrEP-care visits and patient-level characteristics associated with screening among MSM PrEP users in Baltimore City, Maryland. Methods Medical records among MSM initiating PrEP between 30 September 2015 and 31 March 2018 were abstracted. STI screening (syphilis and gonorrhea/chlamydia at all anatomic sites) and positivity at PrEP visits ≤12 months following initiation were calculated. Poisson regression with cluster robust SEs was used to assess associations with STI screening. Results Among 290 MSM initiating PrEP, 43.1% (n = 125) were screened per guidelines at PrEP initiation; 79.3% (230), 69.3% (201), 55.9% (162), and 69.3% (201) were screened for syphilis, urogenital, rectal, and oropharyngeal gonorrhea/chlamydia, respectively. Positivity among those screened was syphilis, 7.8% (n = 18/230); gonorrhea, 5.0% urogenital (10/201), 11.1% rectal (18/162), and 7.5% oropharyngeal (15/201); chlamydia, 5.0% urogenital (10/201), 11.7% rectal (19/162), and 1.5% oropharyngeal (3/201). Reported anal and oral sex (vs neither) was independently associated with STI screening (aPR, 2.11; 1.05–4.27) at PrEP initiation. At biannual PrEP-care visits, STI screening was lower and syphilis and rectal gonorrhea/chlamydia positivity was higher. Conclusions Observed STI screening levels and disease burden suggest the effectiveness of STI screening in PrEP care for STI prevention may be limited. Our results suggest providers may be offering screening based on sexual practices; clarification of STI screening guidelines for PrEP users is needed.

scholarly journals Homeless people under the influence of alcohol admitted to hospital emergency departments in Poland

2020 ◽  
Vol 37 (2) ◽  
pp. 190-200
Author(s):  
Anna Burak ◽  
Katarzyna Cierzniakowska ◽  
Aleksandra Popow
Keyword(s):  
Alcohol Use ◽  
Emergency Departments ◽  
Average Length ◽  
Blood Alcohol Concentration ◽  
Homeless People ◽  
Medical Personnel ◽  
Alcohol Concentration ◽  
Blood Alcohol ◽  
Hospital Emergency ◽  
Hospital Emergency Departments

Aim: To assess the incidence of diagnoses related to alcohol use in the population of homeless people admitted to hospital emergency departments (EDs). Material and method: Data were analysed from three hospitals concerning stays of homeless people in three EDs in Bydgoszcz, Poland, in 2013–2015; 3133 stays were identified. The data were compiled using Microsoft Excel and Statistica 10 statistical software. Results: At the time of admission to EDs, 31% of homeless people were considered to be under the influence of alcohol. Diagnoses related to alcohol use accounted for 25% of all diagnoses. The average blood alcohol concentration in the patients was 2.97 per mille. The average blood alcohol concentration in the group of men was significantly higher than that in the group of women ( p = 0.015). The average length of stay in the ED of patients under the influence of alcohol was significantly longer ( p < 0.0001) than among sober patients. Conclusions: Homeless people under the influence of alcohol account for a third of the population of homeless patients admitted to hospital emergency departments, while alcohol-related ICD-10 diagnoses account for a fourth of all diagnoses in these patients. Homeless patients under the influence of alcohol stay longer in hospital emergency departments than do sober homeless people, which may translate into more frequent acts of aggression towards medical personnel. In Poland there are no systemic ED-level solutions as regards dealing with homeless patients for whom alcohol dependence is in many cases a reality.

Education of Children with Human Immunodeficiency Virus Infection

PEDIATRICS ◽  
1991 ◽  
Vol 88 (3) ◽  
pp. 645-648 ◽  
Author(s):  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Educational Programs ◽  
Chronic Illnesses ◽  
Related Services ◽  
School Population ◽  
Immunodeficiency Virus ◽  
Age Appropriate ◽  
Appropriate Education ◽  
Neurodevelopmental Problems

As the incidence of HIV infection in children increases, so will the school population of children with this disease. With the advent of new drug therapy, it is likely that these children will have a longer survival resulting in an increasing number of HIV-infected children entering school. An understanding of the effect of chronic illness and the recognition of neurodevelopmental problems in these children is essential to provide appropriate educational programs. The Academy recommends that: 1. All children with HIV infection should receive an appropriate education that is adapted to their evolving special needs. The spectrum of needs differs with the stage of the disease. 2. HIV infection should be treated like other chronic illnesses that require special education and other related services. 3.Continuity of education must be assured whether at school or at home. 4.Because of the stigmatization that still exists with this disease, it is essential that confidentiality be maintained by limiting disclosures and disclosing information only with the informed consent of the parents or legal guardians and age-appropriate assent of the student.

scholarly journals Modest Public Health Impact of Nontargeted Human Immunodeficiency Virus Screening in 29 Emergency Departments

2012 ◽  
Vol 172 (1) ◽  
pp. 12 ◽  
Author(s):  
Kayigan Wilson d’Almeida ◽  
Gérald Kierzek ◽  
Pierre de Truchis ◽  
Stéphane Le Vu ◽  
Dominique Pateron ◽  
...  
Keyword(s):  
Public Health ◽  
Human Immunodeficiency Virus ◽  
Emergency Departments ◽  
Health Impact ◽  
Public Health Impact ◽  
Immunodeficiency Virus ◽  
Human Immunodeficiency Virus Screening ◽  
Virus Screening

scholarly journals Essential Nursing Competencies for Genetics and Genomics: Implications for Critical Care

2011 ◽  
Vol 31 (5) ◽  
pp. e1-e7 ◽  
Author(s):  
Lynnette Howington ◽  
Kristina Riddlesperger ◽  
Dennis J. Cheek
Keyword(s):  
Critical Care ◽  
Genetic Factors ◽  
Virus Disease ◽  
Quality Care ◽  
Critical Care Nurses ◽  
Chronic Illnesses ◽  
Genetic Knowledge ◽  
Immunodeficiency Virus ◽  
Nursing Organizations ◽  
Genetics And Genomics

The implications of genetics and genomics for critical care nurses are becoming more evident, not only in the care provided but also in the numerous medications administered. Genetic causes are being discovered for an increasing number of chronic illnesses and diseases, such as Huntington disease. Because of the scientific and pharmacological advances, leading nursing organizations, such as the American Nurses Association, have established competencies in genetic knowledge for nurses. Such competencies help ensure quality care. Recent advances in the pharmacogenomics of therapy for human immunodeficiency virus disease, cancer, cardiovascular disease, and malignant hyperthermia have indicated a genetic linkage; therefore treatments are targeted toward the genetic aspect of the abnormality. Critical care nurses need knowledge of these genetic conditions and of medications affected by genetic factors.

scholarly journals Analyzing Main and Interaction Effects of Length of Stay Determinants in Emergency Departments

2019 ◽  
Author(s):  
Gorkem Sarıyer ◽  
Mustafa Gökalp Ataman ◽  
İlker Kızıloğlu
Keyword(s):  
Length Of Stay ◽  
Emergency Departments ◽  
Secondary Data ◽  
The Elderly ◽  
Interaction Effects ◽  
Urban Hospital ◽  
Main Effect ◽  
High Acuity ◽  
Main Determinants ◽  
Ed Operations

Background: Measuring and understanding main determinants of length of stay (LOS) in emergency departments (EDs) is critical from an operations perspective, since LOS is one of the main performance indicators of ED operations. Therefore, this study analyzes both the main and interaction effects of four widely-used independent determinants of ED-LOS. Methods: The analysis was conducted using secondary data from an ED of a large urban hospital in Izmir, Turkey. Between-subject factorial analysis of variance (ANOVA) was used to test the main and interaction effects of the corresponding factors. P values <.05 were considered statistically significant. Results: While the main effect of gender was insignificant, age, mode of arrival, and clinical acuity had significant effects, whereby ED-LOS was significantly higher for the elderly, those arriving by ambulance, and clinically-categorized high-acuity patients. Additionally, there was an interaction between the age and clinical acuity in that, while ED-LOS increased with age for high acuity patients, the opposite trend occurred for low acuity patients. When ED-LOS was modeled using gender, age, and mode of arrival, there was a significant interaction between age and mode of arrival. However, this interaction was not significant when the model included age, mode of arrival, and clinical acuity. Conclusion: Significant interactions exist between commonly used ED-LOS determinants. Therefore, interaction effects should be considered in analyzing and modelling ED-LOS.

Adolescents' Perception of Epilepsy Compared With Other Chronic Diseases: “Through a Teenager's Eyes”

2006 ◽  
Vol 21 (3) ◽  
pp. 214-222 ◽  
Author(s):  
Christina Cheung ◽  
Elaine Wirrell
Keyword(s):  
Down Syndrome ◽  
Chronic Disease ◽  
Chronic Diseases ◽  
Social Impact ◽  
Tertiary Care ◽  
Chronic Illnesses ◽  
Cognitively Normal ◽  
Immunodeficiency Virus ◽  
Parental Perspectives ◽  
Physical Impact

Adolescent perception of physical and social impact of chronic illness was assessed to determine (1) if there is greater prejudice toward epilepsy than other chronic disease and (2) if adolescents with chronic disease have less prejudice toward similarly affected peers with all types of chronic disease or just their specific chronic disease. Cognitively normal teens aged 13 to 18 years without chronic disease ( n = 41) and with epilepsy ( n = 32), asthma ( n = 38), diabetes ( n = 21), and migraine ( n = 17) were interviewed in the outpatient clinics of a tertiary care pediatric center regarding their perceptions of the physical and social impact of eight chronic diseases (epilepsy, asthma, diabetes, Down syndrome, arthritis, migraine, leukemia, human immunodeficiency virus [HIV] infection). Epilepsy was perceived to have a more adverse physical impact than all chronic illnesses except Down syndrome. The perception was that it more frequently caused mental handicap, injured the afflicted individual and bystanders, and led to death. Epilepsy was also perceived to have a more negative social impact, particularly on behavior, honesty, popularity, adeptness at sports, and fun. Significantly more adolescents expressed reluctance to befriend peers with epilepsy, both from their own and their perceived parental perspectives. Having a chronic disease did not generally alter the adolescents' perceptions of peers with chronic disease. However, cases with epilepsy ranked this disease to have less social impact than teens with other chronic diseases. In conclusion, adolescents consider epilepsy to have a greater physical and social impact than most chronic diseases. Educational efforts should focus on the “normality” of most persons with epilepsy and emphasize the low risk of injury when proper first aid is followed. ( J Child Neurol 2006;21:214—222; DOI 10.2310/7010.2006.00053).

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