Arabin Cerclage Pessary as a Treatment of an Acute Urinary Retention in a Pregnant Woman with Uterine Prolapse

A 35-year-old gravida 7, para 1, and abortus 5 female with hypogastric pain and inability to void urine after 14 + 3 weeks of amenorrhea was examined in the emergency department. One year before, a uterine prolapse had been diagnosed in another hospital. Examination showed a uterine prolapse grade 2 with palpable bladder. The patient was unable to void urine. After a manual reduction of the uterine prolapse, the patient underwent an emergency catheterization for bladder drainage. A Hodge pessary (size 70) was placed, which led to spontaneous micturitions. Due to the persistence of the symptoms the following day, Hodge pessary was replaced by an Arabin cerclage pessary. Although the pessary could be removed from the beginning of the second trimester, due to the uterine prolapse as a predisposing factor in the patient and the uncomplicated progression of pregnancy, it was decided to maintain it in our patient. Therefore, Arabin cerclage pessary allowed a successful pregnancy outcome and was not associated with threatened preterm delivery or vaginal infection.

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Geriatrische revalidatiezorg na triage op de Spoedeisende Hulp: Patiëntkarakteristieken en revalidatie-uitkomsten

Tijdschrift voor Gerontologie en Geriatrie ◽

10.36613/tgg.1875-6832/2019.01.02 ◽

2019 ◽

Keyword(s):

Emergency Department ◽

Residential Care ◽

Functional Decline ◽

Care Facility ◽

Geriatric Rehabilitation ◽

Residential Care Facility ◽

Successful Group ◽

Geriatrische Revalidatiezorg ◽

One Year ◽

Single Contact

In the Netherlands geriatric rehabilitation is possible (among others) for patients who are selected by a geriatrician at the emergency department of a hospital. The aim of this study was to investigate the rehabilitation trajectory of patients who were selected for geriatric rehabilitation at the emergency department after a single contact with the geriatrician and to identify patient factors related to rehabilitation outcome. Successful rehabilitation was defined as discharge to home or a residential care facility after a maximum of 6 months. All patients who in 2016 were selected for geriatric rehabilitation were included. Data were collected retrospectively from electronic patient files. 74 patients were included (mean age 84.7 years). 84% were successfully discharged home or to a residential care facility within six months. The presentation with a fall and the absence of a partner at home was higher in the unsuccessful group. In the successful group more patients lived independent and without professional help prior to rehabilitation. Noteworthy is that the analysed patient group is a frail group, considering the high one-year mortality (21,6%) and overall functional decline despite geriatric rehabilitation.

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Does Active Smoking Influence the Second Trimester Biochemical Markers Concentrations?

Revista de Chimie ◽

10.37358/rc.17.10.5862 ◽

2017 ◽

Vol 68 (10) ◽

pp. 2234-2236

Author(s):

Dan Navolan ◽

Florin Birsasteanu ◽

Adrian Carabineanu ◽

Octavian Cretu ◽

Diana Liana Badiu ◽

...

Keyword(s):

Pregnant Woman ◽

Pregnant Women ◽

Cigarette Smoke ◽

Chorionic Gonadotropin ◽

Reference Values ◽

Biochemical Markers ◽

Smoking Status ◽

Active Smoking ◽

Second Trimester ◽

Harmful Effects

Cigarette smoke contains over 7000 different substances some of them exerting harmful effects on embryo and pregnant woman. Nowadays 15 % of adult people and around 10-15% of pregnant women smoke. Previous studies showed that cigarette smoke compounds could exert pharmacodinamic effects and influence some of the second trimester biochemical markers concentration. Therefore there is a need to adjust the reference values of second trimester markers depending of the smoker status. The aim of our study was to analyse which of the markers are influenced by smoking and whether the software used to calculate the risk for aneuploidies is able to counterbalance this influence. Alpha-fetoprotein (AFP), chorionic gonadotropin hormone (hCG) and free estriol (uE3) values were measured in second trimester sera of 1242 pregnant women: 1089 non-smokers and 153 smokers. Only hCG second trimester values were influenced by smoking whereas AFP and uE3 values were not. The correction of medians according to the smoking status was able to counterbalance this effect.

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Harnessing the Chaplain’s Capacity to Identify Unmet Palliative Needs of Vulnerable Older Adults in the Emergency Department

Journal of Palliative Care ◽

10.1177/08258597211003359 ◽

2021 ◽

pp. 082585972110033

Author(s):

Elizabeth Hamill Howard ◽

Rachel Schwartz ◽

Bruce Feldstein ◽

Marita Grudzen ◽

Lori Klein ◽

...

Keyword(s):

Emergency Department ◽

Palliative Care ◽

End Of Life Care ◽

Older Patients ◽

Chart Review ◽

Retrospective Chart Review ◽

Life Care ◽

Emergency Medicine Physician ◽

Medicine Physician ◽

One Year

Objective: To explore chaplains’ ability to identify unmet palliative care (PC) needs in older emergency department (ED) patients. Methods: A palliative chaplain-fellow conducted a retrospective chart review evaluating 580 ED patients, age ≥80 using the Palliative Care and Rapid Emergency Screening (P-CaRES) tool. An emergency medicine physician and chaplain-fellow screened 10% of these charts to provide a clinical assessment. One year post-study, charts were re-examined to identify which patients received PC consultation (PCC) or died, providing an objective metric for comparing predicted needs with services received. Results: Within one year of ED presentation, 31% of the patient sub-sample received PCC; 17% died. Forty percent of deceased patients did not receive PCC. Of this 40%, chaplain screening for P-CaRES eligibility correctly identified 75% of the deceased as needing PCC. Conclusion: Establishing chaplain-led PC screenings as standard practice in the ED setting may improve end-of-life care for older patients.

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Functional Decline in Emergency Department Patients with Dyspnea; a Register-Based Cohort

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzab047 ◽

2021 ◽

Author(s):

Karoline Stentoft Rybjerg Larsen ◽

Marianne Lisby ◽

Hans Kirkegaard ◽

Annemette Krintel Petersen

Keyword(s):

Emergency Department ◽

Electronic Patient Record ◽

Hospital Admissions ◽

Functional Decline ◽

Patient Characteristics ◽

Risk Of Death ◽

Record Data ◽

Emergency Department Patients ◽

One Year ◽

Historic Cohort

Abstract Background Functional decline is associated with frequent hospital admissions and elevated risk of death. Presumably patients acutely admitted to hospital with dyspnea have a high risk of functional decline. The aim of this study was to describe patient characteristics, hospital trajectory, and use of physiotherapy services of dyspneic patients in an emergency department. Furthermore, to compare readmission and death among patients with and without a functional decline, and to identify predictors of functional decline. Methods Historic cohort study of patients admitted to a Danish Emergency Department using prospectively collected electronic patient record data from a Business Intelligence Registry of the Central Denmark Region. The study included adult patients that due to dyspnea in 2015 were treated at the emergency department (ED). The main outcome measures were readmission, death, and functional decline. Results In total 2,048 dyspneic emergency treatments were registered. Within 30 days after discharge 20% was readmitted and 3.9% had died. Patients with functional decline had a higher rate of 30-day readmission (31.2% vs. 19.1%, p<0.001) and mortality (9.3% vs. 3.6%, p=0.009) as well as mortality within one year (36.1% vs. 13.4%, p<0.001). Predictors of functional decline were age ≥60 years and hospital stay ≥6 days. Conclusion Patients suffering from acute dyspnea are seen at the ED at all hours. In total one in five patients were readmitted and 3.9% died within 30 days. Patients with a functional decline at discharge seems to be particularly vulnerable.

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A Pregnant Woman with Type 2 Diabetes Unintentionally Exposed to Metformin and Voglibose until the Second Trimester of Pregnancy: A Case Report

Journal of Korean Diabetes ◽

10.4093/jkd.2016.17.4.277 ◽

2016 ◽

Vol 17 (4) ◽

pp. 277

Author(s):

Yeo Un Kim ◽

Jae Hoon Kwak ◽

Se Hwan Yeo ◽

Seong Su Moon ◽

Young Sil Lee

Keyword(s):

Type 2 Diabetes ◽

Case Report ◽

Pregnant Woman ◽

Second Trimester

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Abstract 3097: Acute In-hospital Stroke: How Do We Do Compared To Strokes In The Emergency Department?

Stroke ◽

10.1161/str.43.suppl_1.a3097 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Dolora Wisco ◽

Christopher Newey ◽

Pravin George ◽

James Gebel

Keyword(s):

Emergency Department ◽

Time Window ◽

Stroke Treatment ◽

Intravenous Tissue Plasminogen Activator ◽

Tertiary Center ◽

Neuro Imaging ◽

One Year ◽

To Receive ◽

Iv Tpa ◽

Arterial Thrombolysis

Introduction: Intravenous tissue plasminogen activator (IV tPA) has been approved for treating strokes up to 3 hours after onset of symptoms and may be beneficial up to 4.5 hours in patients who qualify. Additionally, neuro-intervention, i.e., intra-arterial thrombolysis or thrombectomy, is also an approved treatment option. Population studies show that 6% receive IV tPA within 3 hours of stroke onset. However, in-hospital strokes present challenges to treating within an adequate time. We present here our experience with in-hospital strokes, treatments, and identifiable delays in treatments. Methods: Single, tertiary center retrospective study of 55 in-hospital strokes over a one-year period from January 2009 to January 2010, and strokes in the Emergency Department over 6 month period from January 2010 to June 2010. Results: Twenty-nine in-hospital strokes were evaluated within 3 hours of symptoms onset. Two (6.9%) received IV tPA, and four (13.8%) received neuro-intervention (either intra-arterial thrombolysis or thrombectomy). None of the patients who presented greater than 3 hours after symptom onset was treated with any treatment (n=28). When compared to patients who present to the ED within 3 hours, in-hospital strokes were less likely to get IV tPA (6.9% vs. 20.8%), and they were more likely to receive neuro-intervention (13.8% vs. 10.3%). Neuro-intervention was performed on 9.09% of all in-hospital strokes (1 of 5 presented beyond the 3 hour time window). For in-hospital strokes that receive any treatment within 3 hours, the average time to neurology evaluation, to CT, and to treatment are 35 min, 68 min, and 237 min, respectively. For strokes in the Ed, the average time to evaluation, to CT, and to treatment are 90 min, 28 min, and 66 min respectively. The delay for in-hospital strokes is in obtaining the CT and initiating the treatment. Discussion: In-hospital stroke patients wait longer than their ED counterparts to be taken to CT and to receive stroke treatment. They are also less likely to receive IV tPA, and more likely to receive neuro-intervention. The longer time to neuro-imaging and thrombolytic treatment may reflect the fact that patients suffering in-hospital strokes have more complex medical co-morbidities that must be taken account during the evaluation and administration of thrombolytic therapy.

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