Longitudinal Assessment of Cocaine Toxicity in Emergency Department Patients

Longitudinal data are necessary to identify changes in drug abuse and resultant toxicity. The development of COC-LOG, a longitudinal database used to assess cocaine-associated emergency department patient visits at Truman Medical Center, the University of Missouri-Kansas City, is described. COC-LOG currently contains 1,054 patient visits. The data demonstrate that cocaine toxicity has remained relatively constant in our emergency department (ED) over the last 4 years. The majority of cocaine use is through smoking crack, and major differences in toxicity are not seen between this route and IV cocaine use. The relatively low prevalence of severe cardiac toxicity and deaths has lead to a series of projects to evaluate cocaine toxicity's clinical course. Electrocardiographic abnormalities are common, but do not frequently indicate severe clinical toxicity. In the first 3 years after ED discharge, deaths in cocaine patients occur almost twice as frequently as in age-, race-, and sex-matched control ED patients. Urine drug testing of pregnant patients suggests that documentation of recent cocaine use by history alone underestimates the prevalence of cocaine use in ED patients approximately four-fold. COC-LOG is a useful method of following cocaine's impact on department patients. Study results can be applied to patient care and the education of ED faculty, residents, students, and personnel.

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Uji Akurasi Dataset Pasien Pasca Operasi Menggunakan Algoritma Naïve Bayes Menggunakan Weka Tools

JURIKOM (Jurnal Riset Komputer) ◽

10.30865/jurikom.v7i1.1761 ◽

2020 ◽

Vol 7 (1) ◽

pp. 134

Author(s):

Muhammad Rahmadi ◽

Fazriyanor Kaurie ◽

Tuti Susanti

Keyword(s):

Blood Pressure ◽

Surface Temperature ◽

Kansas City ◽

Medical Center ◽

Data Sets ◽

University Of Kansas ◽

Postoperative Patient ◽

Data Set ◽

University Of Missouri ◽

School Of Nursing

Postoperative patient data sets taken for testing of this data are sourced from the UCI repository on the website https://archive.ics.uci.edu/ml/datasets/Post-Operative+Patient. Based on the website address, the study was conducted by Sharon Summers, School of Nursing, University of Kansas, Medical Center, Kansas City, KS 66160 and Linda Woolery, School of Nursing, University of Missouri, Columbia, MO 6521. Number of attributes from this data set there are 8 and 1 class, the attributes in question include; L-CORE (patient's internal temperature in C), L-SURF (patient's surface temperature in C), L-O2 (oxygen saturation in%), L-BP (last measurement of blood pressure), SURF-STBL (stability of the patient's surface temperature ), CORE-STBL (stability of the patient), BP-STBL (stability of the patient's blood pressure), COMFORT (perceived comfort of the patient at discharge, measured as an integer between 0 and 20) and ADM-DECS decision class / patient exit decision with information (I = patient sent to intensive care unit, S = patient ready to go home, A = patient sent to general hospital floor).

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Emergency department patient 'dumping': an analysis of interhospital transfers to the Regional Medical Center at Memphis, Tennessee.

American Journal of Public Health ◽

10.2105/ajph.78.10.1287 ◽

1988 ◽

Vol 78 (10) ◽

pp. 1287-1292 ◽

Cited By ~ 33

Author(s):

A L Kellermann ◽

B B Hackman

Keyword(s):

Emergency Department ◽

Medical Center ◽

Emergency Department Patient ◽

Regional Medical ◽

Regional Medical Center

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A Look at the Educational Responsibilities and Cost Impact of the Docent Clinical Pharmacist

Drug Intelligence & Clinical Pharmacy ◽

10.1177/106002808001400405 ◽

1980 ◽

Vol 14 (4) ◽

pp. 266-271

Author(s):

Joel O. Covinsky ◽

Stephen Hamburger ◽

Edward J. Twin

Keyword(s):

Medical School ◽

Clinical Pharmacist ◽

Kansas City ◽

Medical Center ◽

Full Time ◽

University Of Missouri ◽

Cost Impact ◽

Primary Teaching ◽

The Cost ◽

The University

One innovation at Truman Medical Center, the primary teaching hospital of the University of Missouri-Kansas City, is the addition of the clinical pharmacist as a full-time member of the patient-care and educational teams. These practitioner-educators share responsibility for the patients' drug therapies and for the provision of instruction in basic pharmacology and pharmacotherapeutics in the medical school. Examination of the cost impact of these practitioners in separate studies indicates that they reduce drug costs. The unique pharmacology program provided solely by these clinical pharmacists is both well received and successful.

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Feasibility and Effectiveness of Recruiting Latinos in Decídetexto—A Smoking Cessation Clinical Trial from an Emergency Department Patient Registry

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182010859 ◽

2021 ◽

Vol 18 (20) ◽

pp. 10859

Author(s):

Evelyn Arana-Chicas ◽

Francisco Cartujano-Barrera ◽

Chinwe Ogedegbe ◽

Edward F. Ellerbeck ◽

Lisa Sanderson Cox ◽

...

Keyword(s):

Clinical Trial ◽

Emergency Department ◽

Smoking Cessation ◽

Regression Models ◽

Primary Outcome ◽

Medical Center ◽

Emergency Department Patient ◽

Time Of Day ◽

Patient Registry ◽

Day Of The Week

There is an underrepresentation of Latinos in smoking cessation clinical trials. This study describes the feasibility and effectiveness of recruiting Latino smokers in the U.S. from an emergency department (ED) patient registry into a randomized smoking cessation clinical trial. Recruitment occurred from the Hackensack University Medical Center ED. Potential participants were contacted from a patient registry. The primary outcome was whether the participant responded to a call or text. Secondary outcomes included the best day of the week, week of the month, and time of day to obtain a response. Of the 1680 potential participants, 1132 were called (67.5%), while 548 (32.5%) were texted. For calls, response rate was higher compared to text (26.4% vs 6.4%; p < 0.001). More participants were interested in the study when contacted by calls compared to text (11.4% vs. 1.8%) and more participants were enrolled in the study when contacted by calls compared to text (1.1% vs. 0.2%). Regression models showed that ethnicity, age, time of day, and week of the month were not significantly associated with response rates. Recruitment of Latinos from an ED patient registry into a smoking cessation clinical trial is feasible using call and text, although enrollment may be low.

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The acute scrotum: Frequency and range of etiologies in a Middle Eastern setting

Urologia Journal ◽

10.1177/0391560319858491 ◽

2019 ◽

Vol 87 (1) ◽

pp. 15-18 ◽

Cited By ~ 1

Author(s):

Rami Nasr ◽

Ziad Tayara ◽

Ramy Abou Ghayda ◽

Ibrahim Alsheikh Deeb ◽

Diamond Ghieh ◽

...

Keyword(s):

Emergency Department ◽

Confidence Interval ◽

Medical Center ◽

Middle Eastern ◽

Acute Scrotum ◽

Scrotal Pain ◽

American University ◽

American University Of Beirut ◽

Acute Scrotal Pain ◽

Study Results

Aim: To investigate the frequency of different etiologies of acute scrotal pain in males presenting to the emergency department at American University of Beirut Medical Center in Beirut, Lebanon. Materials and Methods: In all, 94 patients between the ages 18 and 40 years presenting to the emergency room at American University of Beirut Medical Center with acute scrotum were recruited. The scrotum was inspected with palpation, and Doppler Ultrasound of the testicle was performed by a radiology resident to confirm the diagnosis. The study results were then collected after the official reports were signed by a board-certified radiology attending with expertise in ultrasound. Results: Of the 94 patients presenting with acute scrotal pain, 23.4% (95% confidence interval (0.70–0.87)) had no ultrasound findings and were considered normal. On the other hand, 54.3% (95% confidence interval (0.45–0.66)) were diagnosed with varicocele, 9.6% (95% confidence interval (0.04–0.16)) were diagnosed with epididymo-orchitis, and 9.6% (95% confidence interval (0.04–0.16)) had a history of trauma to the testicle. Patients presenting with acute scrotum had a pain duration of 13.2 ± 4.5 h, with 10.6% (95% confidence interval (0.04–0.17)) having associated urinary symptoms, 18.1% (95% confidence interval (0.09–0.25)) have had sexual activity within 48 h of presentation, and 10.6% (95% confidence interval (0.04–0.17)) were pre-diagnosed with varicocele. Conclusion: Varicocele is the most common cause of acute scrotal pain in patients presenting to American University of Beirut Medical Center in Beirut. This should direct varicocele to the top of our differential when a patient with acute scrotum presents to the emergency department. Nevertheless, ruling out torsion remains the first step in the workup.

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William S. Worley. J. C. Nichols and the Shaping of Kansas City: Innovation in Planned Residential Communities. Columbia: University of Missouri Press. 1990. Pp. xxv, 324. $29.50

The American Historical Review ◽

10.1086/ahr/96.5.1632 ◽

1991 ◽

Keyword(s):

Kansas City ◽

Columbia University ◽

University Of Missouri ◽

Residential Communities

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Delirium in the Older Emergency Department Patient: A Quiet Epidemic

Emergency Medicine Clinics of North America ◽

10.1016/j.emc.2010.03.005 ◽

2010 ◽

Vol 28 (3) ◽

pp. 611-631 ◽

Cited By ~ 64

Author(s):

Jin H. Han ◽

Amanda Wilson ◽

E. Wesley Ely

Keyword(s):

Emergency Department ◽

Emergency Department Patient

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THU0417 READMISSION RISK AND QUALITY OF CARE IN PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT WITH GOUT FLARES

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3302 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 446.2-446

Author(s):

L. Brunetti ◽

J. Vekaria ◽

P. Lipsky ◽

N. Schlesinger

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Economic Burden ◽

Hospital Admissions ◽

Medical Center ◽

Research Support ◽

Increased Risk ◽

Comorbidity Index ◽

Anti Inflammatory ◽

Gout Flares

Background:Gout is the most common form of inflammatory arthritis and its economic burden is substantial, with estimates for the overall cost exceeding $20 billion (US) annually. Contributing to the economic burden are hospital admissions and iatrogenic events associated with pharmacotherapy. Identification of modifiable risk factors would be an important contribution to clinical practice.Objectives:The aim of this study was to identify opportunities for enhancing gout care in patients presenting to the Emergency Department (ED) with gout flares.Methods:This retrospective cohort study used data from electronic medical records (EMR) at a large community hospital. All consecutive patients visiting the medical center ED with a primary diagnosis of gout from 1/1/2016 to 7/1/2019 were included. Patients were then followed for 90 days to determine whether they were readmitted to the ED for any reason. A chart review identified whether they were on appropriate medications in terms of gout flare management. All data were summarized using descriptive statistics. A multiple logistic regression was constructed to identify risk factors for ED utilization within 90 days of the index visit.Results:A total of 214 patients were included in the analysis. Most patients were male (79%), mean age was 59.4 ± 15.6 years, and mean Charlson comorbidity index was 0.5 ± 1.14. The most common medications prescribed during the ED visit included NSAIDs (41.6%), opioids (28%), corticosteroids (26.6%), and colchicine (21%). Allopurinol and febuxostat were initiated in the ED in 4.7% and 0.9%, respectively. Discharge medications for the management of gout included NSAIDs (37%), corticosteroids (34.6%), opioids (23.8%), colchicine (14%), febuxostat (7%), and allopurinol (6.5%). Of the patients sent home with an opioid, 40% were newly prescribed. An anti-inflammatory medication was not prescribed in 29.6% of patients discharged from the ED. Readmission within 90 days was recorded in 16.8% of patients. Of these readmissions, 33.3% were gout-related and 11.1% were cardiac related.After adjusting for age and comorbidity index, patients receiving colchicine were 2.8 times more likely (OR, 2.81; 95% CI, 1.12 to 7.02; p=0.027) to return to the ED within 90 days. The most common cause of readmission in this subset was gout-related (54.5%).Conclusion:Nearly 30% of patients were discharged from the ED without an anti-inflammatory medication, whereas initiation of urate lowering therapy was rare. Opiates were used frequently, but the indication was uncertain. Only 5.6% of subjects revisited the ED for gout-related diagnoses in the subsequent 3 months. Colchicine prescription was associated with an increased risk of gout-related ED utilization within 90 days. Treatment of gout in the ED is sub-optimal and often does not follow established guidelines.Disclosure of Interests: :Luigi Brunetti Grant/research support from: Astellas Pharma, CSL Behring, Consultant of: Horizon Foundation of New Jersey, Janaki Vekaria: None declared, Peter Lipsky Consultant of: Horizon Therapeutics, Naomi Schlesinger Grant/research support from: Pfizer, AMGEN, Consultant of: Novartis, Horizon Pharma, Selecta Biosciences, Olatec, IFM Therapeutics, Mallinckrodt Pharmaceuticals, Speakers bureau: Takeda, Horizon

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Disagreement between emergency department admission diagnosis and hospital discharge diagnosis: mortality and morbidity

Diagnosis ◽

10.1515/dx-2015-0028 ◽

2016 ◽

Vol 3 (1) ◽

pp. 23-30 ◽

Cited By ~ 5

Author(s):

James Eames ◽

Arie Eisenman ◽

Richard J. Schuster

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Medical Center ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Admission Diagnosis ◽

Mortality And Morbidity ◽

Emergency Department Admission ◽

Icu Length Of Stay ◽

Discordant Group

AbstractPrevious studies have shown that changes in diagnoses from admission to discharge are associated with poorer outcomes. The aim of this study was to investigate how diagnostic discordance affects patient outcomes.: The first three digits of ICD-9-CM codes at admission and discharge were compared for concordance. The study involved 6281 patients admitted to the Western Galilee Medical Center, Naharyia, Israel from the emergency department (ED) between 01 November 2012 and 21 January 2013. Concordant and discordant diagnoses were compared in terms of, length of stay, number of transfers, intensive care unit (ICU) admission, readmission, and mortality.: Discordant diagnoses was associated with increases in patient mortality rate (5.1% vs. 1.5%; RR 3.35, 95% CI 2.43, 4.62; p<0.001), the number of ICU admissions (6.7% vs. 2.7%; RR 2.58, 95% CI 2.07, 3.32; p<0.001), hospital length of stay (3.8 vs. 2.5 days; difference 1.3 days, 95% CI 1.2, 1.4; p<0.001), ICU length of stay (5.2 vs. 3.8 days; difference 1.4 days, 95% CI 1.0, 1.9; p<0.001), and 30 days readmission (14.11% vs. 12.38%; RR 1.14, 95% CI 1.00, 1.30; p=0.0418). ED length of stay was also greater for the discordant group (3.0 vs. 2.9 h; difference 8.8 min; 95% CI 0.1, 0.2; p<0.001): These findings indicate discordant admission and discharge diagnoses are associated with increases in morbidity and mortality. Further research should identify modifiable causes of discordance.

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