scholarly journals Emergency department visits for psychiatric care during the first lockdown in Melbourne

2021 ◽  
pp. 103985622110373
Author(s):  
Karuppiah Jagadheesan ◽  
Vijay Danivas ◽  
Annie Itrat ◽  
Vinay Lakra
Keyword(s):  
Emergency Department ◽  
Psychotic Disorders ◽  
Psychiatric Care ◽  
Control Period ◽  
Patient Characteristics ◽  
Emergency Department Visits ◽  
North West ◽  
The North ◽  
English Speaking ◽  
Acute Psychiatric Care

Objective: We investigated the nature of patients presenting to an emergency department (ED) during the first lockdown in Melbourne. Method: This study compared adult patients in the North West Area Mental Health Service catchment area who presented to the local ED during the lockdown (16 March–12 May 2020) and the control (16 March–12 May 2019) periods. Results: The control and lockdown periods included 321 and 332 patients, respectively. Compared to the control period, patients with non-English speaking backgrounds and presenting complaints of suicidal behaviour were lower, whereas patients with anxiety symptoms and needing compulsory assessments were higher in the lockdown period. Diagnostically, the lockdown period included more patients with anxiety disorders, substance use disorders and psychotic disorders. Conclusions: ED access for acute psychiatric care can vary depending upon certain patient characteristics during lockdowns.

scholarly journals Emergency department visits among patients transported by law enforcement officers

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244679
Author(s):  
David L. Rosen ◽  
Debbie Travers
Keyword(s):  
Emergency Department ◽  
Law Enforcement ◽  
Psychotic Disorders ◽  
Census Data ◽  
Health And Safety ◽  
Law Enforcement Officers ◽  
Patient Characteristics ◽  
Emergency Department Visits ◽  
Rural Counties ◽  
The Impact

Law enforcement officers frequently encounter people with health conditions. We sought to estimate the rates, diagnoses, and characteristics of emergency department (ED) visits among patients transported directly by law enforcement. We analyzed statewide North Carolina Emergency Department data for adults, aged 18+ years, from 2009 to 2016. We estimated transport rates using census data; categorized primary ED diagnoses into 13 major and 8 substituent categories; compared county transport rates by rurality; and examined patient characteristics. There were 136,240 patients transported by law enforcement; annual rates increased from 186.9 (per 100,000 adult residents) in 2009 to 279.2 in 2016. Among visits, 67.7% were among men, the median age was 37 years, and 20.4% resulted in a hospital admission. Most common primary diagnoses were Mental Health Diagnoses (43.1%)—including Schizophrenia and other Psychotic Disorders (7.6%), Mood Disorders (9.7%), and Alcohol and Substance Use (10.7%)—followed by Injury and Poisoning (12.4%) and Circulatory conditions (4.1%). Involuntary commitments constituted 22% of all visits. The median transport rate in rural counties, 291.1, was 2 times that of large metro counties, 145.1. The visit rate increased by nearly 50% during the study period, with the highest rates in rural counties. Many transports were for Mental Illness and involuntary commitments. The relatively common occurrence of law enforcement transports suggests the need for greater research to understand factors influencing law enforcement transport decisions, the impact of these transports on patient health and safety, and the repercussions on patient care of a growing officer presence in EDs.

scholarly journals Characteristics of Parkinson’s Disease in Patients with and without Cognitive Impairment

2021 ◽  
pp. 1-12
Author(s):  
Julie Chandler ◽  
Radhika Nair ◽  
Kevin Biglan ◽  
Erin A. Ferries ◽  
Leanne Munsie ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Emergency Department ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Memory Loss ◽  
Patient Characteristics ◽  
Emergency Department Visits ◽  
Administrative Claims ◽  
Newly Diagnosed ◽  
Comorbidity Burden

Background: Characterizing patients with Parkinson’s disease (PD) and cognitive impairment is important toward understanding their natural history. Objective: Understand clinical, treatment, and cost characteristics of patients with PD pre- and post-cognitive impairment (memory loss/mild cognitive impairment/dementia or dementia treatment) recognition. Methods: 2,711 patients with PD newly diagnosed with cognitive impairment (index) were identified using administrative claims data. They were matched (1:1) on age and gender to patients with PD and no cognitive impairment (controls). These two cohorts were compared on patient characteristics, healthcare resource utilization, and total median costs for 3 years pre- and post-index using Chi-square tests, t-tests, and Wilcoxon rank-sum tests. Logistic regression was used to identify factors predicting cognitive impairment. Results: Comorbidity indices for patients with cognitive impairment increased during the 6-year study period, especially after the index. Enrollment in Medicare Advantage Prescription Drug plans vs. commercial (OR = 1.60), dual Medicare/Medicaid eligibility (OR = 1.36), cerebrovascular disease (OR = 1.24), and PD medication use (OR = 1.46) were associated with a new cognitive impairment diagnosis (all p <  0.05). A greater proportion of patients with cognitive impairment had hospitalizations and emergency department visits and higher median total healthcare costs than controls for each year pre- and post-index. Conclusion: In patients with PD newly diagnosed with cognitive impairment, comorbidity burden, hospitalizations, emergency department visits, and total costs peaked 1-year pre- and post-identification. These data coupled with recommendations for annual screening for cognitive impairment in PD support the early diagnosis and management of cognitive impairment in order to optimize care for patients and their caregivers.

scholarly journals Adjacent Primary Care May Reduce Less Urgent Pediatric Emergency Department Visits

2020 ◽  
Vol 11 ◽  
pp. 215013272092627
Author(s):  
Julia Ellbrant ◽  
Jonas Åkeson ◽  
Helena Sletten ◽  
Jenny Eckner ◽  
Pia Karlsland Åkeson
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Patient Characteristics ◽  
Pediatric Emergency ◽  
Emergency Department Visits ◽  
University Hospital ◽  
Pediatric Emergency Department ◽  
Hospital Data ◽  
Cross Sectional ◽  
Ed Visits

Aims: Pediatric emergency department (ED) overcrowding is a challenge. This study was designed to evaluate if a hospital-integrated primary care unit (HPCU) reduces less urgent visits at a pediatric ED. Methods: This retrospective cross-sectional study was carried out at a university hospital in Sweden, where the HPCU, open outside office hours, had been integrated next to the ED. Children seeking ED care during 4-week high- and low-load study periods before (2012) and after (2015) implementation of the HPCU were included. Information on patient characteristics, ED management, and length of ED stay was obtained from hospital data registers. Results: In total, 3216 and 3074 ED patient visits were recorded in 2012 and 2015, respectively. During opening hours of the HPCU, the proportions of pediatric ED visits (28% lower; P < .001), visits in the lowest triage group (36% lower; P < .001), patients presenting with fever ( P = .001) or ear pain ( P < .001), and nonadmitted ED patients ( P = .033), were significantly lower in 2015 than in 2012, whereas the proportion of infants ≤3 months was higher in 2015 ( P < .001). Conclusions: By enabling adjacent management of less urgent pediatric patients at adequate lower levels of medical care, implementation of a HPCU outside office hours may contribute to fewer and more appropriate pediatric ED visits.

scholarly journals A systematic review of intensive outpatient care programs for high-need, high-cost patients

2020 ◽  
Vol 10 (5) ◽  
pp. 1187-1199
Author(s):  
Rebecca K Delaney ◽  
Brittany Sisco-Taylor ◽  
Angela Fagerlin ◽  
Peter Weir ◽  
Elissa M Ozanne
Keyword(s):  
Emergency Department ◽  
Healthcare Utilization ◽  
Outpatient Care ◽  
Program Effectiveness ◽  
Patient Characteristics ◽  
Emergency Department Visits ◽  
Multidisciplinary Teams ◽  
Patient Reported ◽  
Intensive Outpatient

Abstract Five percent of the patient population accounts for 50% of U.S. healthcare expenditures. High-need, high-cost patients are medically complex for numerous reasons, often including behavioral health needs. Intensive outpatient care programs (IOCPs) are emerging, innovative clinics which provide patient-centered care leveraging multidisciplinary teams. The overarching goals of IOCPs are to reduce emergency department visits and hospitalizations (and related costs), and improve care continuity and patient outcomes. The purpose of this review was to examine the effectiveness of IOCPs on multiple outcomes to inform clinical care. A systematic search of the literature was conducted to identify articles. Six studies were included that varied in rigor of research design, analysis, and measurement of outcomes. Most studies reported results on healthcare utilization (n = 4) and costs (n = 3), with fewer reporting results on patient-reported and health-related outcomes (n = 2). Overall, there were decreasing trends in emergency department visits and hospitalizations. However, results on healthcare utilization varied based on time of follow-up, with shorter follow-up times yielding more significant results. Two of the three studies that evaluated costs found significant reductions associated with IOCPs, and the third was cost-neutral. Two studies reported improvements in patient-reported outcomes (e.g., satisfaction, depression, and anxiety). Overall, these programs reported positive impacts on healthcare utilization and costs; however, few studies evaluated patient characteristics and behaviors (e.g., engagement in care) which may serve as key mechanisms of program effectiveness. Future research should examine patient characteristics, behaviors, and clinic engagement metrics to inform clinical practice.

scholarly journals COVID-19 lock-down significantly reduced the number of surgical presentations in an emergency department

2020 ◽  
Author(s):  
René Fahrner ◽  
Stefan Bähler ◽  
Gregor Lindner
Keyword(s):  
Emergency Department ◽  
Time Course ◽  
Control Period ◽  
Final Analysis ◽  
Patient Characteristics ◽  
Medical Specialty ◽  
World Health ◽  
Number Of Patients ◽  
Health Organization ◽  
The Impact

Abstract IntroductionCoronavirus disease 2019 (COVID-19) is an acute virus infection that was declared by the World Health Organization (WHO) as a pandemic. As a consequence, the Swiss government decreed a public lock-down to reduce and restrict further infections. The aim of this investigation was to provide the impact of the COVID-19 lock-down on the presentations of patients in an interdisciplinary emergency department (ED).Patients, Materials and MethodsA retrospective study was performed at an interdisciplinary Swiss ED during the lock-down period. All patients who presented to the ED were enrolled in this investigation and compared to a control cohort during the same time period in 2019. Data regarding patient characteristics, medical specialty, time course of presentations during the observation period, and outpatient or hospital admission were analyzed.ResultsIn total, 7,072 patients were included in the final analysis. During the lock-down period, the number of ED presentations significantly decreased by 29% in comparison to the control period in the previous year (p<0.0001). The analysis of the time course revealed that in each week, the number of patients was lower, with a 13% to 43% reduction. Irrespective of the medical specialty, the number of presentations decreased during the COVID-19 situation, whereas this decrease was higher in surgical diseases (31%, p<0.0001) than in non-surgical presentations (3.6%, p=0.4).DiscussionThe socio-economic lock-down impacted the number of presentations in an ED. Mainly, surgical diseases and injuries were affected in terms of a reduction of presentations during the COVID-19 lock-down period.

scholarly journals The Impact of Armed Conflict on Agro-Industrial Development in Cameroon: The case of the Cameroon Development Corporation (CDC) within the context of the Anglophone crisis

2020 ◽  
Vol 8 (12) ◽  
pp. 279-288
Author(s):  
Dinsi Stanley Chung ◽  
Keyword(s):  
Armed Conflict ◽  
Industrial Development ◽  
Financial Loss ◽  
North West ◽  
The North ◽  
South West ◽  
Study Results ◽  
Development Corporation ◽  
English Speaking ◽  
The Impact

The Cameroon Development Corporation has been severely affected by the armed conflict in the English speaking (North West and South West regions) part of the country that has been on for close to four years running. How then has the armed conflict in the North West and South West regions of Cameroon affected the Cameroon Development Corporation? How can the growth of the agro-industry be guaranteed? This study looks at the impact of the armed conflict in the North West and South West regions of Cameroon on the Cameroon Development Corporation. Making use of public policy theories, this study establishes a link between government defense strategies/sector development policies and agro-industrial development. The study results show that due to the armed conflict in the English speaking regions, the CDC has incurred major damages including: loss in human capital, drop in production capacity, heavy financial loss and equipment damages. The study results also reveal that, the survival of the CDC depends largely on strategic options to be taken at two separate levels including: political options by conflicting parties - the government and separatist fighters on the one hand, and on the other, options taken by the CDC at both managerial and technical levels. The study concludes that for the CDC to attain structural growth and development that will significantly contribute to the national economy, conflicting.

Abstract 32: Have Choosing Wisely Recommendations Changed Diagnostic Testing Patterns for Patients With Syncope?

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Timothy Anderson ◽  
Robert L Thombley ◽  
Grace A Lin
Keyword(s):  
Emergency Department ◽  
Brain Mri ◽  
Diagnostic Testing ◽  
Patient Characteristics ◽  
Emergency Department Visits ◽  
Choosing Wisely ◽  
Mixed Effect ◽  
Hospital Variation ◽  
Ed Visits ◽  
Cardiac Testing

Background: Syncope is a common reason for emergency department visits. Guidelines suggest minimal initial workup, including history, physical exam, and ECG testing. Additional cardiac testing is recommended in only high risk patients and neuroimaging is rarely indicated. Because of the low yield of neuroimaging, in 2012, the Choosing Wisely campaign recommended against its use for syncope. Our objective was to examine trends in cardiac testing and neuroimaging of patients presenting to the ED with syncope, before and after the Choosing Wisely recommendations and to describe hospital variation in testing rates. Methods: We linked State Inpatient and Emergency Department Databases to conduct a retrospective study of all ED visits in 2009 and 2013 for 8 states reporting procedure utilization. We calculated rates of ECG, advanced cardiac testing (echocardiogram, stress testing, diagnostic catheterization) and neuroimaging (head CT, brain MRI, carotid ultrasound) for all adults with a discharge diagnosis of syncope. Differences between years were estimated using mixed effect regression modeling adjusted for patient characteristics, comorbidities, and hospital random effects. Results: We identified 287,261 ED visits for syncope in 2009 and 315,221 ED visits in 2013 from 676 hospitals. Between 2009 and 2013, adjusted rates of ECG testing increased from 81.1% of discharges to 84.3% (p<.0001). Rates of advanced cardiac testing increased from 10.3% to 12.4% (p<.0001), driven primarily by a substantial increase in the use of echocardiograms (8.3% vs 11.3%, p<.0001). Rates of neuroimaging increased from 36.0% to 42.0% (p<.0001) with increased utilization of all tests. Rates of ECG, advanced cardiac testing and neuroimaging varied significantly between hospitals in both years (Figure). The median hospital-level change in testing between years was 1.6% (IQR -3.5 to 11.2) for ECG, 1.2% (IQR -1.8 to 5.9) for advanced cardiac imaging and 4.2% (IQR -5.3 to 18.4) for neuroimaging. Conclusions: Among patients presenting to the ED with syncope, rates of both high- and low-value diagnostic testing increased between 2009 and 2013, with substantial variation between hospitals. Thus, the 2012 Choosing Wisely recommendations do not appear to have had a significant effect on testing for patients presenting with syncope.

Notes on a Westmeath dialect

1971 ◽  
Vol 1 (1) ◽  
pp. 33-38 ◽  
Author(s):  
E. V. Nally
Keyword(s):  
Eighteenth Century ◽  
English Speakers ◽  
North West ◽  
Mixed Farming ◽  
The North ◽  
The People ◽  
English Speaking

1. What follows is a sketch of the phonology of the English spoken in Emper, Co. Westmeath. Emper is a pocket of fertile country partly enclosed in a loop of the River Inny and situate some eleven or twelve miles to the north-west of Mullingar. The population, fluctuating about two hundred souls, is composed mostly of farmers and farm labourers. They are engaged in mixed farming, that is tillage, stock-raising, and dairying; and are a settled community in that the farms in most cases have been occupied by the same families for generations. It is difficult to say at what date exactly the people of Emper ceased to speak Irish and became English speakers. The evidence is scanty and entirely oral, yet sufficient to warrant the conclusion that at some time after the middle of the eighteenth century, and certainly before 1800, Emper had become English speaking. The findings and conclusions below are based on my own (dialect) pronunciation and my memory of auditory observation of the speech of the older stratum of the inhabitants, and especially of those born before 1900. This is my vernacular speech and I have never lost touch with it.

scholarly journals 104 Management of sports-related concussion in UK emergency departments: a multi-centre study

2020 ◽  
Vol 37 (12) ◽  
pp. 822.2-822
Author(s):  
Haroon Rashid ◽  
Nick Dobbin ◽  
Smarak Mishra
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Online Survey ◽  
Cross Sectional Study ◽  
Return To Play ◽  
Cross Sectional ◽  
Multi Centre Study ◽  
North West ◽  
The North ◽  
Consensus Statements

Aims/Objectives/BackgroundIt is necessary for those working in emergency departments to have adequate knowledge and delivery of current sport-related concussion (SRC) management protocols including identifying patients with concussion, managing their symptoms, giving appropriate advice with regards to return to play and referring those at risk of further injuries to an appropriate service.This study aimed to establish the current practice, knowledge base and views towards SRC management of emergency department clinicians who have trained or are currently training in emergency medicine in the North West of England.Methods/DesignThis study was a multi centre, cross sectional study of 111 emergency department clinicians (EDCs) working across 15 centres in the North West of England A 21 item online survey was issued. The key questions focused on the advice given to patients on discharge, the importance of cognitive and physical rest, and knowledge of GRTP.Results/ConclusionsApproximately, 37% of the population responded to the invitation, with 111 responses included in this study. Only 27% of total respondents were aware of the Consensus Statements of Concussion in Sport guidelines, whilst 45% were unaware of any SRC guidelines. 57% of respondents had heard of a graded return to play (GRTP) protocol. Physical rest following an SRC was advised by 95% of respondents with 61% advising concomitant cognitive rest and 42% of respondents providing specific written advice. 90% of clinicians had not received any SRC training.There is a lack of knowledge amongst EDCs in the North West of England in managing and providing discharge advice according to recommendations for patients with SRC. This is likely a consequence of the limited training that these clinicians have received in managing SRC and suggests further work needs to be undertaken to educate EDCs on current SRC management guidance to ensure appropriate care and discharge advice is given to patients.

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