Dalbavancin Use in the Emergency Department Setting

2019 ◽  
Vol 53 (11) ◽  
pp. 1093-1101 ◽  
Author(s):  
Mitulkumar Patel ◽  
Samantha Smalley ◽  
Yanina Dubrovskaya ◽  
Justin Siegfried ◽  
Christopher Caspers ◽  
...  
Keyword(s):  
Emergency Department ◽  
Selection Criteria ◽  
Primary Objective ◽  
Ambulatory Setting ◽  
Time To Recurrence ◽  
Emergency Department Setting ◽  
Patient Selection Criteria ◽  
Dosing Strategy

Background: Although dalbavancin’s (DBV’s) long half-life and one-time dosing strategy confer ideal administration in the ambulatory setting, the optimal role of DBV in the management of acute bacterial skin and skin structure infections (ABSSSIs) remains to be elucidated. Objectives: The primary objective of this study was to compare treatment outcomes of ABSSSI between patients who received DBV in the emergency department (ED) as part of standard care versus patients who received DBV as part of a telehealth program. Methods: This was a retrospective cohort study evaluating patients who received DBV at 3 urban EDs. The primary end point was the incidence of ABSSSI recurrence. Secondary outcomes included need for hospital admission and ED length of stay (LOS; in hours). Results: A total of 65 ABSSSI treatment courses were included; 42 were included in the telehealth criteria (TC) cohort and 23 in the initial criteria (IC) cohort. There were 14% (6/42) infection recurrences in the TC cohort and 22% (5/23) in the IC cohort, with median time to recurrence being 4 and 14 days, respectively. Median ED LOS was significantly shorter in the TC (5 vs 25 hours, P < 0.05). Numerically fewer individuals in the TC cohort required inpatient admission (0 vs n = 2, 9%). Conclusion and Relevance: Our results suggest that patients may be safely administered DBV in an ED setting, with telehealth follow-up. Providing structured patient selection criteria is an effective method of assisting ED providers in selecting appropriate DBV candidates to limit potential recurrences and readmissions.

Taming Cryoablation for Lung Tumors

2018 ◽  
Author(s):  
Anshuman Bansal ◽  
Fereidoun Abtin
Keyword(s):  
Patient Selection ◽  
Selection Criteria ◽  
Patient Positioning ◽  
Lung Tumors ◽  
Lung Cancers ◽  
Percutaneous Cryoablation ◽  
Patient Selection Criteria ◽  
Physical Principles

This chapter details the indications, uses, and techniques of using percutaneous cryoablation to treat lung tumors. The chapter reviews the role of ablative therapy for primary lung cancers as well as metastatic disease to the lung. It reviews the basic physical principles of cryoablation and the advantages of percutaneous cryoablation compared to other percutaneous heat-based ablative modalities. Patient selection criteria and post-ablation follow-up protocols are discussed. The chapter reviews procedural considerations, including choice of anesthesia, patient positioning, probe trajectory, and post-procedural recovery. It also details techniques that can be used to minimize and treat complications as well as tips for treating more challenging lesions.

Family Placement — in France

1973 ◽  
Vol 18 (4) ◽  
pp. 297-302 ◽  
Author(s):  
David S. Palframan
Keyword(s):  
Social Worker ◽  
Patient Selection ◽  
Selection Criteria ◽  
Large City ◽  
Service Program ◽  
The Social ◽  
Therapeutic Results ◽  
Patient Selection Criteria

A family placement service program wherein stabilized mental patients are placed with families to whom they are not related is described. The service is located south of Paris, France, and is likely to be adaptable to the areas adjacent to any large city. Family recruitment and patient selection criteria are described and the role of the social worker-psychiatrist team is reviewed. The families and patients appear to function best when a situation of mutual need exists. The patient population and the therapeutic results over a brief follow-up period are described statistically.

Management of Pleural Effusions in the Emergency Department.

2020 ◽  
Vol 15 ◽  
Author(s):  
MT Congedo ◽  
GM Ferretti ◽  
D Nachira ◽  
MA Pennisi
Keyword(s):  
Emergency Department ◽  
Systematic Approach ◽  
Acute Chest Pain ◽  
Pleural Effusions ◽  
Therapeutic Approaches ◽  
Massive Pleural Effusion ◽  
Emergency Department Setting ◽  
Clinical Conditions ◽  
Definitive Management

Background: In symptomatic patients, admitted in emergency department for acute chest pain and dyspnea, who require an urgent treatment, a rapid diagnosis and prompt management of massive pleural effusion or hemothorax can be lifesaving. The aim of this review was to summarize the current diagnostic and therapeutic approaches for the management of the main types of pleural effusions that physicians can have in an emergency department setting. Methods: Current literature about the topic was reviewed and critically reported, adding the experience of the authors in the management of pleural effusions in emergency settings. Results: The paper analyzed the main types of pleural effusions that physicians can have to treat. It illustrated the diagnostic steps by the principal radiological instruments, with a particular emphasis to the role of ultrasonography, in facilitating diagnosis and guiding invasive procedures. Then, the principal procedures, like thoracentesis and insertion of small and large bore chest drains, are indicated and illustrated according to the characteristics and the amount of the effusion and patient clinical conditions. Conclusion: The emergency physician must have a systematic approach that allows rapid recognition, clinical cause identification and definitive management of potential urgent pleural effusions.

The Role of Cardiac Risk Factor Burden in Diagnosing Acute Coronary Syndromes in the Emergency Department Setting

2007 ◽  
Vol 49 (2) ◽  
pp. 145-152.e1 ◽  
Author(s):  
Jin H. Han ◽  
Christopher J. Lindsell ◽  
Alan B. Storrow ◽  
Samuel Luber ◽  
James W. Hoekstra ◽  
...  
Keyword(s):  
Emergency Department ◽  
Risk Factor ◽  
Acute Coronary Syndromes ◽  
Cardiac Risk ◽  
Cardiac Risk Factor ◽  
Emergency Department Setting ◽  
Coronary Syndromes ◽  
Risk Factor Burden

Effect of Method of Defining the Active Patient Population on Measured Immunization Rates in Predominantly Medicaid and Non-Medicaid Practices

PEDIATRICS ◽  
2000 ◽  
Vol 106 (Supplement_1) ◽  
pp. 171-176
Author(s):  
Ardythe L. Morrow ◽  
R. Clinton Crews ◽  
Henry J. Carretta ◽  
Mekibib Altaye ◽  
Albert B. Finch ◽  
...  
Keyword(s):  
Selection Criteria ◽  
Immunization Practice ◽  
Immunization Rate ◽  
The Past ◽  
Immunization Rates ◽  
Patient Selection Criteria ◽  
Definition Of ◽  
Practice Assessment ◽  
Active Patients

Objective. To examine the effect of patient selection criteria on immunization practice assessment outcomes. Methods. In 3 high- (50%–85%) and 7 low- (&lt;25%) Medicaid pediatric practices in urban eastern Virginia, we assessed immunization rates of children 12 and 24 months old comparing thestandard criteria (charts in the active files excluding those that documented the child moved or went elsewhere) with 3 alternative criteria for selecting active patients: 1)follow-up: the chart contained a complete immunization record or the patient was found to be active in the practice through follow-up contact by phone or mail; 2) seen in the past year: the chart indicated that the patient was seen in the practice in the past year; 3) consecutive: patients that were seen consecutively for any reason. Results. Of the 1823 charts assessed in the high- and low-Medicaid practices, follow-up identified 61% and 83% as active patients; 78% and 95% were ever seen in the past year. At 24 months, mean practice immunization rates were lower for standard (70%) than all 3 alternative criteria (78%–86%). Immunization rate differences between standard and alternative criteria were greater in high- (17%–23%) than low-Medicaid practices (5%–13%). Conclusion. The standard for practice assessment should be based on a consistent definition of active patients as the immunization rate denominator.

Characterization of unresectable cholangiocarcinoma patients treated with or without chemoradiation.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 403-403
Author(s):  
Jane Elizabeth Rogers ◽  
Van Nguyen ◽  
Graciela M. Nogueras-Gonzalez ◽  
Christopher H. Crane ◽  
Prajnan Das ◽  
...  
Keyword(s):  
Progression Free Survival ◽  
Median Number ◽  
Primary Objective ◽  
First Line ◽  
Dismal Prognosis ◽  
History Of ◽  
Mixed Histology

403 Background: Curative treatment for cholangiocarcinoma (CC) is surgical resection. Unfortunately, most CC patients (pts) present with unresectable disease in which gemcitabine plus platinum (GEM-P) chemotherapy is the mainstay of treatment (tx). Advanced CC has a dismal prognosis with 5-year survival reported at 5-10 %. Data regarding chemoradiation (CRT) in pts with unresectable CC (uCC) remains limited. Methods: We retrospectively reviewed uCC pts from 1/1/2009 to 7/31/2013. Primary objective: to evaluate the percentage of pts treated with CRT and the median number of chemotherapy cycles given prior to CRT. Secondary objectives: response to first-line tx, progression free survival (PFS) with or without CRT, overall survival (OS) with or without CRT, and duration of CRT control. Inclusion criteria: uCC diagnosis, received tx, and had follow-up at our institution. Exclusion criteria: pts who received liver-directed therapy other than CRT, mixed histology tumors, and a history of other malignancies. Results: 114 pts were included with 62% having intrahepatic CC. Disease control (DC) (response + stable disease) with first-line tx was 75% with 71% receiving GEM-P +/- erlotinib first-line. 65% of pts received CRT with a median of 6 chemotherapy cycles given prior to CRT. DC after CRT was 62% with a median duration of radiation control of 6.4 mths. Median PFS and OS for all pts were 13.4 mths and 27.8 mths, respectively. Median PFS in the CRT group was 14.5 mths versus 11.4 mths in the no CRT group (p = 0.105). Median OS in the CRT cohort was 29.4 mths, while median OS without CRT was 22.4 mths (p = 0.005). Median OS and PFS after CRT for pts with DC on first-line tx were 32.0 months (95% CI = 24-44 mths) and 15.7 mths (95% CI =13.5-18.8 mths), respectively. Pts who progressed on first-line tx and received CRT had a median OS of 23.8 mths (95% CI = 7-30 months) and median PFS of 4.2 mths (95% CI = 2.3-9 mths). Conclusions: Our retrospective review reveals a significant improvement in median OS with CRT in uCC pts. Those with DC on first-line tx showed improvement in PFS and OS with CRT. Patient selection is key with the benefit being highest in pts with DC with first-line tx. Our results warrant further investigation of the role of CRT in uCC.

scholarly journals The radiologic roadmap for treatment of an acute appendicitis patient who tested positive for coronavirus disease 19

2021 ◽  
Author(s):  
Şeref Barbaros Arik ◽  
Elif Gunaydin ◽  
Celal İsmail Bİlgiç ◽  
İnanç Güvenç
Keyword(s):  
Emergency Department ◽  
Acute Appendicitis ◽  
Standard Treatment ◽  
Surgical Intervention ◽  
Ultrasound Examination ◽  
Bridging Therapy ◽  
Emergency Surgical Intervention ◽  
Pelvic Ct Scan

Objective: In this study, we aimed to emphasize the role of radiological imaging in determining the treatment of a patient, who tested positive for COVID-19 and diagnosed with acute appendicitis during the pandemic. Methods: A 31-year-old patient presented to the emergency department due to abdominal pain. Ultrasound examination, thoracic and pelvic CT scan were performed. Results: Non-complicated appendicitis can be treated conservatively with antibiotics. Treatment can be maintained by starting with IV antibiotics and bridging therapy with oral antibiotics. Conclusion: This study aims to summarize how radiological follow-up can be used to decide on the suitability of the patient for appropriate medical treatment as an alternative to surgery in a patient, whose gold standard treatment is emergency surgical intervention, which is frequently encountered in the emergency department during the COVID-19 pandemic.

The role of primary care physician and cardiologist follow-up for low-risk patients with chest pain after emergency department assessment

2014 ◽  
Vol 168 (3) ◽  
pp. 289-295 ◽  
Author(s):  
Andrew Czarnecki ◽  
Julie T. Wang ◽  
Jack V. Tu ◽  
Douglas S. Lee ◽  
Michael J. Schull ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Chest Pain ◽  
Primary Care Physician ◽  
Care Physician ◽  
Low Risk ◽  
Risk Patients

scholarly journals Evaluation of Bacteriuria Treatment and Follow-up Initiated in the Emergency Department at a Veterans Affairs Hospital

2017 ◽  
Vol 33 (5) ◽  
pp. 183-188 ◽  
Author(s):  
Emily Y. Kim ◽  
Ursula Patel ◽  
Bhairvi Patel ◽  
Katie J. Suda
Keyword(s):  
Emergency Department ◽  
Inpatient Care ◽  
Asymptomatic Bacteriuria ◽  
Veterans Affairs ◽  
Primary Objective ◽  
Antibiotic Prescribing ◽  
Drug Reactions ◽  
Indwelling Catheters ◽  
Culture And Sensitivity

Background: This study aims to evaluate the treatment and follow-up of bacteriuria in the emergency department (ED). Objective: The primary objective was to determine the frequency of patients discharged from the ED with antibiotics for symptomatic and asymptomatic bacteriuria, and the secondary objectives were to determine the frequency of patients receiving postdischarge antibiotic interventions and antibiotic-related adverse drug reactions (ADRs). Methods: This retrospective study evaluated patients with ED urine cultures sent between October 1, 2015, and November 24, 2015. Patients with indwelling catheters, concurrent antibiotics, and admission for inpatient care were excluded. T tests and contingency tables were applied in SAS; P < .05 was considered significant. Results: Of 429 unique patients with urine cultures drawn in the ED, 13.1% (n = 56) received treatment for a bacteriuria. The majority of patients discharged from the ED with antibiotics had urinary tract infection (UTI) symptoms documented in the medical record (76.8%; n = 43). Of those patients who required postdischarge interventions, 4 out of 13 had appropriate antibiotic adjustments based on culture and sensitivity results at follow-up. In a subset of patients with inappropriately ordered urine cultures (no UTI symptoms documented or antibiotic prescribed), a higher percentage of patients had normal urinalyses (UA) compared to abnormal UAs (83.3% vs 10.4%, P = .0008). No significant ADRs were identified. Conclusions: The majority of patients treated for bacteriuria in the ED had documented symptoms consistent with UTIs and appropriate empiric antibiotics. However, incorporating antimicrobial stewardship activities in the ED targeting unnecessary urine cultures and assuring postdischarge follow-up if treatment modification is needed based on culture results can improve antibiotic prescribing.

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