Emergency Medical Consultation Research Articles

Evaluation of a multicomponent integrated intervention to improve the quality of care for anticoagulated frail older adults in a home care system in the city of Buenos Aires

Introduction: Anticoagulation in older adults is a real challenge due to the presence of health conditions that can alter the adequate control of the patient. Older adults confined to home probably could not attend outpatient medical consultations. On many occasions, the monitoring of the patient's health process at home is carried out by a health professional who does not monitor the anticoagulant treatment (e.g. due to lack of experience of the professional).
 For this reason, the home care section of the Italian Hospital of Buenos Aires (HIBA) created an interdisciplinary team for the telephone follow-up of anticoagulated patients in that area.
 Objectives: Describe the effect of a multicomponent intervention to improve the quality of anticoagulation therapy in frail elderly patients in the home care system of the HIBA.
 Methods: Prospective pragmatic evaluation study of a multiple intervention with a before-after design. Variables were analyzed from secondary databases 6 months before and after the intervention. The unit of analysis was the patient acting as his own control. The setting was the home medicine section of HIBA. We included patients aged 65 years or over receiving dicumarinics with home care and follow-up by a doctor with fewer tools in the management of anticoagulants and with communication barriers. Telephone contacts with patients were made by family physicians. A hematologist was consulted whenever necessary. Pharmacists sent pills of vitamin K with educational brochures to the patient's home. Health and social counsellors contacted patients in complex cases to strengthen education. Reasons for withdrawal of the program were: death, hospitalization, termination of the home care service, follow-up of the treatment by a hematologist or anticoagulant suspension.
 Results: Analysis of the data was performed before the intervention (June 1, 2021 to November 30, 2021) and after the intervention ( December 1, 2021, to June 30, 2022), 41 patients were included, 78% were female, average age was 87 years. The mean of basic activities of daily living was 3.35, the average of the Percentage of International Normalized Ratio Measurements in Range (PINRR) in the pre intervention was 31% and 49% in the post. There weren't thrombotic events and the average of bleeding events was 6% in the pre and 0% in the post, extreme values of INR (>6) in the pre was 3% and in the post 0,5%. Finally the mean of emergency medical consultations was 1,15 in the pre and 0,29 in the post.
 Conclusions: The present work consists in the analysis of an elderly population highly dependent on activities of daily living. The data shows a possible tendency of reduction in the number of emergency medical consultations, bleeding events and improvement in the PINRR. As next steps we propose evaluate patients' satisfaction with the intervention, analize long-term results as the program works in time and generate institutional tools to deprescribe.
 
 

Time trends in infectious and chronic disease consultations in Dakar, Senegal: Impact of COVID-19 sanitary measures.

The impact of COVID-19 sanitary measures on the time trends in infectious and chronic disease consultations in Sub-Saharan Africa remains unknown. We conducted a cohort study on all emergency medical consultations from January 2016 to July 2020, from SOS Medecins in Dakar, Senegal. The consultation records provided basic demographic information such as age, ethnicity (Senegalese or Caucasian), and sex as well as the principal diagnosis using an ICD-10 classification ("infectious", "chronic", and "other"). We first investigated how the pattern in emergency consultation differed from March to July 2020 compared to previous years. Then, we examined any potential racial/ethnic disparities in COVID-19 consultation. We obtained data on emergency medical consultations from 53 583 patients of all ethnic origins. The mean age of patients was 37.0 (standard deviation (SD) = 25.2) and 30.3 (SD = 21.7) in 2016-2019 and 45.5 (SD = 24.7) and 39.5 (SD = 23.3) in 2020 for Senegalese and Caucasian patients, respectively. The type of consultations between January and July were similar from 2016 to 2019; however, in 2020, there was a drop in the number of infectious disease consultations, particularly from April to May 2020, when sanitary measures for COVID-19 were applied (average of 366.5 and 358.2 in 2016-1019 and 133.0 and 125.0 in 2020). The prevalence of chronic conditions remained steady during the same period (average of 381.0 and 394.7 in 2016-2019 and 373.0 and 367.0 in 2020). In a multivariate analysis adjusted for age and sex, infectious disease consultations were significantly more likely to occur in 2016-2019 compared to 2020 (2016 odds ratio (OR) = 2.39, 2017 OR = 2.74, 2018 OR = 2.39, 2019 OR = 2.01). Furthermore, the trend in the number of infectious and chronic consultations was similar among Senegalese and Caucasian groups, indicating no disparities among those seeking treatment. During the implementation of COVID-19 sanitary measures, infectious disease rates dropped as chronic disease rates remained stagnant in Dakar. We observed no racial/ethnic disparities among the infectious and chronic consultations.

Abstract 15836: Time Trends in Infectious and Chronic Disease Consultations in Dakar, Senegal: Impact of Covid-19 Preventative Measures

Background: The impact of COVID-19 preventative measures (use of face masks, social distancing, quarantines, and sanitation and hygiene practices) on the time trends in infectious and chronic disease consultations in Sub-Saharan Africa remains unknown. Methods: We conducted a cohort study on all emergency medical consultations over a five-year period, January 2016 to July 2020, from SOS Medecins in Dakar, Senegal. The consultation records provided basic demographic information such as age, ethnicity (Senegalese v. Caucasian), and sex as well as the principal diagnosis using an ICD-10 classification (‘infectious, ‘chronic’, and ‘other’). Firstly, we investigated how the pattern in emergency consultation differed from March to July 2020 compared to previous years. Secondly, we examined any potential racial/ethnic disparities in COVID-19 consultation. Findings: Data on emergency medical consultations were obtained from 53,583 patients of all ethnic origins. The mean age of patients was 37·0 ± 25·2 and 30·3 ± 21·7 in 2016-2019 and 45·5 ± 24·7 and 39·5 ± 23·3 in 2020 for Senegalese and Caucasians. The type of consultations between the months of January and July were similar from 2016 and 2019; however, in 2020, there was a drop among the numbers of infectious disease consultations, particularly from April to May 2020 when sanitary measures for COVID-19 were applied (average of 366·5 and 358·25 in 2016-1019 and 133 and 125 in 2020). The prevalence of chronic conditions remained steady during the same period (average of 381 and 394·75 in 2016-2019 and 373 and 367 in 2020). In a multivariate analysis after adjusting to age and sex, infectious disease consultations were significantly more likely to occur in 2016-2019 compared to 2020 (OR for 2016= 2·39, 2017= 2·74, 2018= 2·39, 2019= 2·01). Furthermore, the trend in the number of infectious and chronic consultations were similar among Senegalese and Caucasian groups, indicating no disparities among those seeking treatment. Conclusion: During the implementation of COVID-19 preventative measures, infectious disease rates dropped as chronic disease rates stayed stagnant in Dakar. Furthermore, no racial/ethnic disparities were observed among the infectious and chronic consultations.

Complex Pathology of Cardiac Syncope in Old Patients

Syncope is characterized by a transient and rapid loss of consciousness for a short duration, with full spontaneous recovery within minutes. Syncope causes up to 2% of all emergency medical consultations. The incidence of syncope is similar in men and women, is higher in old patients (slightly higher in old women). The prevalence of syncope is up to 23% for the institutionalized elderly. In elderly patients, syncope often presents atypically, such as with falls; these patients might also have difficulty recalling events. The true incidence and prevalence of syncope in elderly patients are expected to be higher than those estimated in most studies. The causes of syncope are highly age-dependent. Reflex or neurally mediated syncope is the most common cause, particularly in younger patients. As individuals age, orthostatic hypotension and cardiac syncope become more frequent. In elderly patients, neurally mediated syncope is the most prevalent form of syncope. Orthostatic syncope is more frequent in the elderly than in young patients. In the elderly, cardiac causes account for about 15% of all cases, and in about 10% of the cases, the origin of syncope is unknown. A combination of different etiologies is common in geriatric patients because many pathophysiologies coexist, including age-related physiological changes, co-morbidities (e.g., neurological pathologies), multiple medications (with interactions, or with lowering of BP and HR), malnutrition, sarcolepsy, and prolonged bed rest. The available clinical guidelines for the diagnosis, investigation, and treatment of syncope are insufficient to address syncope in elderly patients. A comprehensive geriatric approach that considers the functional and cognitive capacities of individuals along with the medical and psychosocial aspects would be more appropriate. Modern medicine can be used to treat syncope in some geriatric patients and should be offered whenever possible.

Impact of the COVID-19 pandemic on appendicitis treatment in Germany-a population-based analysis.

PurposeAcute appendicitis is one of the most common reasons for emergency medical consultation. While simple appendicitis can be treated with antibiotics or surgery, complex appendicitis including gangrene, abscess, and perforation requires appendectomy. During the COVID-19 pandemic in early 2020, an overall drop in emergency room consultations was observed. We therefore aimed to investigate the incidence and treatment strategies of acute appendicitis during that period.MethodsData of insurance holders with the ICD code for “acute appendicitis” or OPS procedure of appendectomy of a major health insurance company in Germany were analyzed retrospectively. Groups were built, containing of the means of March–June of 2017, 2018, and 2019, defined as “pre-COVID group” with the “COVID group,” defined as data from March to June of 2020. Data was analyzed by age, sex, comorbidities, length of hospital stay, diagnoses, and treatment. Data of the COVID group was analyzed for simultaneous COVID-19 infection.ResultsDuring the COVID-19 pandemic of early 2020, an overall reduction by 12.9% of patients presenting with acute appendicitis was noticeable. These results were mainly due to decreased rates of uncomplicated appendicitis, while complicated appendicitis was scarcely affected. Especially in the group of females < 40 years, a drastic reduction was visible. Rates of extended surgery did not change. Likewise, the complication rate like appendix stump leakage or need for re-operation did not differ. In March 2020, 4.8% of acute appendicitis patients had concomitant COVID-19 infection.ConclusionIn line with the overall drop of emergency room visits during the COVID-19 pandemic of spring 2020 in Germany, a significantly lowered number of patients with uncomplicated appendicitis were noticeable, whereas complicated appendicitis did not differ. Also, treatment and complication rate of acute appendicitis did not change. These findings might be a hint that acute appendicitis is not a progressing disease but caused by different entities for uncomplicated and complicated appendicitis and therefore another clue that uncomplicated appendicitis can be treated with antibiotics or observation. Nevertheless provided data does not cover outpatient treatment; therefore, no statement observation or antibiotics in outpatients can be made.

Potentially Inappropriate Prescriptions in Ambulatory Elderly Patients Living in Rural Areas of Romania Using STOPP/START (Version 2) Criteria.

BackgroundRational use of medications and monitoring of prescriptions in elderly patients is important to decrease the number and duration of hospitalizations, emergency medical consultations, mortality, as well as medical costs.PurposeTo identify potentially inappropriate medications (PIMs) and potential prescription omissions (PPOs), and determine their prevalence based on the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) v2 criteria and Screening Tool to Alert doctors to Right Treatment (START) v2 criteria for patients aged >65 years.MethodsThis cross-sectional study was conducted in two rural counties in Romania based on electronic prescriptions for chronic conditions (EPCCs) issued from 30 days to 90 days by a specialist or general practitioner. Collected EPCCs were evaluated by an interdisciplinary team of specialists based on 26 STOPP v2 criteria and 10 START v2 criteria.ResultsPIM prevalence was 25.80% and PPO prevalence was 41.72% for 646 EPCCs. The mean age of patients was 75 years and the mean number of drugs per EPCC was four. The most frequently identified PIMs were treatment duration (6.65%), theophylline administration (5.72%), drug indication (4.64%), cyclo-oxygenase-2 non-steroidal anti-inflammatory drugs (1.39%), and zopiclone prescription (0.77%). Statins (24.76%), beta-blockers (8.04%), and beta-2 agonist/antimuscarinic bronchodilators (5.88%) were the most frequently identified PPOs.ConclusionPPOs were more prevalent than PIMs for elderly populations living in the two rural counties in Romania we studied. Health practitioners (family physicians, specialists, and pharmacists) should focus on prophylactic and curative considerations when prescribing agents to decrease the morbidity and mortality of elderly rural Romanian patients.

Epidemiological transition in morbidity: 10-year data from emergency consultations in Dakar, Senegal

BackgroundIt is thought that low-income countries are undergoing an epidemiological transition from infectious to non-communicable diseases; however, this phenomenon is yet to be examined with long-term data on morbidity.MethodsWe performed...

Bedside echocardiographic evaluation of diastolic function : Step by step

Heart failure with preserved ejection fraction (HFpEF) is acommon condition, especially in the elderly. The principal symptom is dyspnea on exertion, which is often the reason for emergency medical consultation. As HFpEF is associated with asignificant mortality, early diagnosis is warranted. Herein, the potential of bedside echocardiography is presented.

A Matlab based interface for infrared thermographic diagnosis of pediatric musculoskeletal injuries

Background and objectiveOne of the main causes of emergency medical consultations done by children are musculoskeletal injures. In such cases, radiological tests are a common practice to diagnose the gravity of the trauma and determine the likely existence of a fracture. In order to avoid, or at least to reduce, the use of ionizing radiations with children, the infrared thermographic technique was studied as an alternative solution, since it is a non-harmful, non-invasive and non-contact technique, without excessive technical complications and moderate cost when compared to other types of imaging tools. MethodologyWhen an infrared thermographic diagnostic test is performed, and once the pictures of the studied limb are taken accordingly to the established methodology, an imaging post-processing protocol becomes necessary to make a correct interpretation and diagnosis. Aimed at performing the analysis in situ and in real time, in this work we present a software tool based on a Matlab interface. The software programming is based on the results obtained in clinical tests, where several variables were took into consideration. The program is able to determine the probability of fracture basing the diagnosis on a non-linear cataloguing approach, using decision trees. ResultsThe tool implemented allows to diagnose musculoskeletal injures in children shortly after taking the infrared thermographic picture. ConclusionsThe diagnosis tool provides the means for the interpretation of the IT pictures, allows to obtain a diagnosis in a fast way, and may help to decrease the radiation doses in children.

Un circuit court pour désengorger les services d’accueil des urgences pédiatriques

The number of emergency pediatric consultations continues to rise in France. The pediatric emergency department (PED) introduced relocated consultations (RlCs) for unwarranted visits to relieve the overload of emergency medical consultations. The objective of this study was to assess the advantages of implementing these RlCs. A single-center prospective study was undertaken from 21st January to 18 March 2012, with RlCs opened on weekends from 1 to 8 pm in the PED of the Nice Lenval University Hospital Center. All children referred for medical reasons during this period were included. One out of two children labeled stage 5 were transferred to the RlCs. The data evaluated were waiting time, duration of the medical consultation, transit time, and patient and medical staff satisfaction. Eight hundred and seventy-five patients were included. All patients in stages 1-2, 3, 4, and 5, relocated or not, had a mean waiting time before the medical consultation lasting 39.1, 57.7, 54.8, 70.5, and 52.7 min, respectively. The mean duration of the medical consultation was longer for stages 1-2 (61.6 min). The total time spent in the PED did not differ between stage 5 patients who were not relocated (121.3 min) and stages 1-2 (118 min), but both were longer than stage 5 patients who were relocated (90.3 min). Patients and medical staff expressed overall satisfaction during this period. By relocating one out of two stage 5 children, waiting times and consultation times decreased for all patients consulting at the PED. These results confirm that implementing RlCs has improved working conditions and quality of patient management.

9. Emergency Medical Consultation Via Telemedicine following a Russian Disaster

9. Emergency Medical Consultation Via Telemedicine following a Russian Disaster