Reason For Disposition Research Articles

과세처분 취소소송에서 처분사유 추가·변경의 기준

The Supreme Court has used the phrase ‘identity of basic facts’ as the criterion for determining the addition or change of reasons for disposition in general administrative litigation. In lawsuits for revocation of taxation disposition, the expression ‘identity of disposition’ has been mainly used. However, in the case of taxation disposition, the expression ‘identity of disposition’ is only used in a relatively broad sense to reflect the characteristics of taxation disposition and to recognize the scope of addition or change of reasons for disposition. Therefore, the ‘identity of basic facts’ is also a criterion for adding or changing reasons for disposition in a lawsuit for revocation of taxation disposition. The Supreme Court has held that ‘identity of basic facts’ is determined by whether the social facts, as a pre-legal concept, are basically the same. However, these criteria alone do not provide a convincing explanation for the permissibility of adding or changing reasons for disposition. As in the case of an amendment to the bill of indictment, it is necessary to recognize the normative elements in the content of the ‘identity of basic facts’. If this is recognized, the tax unit can function as a normative element in the case of taxation disposition. The Supreme Court held that in the case of withholding tax, the recipient of the amount of income is not an essential factor that distinguishes the unit of tax obligation, so it is possible to change it during the hearing of a lawsuit for revocation of collection disposition. However, changing the tax item as a result was not allowed. If normative factors are recognized, in special cases of withholding tax, even if the tax item changes, it is possible to add or change the reasons for disposition considering the legal structure and defense rights.

경찰기관의 정보공개 처분에 대한 검토

In this study, examine information disclosure and the administrative judgment system, which are means of police control, and examine the current status of the Central Administrative Appeals Commission's citation decision that clearly recognized the illegality and unfairness of the disposition of information disclosure by police agencies in 2023. In addition, it was intended to provide suggestions for reasonable disposition of information disclosure by police agencies. When a citizen exercises the right to request information disclosure from a police agency, the police agency decides whether or not to disclose the information in accordance with the statutory procedures set forth in the Information Disclosure Act. A person requesting information disclosure may appeal a police agency's decision to disclose information by filing an administrative appeal with the Central Administrative Appeals Commission. After reviewing the decision to disclose information to police agencies, be able to confirm the following facts. First, police agencies identified cases where they did not comply with statutory procedures under the Information Disclosure Act or misjudged the application of reasons for non-disclosure. In addition, we were able to confirm cases where police agencies' information disclosure officers lacked basic knowledge of the Information Disclosure Act, adding or changing the reasons for disposition, or restricting the information disclosure claimant's right to object through a substantive refusal with formal legality. The suggestions derived from the review of citation decisions regarding information disclosure by police agencies as discussed above can be summarized as follows. There is a need to do about the First, strengthening disciplinary responsibility for those in charge who do not comply with information disclosure procedures, Second, regular education and evaluation on cases of illegal and unfair information disclosure, Third, the introduction of a training completion system for police agency-specific office workers in the fields of investigation, transportation, and life safety, Fourth, strengthening the supervisory function of the Supervisory Office, Fifth, disclosure of cases of illegal and unfair decisions

Impact of COVID-19 on emergency oral health care in New Jersey

BackgroundThe COVID-19 pandemic led to reduced services of private dental practices. The public emergency clinic of Rutgers School of Dental Medicine (RSDM) (Newark, NJ) faced changing demands during various periods of the pandemic. MethodsRecords of patients visiting the emergency clinic at RSDM during 3 distinct periods (prelockdown, lockdown, teledentistry) from January 10, 2020, through June 30, 2020, were retrospectively reviewed. Qualitative and quantitative attributes pertaining to patient encounters were reviewed and analyzed. ResultsA total of 1,799 records were included in this study. Patient visits increased during the early lockdown but were reduced after the implementation of teledentistry. Trends were noted in patient volume, reasons for visits, treatment needs, symptoms, diagnostic methodology, prescription use, and final disposition of patients. ConclusionsThe lockdown affected emergency dental clinic services at RSDM. Teledentistry visits played a key role in screening patients and in facilitating the delivery of oral health care and timely follow-ups to patients who needed urgent in-person emergency visits. Practical ImplicationsData gathered will lead to a better understanding of patients seen in the emergency clinic and can help with long-term planning for both institutional and smaller outpatient clinics during public health emergencies.

Discursive constructions of family functions in forensic psychiatry: A critical ethnographic perspective.

Significant barriers remain regarding the implementation of family-centred approaches in the domain of forensic psychiatry despite their effectiveness at increasing adherence to treatment, improving attendance to medical appointments, decreasing readmission rates and reducing episodes of relapse. We attribute these barriers to a fundamental gap in our understanding of the family function and its role within the forensic psychiatric system. Despite requesting to be included and considered as partners, some families feel excluded and sidelined, which causes distress, incomprehension and disengagement. We approached this tension at the discursive level through a critical ethnography of the Review Board and the work of Foucault on psychiatric power, which provided us with a unique opportunity to understand how the role of families are constructed and sustained in the Canadian forensic psychiatric system. To do so, we mobilized data stemming from ethnographic observations and documentary artifacts entitled 'reasons for disposition'. Data analysis allowed us to identify two discursive constructions of familial functions: (1) families as repositories of information and (2) families as supervisory agents. These results have implications for health care professionals and administrators in forensic psychiatry who are increasingly adhering to family-centred care models without questioning what such care or what such family engagement entails.

886: EXTUBATION OUTCOMES: CALCULATED RISK OR LUCK OF THE DRAW?

Introduction: Prolonged mechanical ventilation is associated with longer hospitalization and higher mortality rates. Minimizing intubation duration is key in preventing such complications. Many factors have been assessed to predict the outcome of extubation, including Rapid Shallow Breathing Index (RSBI), Spontaneous Breathing Trial, and cough strength but 10-29% of patients who met these criteria still experience reintubation. Although there are no clear definitions of extubation failure, generally it is defined as required reintubation within 48 hours of a planned extubation. This study aims to address the extubation failure rate at Louisiana State University Health Shreveport hospital and provide insight on what patient characteristics were associated with failed extubation outcomes. Methods: A retrospective observational cohort study of intubated patients from 7/2020 – 4/2022 was conducted. Patient characteristics, hospitalization duration, reason for reintubation, oxygen requirements and disposition were recorded. Results: A total of 725 patients were intubated during the study. The most common indication for intubation was airway protection, surgical intervention and respiratory distress. Twenty-eight patients required reintubation in less than 48 hours and met our criteria for extubation failure. The reintubation rate was 3.8%. Approximately 54% of patients were male with average age of 62 years old. Average time to extubation failure was less than 24 hours. Average RSBI prior to extubation was reported as 59.75 with 8% of patients having a successful T-piece trial. The main cause of reintubation was airway protection. Out of the 28 subjects, 12 underwent tracheostomy after reintubation. The mortality rate in this study was 14% among patients who had extubation failure. Conclusions: Extubation failure is associated with an increase in the duration of mechanical ventilation, greater need for tracheostomy and higher mortality rate. Average reintubation rate or extubation failure rate is 10-20%. Lack of standardized practice for predicting extubation outcomes or standardized definitions of extubation failure puts patients at risk of intubation complications and death. Multicentered prospective studies are required for the development of standardized extubation practices to improve patient outcomes.

EARLY DESCRIPTIVE STUDY OF PEDIATRIC ED VISITS FOR COVID-19 DURING THE OMICRON WAVE IN QUEENS, NY

EARLY DESCRIPTIVE STUDY OF PEDIATRIC ED VISITS FOR COVID-19 DURING THE OMICRON WAVE IN QUEENS, NY

Palliative care utilization and mortality in patients who received inpatient chemotherapy.

e24074 Background: Early integration of palliative care (PC) into advanced cancer care has been shown to improve quality of life and prognostic understanding. However, there is a paucity of data on utilization of inpatient PC consultation and survival outcomes in patients (pts) receiving inpatient chemotherapy (IC). Methods: A retrospective review was performed at a single academic center of pts receiving IC between Jan 2016 and Dec 2017. We evaluated utilization of PC services, reasons for consult, code status, disposition, and 60-day mortality. Descriptive statistics and odds ratios (OR) were estimated from logistic regression models with mixed-effect, taking into account correlations from multiple admissions per patient. Cumulative incidence plot and Cox proportional hazard regression models were used to assess the association between mortality and study covariates. Results: Of 880 admissions, 733 (83%) were hematologic malignancies (HM) and 147 (17%) were solid tumors (ST). PC consults were more likely in ST than HM (OR 3.19, 95% CI 1.85 - 5.50) and for KPS ≤50% (OR 22.20, 95% CI 11.51- 42.79). Of 159 PC consults, 91 (57%) were for pain and 25 (16%) for goals of care. 66 pts (10%) who received IC died within 60 days of admission, 44 (67%) HM and 22 (33%) ST (p = 0.002). In pts who died within 60 days, 63% had PC consult. Median time from admission to PC consult was 2 days for ST and 9 for HM. Of those with PC consult, 40% had a change from full code to DNR/DNI and were more likely to have a health care proxy (HCP) assigned (OR 7.31, p = 0.001). PC consults were also associated with significantly higher odds of discharge to hospice (OR 10.52, 95% CI: 4.3-25.6; p = < 0.0001; Table). Mortality risk was higher in those admitted for symptoms/complications related to their disease or with progression (HR 3.24, 95% CI (2.50-4.19), p < 0.001) and in those with advanced stage disease: Stage 3 (p = 0.033); Stage 4 (p = 0.0003). Of the pts who died within 60 days, 33 (50%) died during the admission and 24 (36%) in hospice. Conclusions: Significant 60-day mortality after receiving IC is consistent with aggressive end-of-life care. Pts with ST and those with poor performance status more frequently utilized inpatient PC services; however, there is opportunity to increase utilization amongst pts with HM and introduce PC earlier in the inpatient clinical course. PC consultations improve advanced care planning with appropriate transitions in code status, HCP assignments, and discharge to hospice.[Table: see text]

Trends in suicidal ideation in an emergency department during COVID-19

ObjectiveThis study aims to detail changes in presentations at a United States Emergency Department for suicidality before and after the outbreak of COVID-19. MethodsA retrospective chart review was conducted of all adult patients who presented to an ED with suicidality and underwent psychiatric consultation during the study period. The cohorts consisted of patients who presented between December 2018 – May 2019 and December 2019 – May 2020. Information was collected on demographics, characteristics of suicidality, reasons for suicidality and disposition. The first wave from March – May 2020 was examined, using a difference-in-differences design to control for factors other than COVID-19 that may have influenced the outcomes' trend. ResultsImmediately following the pandemic outbreak there was a statistically significant increase in the proportion of undomiciled patients represented in visits for suicidality (40.7% vs. 57.4%; p-value <0.001). In addition, the proportion of patient visits attributed to social (18.0% vs. 29.2%; p-value 0.003) and structural (14.2% vs. 26.4%; p value <0.001) reasons for suicidality increased. Conversely, the proportion of visits due to psychiatric symptoms (70.5% vs 50.0%; p-value <0.001) decreased. Furthermore, patient visits were more likely to result in a medical admission (2.1% vs. 8.3%; p-value 0.002) and less likely to result in a psychiatric admission (68.4% vs 48.6%; p-value <0.001) during the initial phase of the pandemic. ConclusionsCOVID-19 was associated with increased ED presentations for suicidality among undomiciled patients, as well as greater likelihood of social and structural reasons driving suicidality among all visits.

Finish your plate! Food disposition behaviour among late adolescents

PurposeThis study explores the disposition behaviour of late adolescents towards unfinished food. Specifically, this paper identifies and discusses the manner (the how's) and the reasons (the why's) of food disposition.Design/methodology/approachThis study adopted a taxonomy of decisions pertaining to consumer disposition processes. A generic qualitative approach based on personal interviews and focus group discussions was used to collect data from late adolescents. Data was subsequently analysed using content and thematic analyses.FindingsThe findings revealed five manners (the how's) of food disposition among late adolescents, namely keeping it for original purposes, leaving it for other people to dispose of, converting it for another purpose, trying to finish it and getting rid of it permanently. Additionally, there are three reasons (the why's) for food disposition among late adolescents, namely food-related factors, socio-cultural factors and personal factors.Originality/valueFood waste has continually impacted food production, supply and consumption in a profound way. Responsible food disposition behaviour among individuals has become essential to improve food sustainability. Proper food disposition requires a behavioural change among individuals, including late adolescents, who are growing into adulthood. This study contributes to the body of knowledge of food systems by identifying how and why food is disposed of among late adolescents during their formative years. The findings can be utilised to raise awareness of food disposition behaviour and design food responsibility initiatives.

COVID-19: A Comprehensive Analysis of the Pandemic's Effect on an Emergency Department.

Coronavirus disease 2019 (COVID-19, caused by severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) is a historic pandemic severely impacting health care. This study examines its early effect on a busy academic emergency department. A retrospective analysis of patients from an academic tertiary care Level I trauma, cardiac and stroke center's emergency department seeing an average of 54,000 adults and 21,000 pediatric patients per year. Total visits, reasons for patient visits, demographics, disposition, and length of stay were analyzed from January through July 2020 and compared with the same time period in the previous 2 y. From March through July 2020 there were statistically significant decreases in the total number of patient visits (-47%) especially among pediatric (-73%) and elderly (-43%) patients and those with cardiovascular (-39%), neurological (-63%) complaints, headaches (-60%), back pain (-64%), abdominal pain (-51%), and minor trauma (-71%). There was, however, a significant increase in pulmonary complaints (+54%), as well as admissions (+32%), and length of stay (+40%). There was a significant drop in overall patients and select groups early in the pandemic, while admissions and emergency department length of stay both increased. This has implications for future pandemic planning.

Vascular surgery-related violations of the Emergency Medical Treatment and Labor Act

ObjectiveThe Emergency Medical Treatment and Labor Act (EMTALA) is a federal law established in 1986 to ensure that patients who present to an emergency department receive medical care regardless of means. Violations are reported to the Centers for Medicare and Medicaid Services and can result in significant financial penalties. Our objective was to assess all available EMTALA violations for vascular-related issues. MethodsEMTALA violations in the Centers for Medicare and Medicaid Services publicly available hospital violations database from 2011 to 2018 were evaluated for vascular-related issues. Details recorded were case type, hospital type, hospital region, reasons for violation, disposition, and mortality. ResultsThere were 7001 patients identified with any EMTALA violation and 98 (1.4%) were deemed vascular related. The majority (82.7%) of EMTALA violations occurred at urban/suburban hospitals. Based on the Association of American Medical Colleges United States region, vascular-related EMTALA violations occurred in the Northeast (7.1%), Southern (56.1%), Central (18.4%), and Western (18.4%) United States. Case types included cerebrovascular (28.6%), aortic related (22.4%; which consisted of ruptured aortic aneurysms [8.2%], aortic dissection [11.2%], and other aortic [3.1%]), vascular trauma (15.3%), venous-thromboembolic (15.3%), peripheral arterial disease (9.2%), dialysis access (5.1%), bowel ischemia (3.1%), and other (1%) cases. Patients were transferred to another facility in 41.8% of cases. The most common reasons for violation were specialty refusal or unavailability (30.6%), inappropriate documentation (29.6%), misdiagnosis (18.4%), poor communication (17.3%), inappropriate triage (13.3%), failure to obtain diagnostic laboratory tests or imaging (12.2%), and ancillary or nursing staff issues (7.1%). The overall mortality was 19.4% and 31.6% died during the index emergency department visit. Vascular conditions associated with death were venous thromboembolism (31.6%), ruptured aortic aneurysm (21.1%), aortic dissection (21.1%), other aortic causes (10.5%), vascular trauma (10.5%), and bowel ischemia (5.3%). ConclusionsAlthough the frequency of vascular-related EMTALA violations was low, improvements in communication, awareness of vascular disease among staff, specialty staffing, and the development of referral networks and processes are needed to ensure that patients receive adequate care and that institutions are not placed at undue risk.

Opioid exposures in children under 5 years of age (2004-2019): A retrospective study of calls to Australia's largest poisons information centre.

To describe time trends in opioid exposures in children under 5 years, and to describe patient demographics, the medicines involved, the reasons for exposure and disposition. A retrospective analysis of paediatric (<5 years of age) opioid exposure calls to the New South Wales Poisons Information Centre (NSWPIC, Australia's largest poison centre), 2004-2019. Joinpoint regression analysis was used to examine temporal trends. There were 4807 cases of paediatric opioid exposure during the 16 year study period, with an average of 300 exposures per year. Exposures increased, 2004-2007, with an annual percentage change (APC) of 14.6% (95% CI=4.3 to 26.0%), then decreased, 2007-2016, APC -3.4% (95% CI=-5.3 to -1.3%). A steeper decrease was observed after 2016, APC -14.1% (95% CI=-21.8 to -5.6%). The overall APC was -2.3% (95% CI=-4.7 to 0.2%), 2004-2019. Accidental exposures accounted for 86% of calls (4137). The majority of calls were from family members regarding exposures that happened at home, highlighting the need for safety initiatives. The preparations most frequently involved were paracetamol/opioid combination products (primarily codeine), 53% (2566) and ibuprofen/opioid combinations 14% (650). Twenty-two percent of cases were referred to a hospital (1062), and a further 15% (719) of calls originated from hospital staff. Opioid exposures in young Australian children continue to occur; however, the rate has declined since 2007. Safe storage and parent education initiatives could further reduce the burden of paediatric opioid poisoning in Australia.

A Month in an Acute Palliative Care Unit

Few cancer centers have developed acute palliative care units (APCUs). The purpose of this study is to highlight clinical interventions and financial outcomes during a typical 1-month period on an APCU. We evaluated consecutive patients admitted to our APCU from February 1 to 28, 2009, regarding demographic information, sources of and reasons for admissions, resuscitation status, clinical interventions, disposition, and reimbursement data. Forty-two patients were admitted during a 1-month period. Of these, 30 (71%) were referred from the inpatient palliative care consultation team. In all, 10 (24%) patients had a full code status on admission, and 8 had their status changed to do not resuscitate (DNR) prior to discharge. A total of 11 (26%) patients were discharged home with hospice care, 12 (29%) died on the APCU, and 10 (24%) were discharged home with outpatient follow-up visits. All patients received intravenous medications and the majority received intravenous antibiotics. All patients met acute care criteria for hospitalization, and financial reimbursement was satisfactory and comparable to that of other oncology patients. The APCU model is designed for the care of very complex advanced cancer patients. Palliative interventions are given simultaneously with other medical interventions. The APCU is labor intensive and well reimbursed.

Costs of bleeds relating to acute coronary syndrome therapies

Objective: To estimate the costs to manage selected types of bleeding complications in patients with acute coronary syndrome (ACS) treated with antithrombotics, including antiplatelet, and fibrinolytic therapies: decrease in haemoglobin >3 g/dL, puncture site, and bleeding requiring transfusion of blood products.Methods: Retrospective chart reviews of ACS patients experiencing decrease in Hb, puncture site, or bleeding requiring transfusion were conducted in hospitals in France, Germany, Italy, Spain and Sweden to determine the total length of stay (LOS), stay post-bleeding, procedures to identify the extent of bleeding, number and types of transfusion products, patient demographics, reason for hospital admission and disposition upon discharge. Country-specific costs were applied to estimate the average cost per patient by type of bleeding event.Results: Records of 158 ACS patients with the bleeding complications were examined (26.9% decrease in Hb, 35.5% puncture site, and 37.8% transfusion). The average LOS was 10.6 days for decreasing Hb, 7.7 days for puncture site bleeding, and 11.3 days for patients receiving transfusions due to these bleeding events. The average costs per patient ranged between €3,986 and €10,252. The LOS ranged widely both within and across countries.Limitations: The study has a small sample size and costs are confounded by co-morbidities.Conclusions: The estimated costs for decreasing Hb, puncture site bleeding and bleeding resulting in transfusions provide a tool for researchers to conduct economic analyses of bleeding events associated with therapies for ACS.

Management of free‐ranging birds rescued and admitted to Uganda Wildlife Education Centre: 2000–2004

<b>Management of free‐ranging birds rescued and admitted to Uganda Wildlife Education Centre: 2000–2004</b>

Correlation of intercondylar notch cross sections to the ACL size: a high resolution MR tomographic in vivo analysis

To correlate cross sections of the intercondylar notch to cross sections of the anterior cruciate ligament (ACL) and to analyze gender-related differences in notch and ACL morphometry with an attempt to explain the observation that a small intercondylar notch and the female gender predispose to a rupture of the ACL. High resolution MR imaging was performed on a 1.5 T magnet using a dedicated extremity-coil in ten left and ten right knee joints of 20 volunteers (10 male, 10 female, mean age 25 years) with no history of knee abnormalities. Continuous axial T2-weighted MR images perpendicular to the longitudinal axis of the ACL were acquired. Cross-sectional areas of the ACL midsubstance at the contact area to the posterior cruciate ligament were measured. For imaging and evaluation of the osseous limits of the intercondylar notch a 3D-dataset of the knee was acquired. Anterior, middle and posterior planes of the intercondylar notch were calculated and analyzed for measurement of the notch area AN and notch width index NWI. The ratio of the ACL cross-sectional area of the ACL and the cross-sectional area of the notch was defined as the ACL notch index (ANI) and used as a standardized tool for evaluation. For statistical evaluation, linear regression analysis was performed. Mean values between male and female were compared using a t test. In addition, five matched pairs of male and female volunteers of same height were analyzed. Mean cross-sectional size of the ACL at the crossing with the PCL was 54.4 +/- 20.4 mm2. Regression analysis showed a significant correlation (P < 0.05) of the ACL cross-sectional area to the notch areas on all three planes and NWI, respectively. Comparison between the sexes revealed that female participants had significantly smaller cross-sectional areas of the ACL, the notch areas, the NWI and ANI. This difference was found for both the complete study group and the matched pairs of same height. The smaller the intercondylar notch the smaller the cross-sectional area of the ACL midsubstance. In addition to the impingement of the ACL at the anterior and posterior roof of the notch, a biomechanically weaker ACL may be the reason for disposition to an ACL rupture in patients with a small intercondylar notch. Women have a thinner ACL midsubstance than men of the same height which may be one of the critical etiologic factors that predispose women to an ACL rupture.

Relationships between Patient, Family, and Significant Other Disposition Preferences in Psychiatric Emergency Services and the Clinical Symptom Ratings and Disposition Decisions of Psychiatrists.

A previous paper examined the relationship between 10 clinical ratings made by psychiatrists and 465 psychiatric emergency service (PES) dispositions. A logistic regression model explained 52% of the variance in the psychiatrist's decisions to admit to inpatient services or release. The 5 clinical ratings in the model, rated on 8-point scales, were severity of danger to self, psychosis, inability to care for self, impulse control, and depression. The current paper examines the relationships between patient and family/significant other dispositional preferences expressed in the PES, and the psychiatrist's disposition decision and the 10 clinical ratings. It found that the dispositional preferences of the patient, family, and other individuals (community clinician, police, or ambulance driver) were very consistent with the actual decision made by the PES psychiatrist. Further, it found that these preferences explained an additional 35% of the variability in the psychiatrist's decision to admit or release. Finally, the ten clinical ratings made by the PES psychiatrist explained only a small amount of the variance in the dispositional preferences, and some of the significant coefficients were in the opposite direction expected. Patient, family and other significant individuals' expressed preferences and expectations in the PES are important and should be routinely recorded in the charts. The small relationships between clinical ratings and preferences suggests that the reasons the family/significant other and the patient seeks hospital admission or release may differ with psychiatrists' reasons for disposition.

Transfer of elderly patients from health care facilities to emergency departments: Prospective observational study of the emergency department in Japan

Background: The purpose of the present paper is to describe the current status of emergency departments (ED) that are used by health care facilities for elderly (HCFFE) residents in Japan.Methods: The present paper is based on a prospective, observational study that was undertaken at a teaching hospital in Nagoya city over a 12‐month period. All patients transferred to the hospital ED from a regional HCFFE were analyzed. Demographic data, timing of the visit, the primary reason for transfer, diagnosis and disposition were recorded. The need for ambulance use was graded prospectively using three categories of urgency.Results: A total of 102 HCFFE residents made 116 ED visits. Their mean age was 83.3 years (range 58–101), 68% were female. The majority of patients (93%) were transferred by ambulance. Ambulance transfer was classified as emergency (20% of patients), urgent (51%) and routine (29%). The main reasons for patients to be transferred were fever (15.5%), fall (11.2%), altered mental status (10.3%), focal neurological deficits (10.3%), and weakness (9.5%). A total of 88% of the ED visits led to admission to the hospital. After admissions, the mean length of stay was 21.4 days and the mortality rate was 13%.Conclusion: Elderly patients staying in HCFFE are frequently transferred to an ED, and their visits are likely to lead to admission to the hospital, which is associated with prolonged lengths of stay as well as high mortality rates.

Abuse of Coricidin HBP cough & cold tablets: episodes recorded by a poison center.

Cases involving ingestion of a dextromethorphan-containing product recorded at a poison control center were studied. A retrospective review of all consultations involving the ingestion of Coricidin HBP Cough & Cold tablets recorded by the California Poison Control System was conducted for the period from January 1 to October 1, 2000. Computerized charts on the consultations were reviewed to obtain data on patient age and sex, number of tablets taken, reason for tablet ingestion, symptoms, treatment, disposition, and outcome. A total of 92 charts (for 92 patients) documenting Coricidin HBP Cough & Cold tablet ingestion were reviewed. The reason for tablet ingestion was classified as abuse in 65 patients (71%), a suicide attempt in 8 (9%), misuse in 1 (1%), malicious administration in 1 (1%), and normal use (but with an adverse drug reaction) in 1 (1%); 16 patients (17%) consumed the tablets for an unknown reason. The 92 patients comprised 42 males and 50 females. Among all patients, 78 (85%) were 13-17 years old, and among those classified as having abusive intent, 58 (89%) were in the same age range. The most commonly reported signs and symptoms associated with ingestion were tachycardia (50 patients), hypertension (29), lethargy (40), mydriasis (20), agitation (15), ataxia or dizziness (20), and vomiting (9). Sixty-one patients (66%) had some alteration in mental status. Fifty-six (61%) were treated in the emergency department; 11 (12%) were admitted. All patients recovered completely. Information on the ingestion of Coricidin HBP Cough & Cold tablets recorded at a poison control center indicated a high rate of abuse of the product among teenagers.

Adult emergency visits for chronic cardiorespiratory disease: does dyspnea matter?

Dyspnea is among the most common reasons for emergency department (ED) visits, yet little is known about how it is associated with visit characteristics and disposition or about how such associations differ across diagnoses. To characterize ED visits for chronic cardiorespiratory diseases in which dyspnea is a prominent symptom. Visit demographics and relations among reasons for presenting, visit urgency, medications, and visit disposition were examined. Data for this cross-sectional descriptive-exploratory study came from the 1992 National Hospital Ambulatory Medical Care Survey. All adult ED visits in the dataset for asthma (n = 395), chronic obstructive pulmonary disease (COPD; n = 239), and congestive heart failure (CHF; n = 320), as well as for mixed and restrictive chronic lung diseases (n = 18 and n = 14, respectively), were analyzed. Dyspnea was the most common reason for ED visit across diagnoses, and was associated with an approximate twofold increase in likelihood of admission for patients with COPD (odds ratio [OR] = 1.9, p < .04), and, controlling for age, CHF (OR = 1.7, p = .035). Dyspnea, alone or controlling for age, did not significantly increase the likelihood of admission for asthma. However, across all diagnoses, dyspnea was associated with a two- to threefold increase in the likelihood of receiving intravenous (i.v.) fluids (p < or = .006), whereas receiving an i.v. markedly increased the likelihood of admission (OR = 10.0, p < .0001 for COPD; OR = 10.2, p < .0001 for asthma; and OR = 3.8; p < .0001 for CHF). Age independently predicted admission for asthma and CHF, but not COPD. The percentage of nonurgent visits resulting in admission was markedly higher for COPD (19%) and CHF (41%) than for asthma (4%) or adult visits in general (6%). Reports of dyspnea increased the likelihood of admission from the ED either directly or indirectly, depending on diagnosis. Judgments of nonurgency may be less dependable in ED visits for COPD and CHF than for asthma or adult visits generally.