Emergency Room Treatment Research Articles

Criminal History, Physical and Mental Health, Substance Abuse, and Services Use Among Incarcerated Substance Abusers

Recent research shows that drug-involved offenders engage in many health-risky behaviors, but relatively little is known about the impact of criminal history on the health of these individuals. In this study, criminal history and health information was collected from 661 male drug-abusing prisoners. Findings showed that having a more extensive criminal history was associated with higher rates of overall physical health problems but not mental health problems. Although no relationship between mental health and crime was observed, future research on the connection between psychological problems and criminal history is discussed. Years of lifetime use of five different drugs was positively related to criminal history. In terms of health services utilization, offenders with more serious criminal histories were more likely to have received previous medical treatment in a hospital emergency room and to have received treatment for drug or alcohol abuse.

Omalizumab, a recombinant humanized anti-IgE antibody, reduces asthma-related emergency room visits and hospitalizations in patients with allergic asthma

Background: Prevention of serious asthma exacerbations is an important therapeutic goal in patients with asthma. Objective: The purpose of this study was to investigate the effect of omalizumab (Xolair), a recombinant humanized monoclonal anti-IgE antibody, on the rate of serious exacerbations during long-term therapy. Methods: A pooled analysis was completed of 3 multicenter, randomized, double-blind, placebo-controlled phase III studies with omalizumab in adults/adolescents aged ≥12 years (n = 1071) and in children aged 6 to 12 years (n = 334) who required treatment with inhaled corticosteroids for allergic asthma. Rates of serious asthma exacerbations were computed and compared between omalizumab- and placebo-treated patients. Serious exacerbations were those leading to unscheduled outpatient visits, emergency room treatment, or hospitalization during 1 year of treatment. Results: In all, 767 patients were treated with omalizumab (at least 0.016 mg/kg/IgE [IU/mL], administered subcutaneously every 4 weeks). Another 638 patients were treated with placebo. The rate of unscheduled, asthma-related outpatient visits was lower for the omalizumab-treated patients than for the placebo-treated patients (rate ratio [95% CI], 0.60 [0.44, 0.81]; P < .01), as were asthma-related emergency room visits (rate ratio [95% CI], 0.47 [0.24, 1.01]; P = .05). Importantly, hospitalizations for asthma were markedly reduced in patients receiving omalizumab (rate ratio [95% CI], 0.08 [0.00, 0.25]; P < .01). Conclusion: Omalizumab reduces the rate of serious asthma exacerbations and the need for unscheduled outpatient visits, emergency room treatment, and hospitalization in patients with moderate-to-severe allergic asthma. (J Allergy Clin Immunol 2003;111:87-90.)

Changing the focus: the case for recognizing and treating cannabis use disorders.

During the late 1960s, cannabis emerged from relative obscurity to become the most common illicit drug used in the United States, and has remained so ever since. From an epidemiological perspective, three major waves of successively younger new users can be identified during the past 40 years. Contrary to popular opinion, cannabis use can be problematic for many people (particularly adolescents). Moreover, the drug has become increasingly more potent. Cannabis is currently one of the leading substances reported in arrests, emergency room admissions, autopsies and treatment admissions. Like alcohol and tobacco, the need for effective approaches to treating cannabis use disorders transcends debates about whether it should be legal. Moreover, the costs to society are continuing to mount from past neglect of this continuing public health problem. This paper provides background on the need to develop effective models for treating cannabis use disorders.

A Follow-up Study of Adolescent Attempted Suicide in Israel

(1) To compare the outcome of adolescent subjects who have made a suicide attempt with the outcome of matched controls, using their psychological and psychometric screening tests for military service at age 16.5 years. Their subsequent performance during military service between ages 18 and 21 was also evaluated. (2) To compare the prognosis of those attempters who received intensive psychiatric inpatient evaluation in a general hospital with the prognosis of those who received emergency room treatment only. The computerized military records of 216 adolescents, who had been treated between 1987 and 1988 for attempted suicide in a general hospital emergency room, prior to their induction into the army, were evaluated. They were rated on the following tests: cognitive/educational performance and psychosocial adaptation, psychiatric and psychological health diagnoses, and performance during their military service between 1989 and 1992. Although the female attempters had slightly more problems in the military than the controls, their overall prognosis was surprisingly good. The male suicide attempters did very poorly in their subsequent military service. There was no long-term advantage in having had a psychiatric evaluation performed in a hospital over a brief emergency room evaluation. Most differences between attempters and controls were in service performance, rather than in cognitive and psychometric tests. There may be marked differences between the sexes in the significance of attempted suicide and in the indications for intervention. The policy of mandatory general hospitalization for suicide attempters may need reevaluation.

Continuity of medical care and risk of incarceration in HIV-positive and high-risk HIV-negative women.

Incarceration rates in the United States have tripled over the past two decades and have increased even more rapidly among women than men. To identify risk factors that predict incarceration in HIV-positive (HIV+) and high-risk HIV-negative (HIV-) women and to evaluate the association between continuity of medical care and risk of incarceration, this analysis was conducted. This was a prospective cohort study of HIV+ and high-risk HIV- women enrolled between April 1993 and January 1995 at four urban centers: Providence, Rhode Island; New York, New York; Baltimore, Maryland; and Detroit, Michigan. The HIV Epidemiology Research (HER) Study enrolled 871 HIV+ and 439 high-risk HIV- innercity women between the ages of 16 and 55 years. All participants had a history of injection drug use or high-risk sexual behavior. Interviews, including questions on continuity of medical care and incarceration, were administered at baseline and 6 and 12 months after enrollment. Any incarceration in the 1-year period following enrollment was the main outcome measure. Continuity of care was measured as having seen one healthcare provider for at least 2 years, having received medical care from one usual physician or clinic, and having obtained medical care in a primary care setting as opposed to an emergency room or drug treatment center. Twelve percent of women were incarcerated within 1 year postenrollment. Factors associated with incarceration included recent drug use, prior incarceration, lack of college education, engaging in sex for drugs or money, and having multiple unmet basic needs at the time of enrollment in the study. Continuity of care with a single healthcare provider for more than 2 years prior to enrollment in the study was associated with decreased rates of incarceration even after adjusting for possible confounding factors (OR = 0.67, 95% CI = 0.48 - 0.92). HIV serostatus did not correlate with incarceration. History of prior incarceration and recent drug use were associated with increased risk of incarceration. Continuity of medical care by a single healthcare provider was associated with decreased likelihood of incarceration, suggesting that the provider may play an important role in designing interventions to prevent incarceration in this high-risk population.

Emergency Room Treatment of Migraine Headache.

Headache is the chief complaint in the emergency room in between 0.36% and 2.5% of patients. It is essential that the headache diagnosis be established to rule-out a potentially morbid disorder, as well as facilitate selection of appropriate interventions. Referral with follow-up care is essential to patients with frequent headaches in order to prevent repeat emergency room visits and possible narcotic dependency. Two stages define emergency room treatment of any form of headache--initial stabilization and treatment (which may be started in the emergency room). Despite the introduction of migraine-specific therapy in 1993, only a minority of migraine headache patients are prescribed this treatment.

Trajectories of cognitive recovery following a minor brain injury.

Minor brain injury (MBI) is the most frequently diagnosed head trauma in the United States, with treatment costing more than $1.5 billion annually and many patients incapacitated for months following injury. The purpose of this study was to characterize the brain function disruptions associated with MBI and to determine the time trajectory of recovery, using a theoretical model of attention. Distractibility, impulsivity, irritability, and impaired executive functioning were demonstrated in all participants during the 24 hr after injury. Twenty percent of participants continued to complain of distractibility, impulsivity, and/or irritability throughout the 30-day study. Loss of consciousness was shown to confound participants' healing trajectories. These results suggest that standard emergency room treatment following MBI is inadequate and should include discharge directives to reduce cognitive demands for at least 48 hr at a minimum, for 30 days or longer for those with loss of consciousness.

Structured radiologic diagnosis in polytrauma

Development of a concept for structured diagnostic imaging in patients with multiple trauma. Evaluation of data from a prospective trial with over 2400 documented patients with multiple trauma. All diagnostic and therapeutic steps, primary and secondary death and the 90 days lethality were documented. Structured diagnostic imaging of multiple injured patients requires the integration of an experienced radiologist in an interdisciplinary trauma team consisting of anesthesia, radiology and trauma surgery. Radiology itself deserves standardized concepts for equipment, personnel and logistics to perform diagnostic imaging for a 24-h-coverage with constant quality. This paper describes criteria for initiation of a shock room or emergency room treatment, strategies for documentation and interdisciplinary algorithms for the early clinical care coordinating diagnostic imaging and therapeutic procedures following standardized guidelines. Diagnostic imaging consists of basic diagnosis, radiological ABC-rule, radiological follow-up and structured organ diagnosis using CT. Radiological trauma scoring allows improved quality control of diagnosis and therapy of multiple injured patients. Structured diagnostic imaging of multiple injured patients leads to a standardization of diagnosis and therapy and ensures constant process quality.

The Fate of Early Memories: Developmental Science and the Retention of Childhood Experiences

The Fate of Early Memories: Developmental Science and the Retention of Childhood Experiences

Hospital emergency rooms and children's health care attitudes.

To assess attitudes of children requiring hospital emergency room (ER) treatment for trauma injuries 5 years afterward to evaluate the long-term effect of treatment distress. For comparison, health care attitudes of a large random sample of children were assessed. Children (N = 139, 7-19 years old) recruited from the ER completed a health care attitude questionnaire. Comparable schoolchildren (N = 1,300) completed the same questionnaire, with the addition of a few questions asking about hospital contact. The ER-recruited group was part of a 5-year follow-up study, and at the time of initial recruitment, their parents had rated their children's degree of distress at both the time of injury and of ER treatment on a 6-point scale. For the ER-recruited sample, the degree of distress during ER treatment did not seem to have longterm effects on children's attitudes. For the random sample, contact with the ER, especially for a trauma injury, was related to children liking the ER more. Although other research has shown that aversive medical experiences may negatively affect children's attitudes, these findings suggest that the nature of the medical contact is important in how children interpret medically induced pain, which is related to their attitudes.

Time optimized modern shock room management using digital techniques

Emergency room management means time management. A time and four color based algorithm is described to improve workflow, follow up of diagnostic procedures and initial treatment. As a result introducing the time based interdisciplinary emergency algorithm within 60 minutes all necessary treatment and diagnostic procedures were completed. This algorithm is an effective tool to improve emergency room treatment.

Management Pitfalls in the use of Embolization for the Treatment of Severe Epistaxis

Angiographic embolization for the treatment of severe recurrent epistaxis was added to the traditional treatment options--nasal packing, cauterization, and surgical vessel ligation--in 1974. Since then, clinical experience has shown that this procedure is safe and effective. When epistaxis cannot be controlled with cautery, nasal packing is the most common next step. As such, it is often performed by emergency physicians and other clinicians who are not otolaryngologists. We report two cases in which intranasal neoplasms were obscured as a result of a significant distortion of the normal anatomy. This distortion was secondary to emergency-room treatment of severe epistaxis by repeated nasal packing followed by angiographic embolization. Pre-embolization angiographic studies and subsequent postembolization endoscopic evaluations did not reveal the presence of the occult neoplasms because of the presence of inflammation and edema after treatment. Clinicians should be aware that nasal packing and embolization can obscure the underlying source of epistaxis, and follow-up radiologic studies and endoscopic evaluations are essential to avoid delays in diagnosis.

Use of heliox in patients with severe exacerbation of chronic obstructive pulmonary disease.

To assess whether patients with chronic obstructive pulmonary disease treated with heliox have a better prognosis than those treated with standard therapy. Retrospective analysis over 18 months. Academic emergency department. Eighty-one patients admitted with exacerbation of chronic obstructive pulmonary disease and respiratory acidosis. Use of helium-oxygen mixture as an adjunctive therapy. The following data were collected: age, gender, medical history, vital signs, arterial blood gas at admission, emergency room treatment, requirement for intubation, admission in intensive care unit, length of stay, and evolution. Patients were classified into two groups according to whether heliox was used as a therapeutic agent (heliox group) or not (standard group). Chi-square test and Student's t-test were used for statistical analysis (significant at p <.05). In both groups, the following data were similar: age, gender, medical history, vital signs, initial arterial blood gas, and emergency room treatment. Significant decreases in intubation, and mortality rate were identified in the heliox group. Significant decreases in intensive care unit stay and in-hospital stay were observed for survivors in the heliox group. Use of heliox seems to improve prognosis in patients with severe acute exacerbation of chronic obstructive pulmonary disease. Prospective randomized studies are needed to confirm these results.

PSYCHOLOGIC FACTORS AND PATIENT ADHERENCE

Clinical practice guidelines have been issued to assist physicians in choosing the most appropriate and effective medications to improve patient outcomes. 33 Most of these guidelines explicitly acknowledge that the success of medical therapy depends on the efficacy of the recommended treatment and the patient's adherence with that regimen. Adherence may be defined as the extent to which the patient's actual practice corresponds to the prescribed regimen. 75 For ambulatory patients, adherence constitutes the link between medical process and treatment outcome. 75 The goals of asthma management set down by two Expert Panel Reports under the auspices of the National Heart, Lung, and Blood Institute (NHLBI) are to (1) treat the patient with the least aggressive therapy sufficient to prevent chronic symptoms and exacerbations, (2) maintain normal activity and normal or near-normal lung function, (3) avoid missing school or work, and (4) eliminate sleep disruption. 51,52 The recommended treatment is organized around four components: (1) step-wise pharmacologic therapy adjusted to the severity of the patient's disease, (2) use of objective measures of lung function, (3) environmental control, and (4) patient education to advance a partnership among the patient, family, and clinicians. 51,52 The intent of the final component is to promote adherence fundamental to the success of the other three components. Accordingly, the step-wise approach to therapy recommended by these Expert Panel Reports can only succeed if there is adequate adherence by both physicians and patients. The goals of the Expert Panels are not being met (Table 1). Asthma continues to be a leading cause of preventable hospitalization in the United States with 470,000 admissions and more than 5000 deaths a year. 55 Fewer than half of the children who need emergency room treatment 28 and adults who require hospitalization 35 receive the anti-inflammatory therapy advocated by the Expert Panel Report-2, 52 a deplorable neglect given that the use of low-dose inhaled corticosteroids is associated with a decreased risk of death from asthma (Fig. 1). 73 Estimates of adherence rates to therapeutic recommendations in long-term medical regimens range between 50% and 65%. 46 For children with asthma, the average medication adherence rate of 48% was found in a review of 10 studies, 20 and similar findings have been reported for adult patients. 59,69 One publication demonstrates that adolescents with diabetes who agree to participate in studies have a higher rate of adherence than those who do not. 61 The accepted figures for adherence, though disappointing, may be overly optimistic.

Alternate strategies for postmortem drug testing.

Alternate strategies for postmortem drug testing.

Recounting the same events again and again: children's consistency across multiple interviews

AbstractChildren (2–13 years at time of injury) were interviewed four times about an injury that required hospital Emergency Room treatment, namely at 1 week, 6 months, 1 year, and 2 years. The consistency of children's reports was assessed and all children gave mostly the same information at each interview, although consistency was higher for older children and for injury rather than hospital details. Furthermore, details recalled at every interview were virtually always accurate while details that were sometimes omitted were a little less likely to be accurate. New information that was introduced after 6 months was more likely to be accurate than inaccurate but new information introduced at 1 or 2 years post‐injury was just as likely to be wrong as right (except for 12–13‐year‐olds). Implications for forensic situations are discussed. Copyright © 2001 John Wiley &amp; Sons, Ltd.

Acute treatment of migraine and the role of triptans.

The use of triptans has improved the ability to treat migraine successfully compared with older treatments. Speed of relief, consistency of effect, and good tolerability have been the hallmarks of these agents. All of the currently available triptans have comparable efficacy and tolerability. Variables between the agents may lead to one agent or dose form being preferred over another in various clinical scenarios. The triptans that are forthcoming may improve on these options through enhanced efficacy rates, tolerability, and headache recurrence rates. There exist increasing options for migraine treatment that may further improve the clinical effects of the older and newer triptans through early treatment of migraine at the stages of mild migraine pain, or even during the prodromal phase of the attack. Additionally, recent work suggests that mini-prophylaxis of migraine at the menses is a highly successful treatment option with the triptans. In this age of managed care, providing cost-effective treatment of headache will take on increasing importance. Techniques such as stratification of acute treatments may enhance cost-effective care, whereas ready availability of the triptans may lead to significant improvements in utilization of parameters such as office visits, emergency room treatment, and even hospitalization.

Equity in the diagnosis of chest pain: race and gender.

To explore gender and racial equity in emergency room treatment of chest pain. Three hundred seventy-nine patient records were analyzed, taking into account effects of age, clinic, comorbid status, and insurance status. Analysis of covariance and logistic regression revealed statistically significant differences between races but not between genders for time to first EKG and percent of patients receiving cardiac catheterization and echocardiography. Blacks waited longer than whites for an EKG and were less likely to receive cardiac catheterizations but more likely to receive echocardiography. This study demonstrates a lack of equity by race in treatment of chest pain emergencies.

Establishing a new research agenda for studying psychiatric emergency room treatment decisions.

With the growing complexity of treatment decisions made at presentation to a psychiatric emergency room (PER) and the increasing influence of managed care on the decision-making process, it is increasingly important to establish a new and more sophisticated research agenda for studying PER decision making. The main goal of this paper is to propose a comprehensive conceptual model of the PER decision-making process that will facilitate active pursuit of such a research agenda. The proposed model presents both traditional and emerging elements of the PER decision-making process (i.e., determinants, mediating mechanisms, and outcomes) and explicates the nature of the relationships among them at different levels of analysis. The model's theoretical and empirical implications for future research are discussed and suggestions are made as to the research designs and methods needed to pursue this agenda.

The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease, 3rd ed.

The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease, 3rd ed.