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Epidemiology of severe sepsis in the emergency department and difficulties in the initial assistance

Rezende,Ederlon; Silva Junior,João Manoel; Isola,Alexandre Marine; Campos,Edvaldo Vieira; Amendola,Cristina Prata; Almeida,Samantha Longhi
Fonte: Faculdade de Medicina / USP Publicador: Faculdade de Medicina / USP
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2008 Português
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BACKGROUND: The aim of this study was to determine the occurrence rate, demographics, clinical characteristics, and outcomes of patients with severe sepsis admitted to the emergency department. METHODS: A prospective study evaluating all patients admitted to the emergency department unit in a public hospital of tertiary complexity in a six-month period was conducted. During this period, the emergency team was trained to diagnose sepsis. Patients who met the diagnostic criteria for severe sepsis were followed until their discharge from the hospital. RESULTS: A total of 5,332 patients were admitted to the emergency department, and 342 met the criteria for severe sepsis/septic shock. The median (interquartile range) age of patients was 74 (65-84) years, and 52.1% were male. The median APACHE II and SOFA scores at diagnosis were 19 (15-25) and 5 (3-7), respectively. The median number of dysfunctional organ systems per patient was 2 (1-3). The median hospital length of stay was 10 (4.7-17) days, and the hospital mortality rate was 64%. Only 31% of the patients were diagnosed by the emergency department team as septic. About 33.5% of the 342 severe sepsis patients admitted to the emergency department were referred to an ICU, with a median time delay of 24 (12-48) hours. Training improved diagnosis and decreased the time delay for septic patients in arriving at the ICU. CONCLUSIONS: The occurrence rate of severe sepsis in the emergency department was 6.4%...

Decreased levels of alpha-1-acid glycoprotein are related to the mortality of septic patients in the emergency department

Barroso-Sousa,Romualdo; Lobo,Romulo R.; Mendonca,Patricia R.; Memoria,Renan R.; Spiller,Fernando; Cunha,Fernando Q.; Pazin-Filho,Antonio
Fonte: Faculdade de Medicina / USP Publicador: Faculdade de Medicina / USP
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2013 Português
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OBJECTIVE: To determine the validity of alpha-1-acid glycoprotein as a novel biomarker for mortality in patients with severe sepsis. METHODS: We prospectively included patients with severe sepsis or septic shock at the emergency department at a single tertiary referral teaching hospital. All of the patients were enrolled within the first 24 hours of emergency department admission, and clinical data and blood samples were obtained. As the primary outcome, we investigated the association of serum levels of alpha-1-acid glycoprotein and 96-hour mortality with logistic regression analysis and generalized estimating equations adjusted for age, sex, shock status and Acute Physiology and Chronic Health Evaluation II score. RESULTS: Patients with septic shock had lower alpha-1-acid glycoprotein levels at the time of emergency department admission compared to patients without shock (respectively, 149.1 ±42.7 vs. 189.8 ±68.6; p = 0.005). Similarly, non-survivors in the first 96 hours were also characterized by lower levels of alpha-1-acid glycoprotein at the time of emergency department admission compared to survivors (respectively, 132.18 ±50.2 vs. 179.8 ±61.4; p = 0.01). In an adjusted analysis, alpha-1-acid glycoprotein levels ≤120 mg/dL were significantly associated with 96-hour mortality (odds ratio = 14.37; 95% confidence interval = 1.58 to 130.21). CONCLUSION: Septic shock patients exhibited lower circulating alpha-1-acid glycoprotein levels than patients without shock. Alpha-1-acid glycoprotein levels were independently associated with 96-hour mortality in individuals with severe sepsis.

Perceptions of Emergency Department Crowding in the Commonwealth of Pennsylvania

Pines, Jesse M.; Isserman, Joshua A.; Kelly, John J.
Fonte: Department of Emergency Medicine, University of California, Irvine Publicador: Department of Emergency Medicine, University of California, Irvine
Tipo: Artigo de Revista Científica
Publicado em /02/2013 Português
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Introduction: The state of emergency department (ED) crowding in Pennsylvania has not previously been reported.

Advertising Emergency Department Wait Times

Weiner, Scott G.
Fonte: Department of Emergency Medicine, University of California, Irvine School of Medicine Publicador: Department of Emergency Medicine, University of California, Irvine School of Medicine
Tipo: Artigo de Revista Científica
Publicado em /03/2013 Português
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Advertising emergency department (ED) wait times has become a common practice in the United States. Proponents of this practice state that it is a powerful marketing strategy that can help steer patients to the ED. Opponents worry about the risk to the public health that arises from a patient with an emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standard definition of the reported time, and directing lower acuity patients to the higher cost ED setting instead to primary care. Three sample cases demonstrating the pitfalls of advertising ED wait times are discussed. Given the lack of rigorous evidence supporting the practice and potential adverse effects to the public health, caution about its use is advised.

Does Prolonged Length of Stay in the Emergency Department Affect Outcome for Stroke Patients?

Jain, Minal; Damania, Dushyant; Jain, Anunaya R.; Kanthala, Abhijit R.; Ganti, Latha; Jahromi, Babak S.
Fonte: Department of Emergency Medicine, University of California, Irvine Publicador: Department of Emergency Medicine, University of California, Irvine
Tipo: Artigo de Revista Científica
Português
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Introduction: Conflicting data exist regarding the association between the length of stay (LOS) of critically ill patients in the emergency department (ED) and their subsequent outcome. However, such patients are an overall heterogeneous group, and we therefore sought to study the association between EDLOS and outcomes in a specific subgroup of critically ill patients, namely those with acute ischemic stroke/transient ischemic attack (AIS/TIA).

Follow Up for Emergency Department Patients After Intravenous Contrast and Risk of Nephropathy

Hassen, Getaw Worku; Hwang, Albert; Liu, Lydia Liyun; Mualim, Felicia; Sembo, Toshiro; Tu, Ting Jia; Wei, Daniel Hsiang; Johnston, Paul; Costea, Ana; Meletiche, Carlos; Usmani, Shakeel; Barber, Andre; Jaiswal, Rajnish; Kalantari, Hossein
Fonte: Department of Emergency Medicine, University of California, Irvine Publicador: Department of Emergency Medicine, University of California, Irvine
Tipo: Artigo de Revista Científica
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Introduction: Contrast-induced nephropathy (CIN), defined as an increase in serum creatinine (SCr) greater than 25% or ≥0.5 mg/dL within 3 days of intravenous (IV) contrast administration in the absence of an alternative cause, is the third most common cause of new acute renal failure in hospitalized patients. It is known to increase in-hospital mortality up to 27%. The purpose of this study was to investigate the rate of outpatient follow up and the occurrence of CIN in patients who presented to the emergency department (ED) and were discharged home after computed tomography (CT) of the abdomen and pelvis (AP) with IV contrast.

Reading Form for Student Assignment for Panama Silver, Asian Gold : Migration, Money, and the Making of the Modern Caribbean ( Digital Humanities Course )

Rosenberg, Leah; Cobham-Sander, Rhonda; Black Studies Department, Amherst College
Fonte: Black Studies Department, Amherst College; Department of English, University of Florida; Black Studies Department, Amherst College ( Amherst, MA ); Department of English, University of Florida ( Gainesville, FL ) Publicador: Black Studies Department, Amherst College; Department of English, University of Florida; Black Studies Department, Amherst College ( Amherst, MA ); Department of English, University of Florida ( Gainesville, FL )
Tipo: mixed material Formato: Course work materials
Publicado em // Português
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Based on the reading form for BLST 111 from the Black Studies Department, Amherst College.

Effects of multidisciplinary teamwork on lead times and patient flow in the emergency department: A longitudinal interventional cohort study

Muntlin Athlin, A.; von Thiele Schwarz, U.; Farrohknia, N.
Fonte: BioMed Central Ltd Publicador: BioMed Central Ltd
Tipo: Artigo de Revista Científica
Publicado em //2013 Português
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BACKGROUND Long waiting times for emergency care are claimed to be caused by overcrowded emergency departments and non-effective working routines. Teamwork has been suggested as a promising solution to these issues. The aim of the present study was to investigate the effects of teamwork in a Swedish emergency department on lead times and patient flow. METHODS The study was set in an emergency department of a university hospital where teamwork, a multi-professional team responsible for the whole care process for a group of patients, was introduced. The study has a longitudinal non-randomized intervention study design. Data were collected for five two-week periods during a period of 1.5 years. The first part of the data collection used an ABAB design whereby standard procedure (A) was altered weekly with teamwork (B). Then, three follow-ups were conducted. At last follow-up, teamwork was permanently implemented. The outcome measures were: number of patients handled within teamwork time, time to physician, total visit time and number of patients handled within the 4-hour target. RESULTS A total of 1,838 patient visits were studied. The effect on lead times was only evident at the last follow-up. Findings showed that the number of patients handled within teamwork time was almost equal between the different study periods. At the last follow-up...

History of the Indiana University Department of Geological Sciences: 1840-1997

Lane, N. Gary
Fonte: Department of Geological Sciences Indiana University, Bloomington Publicador: Department of Geological Sciences Indiana University, Bloomington
Tipo: Trabalho em Andamento
Português
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Study of the geological sciences at Indiana University Has had a long and distinguished history. Beginning with the first lectures in 1840, the university has attracted and retained a series of outstanding teachers and research scientists who have consistently trained students to become able scientists n academics, governments, and industry. The faculty and alumni of the Department of Geological Sciences can rightly be proud of their heritage at Indiana University. The department has fulfilled and continues to fulfill one of the roles of a state-supported institution--providing well-trained personnel to assist in the economic and educational advancement of the citizens of Indiana.

A case study of the Materials Management Department at the Naval Medical Center San Diego benchmarking effort

Boston, Pia S.
Fonte: Monterey, California. Naval Postgraduate School Publicador: Monterey, California. Naval Postgraduate School
Tipo: Tese de Doutorado
Português
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Approved for public release; distribution is unlimited; This thesis sought to provide lessons learned, recommendations and provoke thought among medical logisticians on the use of benchmarking. The researcher used a single case research strategy to assess how successful the Materials Management Department at the Naval Medical Center San Diego has been in implementing benchmarking as suggested by strategic objective 2.5.43 of the 1994 draft of the Navy Medical Logistics Strategic Plan. Information on the implementation of benchmarking in the Materials Management Department was based upon a questionnaire, document reviews and direct observation. The research included reading and reviewing the current literature on benchmarking to compare private sector thinking with current practices in the Materials Management Department. The benchmarking case used the Ten-Step Department of the Navy Benchmarking Model and interview questions. The analysis and conclusions are based upon the initial research questions and the framework of the critical success factors for a benchmarking study. The results of the case suggest a cost-benefit analysis was done to purchase sterilization equipment.

A data-based Financial Management Information System (FMIS) for Administrative Sciences Department

Ford, Neil Spencer; Zimmon, Nicholas Waldon
Fonte: Monterey, California: Naval Postgraduate School Publicador: Monterey, California: Naval Postgraduate School
Tipo: Tese de Doutorado
Português
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Approved for public release; distribution is unlimited.; The Administrative Sciences (AS) Department of the Naval Postgraduate School (NPS) is placing an increasing emphasis on keeping departmental expenses at minimum levels requiring the AS Department to carefully monitor a large number of complex financial accounts. It becomes necessary to develop a Financial Management Information System that would result in improved management of financial assets, better use of clerical skills, and more detailed, accurate, and up-to-date reporting within the AS Department. Based on the requirement analysis and prototypes performed by previous work, this thesis develops and implements a personal computer-based Management Information System for the Management of the many funding accounts controlled by the Administrative Sciences Department. The central objective was to integrate accounting transactions performed in several different offices, currently using different software programs, into a single all-encompassing Management Information System. The system was written using dBASE IV and is currently operational.

Summary of Research 2001, Department of Applied Mathematics

Faculty of the Naval Postgraduate School, Department of Applied Mathematics
Fonte: Office of the Associate Provost and Dean of Research, Naval Postgraduate School. Publicador: Office of the Associate Provost and Dean of Research, Naval Postgraduate School.
Tipo: Relatório
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The views expressed in this report are those of the authors and do not reflect the official policy or position of the Department of Defense or U.S. Government.; This report contains project summaries of the research projects in the Department of Applied Mathematics. A list ofrecent publications is also included, which consists of conference presentations and publications, books, contributions to books, published journal papers, and technical reports. Thesis abstracts of students advised by faculty in the Department are also included.

Closing the Loop on Visa Security: A Case for Change

Hernandez, James G.
Fonte: Monterey, California. Naval Postgraduate School Publicador: Monterey, California. Naval Postgraduate School
Tipo: Tese de Doutorado Formato: 57 p.
Português
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This thesis presents the findings of a policy analysis conducted on the current policy governing the visa issuing function versus a policy of The U.S. Department of Homeland Security assuming operational and tactical level control of the visa issuing function from the Department of State. Responsibility for this system is currently divided between the U.S. Department of State (DOS) and the U.S. Department of Homeland Security (DHS). This results in a duplication of effort, unclear responsibilities, an increased need for communication and collaboration between government departments, and a loss of mission focus. In an effort to increase security, streamline the immigration process, and address the above issues, this thesis recommends that the visa issuing function should be exclusively the responsibility of, and performed by, DHS.; U.S. Immigration and Customs Enforcement author

Analysis of the Department of Defense Homeland Security Support Organization

Cavil, Michael P.
Fonte: Monterey, California. Naval Postgraduate School Publicador: Monterey, California. Naval Postgraduate School
Tipo: Tese de Doutorado Formato: x, 57 p. : col. ill.
Português
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Approved for public release, distribution is unlimited; Implementing U.S. Homeland Security Strategy is probably the most difficult challenge facing the U.S. today. As a result of the Strategy, it is envisioned that many federal, state, local and private organizations will need to develop internal organizations for coordinating support with the Department of Homeland Security. The organization that could potentially have the greatest impact on U.S. Homeland Security Strategy achievement is the Department of Defense. Therefore, it is critical that the Department of Defense design an effective internal organization for supporting the U.S. Homeland Security Strategy and the Department of Homeland Security. This thesis will analyze the Department of Defense's initial efforts in developing its Homeland Security Support organization, and will evaluate its potential effectiveness for supporting the U.S. Homeland Security Strategy. This thesis further seeks to provide a model for organizations to utilize in developing and diagnosing their homeland security support organizations.; Lieutenant Commander, United States Naval Reserve

An evaluation of the effectiveness and acceptability of nurse practitioners in an adult emergency department

Wilson, A.; Shifaza, F.
Fonte: Blackwell Science Asia Pty Ltd Publicador: Blackwell Science Asia Pty Ltd
Tipo: Artigo de Revista Científica
Publicado em //2008 Português
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This study aimed to investigate the effectiveness of nurse practitioner services for minor injuries in an adult emergency department and to ascertain consumers' satisfaction with the care received. Nurse practitioner roles in Australia have been progressively developing since a pilot project in 1990 examined their feasibility. Currently, nurse practitioners in Australia practise in a variety of specialist areas including coronary care cardiology, adult and paediatric palliative care, emergency, diabetics, aged care and perinatal care. The reported study used a retrospective design that conducted case-note audits and explored patient satisfaction with after-care questionnaires. One hundred case notes of patients treated by the nurse practitioner were audited and 57 patients completed questionnaires exploring their satisfaction and perception of the care received. Analysis of the case-note data indicated that the majority of presenting complaints were minor injuries. Of these injuries, 96.3% of presentations triaged level 4 and 94.4% of those triaged level 5 were seen within the time frame recommended by the Australasian Triage Scale. Forty-six per cent of patients required X-rays and 2% required pathology tests during their emergency department stay. The majority of patients were satisfied with the treatment received from the nurse practitioner. Patients are satisfied with management of small injury presentations by nurse practitioners in the emergency department. Incidentally...

Secondary School Department Heads as Teacher Leaders: A Study in Suburban Ontario

Clarke, Kristen A.
Fonte: Brock University Publicador: Brock University
Português
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This study focused on the leadership perceptions of 6 department heads, the conditions for their leadership role and their strategies, and supports for navigating their role. Research participants engaged in 2 sets of semistructured interviews; this resulted in a wealth of richly detailed data. It is clear that department heads do act as teacher leaders, even if they do not use this language to discuss their roles. Five elements of the role of the department head as teacher leader unfolded. The research participants perceived their leadership role to be rooted in teaching. They noted their management and leadership roles. They recognized the importance of support for their work and the support that they provide to others. In addition, they provided an overview of key strategies that they implement to lead in their individualized contexts. Department heads also noted the difficulties associated with their position and the effects that these challenges have on them as individuals. This research has resulted in a number of key recommendations for stakeholders. Department heads themselves need to openly discus's their leadership role with their colleagues and their administrators. In turn, administrators need to develop a deeper understanding of the role along with the potential for balkanization in schools. In addition...

Emergency department rectal temperatures in over 10 years: A retrospective observational study

Walker, Graham A.; Runde, Daniel; Rolston, Daniel M.; Wiener, Dan; Lee, Jarone
Fonte: Second Affiliated Hospital of Zhejiang University School of Medicine Publicador: Second Affiliated Hospital of Zhejiang University School of Medicine
Tipo: Artigo de Revista Científica
Português
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BACKGROUND: Fever in patients can provide an important clue to the etiology of a patient's symptoms. Non-invasive temperature sites (oral, axillary, temporal) may be insensitive due to a variety of factors. This has not been well studied in adult emergency department patients. To determine whether emergency department triage temperatures detected fever adequately when compared to a rectal temperature. METHODS: A retrospective chart review was made of 27 130 adult patients in a high volume, urban emergency department over an eight-year period who received first a non-rectal triage temperature and then a subsequent rectal temperature. RESULTS: The mean difference in temperatures between the initial temperature and the rectal temperature was 1.3 °F (P<0.001), with 25.9% of the patients having higher rectal temperatures ≥2 °F, and 5.0% having higher rectal temperatures ≥4 °F. The mean difference among the patients who received oral, axillary, and temporal temperatures was 1.2 °F (P<0.001), 1.8 °F (P<0.001), and 1.2 °F (P<0.001) respectively. About 18.1% of the patients were initially afebrile and found to be febrile by rectal temperature, with an average difference of 2.5 °F (P<0.001). These patients had a higher rate of admission (61.4%...

Epidemiology of severe sepsis in the emergency department and difficulties in the initial assistance

Rezende, Ederlon; Silva Junior, João Manoel; Isola, Alexandre Marine; Campos, Edvaldo Vieira; Amendola, Cristina Prata; Almeida, Samantha Longhi
Fonte: Universidade de São Paulo. Faculdade de Medicina Publicador: Universidade de São Paulo. Faculdade de Medicina
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; ; Formato: application/pdf
Publicado em 01/01/2008 Português
Relevância na Pesquisa
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BACKGROUND: The aim of this study was to determine the occurrence rate, demographics, clinical characteristics, and outcomes of patients with severe sepsis admitted to the emergency department. METHODS: A prospective study evaluating all patients admitted to the emergency department unit in a public hospital of tertiary complexity in a six-month period was conducted. During this period, the emergency team was trained to diagnose sepsis. Patients who met the diagnostic criteria for severe sepsis were followed until their discharge from the hospital. RESULTS: A total of 5,332 patients were admitted to the emergency department, and 342 met the criteria for severe sepsis/septic shock. The median (interquartile range) age of patients was 74 (65-84) years, and 52.1% were male. The median APACHE II and SOFA scores at diagnosis were 19 (15-25) and 5 (3-7), respectively. The median number of dysfunctional organ systems per patient was 2 (1-3). The median hospital length of stay was 10 (4.7-17) days, and the hospital mortality rate was 64%. Only 31% of the patients were diagnosed by the emergency department team as septic. About 33.5% of the 342 severe sepsis patients admitted to the emergency department were referred to an ICU, with a median time delay of 24 (12-48) hours. Training improved diagnosis and decreased the time delay for septic patients in arriving at the ICU. CONCLUSIONS: The occurrence rate of severe sepsis in the emergency department was 6.4%...

The Fire Department in Disaster Operations in the 1960's

Warheit, George J.
Fonte: Disaster Research Center Publicador: Disaster Research Center
Tipo: Outros Formato: 3631290 bytes; application/pdf
Português
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Along with the police department, the fire department in the United States is one community organization typically called upon in a crisis situation such as a natural/technological disaster or a riot/civil disturbance. This report analyzes data from fire department operations in the 1960s, both in disasters and civil disturbances. Thus, whatever is said is most relevant to that time period in American society, although it is probably true that much of what is reported is still applicable at the present time. This report analyzes fire departments in terms of (1) their typical organizational patterns; (2) their disaster-related tasks and activities which are a response to the demands upon them; (3) their organizational adaptation to demand situations, especially those of high intensity; (4) their interorganizational relationships; and (5) their potential involvement and organizational adaptation to a postnuclear attack environment as this was visualized in the 1960s. The local fire department perhaps changes less from its precrisis to its emergency time operations than any other community organization. Fire departments are likely to continue to cope with tasks similar to their preimpact responsibilities. They are organizations that retain a great deal of autonomy both in disasters and civil disturbances since their specialized tasks can seldom be preempted by other groups or agencies. They are organized to deal with crises...

An empirical investigation into in-service training at North West Provincial Department of Agriculture

Masukela,P. M.; Lubbe,S.; Pelser,T. G.
Fonte: South African Journal of Agricultural Extension Publicador: South African Journal of Agricultural Extension
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2013 Português
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Farmers' (emerging and commercial) results do not only reflect performance but also depict the quality of learning and teaching that they have received. However, the focus seems to be only on farmers' results, particularly emerging farmers results' (rural areas), without regard to other facets of the Department of Agriculture, Conservation & Environment which have a direct impact on the farmers' results. Amongst others, there are extension officers and in-service trainers who need to be taken into account to ascertain the quality of service that farmers receive. This study focuses on the provision of in-service training through the cascade model of training in the North West Provincial Department of Agriculture, Conservation & Environment (DACE). While their training approaches are varied and enjoyed by most extension officers, there are inconsistencies in terms of the evaluation of the in-service training sessions. The results show, both the in-service trainers and extension officers are satisfied with in-service training in the Provincial Department of Agriculture, Conservation & Environment. However, in-service training in general needs to be reviewed in order to maximize the implementation of effective skills development within of the department.