A stroke imaging protocol in patients with a history of contrast-induced anaphylaxis.

The need for emergent, contrast-enhanced neuroimaging in stroke patients with a history of severe reaction to iodinated contrast represents a unique dilemma in emergency departments. There is currently a lack of evidence-based management protocols for these cases. We describe a protocol established at our institution, based off American College of Radiology (ACR) guidelines and institutional experience, to guide decision-making in these scenarios.

Enhancing access to specialist appointments in tertiary healthcare in Shanghai, China: a structured reservation pathway using digital health technologies.

Objective: The aim of this study is to develop, implement the precise reservation path (PRP) and investigate its prediction function for scheduling shunting patients for specialist appointment registration in Shanghai, China.

Design: The PRP system was built on the hospital's existing information system, integrated with WeChat (WeCom) for user convenience. The outcome analysis employed a mixed-methods approach, integrating quantitative analysis with statistical and machine learning techniques, including multivariate logistic regression, random forest (RF) and artificial neural network (ANN) analysis.

A Prehospital Quality Improvement Framework to Reduce Mortality and Other Harms Associated with Opioid Use Disorder.

Objectives: In response to the escalating overdose crisis there is an urgent need for innovative strategies to reduce overdose death. Emergency Medical Services (EMS) is uniquely poised to reduce mortality and other harms associated with opioid use through prevention, harm reduction, and treatment, yet there is a paucity of nationally recognized best practices or quality measures to guide prehospital quality improvement (QI) efforts related to opioid use disorder (OUD).

Methods: A multidisciplinary team of subject matter experts in addiction medicine, EMS, public health, and QI was convened to develop recommendations for a model QI framework for prehospital OUD prevention, harm reduction, and treatment based on the Model for Improvement framework.

Safety, tolerability and pharmacokinetics of subcutaneous cefazolin as an alternative to intravenous administration.

Background: Subcutaneous (SC) administration of antibiotics is a practical alternative to IV administration. Cefazolin is widely used for skin and soft tissue infections and other complex infections by IV administration.

Methods: In this prospective, cross-over self-controlled study, a single dose of SC cefazolin was administered to 15 stable inpatients established on IV cefazolin as part of their management plan.

Five-year analysis of hospital complaints at a Japanese tertiary teaching hospital.

Background: Patient complaint taxonomies strongly support the use of healthcare complaints as a powerful tool to improve the quality and safety of patient care. Hospitals use complaint data at the organizational level to address quality variation across service lines and departments.

Methods: We applied a validated typology method to identify where the complaints occured and gained deeper insights about how they can be more effectively utilized to drive and implement continuous quality and service improvement activities within a tertiary hospital.

Awareness of Emergency Department Workforce about the Operational Metrics: A Cross-sectional Study.

Introduction: The awareness of the Emergency Department (ED) workforce about the department's operational guidelines and metrics is essential to optimize the workflow and reduce workload and patient revisits to the ED. Therefore, this study aimed to evaluate the knowledge of the ED workforce regarding operational metrics.

Methods: We conducted a national cross-sectional study using an online survey in the Kingdom of Saudi Arabia between September and December 2020.

Deaf culture awareness among physicians and advanced practice providers in the emergency department: A multicenter study.

Background And Objective: In areas with a large Deaf/hard-of-hearing (DHH) population, emergency medicine (EM) providers may benefit from cultural awareness training as this has been shown to foster delivery of more equitable care in other minority populations. Rochester, New York, has been touted to be the home to the largest per-capita DHH population in the United States. Given the large local DHH community and DHH professionals working in Rochester, University of Rochester (UR) providers likely have higher exposure to DHH people than most other EM providers in the United States.

Patient flow analysis with fast-track MRI for suspected stroke in the emergency department and associated non-comprehensive stroke center.

Background: Good outcomes in stroke care require swift diagnostics, for which magnetic resonance imaging (MRI) as first-line brain imaging is superior to computed tomography scans. Reduced length of stay (LOS) in hospital and emergency departments (ED) may optimize resource use. Fast-track stroke MRI was implemented as the primary imaging technique for suspected stroke, in the ED at Copenhagen University Hospital-Herlev and Gentofte in 2020.

Associations between subclinical thyroid dysfunction and cardiovascular risk factors according to age and sex.

Context: Subclinical thyroid dysfunction (ScTD) comprising subclinical hypothyroidism (SHypo) and subclinical hyperthyroidism (SHyper) has been associated with increased risk for cardiovascular events.

Objective: To assess associations between ScTD and cardiovascular risk factors (cvRFs) according to age and sex.

Design And Setting: Pooled individual participant data analysis of large prospective cohort studies from the Thyroid Studies Collaboration.

Hospitals Infrequently Receive EMS Patient Care Reports in the Era of Electronic Medical Records: A Preliminary Report.

Objectives: Emergency Medical Services (EMS) patient care reports (PCRs) are an important component for the transfer of patient care from EMS systems to hospitals and a foundational element of EMS quality improvement (QI). The PCR may serve as the only objective source of information for EMS patient presentation. Surprisingly little data, either objective or anecdotal, exists regarding the reliability of this process.

Firearm Injury Risk Prediction Among Children Transported by 9-1-1 Emergency Medical Services: A Machine Learning Analysis.

Objective: Among children transported by ambulance across the United States, we used machine learning models to develop a risk prediction tool for firearm injury using basic demographic information and home ZIP code matched to publicly available data sources.

Methods: We included children and adolescents 0-17 years transported by ambulance to acute care hospitals in 47 states from January 1, 2014 through December 31, 2022. We used 96 predictors, including basic demographic information and neighborhood measures matched to home ZIP code from 5 data sources: EMS records, American Community Survey, Child Opportunity Index, County Health Rankings, and Social Vulnerability Index.

Trends in access to clinical mental healthcare by very old people in Australia since 'Better Access' commenced in 2006.

Objectives: To examine trends in access to mental healthcare by old and very old people since the commencement of Australia's Better Access Initiative in 2006.

Methods: Descriptive analysis of changes in access by people aged 75-84 and over 85 using data analysed and published by the AIHW.

Results: Since the introduction of Better Access, rates of access to specialist inpatient and community mental healthcare have reduced for those aged 75 years and older.

Models of Field Hospital Emergency Departments: The Israeli Experience.

The World Health Organization has classified Emergency Medical Teams (EMTs) into 3 types for international disaster response. They range from those that operate as daytime clinic facilities to those that have complete hospital capabilities that can provide 24/7 inpatient care. The most complex EMT (Type 3) includes a full-scale emergency department (ED), operating rooms, a medical/surgical ward, an intensive care unit, and laboratory services.

Youth Emergency Department and Inpatient Psychiatric Recidivism After Treatment in a Community-Based Crisis Program.

Objective: In emergency departments (EDs) nationwide, increasing numbers of youths in psychiatric crisis are "boarding," or awaiting psychiatric care in a nonpsychiatric setting. Community stabilization programs may reduce the prevalence of boarding while supporting behavioral health. This study aimed to evaluate ED and inpatient (IP) psychiatric recidivism of youths receiving Crisis and Transition Services (CATS), a community-based program providing in-home behavioral health crisis services.

Patient Preferences for Code Status Discussions: A Randomized Trial of Information- vs. Patient Values-Centered Frameworks.

Background: Helping patients make decisions about their preferences for cardiopulmonary resuscitation (i.e., code status) is an important way to respect patient autonomy in the hospital.

Analysis of financial risk protection indicators in Sri Lanka for pediatric surgery.

Purpose: To investigate the incidence of the Sri Lankan pediatric population who seek emergency surgical services and who are subsequently at risk of impoverishment and catastrophic expenditure.

Methods: Prospective data collection at a tertiary pediatric Sri Lankan hospital of direct out-of-pocket (OOP) medical and nonmedical expenses related to pediatric surgical interventions. Catastrophic expenditure and risk of impoverishment were respectively described as expenses superior to 10% of household income and falling below the impoverishment line due to income drop.

The Role of Emergency and Primary Care in Combating the Rise of Gonorrhea: Another Purview Paradox?

Introduction: Drug-resistant is an urgent threat to public health. Novel prevention and treatment strategies are emerging, including immunizations, pharmacologic post-exposure prophylaxis, rapid molecular resistance assays, and novel antibiotics. However, where and how such strategies are optimally implemented remains unclear.

Hurricane Ida - Mitigation and Preparedness for Flash-Flooding in New York City.

Objectives: Hurricane Ida delivered record rainfall to the northeast, resulting in 11 deaths in New York City. We review these deaths, identify risk factors, and discuss solutions to prevent recurrence.

Methods: Deaths were confirmed by multiple sources.

Efficacy of laundry practices in eliminating monkeypox virus (MPXV) from fabrics.

Background: The declaration of mpox as a Public Health Emergency of International Concern highlights the need for interventions to interrupt virus transmission, including transmission via fabrics. Current World Health Organization guidance on clothes washing is based on a general consensus of virus inactivation; however, there is uncertainty about the efficacy of laundry detergents and disinfectants or the reduction of risk achieved by washing clothes for monkeypox virus (MPXV) specifically.

Methods: This study investigates the efficacy of manual washing for inactivating MPXV from clothes.