17 results on '"Cantor Z"'
Search Results
2. LO15: Paramedic and allied health professional interventions at long-term care facilities to reduce emergency department visits: systematic review
- Author
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Leduc, S., primary, Cantor, Z., additional, Kelly, P., additional, Thiruganasambandamoorthy, V., additional, Wells, G., additional, and Vaillancourt, C., additional
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- 2020
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3. P126: Utilization and outcomes of children presenting to an emergency department by ambulance
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Cantor, Z., primary, Aglipay, M., additional, and Plint, A., additional
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- 2020
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4. P016: Utilization and outcomes of children presenting to an emergency department by ambulance
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Cantor, Z., primary, Aglipay, M., additional, and Plint, A., additional
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- 2019
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5. LO25: How safe are our pediatric emergency departments? A multicentre, prospective cohort study
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Plint, A., Calder, L., Cantor, Z., Aglipay, M., Stang, A.S., Newton, A.S., Gouin, S., Boutis, K., Joubert, G., Doan, Q., Dixon, A., Porter, R., Sawyer, S., Bhatt, M., Farion, K., Crawford, T., Dalgleish, D., Johnson, D.W., Klassen, T., and Barrowman, N.
- Abstract
Introduction:Data regarding adverse events (AEs) (unintended harm to the patient from health care provided) among children seen in the emergency department (ED) are scarce despite the high risk setting and population. The objective of our study was to estimate the risk and type of AEs, and their preventability and severity, among children treated in pediatric EDs. Methods:Our prospective cohort study enrolled children <18 years of age presenting for care during 21 randomized 8 hr-shifts at 9 pediatric EDs from Nov 2014 to October 2015. Exclusion criteria included unavailability for follow-up or insurmountable language barrier. RAs collected demographic, medical history, ED course, and systems level data. At day 7, 14, and 21 a RA administered a structured telephone interview to all patients to identify flagged outcomes (e.g. repeat ED visits, worsening/new symptoms, etc). A validated trigger tool was used to screen admitted patients’ health records. For any patients with a flagged outcome or trigger, 3 ED physicians independently determined if an AE occurred. Primary outcome was the proportion of patients with an AE related to ED care within 3 weeks of their ED visit. Results:We enrolled 6377 (72.0%) of 8855 eligible patients; 545 (8.5%) were lost to follow-up. Median age was 4.4 years (range 3 months to 17.9 yrs). Eight hundred and seventy seven (13.8%) were triaged as CTAS 1 or 2, 2638 (41.4%) as CTAS 3, and 2839 (44.7%) as CTAS 4 or 5. Top entrance complaints were fever (11.2%) and cough (8.8%). Flagged outcomes/triggers were identified for 2047 (32.1%) patients. While 252 (4.0%) patients suffered at least one AE within 3 weeks of ED visit, 163 (2.6%) suffered an AE related to ED care. In total, patients suffered 286 AEs, most (67.9%) being preventable. The most common AE types were management issues (32.5%) and procedural complications (21.9%). The need for a medical intervention (33.9%) and another ED visit (33.9%) were the most frequent clinical consequences. In univariate analysis, older age, chronic conditions, hospital admission, initial location in high acuity area of the ED, having >1 ED MD or a consultant involved in care, (all p<0.001) and longer length of stay (p<0.01) were associated with AEs. Conclusion:While our multicentre study found a lower risk of AEs among pediatric ED patients than reported among pediatric inpatients and adult ED patients, a high proportion of these AEs were preventable.
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- 2017
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6. Closing the Loop: The Value of Outcome Letters for Prehospital Pediatric Care.
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McGahern C, Cantor Z, De Mendonca B, Dawson J, Boisvert L, Dalgleish D, Newhook D, Reddy D, Bresee N, and Alnaji F
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- Humans, Male, Child, Adult, Surveys and Questionnaires, Emergency Service, Hospital, Ontario, Hospitals, Pediatric, Emergency Medical Services
- Abstract
Objectives: Providing emergency care to acutely ill or injured children is stressful and requires a high level of training. Paramedics who provide prehospital care are typically not involved in the circle of care and do not receive patient outcome information. The aim of this quality improvement project was to assess paramedics' perceptions of standardized outcome letters pertaining to acute pediatric patients that they had treated and transported to an emergency department., Methods: Between December 2019 and December 2020, 888 outcome letters were distributed to paramedics who provided care for 370 acute pediatric patients transported to the Children's Hospital of Eastern Ontario in Ottawa, Canada. All paramedics who received a letter (n = 470) were invited to participate in a survey that collected their perceptions and feedback about the letters, as well as their demographic information., Results: The response rate was 37% (172/470). Approximately half of the respondents were Primary Care Paramedics and half Advanced Care Paramedics. The respondents' median age was 36 years, median years of service was 12 years, and 64% identified as male. Most agreed that the outcome letters contained information pertinent to their practice (91%), allowed them to reflect on care they had provided (87%), and confirmed clinical suspicions (93%). Respondents indicated that they found the letters useful for 3 reasons: 1) increases capacity to link differential diagnoses, prehospital care, or patient outcomes; 2) contributes to a culture of continuous learning and improvement; and 3) gives closure, reduces stress, or provides answers for difficult cases. Suggestions for improvement included providing more information, provision of letters on all patients transported, faster turnaround time between call and receipt of letter and inclusion of recommendations or interventions/assessments., Conclusions: Paramedics appreciated receiving hospital-based patient outcome information after their provision of care and reported that the letters offered opportunities for closure, reflection, and learning., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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7. The hospital care and outcomes of long-term care patients treated by paramedics during an emergency call: exploring the potential impact of 'treat-and-refer' pathways and community paramedicine.
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Leduc S, Wells G, Thiruganasambandamoorthy V, Cantor Z, Kelly P, Rietschlin M, and Vaillancourt C
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- Adult, Humans, Paramedics, Long-Term Care, Paramedicine, Canada, Emergency Service, Hospital, Hospitals, Emergency Medical Technicians, Emergency Medical Services
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Introduction: Adults living in long-term care (LTC) are at increased risk of harm when transferred to the emergency department (ED), and programs targeting treatment on-site are increasing. We examined characteristics, clinical course, and disposition of LTC patients transported to the ED to examine the potential impact of alternative models of paramedic care for LTC patients., Methods: We conducted a health records review of paramedic and ED records between April 1, 2016, and March 31, 2017. We included emergency calls originating from LTC centers and patients transported to either ED campus of The Ottawa Hospital. We excluded scheduled or deferrable transfers, and patients with Canadian Triage and Acuity Scale of 1. We categorized patients into groups based on care they received in the ED. We calculated standardized differences to examine differences between groups., Results: We identified four groups: (1) patients requiring no treatment or diagnostics in the ED (7.9%); (2) patients receiving ED treatment within current paramedic directives and no diagnostics (3.2%); (3) patients requiring diagnostics or ED care outside current paramedic directives (54.9%); and (4) patients requiring admission (34.1%)., Conclusion: This study found 7.9% of LTC patients transported to the ED did not receive diagnostics, medications, or treatment, and overall 11.1% of patients could have been treated by paramedics within current medical directives using 'treat-and-refer' pathways. This group could potentially expand utilizing community paramedics with expanded scopes of practice., (© 2023. The Author(s), under exclusive licence to Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).)
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- 2023
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8. Applying the Theoretical Domains Framework to identify police, fire, and paramedic preferences for accessing mental health care in a First Responder Operational Stress Injury Clinic: a qualitative study.
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Testa V, Bennett A, Jutai J, Cantor Z, Burke P, McMahon J, Carleton RN, Colman I, Fikretoglu D, Heber A, Leduc S, Heisel MJ, Thavorn K, Corsi DJ, and Hatcher S
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- Humans, Mental Health, Paramedics, Qualitative Research, Police, Emergency Responders psychology
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Introduction: First responders and other public safety personnel (PSP; e.g. correctional workers, firefighters, paramedics, police, public safety communicators) are often exposed to events that have the potential to be psychologically traumatizing. Such exposures may contribute to poor mental health outcomes and a greater need to seek mental health care. However, a theoretically driven, structured qualitative study of barriers and facilitators of help-seeking behaviours has not yet been undertaken in this population. This study used the Theoretical Domains Framework (TDF) to identify and better understand critical barriers and facilitators of help-seeking and accessing mental health care for a planned First Responder Operational Stress Injury (OSI) clinic., Methods: We conducted face-to-face, one-on-one semistructured interviews with 24 first responders (11 firefighters, five paramedics, and eight police officers), recruited using purposive and snowball sampling. Interviews were analyzed using deductive content analysis. The TDF guided study design, interview content, data collection, and analysis., Results: The most reported barriers included concerns regarding confidentiality, lack of trust, cultural competency of clinicians, lack of clarity about the availability and accessibility of services, and stigma within first responder organizations. Key themes influencing help-seeking were classified into six of the TDF's 14 theoretical domains: environmental context and resources; knowledge; social influences; social/professional role and identity; emotion; and beliefs about consequences., Conclusion: The results identified key actions that can be utilized to tailor interventions to encourage attendance at a First Responder OSI Clinic. Such approaches include providing transparency around confidentiality, policies to ensure greater cultural competency in all clinic staff, and clear descriptions of how to access care; routinely involving families; and addressing stigma., Competing Interests: The authors declare that they have no conflicts of interest to report with respect to the research, authorship, and publication of this article.
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- 2023
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9. The Clinical Significance of Aspergillus Detected in Lower-Respiratory-Tract Samples of Critically Ill COVID-19-Positive Patients.
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Osman H, Shaik AN, Nguyen PL, Cantor Z, Kaafarani M, and Soubani AO
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- Humans, Clinical Relevance, Critical Illness, Retrospective Studies, Aspergillus, COVID-19 epidemiology, Invasive Pulmonary Aspergillosis diagnosis
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Objective : Critically ill patients with acute respiratory distress syndrome (ARDS) due to viral infection are at risk for secondary complications, including invasive aspergillosis. Our study aimed to characterize the clinical significance and outcome of Aspergillus species isolated from lower-respiratory-tract samples of critically ill OVID-19 patients at a single center. Design : We conducted a retrospective cohort study to evaluate the characteristics of patients with COVID-19 and aspergillus isolated from the lower respiratory tract and to identify predictors of outcomes in this population. Setting : The setting was a single-center hospital system within the metropolitan Detroit region. Results : The prevalence of Aspergillus isolated in hospitalized COVID-19 patients was 1.18% (30/2461 patients), and it was 4.6% in critically ill ICU patients with COVID-19. Probable COVID-19-associated invasive pulmonary aspergillosis (CAPA) was found in 21 critically ill patients, and 9 cases were classified as colonization. The in-hospital mortality of critically ill patients with CAPA and those with aspergillus colonization were high but not significantly different (76% vs. 67%, p = 1.00). Furthermore, the in-hospital mortality for ICU patients with or without Aspergillus isolated was not significantly different 73.3% vs. 64.5%, respectively (OR 1.53, CI 0.64-4.06, p = 0.43). In patients in whom Aspergillus was isolated, antifungal therapy ( p = 0.035, OR 12.3, CI 1.74-252); vasopressors (0.016, OR 10.6, CI 1.75-81.8); and a higher mSOFA score ( p = 0.043, OR 1.29 CI 1.03-1.72) were associated with a worse outcome. In a multivariable model adjusting for other significant variables, FiO
2 was the only variable associated with in-hospital mortality in patients in whom Aspergillus was isolated (OR 1.07, 95% CI 1.01-1.27). Conclusions : The isolation of Aspergillus from lower-respiratory-tract samples of critically ill patients with COVID-19 is associated with high mortality. It is important to have a low threshold for superimposed infections such as CAPA in critically ill patients with COVID-19.- Published
- 2023
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10. Chest rise.
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Cantor Z
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- Humans, Chest Pain, Allied Health Personnel, Emergency Medical Services
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- 2023
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11. Need for inpatient rehabilitation and skilled nursing services in COVID-19 patients post hospitalization: a retrospective cohort study.
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Kapur S, Cantor Z, Bishop P, Benjaram S, and Lohia P
- Abstract
Background: The need for rehabilitation and skilled nursing services for coronavirus disease 2019 (COVID-19) survivors has been speculated from the beginning of the pandemic. However, real-world data describing utilization of these services post COVID-19 hospitalization and the factors associated with the same is limited. This retrospective cohort study on COVID-19 patients aims to identify the patients discharged to inpatient rehabilitation or nursing facilities post-hospitalization and the factors associated with the same., Methods: A retrospective cohort study on COVID-19 patients during second wave of the pandemic in the state of Michigan. Primary outcome was discharge disposition. Binary logistic regression was conducted to identify the factors associated with discharge to a facility., Results: A total of 559 COVID-19 patients [median age 64 years, interquartile range (IQR) 53-73 years, 48.5% males (n=271), 67.6% Blacks (n=378)] were included in the study. During hospitalization, 17.4% of the patients (n=97) died. Around 65% (n=365) patients were discharged home whereas 12.5% (n=70) were discharged to a facility for inpatient rehabilitation/nursing services. Older patients, males, those with longer hospital stay, and patients who needed new percutaneous endoscopic gastrostomy (PEG) tube, tracheostomy, initiation of hemodialysis or continuous renal replacement therapy (CRRT), or had an acute stroke during admission were more likely to be discharged to a facility post-hospitalization., Conclusions: About 12.5% of hospitalized COVID-19 patients needed discharge to a facility for inpatient rehabilitation/nursing services. Knowledge of the factors associated with discharge to a facility can optimize discharge planning, efficient resource allocation, and improve long-term COVID-19 care.
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- 2023
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12. Code Angel: a reflection from the frontlines.
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Cantor Z
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- Humans, Allied Health Personnel, Emergency Medical Technicians, Emergency Medical Services
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- 2023
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13. How safe are paediatric emergency departments? A national prospective cohort study.
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Plint AC, Newton AS, Stang A, Cantor Z, Hayawi L, Barrowman N, Boutis K, Gouin S, Doan Q, Dixon A, Porter R, Joubert G, Sawyer S, Crawford T, Gravel J, Bhatt M, Weldon P, Millar K, Tse S, Neto G, Grewal S, Chan M, Chan K, Yung G, Kilgar J, Lynch T, Aglipay M, Dalgleish D, Farion K, Klassen TP, Johnson DW, and Calder LA
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- Child, Humans, Infant, Child, Preschool, Prospective Studies, Cohort Studies, Emergency Service, Hospital, Hospitalization, Patient Safety
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Background: Despite the high number of children treated in emergency departments, patient safety risks in this setting are not well quantified. Our objective was to estimate the risk and type of adverse events, as well as their preventability and severity, for children treated in a paediatric emergency department., Methods: Our prospective, multicentre cohort study enrolled children presenting for care during one of 168 8-hour study shifts across nine paediatric emergency departments. Our primary outcome was an adverse event within 21 days of enrolment which was related to care provided at the enrolment visit. We identified 'flagged outcomes' (such as hospital visits, worsening symptoms) through structured telephone interviews with patients and families over the 21 days following enrolment. We screened admitted patients' health records with a validated trigger tool. For patients with flags or triggers, three reviewers independently determined whether an adverse event occurred., Results: We enrolled 6376 children; 6015 (94%) had follow-up data. Enrolled children had a median age of 4.3 years (IQR 1.6-9.8 years). One hundred and seventy-nine children (3.0%, 95% CI 2.6% to 3.5%) had at least one adverse event. There were 187 adverse events in total; 143 (76.5%, 95% CI 68.9% to 82.7%) were deemed preventable. Management (n=98, 52.4%) and diagnostic issues (n=36, 19.3%) were the most common types of adverse events. Seventy-nine (42.2%) events resulted in a return emergency department visit; 24 (12.8%) resulted in hospital admission; and 3 (1.6%) resulted in transfer to a critical care unit., Conclusion: In this large-scale study, 1 in 33 children treated in a paediatric emergency department experienced an adverse event related to the care they received there. The majority of events were preventable; most were related to management and diagnostic issues. Specific patient populations were at higher risk of adverse events. We identify opportunities for improvement in care., Competing Interests: Competing interests: LAC is the CEO of the Canadian Medical Protective Association and chair of the Saegis Board of Directors (paid positions). KC is the chair of Acute Care Committee, Canadian Paediatric Society, and the past president of the Section for Emergency Medicine, Canadian Paediatric Society (unpaid positions). GY is a voting member of the Royal College Committee for Pediatric Emergency Medicine (Canada) (unpaid). ASN is the secretary-treasurer for the Mental Health Executive, Canadian Paediatric Society (unpaid)., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2022
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14. Statins and clinical outcomes in hospitalized COVID-19 patients with and without Diabetes Mellitus: a retrospective cohort study with propensity score matching.
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Lohia P, Kapur S, Benjaram S, Cantor Z, Mahabadi N, Mir T, and Badr MS
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- Aged, COVID-19 diagnosis, Cohort Studies, Diabetes Mellitus diagnosis, Female, Humans, Male, Middle Aged, Propensity Score, Retrospective Studies, Treatment Outcome, COVID-19 mortality, Diabetes Mellitus drug therapy, Diabetes Mellitus mortality, Hospitalization trends, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, COVID-19 Drug Treatment
- Abstract
Background: The pleiotropic effects of statins may reduce the severity of COVID-19 disease. This study aims to determine the association between inpatient statin use and severe disease outcomes among hospitalized COVID-19 patients, especially those with Diabetes Mellitus (DM)., Research Design and Methods: A retrospective cohort study on hospitalized patients with confirmed COVID-19 diagnosis. The primary outcome was mortality during hospitalization. Patients were classified into statin and non-statin groups based on the administration of statins during hospitalization. Analysis included multivariable regression analysis adjusting for confounders and propensity score matching to achieve a 1:1 balanced cohort. Subgroup analyses based on presence of DM were conducted., Results: In the cohort of 922 patients, 413 had a history of DM. About 27.1% patients (n = 250) in the total cohort (TC) and 32.9% patients (n = 136) in DM cohort received inpatient statins. Atorvastatin (n = 205, 82%) was the most commonly prescribed statin medication in TC. On multivariable analysis in TC, inpatient statin group had reduced mortality compared to the non-statin group (OR, 0.61; 95% CI, 0.42-0.90; p = 0.01). DM modified this association between inpatient statins and mortality. Patients with DM who received inpatient statins had reduced mortality (OR, 0.35; 95% CI, 0.21-0.61; p < 0.001). However, no such association was noted among patients without DM (OR, 1.21; 95% CI, 0.67-2.17; p = 0.52). These results were further validated using propensity score matching., Conclusions: Inpatient statin use was associated with significant reduction in mortality among COVID-19 patients especially those with DM. These findings support the pursuit of randomized clinical trials and inpatient statin use appears safe among COVID-19 patients., (© 2021. The Author(s).)
- Published
- 2021
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15. The Safety and Effectiveness of On-Site Paramedic and Allied Health Treatment Interventions Targeting the Reduction of Emergency Department Visits by Long-Term Care Patients: Systematic Review.
- Author
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Leduc S, Cantor Z, Kelly P, Thiruganasambandamoorthy V, Wells G, and Vaillancourt C
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- Allied Health Personnel, Emergency Service, Hospital, Humans, Long-Term Care, Emergency Medical Services, Emergency Medical Technicians
- Abstract
Introduction: Programs that seek to avoid emergency department (ED) visits from patients residing in long-term care facilities are increasing. We sought to identify existing programs where allied healthcare personnel are the primary providers of the intervention and, to evaluate their effectiveness and safety., Methods: We systematically searched Medline, CINAHL and EMBASE with terms relating to long-term care, emergency services, hospitalization and allied health personnel. We reviewed 11,176 abstracts and included 22 studies in our narrative synthesis, which we grouped by intervention category., Results: We found five categories of interventions including: 1) use of advanced practice nursing; 2) a program called Interventions to Reduce Acute Care Transfers (INTERACT); 3) end-of-life care; 4) condition specific interventions; and 5) use of extended care paramedics. Among studies measuring that outcome, 13/13 reported a decrease in ED visits, and 16/17 reported a decrease hospitalization in the intervention groups. Patient adverse events such as functional status and relapse were seldom reported (6/22) as were measures of emergency system function such as crowding/inability of paramedics to transfer care to the ED (1/22). Only 4/22 studies evaluated patient mortality and 3/4 found a non-statistically significant worsening., Conclusion: We found five types of programs/interventions which all demonstrated a decrease in ED visits or hospitalization. However, most studies were observational and few assessed patient safety. Many identified programs focused on increased primary care for patients, and interventions addressing acute care issues, such as community paramedics, deserve more study.
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- 2021
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16. Hemophagocytic Lymphohistiocytosis Following Skin and Soft Tissue Infection in a Patient With Human Immunodeficiency Virus.
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Yazdanpanah O, Monday LM, Shaik AN, Cantor Z, and Chi J
- Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a systemic inflammatory syndrome of inappropriate immune cell activation which can be rapidly fatal if not recognized and treated. Here we discuss a case of a 26-year-old male with HIV on antiretroviral therapy who presented with sepsis secondary to soft tissue infection and ultimately progressed to multi-organ dysfunction despite broad-spectrum antibiotics and an improvement in soft tissue infection. Continued fever and pancytopenia without an explanation found during additional infectious and rheumatologic testing eventually led to bone marrow biopsy and laboratory criteria consistent with HLH. Although pancytopenia is a common finding in patients with HIV, here it marked a more rapidly progressing and fatal disease, HLH. Here we highlight the difficulty in identifying and diagnosing this rare condition, including a discussion of the characteristics, outcomes, underlying etiologies, and treatment of HLH in patients with HIV., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Yazdanpanah et al.)
- Published
- 2021
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17. REDCap: a pediatric ED experience.
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Cantor Z, Plint AC, Kamil Y, and Zemek R
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- Adolescent, Biomedical Research methods, Canada, Child, Computers, Handheld, Emergency Service, Hospital organization & administration, Humans, Data Collection methods, Emergency Service, Hospital statistics & numerical data
- Published
- 2016
- Full Text
- View/download PDF
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